Creating the Results that Matter: Portfolio Management and

Portfolio Management and Execution

Patient Safety Officer Executive Development Program

Institute for Healthcare Improvement

Creating the Results that

Matter: Portfolio Management

and Execution

Carol Haraden, PhD

APAC Forum

Objectives

• Differentiate between projects, portfolios,

and big dots and the role each plays in

improvement work.

• Outline what is needed in each of the

three tiers of a portfolio management

system.

• Use a portfolio approach in your planning.




Components for Effective Improvement

• Will

• Ideas

• Execution

Execution of Improvement Work in Very Large Systems

Projects

“Meso-System”

Very Large System




The Intuitive Structure

Very Large System

“Meso-

System”

“Meso-

System”“Meso-

System”

Project

Project Project

ProjectProject

Project

Project

Project

Tier 1

Tier 2

Tier 3

Example: System Medication

Safety

Med. reconciliation

Hospitals

SYSTEM Medication Safety

Rehab Offices

Standardized dosing

Family Capacity

Self med

Correct list

availability

Patient capability

Tier 1: Big Dot

Tier 2:Portfolio

Tier 3:Projects




Example: Hospital Medication

Safety

Med. reconciliation

Med Surg

Hospital Medication Safety

Pharm

IV pumps Standardized dosing

availability

Admix

Tier 1: Big Dot

Tier 2:Portfolio

Tier 3:Projects

IssuesTier 3:Projects

� Team organization and capacity matter.

� Front-line leadership is critical.

� Measures tracked over time and visible.

� Senior leaders remove obstacles.

� Clear changes important.

� Ability to run PDSA cycles.




IssuesTier 2:Portfolio

� Middle Management key.

� What are the “drivers” of the outcomes we want?

� Outcomes tracked over time.

� “Connecting the Dots” – Putting the learning together.

� Continual readjustment of portfolio.

� Strong linkage to finance.

IssuesTier 1: Big Dot

� Aims of strategic importance to the system as a whole.

� “Big Dot” measure of progress.

� Executive, Board and Senior Leader engagement.

� Vision and the associated structural changes.

� Strong linkage to finance.

� Managing the learning, the politics, and the risks.




A “Project”…

Source: J. Reinertsen, 2005

Moving a Big Dot!June 6, 1944

Source: J. Reinertsen, 2005




What’s the Difference?

A Project Moving a Big Dot!Source: J. Reinertsen, 2005

The Differences Are…

• Level of ambition

• Commitment: hearts pounding

• Core strategy: staying alive

• Clear measure of daily success: territory

• Clear overarching goal: Berlin

• People are shooting live ammo!

• Will, Ideas and Execution!




Leading the Whole System to Provide Highly

Efficient and Effective Results

The Big Picture View (Management)

The Ground Level

View (Staff)

Large System Metrics (Big Dots):

Three Examples

• Example #1: Patient Experience.

• Example #2: Reliable Evidence-Based Care.

• Example #3: Hospital Adverse Events per 1,000 Patient Days (Using IHI’s Global Trigger Tool).




Developing a Portfolio

of Projects

Portfolio

What would a portfolio of projects look like

for various units/departments/areas?

1. Patient experience

2. Outcomes that matter (reliability)

3. Safety

4. Staff’s joy in work




The Intuitive Structure

Project

“Meso-

System”

Very Large System

“Meso-

System”

“Meso-

System”

Project Project

ProjectProject

Project

Project

Project

Tier 1

Tier 2

Tier 3

Documents

Creating the Results that Matter: Portfolio Management and