Healthcare Project Management Kathy Schwalbe and Dan Furlong February 28, 2014 AACN Master’s...

1Healthcare Project ManagementKathy Schwalbe and Dan Furlong

February 28, 2014

AACN Master’s Education Conference

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Kathy Schwalbe Ph.D., PMP, and mother of 3!

Professor, author, and publisher

Jennifer Lawrence copied my new do? (Actually cut it after breaking my wrist!)

www.kathyschwalbe.com

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Dan Furlong

PMP, MBA, “doctor to be” (abd)

PMO for MUSC, an Academic Medical Center

Author

Adjunct Faculty at MUSC (www.musc.edu)

Affiliated Faculty at College of Charleston

Owner of PM One, LLC (www.pmone.net)

Photo courtesy of pmi.orgPM Network, Dec 2013

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Questions About You

1. Do you currently teach project management?

2. Have you worked on projects related to healthcare?

3. Do you plan to work on projects or teach a class about healthcare projects?

4. Are you interested in good resources to help you teach or apply good project management in a healthcare environment?

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Session Objectives Describe the growing need for

improving healthcare project management (PM)

Provide a conceptual framework for PM and for teaching it

Explain sample PM outputs applied to a healthcare project

Discuss challenges in developing and teaching a PM course

Share teaching approaches and available resources

Q&A and collaboration

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The Need Healthcare spending was 17.9% of U.S. GDP in

2010, an average of $8,402 per person*

The Centers for Medicare and Medicaid Services (CMS) estimates that healthcare spending will grow to about 19.8% of GDP by 2020*

Compared to other Organisation for Economic Co-operation and Development countries, the U.S. spends 48% more on healthcare compared to the next highest country, Switzerland*

US Healthcare was heading for a crash, and everyone knew it…but did little about it.*The Henry J. Kaiser Family Foundation. Healthcare Costs: A Primer, Key

Information on Healthcare Costs and Their Impact (2012).

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The Triple Aim*

Improving the U.S. healthcare system requires simultaneous pursuit of three aims:

1. Improving the experience of care

2. Improving the health of populations

3. Reducing per capita costs of health care

*Donald M. Berwick, Thomas W. Nolan, Whittington J. The Triple Aim:Care, Health, And Cost. HealthAffairs. (2008;27(3):759-69).

It is Like Changing the Engines on a Plane While in Flight

…the healthcare industry is in major flux…

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Healthcare Project Drivers American Recovery & Reinvestment Act

(2009) Included the Health Information Technology for

Economic & Clinical Health (HITECH) Act

Increased HIPAA rules, enforcement, fines

Creates incentives / penalties for meaningful use of EMRs

Patient Protection and Affordable Care Act (2010) Accountable Care Organizations (ACO)

Disproportionate Share payments gone

Forces improvements in efficiencies

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Healthcare Project Drivers These acts, coupled with movements

to patient-centered care, evidence-based medicine, centers of excellence, and other forces have spawned a current climate of what may be an unsurpassed number of healthcare projects

Our industry is in a state of chaos…

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Education Can Help

Public health and healthcare leaders need to:

Work on the right projects

Get the most bang from every buck

Educate IT staff on clinical work & clinical staff on IT work

Make investments in IT, infrastructure, and quality improvements that will allow them to reduce costs while improving (or maintaining) quality…

Good project management is required!

Training clinical leaders on PM is a must!

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Findings from Recent Study* Healthcare workers do not understand the

differences between service work and project work. They understand activities to provide better service to patients, but they have not been trained to make more radical, disruptive changes that challenge the status quo.

Healthcare projects are done to create something that is delivered to the organization, unlike operational work which produces outcomes aimed at patients. “In other words, it is only once the project’s outcome is implemented and becomes ‘the new way we work now’ that it starts exerting its impact on patients.”

 *Francois Chiocchio et al, “Stress and Performance in Health Care Project Teams,” Project Management Institute (2012).

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Suggestions from Recent Study Train healthcare workers on PM,

emphasizing collaborating on achieving project goals and understanding their roles on project teams, which may differ from their roles in their day-to-day work

Management needs to structure project teams by properly planning workers’ time and payment to allow them to successfully engage in project work!

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What’s Different About Healthcare PM? There are two major “camps” of staff:

clinical (patient focused) enterprise viability and sustainability

(business focused)

Healthcare has unique terms / processes Projects often have separate paths that

can be divided into phases – technical and clinical

Project management is not as mature / practiced in healthcare

Small changes in project success rates and can have a large impact on patient outcomes and delivery costs!

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What’s Different About Healthcare PM? Improving efficiency or margins is often

considered to demonstrate a lack of caring

Expertise in the industry is critical Many projects affect clinical workflow,

and patient care must take priority Healthcare is a rapidly changing industry Healthcare is investing tens of billions of

dollars on new technology Healthcare changes are requiring the

addition of at least 70,000 more technology staff members!

