Project Management and Healthcare
Daniel B. McLaughlin Center for Health and Medical Affairs
v7
Outline
Issues in American health care today The Need for Project Management PM Systems
PMI Lean Six Sigma Agile IHI
A systems view of health care and Opportunities for PM Discussion
The Best Health Care System in the World
The Best
Medical Research Drug and Device Development Innovative Care Delivery
Minute Clinic Electronic Health Record Health 2.0
Health Services Research Passionate and skilled caregivers Engaged Consumers and Patients
Paradox
Geographic Practice disparity Quality: over use, under use, misuse and safety Acute care model for Chronic disability Professions shortage
Primary care Nursing Emerging public health problems Access problems: uninsured, underinsured, bankruptcy Insurance: pre existing conditions, deductibles & co-pays, lifetime limits Welfare payment for aged and disabled Most costly system in the World 17% of GDP
Total National Health Expenditures (NHE), 20092020 Current Projection and Alternative Scenarios
NHE in trillions
Cumulative reduction in NHE through 2020: $3 trillion
Note: GDP = Gross Domestic Product. Data: Estimates by The Lewin Group for The Commonwealth Fund. Source: Commonwealth Fund Commission on a High Performance Health System, The Path to a High Performance U.S. Health System: A 2020 Vision and the Policies to Pave the Way (New York: The Commonwealth Fund, Feb. 2009).
Why is change so Hard?
Medicine
Most intense science of all 10,000 new articles a year 17 years from research to practice (AHRQ)
Business
Predominately privately owned and operated Still cottage industry in many places Many interests dont want change Market failures abound
Compassion
Hippocratic oath Technological Imperative
Its Personal
Everyone is part of the system Strong feelings about my health, my familys health, my doctor
Project Management - The Need
Cedars Sinai example Now a defined science
Origins in DOD procurement
Evidence based management Widely used product development, IT and construction Project Management Institute PMI Competitive advantage
Honeywell example
Project Management Elements
Initiation & Charter Scope Requirements Project Plan
Scope management and Work Breakdown Stakeholders Schedule management
Cost Management Quality Control
Communications
Risk management
Procurement
Close out
Basic Six Sigma Tools
Improve Efficiency/Reduce Waste Define Measure Analyze Improve Control
Process Map Checksheet Pareto Run Chart C&E Diagram Scatter Plot Statistical Tools
Courtesy of Marshfield Clinic
Lean Tools for Improving Flow
Value stream mapping Geographic mapping (spaghetti diagrams) 5 Whys (better to use C and E diagram) 5S Standard work Visual Management Takt time
Kaizen Events
(Rapid Process Improvement Workshops RPIW) Short time periods (1/2 day to 5 days) Use simple tools
Spaghetti diagrams Process diagrams value streams
People who perform the process or observers Focus on immediate recommendations for change Necessary resources available immediately PDCA on changes Many Kaizen events per year
The A3
Summary of PI project on A3 size paper (2 x 8 by 11 pages)
Issue Background Current condition Problem analysis Target Condition Countermeasures Implementation Plan Financial analysis Test Follow up
Agile
Collaborate with customers to define and refine requirements Build prototype service or process No
Charter Project Determine expected time frame, cost and performance
Does it meet expected performance?
Yes
Implement - go to scale.
Institute for Healthcare Improvement
Set Aims Establish Measures Select Changes
Plan Do
Test Changes
Act
Study
More is not number and soon is not a date Dr. Don Berwick, CEO IHI
Health Care A Systems View
Professional - Patient
Health System Core
Tools Dx & Rx
Consumer Behavior
Professional - Patient
Knowledge
Illness Burden
Health System Tools
Facilities Health Care Workers
PM
- Improved payment for primary care services - More funding for training primary care providers
Medical Technology
Information Technology
Tools Dx & Rx
Professional - Patient
PM
$18 Billion for Health Information Technology (Stimulus bill)
PM
Newer products - less cost - more efficacy
PM - structure
Accountable Care Organizations
Health System Consumer
Information Market/Clinical Financial resources & goals Past Experience Personal, networks Consumer Behavior
Tools Dx & Rx
Professional - Patient
Environment: - Air, food, water -Economic - Cultural
Knowledge
Illness Burden Genetics of the Individual
Consumer Behavior and Illness
PM - Disease Management Chronic Disease Management Medical home Health IT to track chronic patients PM - Consumer behavior Health promotion and disease prevention Financial incentives to employers for wellness programs (Safeway model)
Health System Education & Research
Tools Dx & Rx
Consumer Behavior
Professional - Patient
Knowledge
Continuing Education
Illness Burden
Primary Education
Research
Education and Research
PM Research Funding for Comparative Effectiveness Research (Stimulus) Evidence Based medicine projects Clinical Decision support Data Mining
Health System Financing
Financial resources & goals
Tools Dx & Rx Financing Sources & Structure
Consumer Behavior
Professional - Patient
Government Knowledge Employers Illness Burden
Individuals
Employers Remain Primary Sponsor of Coverage
Distribution of 307 Million People by Primary Source of Coverage
Uninsured 49m 16% Medicaid 42m 14% Employer Direct 164m 53%
Employer Direct 55m 18% Medicare 41m 13%
Medicare 39m 13% Individual Direct 14m 5%
Total Employer 164m (53%) Total Individual 14m (5%)
Source: The Lewin Group, The Path to a High Performance U.S. Health System: Technical Documentation (Washington, D.C.: The Lewin Group, 2009).
PM - Insurance
Health Information Interchanges Simplified and standardized billing
Total Health System Model
Facilities Health Care Workers Information Technology Information Market/Clinical Financial resources & goals Past Experience Personal, networks Consumer Behavior
Medical Technology
Tools Dx & Rx Financing Sources & Structure
Professional - Patient
Environment: - Air, food, water -Economic
Government Knowledge Employers Primary Education
Continuing Education
- Cultural Illness Burden
Research
Individuals
Genetics of the Individual
Americans always do what is right, but only after trying everything else.
Winston Churchill
Discussion
Thank You
