Project Management David Borrill, MT, MBA, PMP Objectives Nobody falls asleep or walks out. Presentation of some of the main points in the management of projects in the healthcare environment. Everybody learns at least three facts that they can take back and use within their organization irrespective of whether or not they are managing a project. There are at least three questions at the end. 1
Does this look familiar? Strategy without execution is just a conversation in theory Execution without planning is chaos Project Management will help your organization bridge strategy and execution 3 Start with the Basics Project: A temporary group activity intended and designed to produce a unique product, service or result. Defined beginning, identifiable end, defined scope, budget and resources. May include people who do not often work together. Not a routine or repeatable process. Should align with strategic goals 4 2
Which projects should we consider? IT Do Can has Are we enough all prioritize track of our resources investment goals projects as to A solid business case analysis will based indicate accomplish dollars executives on which our going projects strategy our and towards goals, are as worth or does operational the achieving loudest right? pursuing our leaders? voice goals? win? 5 Healthcare Project Drivers Optimization initiatives Meaningful Use ICD-10 Accountable Care Pay For Performance HIE, PHR, Portals HIPPA Population Health Mgmt. Telemedicine Health Analytics Advanced testing (Molecular) Government Regulations BYOD / BYON Share patient information securely and discretely. Securely exchange information with new sets of stakeholders Integrate the information to increase capabilities (ereferrals, e-rx) Provide and improve value for covered populations while controlling costs, managing quality and mitigating risk. Maximize reimbursement while embracing/developing new technologies. 6 3
Remember Resources are probably already at a premium. Rarely is there time for do-overs. Vendor-dependent projects naturally increase risk. Expectations are that project management will drive value and deliver an on-time and within budget project, BUT... Is this the true definition of success? 7 Definitions Of Success? 8 4
Project Management in Healthcare Traditionally lacked PM innovation or focus. Projects executed without formal methodology or process. Healthcare IT projects are DISRUPTIVE! Patient Care must always take priority. Characterized, influenced and driven by a variety of forces as previously stated. Deliverables and metrics for healthcare projects differ from more traditional projects. 9 Project Management in Healthcare Time Efficient Clinical Workflows Traditional Project Management Triple Constraint Patients Clinical Regulatory Clinical Drivers Cost Scope Patient Safety Expected Outcomes 10 2013 LEIDOS. ALL RIGHTS RESERVED. 5
Project Management in Healthcare Patient Safety Cost Time Expected Outcomes Healthcare Project Management Efficient Clinical Workflows Scope 11 Fundamentals Engage stakeholders, keep them informed and aware. Prepare the organization for change and recruit change-agents when necessary. Understand: People, process and culture Decisions must be made Who makes what decisions Hold everyone accountable Build relationships while leading and managing. Manage scope VERY carefully: Cosmetic changes Steering Committee approval but low impact on triple constraint Change Request 12 6
Project Planning If you fail to plan you plan to fail Start with the end in mind. Project planning is the least appreciated, most maligned and most important part of the project lifecycle. Without proper planning the project baseline is irrelevant as are the metrics and measurements of progress. Pressure from stakeholders to see results! If you don t know where you re going You ll end up someplace else! 13 - Yogi Berra Project Planning You are assigned a project Now what do you do? Prepare an inventory as part of your planning process. 14 7
Sample Project Management Inventory What does done look like? Who are the project sponsors? Why do they want to do this project? What are the goals and objectives? Who are the stakeholders? What is the urgency, are there timelines and what happens if a date is missed? Is there an SOW, do you have or do you need consultants? Will Hardware/software be needed? Has it been identified? Are there any mandatory performance metrics? What is the budget? Have resources been assigned? Are they available? Have the risks been identified? 15 The Project Charter According to A Guide to the Project Management Book of Knowledge (PMBOK Guide), a project charter is a document issued by the project initiator or sponsor that formally authorizes the existence of a project, and provides the project manager with the authority to apply organizational resources to project activities. A charter should be completed within the first weeks of the project and should contain the overall scope, what is included, excluded and how success will be defined. Changes to the charter should be managed through the change control process. 16 8
Common Elements of a Charter Purpose Business Case Why are we doing this? Opportunity Statement What are the pain points? What is wrong? Business Impact Success Criteria Goal Statement Improvement objectives and targets Project Scope What are we addressing? What processes are impacted? What is not within scope? Boundaries Activities Project Plan How are we going to do this? When are we going to do this? Governance What authority do we have? Who are the team members? What responsibilities do they have? Who and What 17 Project Planning Software? Project Planning Software Pros Detailed functionality Multiple reporting capabilities Linkages, dependencies, other Cons Complex Steep learning curve Requires effort to maintain Spreadsheet Pros Easy to use Works well with simple projects Cons Does not provide functionality required for large, complex projects 18 9
Tips for project planning Choose the tool that is right for your project. Learn the tool (or have a mentor nearby) Make use of the functionality (staffing options, dependencies, durations, milestones, etc.). Learn the reporting capabilities and use them. Start early in the project. Keep a back up! Develop a process by which you keep the schedule current. Own this process it s not simply data entry. 19 The Budget and the Forecast Forecasts are critical to the project metrics. A project manager will need preliminary estimates and timeframes to develop the schedule and provide accurate variance to budget reports. Break out the details into the main components and review the original and forecasted spend budget with the executive steering team. Decide to use accurate data! 20 10