17Project Management Communities of Practice

TOP INDUSTRY AREAS WITH LARGEST MEMBERSHIPS

Information Technology 23,893Computers / Software / DP

14,180

Healthcare 13,105 (43% growth in past 12 months)

Financial Services 10,586

Telecommunications 9,746Business Management Services

6,705

Engineering 3,718

Defense 3,681

Education/Training 3,527

Aerospace 3,493

Utilities 2,662

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How do we get past this?

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“How am I supposed to find the time to fill out all these requirement documents?

I am here to treat patients, not do paperwork!”

19 Why Should We Teach PM to Nurses?

Healthcare is different and we need clinicians leading projects

Our risks (and rewards) are different We want to maintain control of our own

industry Nurses are typically the largest stakeholder

group impacted Nurses are natural communicators Nurses are strong leaders Nurses know the business Because our success criteria are different!

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Clinicians ViewProject “Success” Differently

TYPICALPERSPECTIVE

TIME COST

SCOPE

CLINICALPERSPECTIVE

Patient Safety Outcomes

EfficientClinical Workflows

21PM Conceptual Framework-Same for All Projects*

*Kathy Schwalbe and Dan Furlong, Healthcare Project Management, Schwalbe Publishing (2013).

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Healthcare vs. Other Industries

Projects include 10 knowledge areas and 5 process groups

Projects have similar attributes and constraints

Projects use similar tools and techniques

Projects require structure and methodology

Consumers keep expecting more for less

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Source: xkcd.com

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Framework for Teaching and Learning PM

Provide motivation to take a course(s) in PM Explain key concepts Provide real-world examples with references

of what went right, what went wrong, best practices, healthcare perspectives, and videos

Explain how to apply concepts with samples – like our running case on Ventilator Associated Pneumonia Reduction (VAPR)

Help students apply PM practices in real-world situations

25Possible Motivation: PMP Certification and Jobs

Healthcare is one of the 6 sectors to watch for growth in PM jobs*

*Kate Sykes, “Global Jobs Report: 6 Sectors to Watch,” PM Network (January 2014).

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Sample PM Outputs Initiating: business case, stakeholder analysis,

charter

Planning: project management plan, scope statement, requirements traceability matrix, WBS, project schedule, cost baseline, quality metrics, human resource plan, project dashboard, probability/impact matrix, risk register, supplier evaluation matrix, stakeholder management plan

Executing: deliverables, milestone report, change requests, project communications, issue logs

Monitoring and controlling: earned value chart, accepted deliverables, quality control charts, performance reports

Closing: project completion form, final report, transition plan, lessons-learned report, contract closure notice

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Business Case

Copyright 2013 Schwalbe Publishing

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Power/Interest Grid

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StakeholderAnalysis

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Project Charter

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Project Charter

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Work Breakdown Structure

Project deliverables

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Gantt Chart

Copyright 2013 Schwalbe Publishing

Project Schedule

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Probability Impact Matrix

Copyright 2013 Schwalbe Publishing

Identify & PrioritizeRisks

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Project Dashboard

Metric Description Status How Measured ExplanationScope Meeting project

goals Earned value

chartOn target

Time Staying on schedule

Earned value chart

Slightly behind schedule

Cost Staying on budget Earned value chart

Under budget

VAP Bundle Identify AHS systems with required elements

Percent of elements identified in AHS systems

All elements identified and available

VAP reduction Reduce by 50% within six months

Infection Control data

Cannot collect until after implementation

Percent of ICU staff trained

Train all ICU staff prior to go live

Training Management System test results

Learning management system down for four days causing a delay in training. We expect to catch up quickly.

On Target Off Target / problem area Slightly off target / caution area Not able to collect data yet

Copyright 2013 Schwalbe Publishing

Track Metrics

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Cause and Effect Diagram

Copyright 2013 Schwalbe Publishing

Find Root Cause

36 Progress Report

Copyright 2013 Schwalbe Publishing

Easy Yet“Super” Tool

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Earned Value Chart

Copyright 2013 Schwalbe Publishing

Assess ProgressIn Meeting Goals

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Best Practice-Earned Value Management

The Centers for Medicare & Medicaid Services (CMS) manages approximately twenty percent of the entire Federal budget, so it is important that they use the taxpayers' dollars as efficiently and effectively as possible.

 “Once an investment—with its individual projects—is approved for funding, it falls to the investment manager and the project managers to insure that the projects are implemented successfully. Earned value monitoring and management provides early warning when a project is straying from its baseline plan, and shows whether actions taken to correct the situation are effective. Health and Human Services (HHS) requires that certain investments track and report on cost and schedule status monthly.”*

*CMS Centers for Medicare & Medicaid Services, Division of Information Technology Investment Management Enterprise Architecture & Strategy Group Office of Information Services, “Earned Value Management Best Practices” (Nov 19, 2009).

39Team Project Web Sites

Great Communications Tool and Real Project Experience

40 Challenges in Developing and Teaching a Course In Healthcare PM

What are the challenges you face? How can we overcome them?

