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Healthcare Project
Management
Kathy Schwalbe and Dan Furlong
February 28, 2014
AACN Master’s Education Conference
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 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
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 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
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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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 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
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 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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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).
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 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
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 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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“Complex? Oh, this is just where the nurses get engaged in the project!”
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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!
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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 dayto-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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 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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 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!
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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 am I supposed to find the time to fill out all these
requirement documents?
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18 to treat patients, not do paperwork!”
I am here
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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!
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PM Conceptual Framework
-Same for All Projects*
*Kathy Schwalbe and Dan Furlong, Healthcare Project
Management, Schwalbe Publishing (2013).
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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
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Source: xkcd.com
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 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
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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).
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 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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Metric
Scope
Description
Meeting project
goals
Time
How Measured
Earned value
chart
Explanation
On target
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
Infection Control
data
Cannot collect until
after implementation
Training
Management
System test
results
Learning management
system down for four
days causing a delay in
training. We expect to
catch up quickly.
VAP reduction Reduce by 50%
within six months
Percent of ICU Train all ICU staff
staff trained
prior to go live
On Target
Slightly off target / caution area
Status

Off Target / problem area
 Not able to collect data yet
Copyright 2013 Schwalbe Publishing
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Copyright 2013 Schwalbe Publishing
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Copyright 2013 Schwalbe Publishing
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 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).
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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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GOAL
Healthcare
Quality, real effect
Time
Group, you, client,
breaks, graduation
Access to projects
Privacy, complexity,
timeframe, prior knowledge
Little basis in topic
Business, project management,
healthcare, basic software
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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
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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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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! 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
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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?
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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!
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 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
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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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