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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
3
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
4
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
6
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
10
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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12
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!
13
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?
40
“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!
20
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).
22
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
23
Source: xkcd.com
24
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
Copyright 2013 Schwalbe Publishing
StakeholderAnalysis
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Copyright 2013 Schwalbe Publishing
Project Charter
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Copyright 2013 Schwalbe Publishing
Project Charter
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Copyright 2013 Schwalbe Publishing
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
48
Create tools to help teams work toward solutions
49
Use Multi-voting to avoid authority bias
50
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