Friday, October 21, 2011

Performance Improvement Tip of the Day: Performance Oriented Project Management

Start with a "burning platform"
- what is a critical performance issue that needs to be solved at your institution? Is your CEO staying up at night worrying about something? Is the Board requesting frequent reports on a particular topic? What information is being publicly posted (e.g., on that represents a vulnerability for the organization?

Build your support - executive leadership and leadership. Talk to some of the key stakeholders in the project of your choice to ensure that they will support the endeavor. In most healthcare organizations, there are so many competing priorities, while the resources and staffing to tackle them are very limited, that you have to ensure that your leadership team will support the project, especially when it comes to the tough issues that will need to be dealt with.

Build your PI team - some of these may be the same executive leaders and leaders that you spoke to in the "building support round". However, many of these individuals will be frontline staff - nurses, physicians, pharmacists, therapists. The team should be multidisciplinary in order to ensure that you are getting wide-ranging input into the project. Most clinical performance improvement projects have ramifications that you may not be able to predict, or may not realize. Having a team of people from different disciplines, and at different levels of the organization, allows the right solutions to emerge, and enables effective problem-solving.

Create the project plan - one of the first things to accomplish when you get the PI team together is create a "formal" project charter, including mission, vision, goals, outcomes, meeting frequency. This can be more structured if you like, including defining team roles - team leader, meeting facilitator, note taker, and time keeper. However, I've generally found that the strict definition of these roles is not critical, particularly in an organization that is not operating otherwise with this level of structure.
  • There are some "outcome oriented project management tools" - such as Meeting Agenda, Action Item Log - which can be vital to success. I'll discuss these tools in future blogs.
How often will you meet? - Meeting frequency is one of the project plan parameters that is very important. Contrary to popular opinion which in general disdains meetings, significant progress cannot be made without effective meetings. Meetings allow for multi-directional sharing of information, resolving of concerns, problem-solving, and synchronization. For projects that are high priority or require sustenance of momentum, consider meeting weekly or bi-weekly. For some projects, we've coordinated daily meetings, which proved to be one of the most instrumental factors in attacking difficult problems:
  • Patient Flow from ED to Inpatient: Daily huddles led by our CEO, attended by all critical disciplines - particularly frontline staff - helped to identify problems "real-time" with a major change in the way that patients were being admitted to the inpatient units (admission evaluation completed on the inpatient units rather than in the ED). The direct presence of top leadership, transparency of communication, and the speed with which problems were addressed helped the frontline staff accept and adjust to the changes. This project was highly successful, leading to a reduction of time to admission by an average of 90 minutes per patient.
  • Communication of Discharge Documentation: Our Hospitalist Program Director and the Director of Quality & Safety moved to daily meetings to address ongoing challenges with getting discharge summaries and other documentation to primary care physicians (PCPs) in a timely and reliable manner. The daily meetings led to rapid identification of ongoing issues, and to resolution of the same in a timely manner. Information from these meetings was communicated to some of our PCPs, who reported greater confidence in our discharge communication.
Identify the PI Specialist - Although there are a number of roles, as mentioned above, that come into play in a complex project, there are none more important than the PI Specialist. This individual is the day-to-day project leader; the person who ensures that the project is moving forward, and following up in between meetings to ensure that action items are being completed.
  • This individual often collects data, disseminates data, provides feedback to providers, and identifies irresolute problems for the PI team to troubleshoot. I'll provide more details about these activities in upcoming blogs.

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