1 Healthcare Project Management Kathy Schwalbe and Dan

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

2 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. org PM 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?

5 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 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 Cooperation 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).

7 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. Health. Affairs. (2008; 27(3): 759 -69).

8 It is Like Changing the Engines on a Plane While in Flight …the healthcare industry is in major flux…

9 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…

11 “Complex? Oh, this is just where the nurses get engaged in the project!”

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).

14 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!

15 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!

16 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!

17 Project Management Communities of Practice TOP INDUSTRY AREAS WITH LARGEST MEMBERSHIPS Information Technology 23, 893 Computers / Software / DP 14, 180 Healthcare 13, 105 (43% growth in past 12 months) Financial Services 10, 586 Telecommunications 9, 746 Business Management Services 6, 705 Engineering 3, 718 Defense 3, 681 Education/Training 3, 527 Aerospace 3, 493 Utilities 2, 662

How do we get past this? “How am I supposed to find the time to fill out all these requirement documents? 40 18 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!

Clinicians View Project “Success” Differently 20 SCOPE Efficient Clinical Workflows TIME COST CLINICAL PERSPECTIVE Patient Safety Outcomes

21 PM 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

25 Possible 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).

26 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

27 Business Case Copyright 2013 Schwalbe Publishing

28 Power/Interest Grid Stakeholder Analysis Copyright 2013 Schwalbe Publishing

29 Project Charter Copyright 2013 Schwalbe Publishing

30 Project Charter Copyright 2013 Schwalbe Publishing

Work Breakdown Structure 31 Project deliverables Copyright 2013 Schwalbe Publishing

Project Schedule 32 Gantt Chart Copyright 2013 Schwalbe Publishing

33 Probability Impact Matrix Identify & Prioritize Risks Copyright 2013 Schwalbe Publishing

34 Project Dashboard Metric Scope Description Meeting project goals Time Staying on schedule Cost VAP Bundle How Measured Earned value chart Explanation On target Earned value chart Slightly behind schedule Staying on budget Earned value chart Under budget 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 Cannot collect until data after implementation Percent of ICU Train all ICU staff trained prior to go live Training Management System test results On Target Slightly off target / caution area Status Off Target / problem area Not able to collect data yet Copyright 2013 Schwalbe Publishing Learning management system down for four days causing a delay in training. We expect to catch up quickly. Track Metrics

35 Cause and Effect Diagram Copyright 2013 Schwalbe Publishing Find Root Cause

36 Progress Report Easy Yet “Super” Tool Copyright 2013 Schwalbe Publishing

37 Earned Value Chart Copyright 2013 Schwalbe Publishing Assess Progress In Meeting Goals

38 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).

39 Team 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?

41 Challenges and Nuances GOAL Healthcare Time Quality, real effect Group, you, client, breaks, graduation Access to projects Privacy, complexity, timeframe, prior knowledge Little basis in topic Business, project management, healthcare, basic software

42 Teaching Approaches Type of Training/Course Presentation Presence Workgroup Project Assignment and Assessment Traditional Team Real or Textbook Case Online/Hybrid Pair Papers/Exams Flip Course Individual Actual Project Seminar Full Course, undergrad/grad Compressed Course

43 Clinicians must talk IT-ese & IT talk Clinical-ese Nurses can provide that link & be that liaison

44 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…

45 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)…

In Bandit 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! Manage Plan Changes Did they adapt? Verify Objectives are Met Delivery was made on time!

In Clinical 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

Risk Matrix

49 Create tools to help teams work toward solutions

50 Use Multi-voting to avoid authority bias

51 Ten 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?

52 Ten 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!

53 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

54 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!

55 Too bad we can’t implant software to make us all smarter – yet! Source: xkcd. com

56 Questions? www. healthcarepm. com