The Quality-Cost Connection
Plan and execute your projects more effectively
How to brainstorm with note cards
By Patrice Spath, RHIT
Brown-Spath Associates
Forest Grove, OR
In today’s busy health care environment, quality improvement (QI) managers often find themselves burdened with an increasing number of projects. The time demands on the people involved can be overwhelming.
The organization’s leaders rely on the QI staff to assist project teams in bringing initiatives to a successful conclusion. QI staff may serve as a project team leader, facilitator, or team member. Whatever the role of the QI staff, their technical expertise in project management can greatly benefit the team. Project management involves three steps: pre-work, planning and execution, and post-project evaluation. The topic of project pre-work was covered in last month’s column. The planning and execution step of a project is detailed this month. Project planning can begin once the goals are clear and the team is assembled.
During the planning process, a detailed schedule for the project is developed and implemented. The people doing the work (the project team) should be involved in designing the work that needs to be done to complete the project. Start the project by asking the team to identify the major tasks based on the stated goals. For example, the team that is charged with improving inpatient satisfaction with pain management practices might identify three major tasks:
- gather data;
- benchmark current practices;
- recommend improvements.
Next, have the team brainstorm the subtasks that need to occur during completion of each major task. Use a Post-it note process during the brainstorming session. Projects should be planned in layers, starting at the highest level and working down. Use 3-inch by 5-inch size notes to record major tasks. Space these across the top of the planning sheet. The 3-inch by 3-inch size note is used for subtasks. Place the subtasks below the major tasks on the planning sheet.
It may be necessary to spell out each subtask in considerable detail depending upon people’s familiarity with the work to be done. The team also should describe any key decisions or approvals that might need to occur during the completion of major tasks. These are recorded on a 3-inch by 3-inch size note turned to the side (diamond-shaped).
At this stage in the planning, don’t worry about arranging the work. Just try to get the team to identify some of the work that will be necessary for each major task. Once the team has defined a fair number of subtasks and decisions, you can begin to organize the project.
Click here to see an excerpt from the pain management project team’s planning document. Two of the major tasks are shown, along with some of the subtasks, and decisions or approvals that need to occur.
Later, the team will go back to the planning sheet and use 1½-inch by 2-inch size notes to add resource assignments, schedule estimates, and comments.
Once the team has defined a good number of subtasks and decisions, you can begin to apply some structure to the developing project plan. Start by arranging the brainstormed subtasks on the planning sheet to illustrate the relationship between the subtasks. Place the subtasks according to time of completion; with time running horizontally from left to right. As the team begins to layout the project subtasks, the sequence and time relationships among the subtasks will become evident. Some subtasks can begin at the same time. Place these parallel subtasks on the planning sheet in vertical sets — stacking one on top of the other.
Subtasks that must be completed in sequence are placed in a line from left to right. Subtasks that can start at different times but must be finished at the same time before the next subtask can take place are placed on the sheet, one below the other. These interval subtasks are placed in the order in which they must occur. The chart review subtasks are expected to occur at the same time, however the team wants these reviews to be done prior to patient surveys. The interval subtasks of focus group discussions do not need to be done in parallel with the chart reviews, but do need to be completed before patient surveys.
Once the major tasks, subtasks, decisions, and approvals are all mapped out on the planning sheet, a Gantt chart is developed. This chart lists subtasks activities down the vertical axis and time along the horizontal axis.
While constructing this chart, the team will need to establish time lines and duration times. What is the overall time (start to finish) for completing the entire project? When should focus group discussions with physician start? How long should it take to complete this activity? To establish the project time lines, have the team discuss the optimistic time (if all goes well) and the pessimistic time (if everything goes wrong). Through these discussions, the team should be able to come up with the most likely time. (In your best judgment, what is a realistic estimate of how long it will take to deliver?)
The subtasks are recorded on the left side of the Gantt chart listed in the order in which they will be accomplished. There should be no activity on the project flow-chart or the project schedule that does not have a specific individual responsible for its accomplishment. Each person’s level of involvement in the accomplishment of the subtask should be defined. There are basically four levels of participation:
— Consultation. The consultant has information that is necessary to complete the activity, but does not need to schedule time to work on it.
— Advisement. The advisor should be told about the activity, specifically when it is started or completed and the ongoing progress.
— Involvement. One person must be involved in the work of completing the activity; he or she must schedule time to work on the subtask and produce work output.
— Responsibility. One person is responsible for seeing that the activity is completed.
Talk with each of the individuals that fall into these four categories to be certain they agree to accept the role they have been assigned. Be sure that only one person is assigned the responsibility role for every subtask. Also, don’t overlook assigning responsibilities to each activity on the Gantt chart. Otherwise, you may find some project subtasks not completed as expected.
The Gantt chart, which is developed as part of the planning activity, is the basis for all subsequent project planning. It is a graphic representation of the series of activities and deliverables that will lead to the accomplishment of the project goal.
By adding information to a basic Gantt chart (such as the people working on each task, notes about critical activities, etc.), the chart can be expanded to show more the of the project’s flow. It is sometimes helpful (depending on the complexity or duration of the project) to construct several charts showing smaller manageable pieces of the project and to then combine these into a single chart for the total project. Your project schedule is complete and sufficiently detailed if the team is able to answer "yes" to the following questions:
- Do you know the significant deliverables throughout the project?
- Do you know what activities must be completed in order to accomplish each deliverable?
- Do you know what peripheral activities support major tasks?
- Do you know the order in which subtasks must be completed?
- Do you know which activities result in critical deliverables (those which must be completed before succeeding activities can begin)?
- Do you know who is responsible for each activity?
- Do you know the time estimate for each activity?
Successful project planning requires good leadership. Too often, teams want to jump into the initiative without a clear plan of what needs to be accomplished and the sequence of events. Even if you have to start the project before planning is completed, the team should keep planning to stay ahead of the activities. A systematic project plan helps the team stay on track and achieve project goals.
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