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In 2012, the Chief Information Officer (CIO) of Worthington Health-Care System (WHCS), a St Louis company with 27 health-care facilities, is considering how to improve IT project governance. Over the previous 7 years, three approaches to developing project oversight had been attempted, including a Project Management Office, a project Portfolio Management application (PlanView), and more recently, an incremental approach to process improvement, which was meeting with increasing resistance. The CIO's challenge is to find an effective solution to IT project work and oversight at WHCS. This teaching case was prepared to support a Business Process Consulting course, but it may also be suitable in an IT Management, IS Project Management, Business Process Improvement and IT-Enabled Change, and Accounting Information Systems class.