The Quality-Cost Connection
Hone your project management skills
Patrice Spath, RHIT
Brown-Spath Associates
Forest Grove, OR
You’ve just been asked to chair a task group responsible for revising the pain management protocols used in your hospital. People from various departments and disciplines have been appointed to the task group. The first meeting is in two weeks. As leader of this group, what can you do to make certain the project stays on track and on target?
Effective project management skills are an important part of the quality manager’s repertoire of abilities. Whether you are chairing an interdisciplinary task group or overseeing a short-term project within the quality department, good planning and follow-through are critical. The uniqueness of projects varies greatly from one of a kind (never been done before) to fairly routine (similar to the last project). Many of the projects that involve quality managers fall into the routine end of the spectrum — variations on a common theme. What is also true of most quality improvement projects is that the people involved are not dedicated to the project full-time. People resources are in limited supply. That’s why it is so important that the time spent by the leader and the team members be used productively.
Prior to the start of any project, pre-work is needed to assure that everything is in place before the project starts. Project planning and execution is the next phase. Upon completion of the project, evaluations are needed to determine success. The first phase of project management, pre-work, is described in this article. The next two phases will be covered in upcoming issues.
Prior to the start of the project, it is important to have a clear understanding of the problem or opportunity to be addressed. In some instances, the reason for doing the project will be very clear, and you won’t need to spend much time defining the purpose. In many cases, however, the goal of the project is not clear. For example, there may be several reasons why a hospital’s pain management protocols need to be revised. The protocols may be inconsistent with current practice guidelines. Patients may be complaining about inadequate pain control. The physicians and nursing staff may find the protocols cumbersome. Good project managers always have a goal in front of themselves and the team. Changes in requirements or resources may shift the goal, but the current activities of the project always must be aimed at achieving the goal.
A simple way to identify the goal of a project is to use the "as is" and "to be" technique. Creating an objective statement of the current situation and the desired outcomes does this. Don’t clutter the statements up with a lot of "whys" and "hows." For example, the "as is" statement, "During the last six months of 2000, more than 50% of patients undergoing elective surgery reported that their pain was not adequately controlled postoperatively," simply states an observable fact. There is no implication of why patients rate pain control as inadequate or what should be done about it. The solution or "to be" statement follows the same pattern.
In most cases, the solution statement is simply a rewording of the problem statement with a focus on the desired future situation: "In six months, more than 80% of patients undergoing elective surgery will report adequate control of postoperative pain." The solution statement does not imply how this goal will be achieved. It simply states the goals in measurable terms. Achieving this goal is the charge to the project team. It is far better to give the team a specific problem to be solved rather than a predefined solution. Revising the pain management protocols may not be the best solution. Let the project team determine the best way to improve postoperative pain control; otherwise you may end up with new protocols that don’t put an end to patient dissatisfaction.
The goal should be so clear that anyone reading it would understand what the project would deliver. By making the project goal explicit, the people who control the resources you need to get the job done will be more supportive. Advice and assistance may be needed from senior leaders and medical staff members. If you want people to be an advocate for your project, it’s important for them to understand the project goal.
Project goals also should be realistic. Realistic is not a synonym for "easy." Realistic means "appropriate" in terms of something the organization should be involved in. Senior leaders generally determine the appropriateness of quality improvement projects during the annual quality planning process. Improving the management of patients’ pain would be an appropriate project in many hospitals, given the current focus on patients’ rights by the Joint Commission.
Project goals must be time-framed. Not much gets done without a deadline. While the beginning point of some projects may be vague, the ending point should be well defined. Incorporate deadlines into the project goals, e.g., "By the end of the second quarter of 2002, patient satisfaction with pain control will improve by 30%." Time-specific goals give the team a better understanding of the work that will be necessary to complete the project and the resources that will be required.
Before starting the project, determine what could cause the project to fail. Barriers to project completion are known as risks. Project risks usually fall into fairly broad categories: financial, technology, legal/regulatory, and safety. Using the example below, identify what might be the inherent barriers to the project. Financial risks include the cost of the project outcome. If the organization is going to be asked to expend significant amounts of money, senior leaders probably are going to expect significant return on that investment. As long as the need for the expenditure is stated clearly and understood at the outset, this barrier can be overcome.
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Project Risk Assessment |
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What could cause this project to fail? |
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| 1. | Financial Risks: ______________________________ |
| 2. | Technology Risks: ____________________________ |
| 3. | Legal/Regulatory Risks: ______________________________________ |
| 4. | Safety Risks: _________________________________ |
If the project will require your organization to adopt new technologies, the project may be at risk. Your organization may not want to be the first one to discover the fatal bug in a newly released software program. Even if the technology is well-tested in other organizations, it may be very new to the people in your facility. The learning curve on new technologies can be very steep. The introduction of any new technology to a health care organization should be viewed as a potentially risky undertaking.
The project may involve legal or regulatory risks. These barriers involve restrictions placed on the project from outside the organization. The main issue to be considered when evaluating legal or regulatory risks is whether the project will need to involve some work that might not otherwise be necessary for achieving the project goal. For example, changes in pain management techniques may require additional work on documentation tools that are needed to meet Joint Commission requirements.
Safety risks relate to the harm that might occur as a result of the project. It’s important to consider if your project could be inherently dangerous to patients or to employees. For example, new technologies could increase the chance of medical accidents, or changes in working conditions may cause more employee injuries.
These are the basic steps in project pre-work. The degree to which you are able to do each one will depend on the project. Unfortunately, too often we simply dive in to the project and skip the pre-work phase. Spend a little more time planning the project and you’ll encounter fewer problems in the later phases of the project. Plus, when project plans are reviewed and critiqued before the project gets under way, you are less likely to waste the time of the project leader and team members.
(Next month’s Cost-Quality Connection column will describe project planning tools and techniques.)
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