Construction costs, labor availability, and market conditions are often blamed when capital projects fall behind schedule. While these factors often have a significant impact on project schedule, there is another factor that receives far less attention.
Across complex capital programs, projects tend to slow because critical decisions take longer than the project team anticipated. As project overruns arise, little attention is paid to the financial impact of delayed decisions.
As executive approval timelines extend, organizational priorities compete, and authority becomes unclear, the effects can be seen throughout the entire capital program. Although the effects may appear minor at an individual project level, the impact on schedules, budgets, and overall momentum of the capital program can become unrecoverable.
This article is the second in a series examining lessons learned while supporting a large academic health system through a complex capital program transition. Read below to learn more about the critical role that decision latency plays in project success.
Despite capable project teams and an established set of governance practices, projects across a large academic healthcare system’s capital program continued to run behind schedule and over budget. As leadership reviewed the pattern of overruns, a common thread emerged: the delays weren’t concentrated in construction. They were concentrated in the weeks before construction decisions could even be made.
A decision might be ready for executive sign-off, but the sponsor accountable for it wasn’t clearly the sponsor of record, or was, but had no forum on the calendar to actually make the call. Other times, a decision touched more than one executive’s area, and without a defined pathway for resolving competing priorities, it simply sat until someone escalated it informally. None of these were technical problems. They were organizational ones: unresolved ownership, no fixed cadence for review, and no clear path for a stuck decision to reach someone with the authority to unstick it.
The cost compounded quietly. A two-week delay on a single decision rarely showed up as its own line item, but multiplied across a portfolio of active projects, the impact became significant.
Decision latency became one of the largest, and least visible, drivers of schedule slippage and cost growth in the entire program.
Having identified decision latency as a hidden driver of project performance, Keel treated it as a direct extension of the governance work already underway. The stage-gate framework and executive sponsorship model gave the organization defined decision points, but didn’t yet guarantee those decisions would be made on time.
The team addressed this in two ways. First, by tying decision authority explicitly to the sponsor model: every gate review had a named executive owner, so a stalled decision had an obvious person to escalate to rather than an ambiguous “leadership.” Second, by replacing ad hoc scheduling with a standing decision cadence, a recurring governance forum where gate reviews and other time-sensitive approvals were addressed on a fixed rhythm rather than whenever calendars happened to align. Lower-tier decisions, sized to lower-risk projects, were routed to a lighter-weight review so they didn’t compete for time on the same agenda as major capital approvals, reinforcing the tiered structure introduced in the governance framework itself.
Together, these changes gave the organization not just a framework for what needed to be decided, but a mechanism ensuring decisions actually got made on a predictable timeline.
The standing decision cadence had an immediate, visible effect. Approval cycles that had previously stretched over multiple weeks, often because there was no fixed forum for them to be raised, compressed to a matter of days once they had a guaranteed slot on a recurring agenda. Decisions that had been informally escalated, sometimes losing days simply to figuring out who needed to weigh in, now moved directly to a named sponsor with clear authority to act.
The financial effect followed from the schedule effect: less idle time on active projects, less schedule-driven cost growth, and fewer decisions accumulating into the kind of late-stage scope changes that are far more expensive to absorb once design and procurement are underway.
The clearest lesson from this work is that governance and decision speed are the same problem, not two separate ones. A framework that defines what needs approval without also guaranteeing when it will be reviewed simply relocates the delay from the field to the boardroom. Fixing decision latency didn’t require loosening oversight; a standing cadence and clear ownership let the organization move faster while preserving, and in some cases strengthening, the same stakeholder engagement the governance framework was built to protect.
While this work took place within a large academic health system, the underlying principle isn’t specific to healthcare or to large portfolios: any capital program that lacks a predictable rhythm for executive decisions is, in effect, building schedule risk into its governance structure.