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Little basis in topicBusiness, project management, healthcare, basic software

Access to projectsPrivacy, complexity, timeframe, prior knowledge

TimeGroup, you, client, breaks, graduation

GOAL HealthcareQuality, real effect

Challenges and Nuances

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Teaching Approaches

Type of Training/Course

Presentation

Seminar

Full Course, undergrad/grad

Compressed Course

Presence

Traditional

Online/Hybrid

Flip Course

Workgroup

Team

Pair

Individual

Project Assignment

and Assessment

Real or Textbook Case

Papers/Exams

Actual Project

Clinicians must talk IT-ese & IT talk Clinical-ese

Nurses can provide that link & be that liaison

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Course Delivery Suggestions

Give them hands-on experience Online/executive – project assessments Resident/face-to-face – run live

projects

Tailor the course to your students & course delivery method

Use students as project resources Steal, adapt, then own it Find clever ways to connect the

dots…

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Course Delivery Suggestions

Let them fail (a bit) Provide overwhelming support,

tools, templates, etc. Provide lots of current, real-world

examples Provide mentors, preceptors, or

access to other healthcare project managers if possible

Keep it real (in their terms)…

Clarify Objectives Drive from Atlanta to Texarkana to get 400 cases of Coors and deliver to Atlanta within 28 hrs in order to win $80,000 for a new rig

Prioritize Objectives 28 hours Atlanta-Texarkana-Atlanta; 400 cases

Identify and Manage Threats Smokies >> Blocker Car & CB

Develop a Plan to Implement the Solution …

Execute the Plan Snowman drives truck, Bandit blocker

Manage Issues Closely Warehouse locked; Frog; Sheriff Justice

Communicate to Stakeholders Breaker! Breaker!

Manage Plan Changes Did they adapt?

Verify Objectives are Met Delivery was made on time!

Clarify Objectives Drive from Atlanta to Texarkana to get 400 cases of Coors and deliver to Atlanta within 28 hrs in order to win $80,000 for a new rig

Prioritize Objectives 28 hours Atlanta-Texarkana-Atlanta; 400 cases

Identify and Manage Threats Smokies >> Blocker Car & CB

Develop a Plan to Implement the Solution …

Execute the Plan Snowman drives truck, Bandit blocker

Manage Issues Closely Warehouse locked; Frog; Sheriff Justice

Communicate to Stakeholders Breaker! Breaker!

Manage Plan Changes Did they adapt?

Verify Objectives are Met Delivery was made on time!

In Bandit Terms…

Clarify Objectives Diagnose Patient

Prioritize Objectives Prioritize Patient Needs

Identify and Manage Threats Identify Allergies

Develop a Plan to Implement the Solution Plan of Care

Execute the Plan Intervention - Treat Patient

Manage Issues Closely Monitor Patient Outcomes

Communicate to Stakeholders Communicate ! ! !

Manage Plan Changes Evaluate Plan Success & Modify

Verify Objectives are Met Verify Patient is Responding

Clarify Objectives Diagnose Patient

Prioritize Objectives Prioritize Patient Needs

Identify and Manage Threats Identify Allergies

Develop a Plan to Implement the Solution Plan of Care

Execute the Plan Intervention - Treat Patient

Manage Issues Closely Monitor Patient Outcomes

Communicate to Stakeholders Communicate ! ! !

Manage Plan Changes Evaluate Plan Success & Modify

Verify Objectives are Met Verify Patient is Responding

In Clinical Terms…

Risk Matrix

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Create tools to help teams work toward solutions

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Use Multi-voting to avoid authority bias

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51Ten Reasons Why We Must Teach Nurses Project Management

If nurses aren’t prepared to take the lead, then who will?

Just as nurses learned in nursing school, if you can’t measure it and you can’t describe it, how can you get others to believe it?

70% of projects fail; the patients are counting on nurses to lead projects to success.

The nursing process (Assess, Diagnose, Plan, Implement, Evaluate) has made nurses a project manager all of this time and they didn’t even know it!

How many times has a nurse shown up to work and found a change that they had no input on?

52Ten Reasons Why We Must Teach Nurses Project Management

Learn to talk the talk – project management language will allow you to speak a language that crosses all professions.

Why not give your project a care plan? We use pathways and care plans for our patients, transfer these skills to create project success on your unit.

If nurses are not at the table, then we’ll be on the menu. Being a knowledgeable stakeholder is vital.

Resources are limited, this makes communication and project success vital.

You manage projects everyday, think of your workflow and processes you use to deliver patient care!

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Resources FREE companion Web site for Healthcare

Project Management includes Over 60 template files Links to great videos Interactive quizzes, cases, PMP info, etc.

Secure instructor site (lecture slides, sample syllabi, test banks, etc.) and desk/review copies also available

www.healthcarepm.com

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Conclusions

The healthcare industry is behind most other industries in terms of project, program, and portfolio management

There’s a huge need to educate clinical staff in managing the many healthcare-related projects

If we don’t improve the way we do business in healthcare, there will be even more outside influence on the way we do business

We can improve healthcare in this country – one student, one course, and one project at a time!

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Too bad we can’t implant software to make us all smarter – yet!

Source: xkcd.com

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Questions?

www.healthcarepm.com