Tips for Financial Tracking A simple spreadsheet can work wonders. Budget ITD (Inception to Date) ETC (Estimate to Complete) EAC (Estimate at Complete) Variance (EAC to Budget) Line Item Budget ITD ETC EAC VARIANCE License Fees $800,000 $403,522 License Fees $217,794 $105,872 Interface Development $83,187 $49,912 Project Management $1,981,345 $1,941,149 $10,000 $1,951,149 -$30,196 Staff Augmentation $310,500 $219,551 $4,000 $223,551 -$86,949 Testing $890,000 $648,878 $0 $648,878 -$241,122 Travel $105,000 $74,519 $0 $74,519 -$30,481 Implementation $2,337,249 $1,811,470 $80,000 $1,891,470 -$445,779 Education $0 $180,340 $0 $180,340 $180,340 Equipment/Supplies $0 $109,537 $0 $109,537 $109,537 Other $0 $2,408 $0 $2,408 $2,408 Travel $310,500 $281,132 $6,000 $287,132 -$23,368 21 Guided Execution Execution is the most noticed process group. Coordinate planning, risk management and execution. Be creative. Use Soft Skills to motivate and celebrate. Communicate, Communicate, Communicate. (MBWA). Understand and support corporate mission, vision, values and culture. 22 11
Executing the work Direct and Manage the project. Work the plan Use the subsidiary plans Measure, monitor and control Perform established Quality Checks Acquire, develop, manage and MOTIVATE the team. Understand the leadership styles and know when to use each one. Manage stress For yourself For the team Manage stakeholders Use change requests Spend up to 90% of your time communicating in some fashion. 23 Common Pitfalls to Execution Incomplete scope or poor scope control Insufficient planning Project Manager is: Inexperienced at managing people. Not familiar with the application Does not understand the organizational objectives. Time / Cost estimates are unrealistic. Stakeholder or political issues. Lack of or variations in commitment from different project influencers. Changes in business needs, technology or overall strategy. Untrained, unmotivated or over allocated project resources. Poor communication. Unresolved conflict. Unresolved issues during procurement (vendor selection). 24 12
Conflict and Resolution Schedules Testing Domain Strategies Competing priorities Resources Technical Opinions Costs Personalities Administrivia Confronting or problem solving Compromising Withdrawal or avoidance Smoothing Collaborating Forcing 25 Risks and Issues Risk: An uncertain event or condition that, if it occurs, has a positive or negative impact on the project. Mitigate risk. Issue: A risk that cannot be managed or an event that has already occurred that could have a negative impact on the project. Manage issues. Issues Risks Strategies 26 13
Risk: Identify, Log and Mitigate Make every effort to identify and log all known risks at the beginning of the project. What might occur? Probability of occurrence How can we prevent the occurrence? Brainstorming, listening, asking, personal experience. Log, develop mitigation plans (communicate those plans) and monitor/update often. Risks Common to Healthcare Projects. Lack of resources. Conflicting schedules / priorities. Lack of stakeholder buy-in. Physicians/ Clinical Community Multi-organizational challenges Unrealistic timeframes Insufficient planning / poor scope definition. Insufficient or inadequate testing. Lack of proper change management (Scope Creep). Vendor issues 27 Issues: Identify, Log and Manage Reported by ALL team members. What happened? Severity and impact? CAPA? Issues log should be on the agenda at each team meeting. High impact/probability risks and action plans should be shared with steering committee. Issues Common to Healthcare Projects. Decision making is too slow. Staff unavailable to build, test or train due to staffing shortages or conflicting IT projects. Inadequate testing (or test plans) resulting in more work and effort than expected. Insufficient planning / poor scope definition. Lack of proper change management (Scope Creep). 28 14
Definition of Success Interaction and dialogue with sponsors and project executives is essential for defining success. Do not assume that on time, within scope and under budget are the only means by which success should be measured. 29 Successful Project Criteria Project met the scope, time, cost, quality and customer satisfaction goals. Project met the expectations of the stakeholders and the sponsors. Project met its main clinical, technical and financial objectives. Definitions of success outlined in the Charter have been met. Service Performance Workflow Responsiveness Decreased TAT for STAT and routine tests Cost savings. Test Repatriation. Diagnostic efficiencies Optimal use of tech time Reduced wait times Improved customer satisfaction 30 2013 LEIDOS. ALL RIGHTS RESERVED. 15
Ending the Project Project Lessons Learned Operations Conduct a Post Mortem What worked well Or didn t? Areas for improvement. Survey the team Written, focus groups, survey Formal or informal Review governance documentation. Meeting Minutes Change control logs Issue / Risk logs Compile and communicate to the organization. 31 The Proper Mix and Mindset Project Management is as much art as science, and requires the right experience, a proven methodology, soft skills and the support of the organization as a whole. Think of Olympic ice skating Part of the score is for technical merit and part of the score is for artistic impression. The top performers excel in both. 32 16
The Total Project Manager Has market, product, project and customer knowledge. Is a leader AND a manager. Has exceptional people skills. Understands change management. Is personable and has a sense of humor. Understands the art of negotiation. Is politically savvy yet non-aligned. Understands organizational goals. 33 Key Takeaways Spend time developing the plan. Interview, listen, question and learn. Proper, controlled execution is critical to project success. Carefully manage risks and issues. Report them regularly. Monitor and understand budget variances. Good PM s do not assume their definition of success is the same as that of the sponsor. Manage scope. Use the proper tools for your type of project. A skilled healthcare PM can negotiate differences between various factions to ensure project success. The healthcare PM must build trusting relationships and alliances between physicians, nurses, administration and other leaders. Celebrate wins with the team. Own the failures yourself. 34 17
Questions? 35 18