Healthcare Project Management Techniques - A Pragmatic Approach to Outcomes Improvement

Healthcare Project Management Techniques:
A Pragmatic Approach to Outcomes Improvement

© 2018 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Healthcare leaders are working hard to continuously
refine and advance their processes in order to improve
patient care, reduce costs, and improve the patient’s
overall experience and satisfaction–the Triple Aim.
Healthcare project management skills have
become increasingly important to businesses,
including the healthcare industry, because
they help control costs, manage risk, and
improve project outcomes.
Healthcare Outcomes Improvement

This presentation explores project management
techniques and offers considerations for healthcare
leaders when adapting these techniques for clinical,
financial, and operational process improvement.
It also provides practical and pragmatic
approaches for implementing project
management in a healthcare setting.
There are a variety of project management
techniques developed for other industries
that can be applied in a healthcare setting,
but the most common and the ones this
article will focus on are Agile and
Waterfall project management.
Healthcare Outcomes Improvement

Waterfall project management is a sequential,
linear process that consists of a number of
distinct phases.
In waterfall, the project is mapped out with clear
requirements and deliverables for each phase.
Progress is regularly documented along
the way and each phase is completed
before the next one begins.
In healthcare, there are a lot of people
who are both familiar and comfortable
with a waterfall approach.
Waterfall Project Management in Healthcare

Healthcare executives want to see a sequence of tasks laid
out from beginning to end and organized in a Gantt chart.
This provides a visual overview of the
project with a timeline of events and
a good idea how long each phase of
the project is going to take.
Waterfall project management does
a great job of communicating the
overall project scope, tasks, and
the timeline.
See Figure 1 on the next slide.

Figure 1: A Gantt chart provides a visual overview of the project. Source: TechnologyAdvice.com

Waterfall tends to be rigid in structure—for good reason.
Waterfall methodology has its roots in industries
such as manufacturing and construction where
the rigidity arose out of necessity–a builder
can’t paint a room if he hasn’t put up drywall yet.
However, with the translation of waterfall to
other industries, such as software develop-
ment or in process improvement projects,
the rigidity is often challenging and can
hinder a project, both in terms of speed
and effectiveness.

With healthcare process improvement
projects using a waterfall-only approach,
it can be difficult stick to a sequential,
step-by-step process of a project from
beginning to end.
In fact, most improvement projects are
iterative in nature and use Plan, Do,
Study, Act (PDSA) cycles of iterations.
These PDSA cycles allow teams to
iterate and show progress earlier, the
results are usually better, and the client
is more satisfied with the end result.

Waterfall project management has been used
successfully for decades to complete large-
scale projects, but these projects are often
over budget and behind schedule.
Stakeholders can also be dissatisfied with the
end result because they are typically not as
intimately involved in the process and don’t
see final results until the project is complete.

With the economic pressures faced by
hospital systems, it’s more important than
ever to deliver faster results with continuous
involvement and feedback from stakeholders
incorporated throughout the process.
This is where lean methodologies such as
agile project management can be utilized
by process improvement teams to achieve
faster, high-quality results.

Agile is an iterative project management style derived from lean principles.
Agile project methodology took shape from team-based software
development and encourages collaboration and frequent adaptation.
There are a few hallmarks of agile project management:
Agile Project Management in Healthcare
Sprints – Projects are typically divided into
sprints where a project team produces a set
amount of work within a specific time frame
(typically two weeks).
Scrum Master – a Scrum master or project
leader brings everyone on together and asks
team members for commitments of what they
will accomplish during each sprint.
Standup Meetings – Agile teams meet
regularly (every day or twice a week, etc.) to
touch base about their progress. Teams
review the commitments, the progress so far,
and any impediments to progress.
Retrospective – At the end of each sprint, the
team comes together to review what they
accomplished and what they learned from the
process that can hopefully be incorporated
into the next sprint.

The focus on frequent communication, removing
obstacles, and fulfilling commitments in set
timeframes makes agile project management
a very effective tool for process improvement
teams that want to show value early and
incorporate constant feedback from
executives and clinicians as they progress
from iteration to iteration.

Agile is increasingly popular for the benefits mentioned
above: fast results, continuous improvements, and
increased buy-in from stakeholders.
However, there are potential pitfalls.
If teams don’t have a longer-term view of the
plan represented in a Gantt chart or something
similar, they can easily get stuck enhancing
features or doing work that provides little value
to the user – sometimes called “gold plating.”

While agile is a good day-to-day
blocking and tackling project
management technique, teams can
easily get lost in the detail without
keeping an eye on the bigger picture.
This is where teams could benefit
from having some of the structure
of waterfall in place.

There are benefits and drawbacks of both waterfall
and agile project management techniques.
In the Professional Services organization at
Health Catalyst, taking a hybrid approach to
healthcare project management in hospital
systems is frequently the best option.
In a hybrid approach, teams leverage the
best aspects of both techniques with a
heavier focus on agile, but enough waterfall
planning to provide a clear roadmap to key
stakeholders and senior leadership.
Taking a Hybrid Approach

While every organization and project is unique,
this hybrid approach can be effectively applied to
outcome improvement projects.
What this might look like is having a team create
a Gannt chart that shows the high-level timeline
of the project, an overall breakdown of work in
phases, and any dependencies that exist.
This chart would then be presented to senior
leadership and clinicians in order to get buyoff.

For the improvement team, each phase of
work would then be broken down into a more
detailed set of tasks, typically applying agile
principles with sprints outlined and team
member commitments specified.
If a team is working on developing a sepsis
outcome improvement application, for
example, they might set out to complete
the effort in three months.
The project might be broken down into
three sperate iterations each lasting
approximately one month in duration.

Health Catalyst typically begins with a pre-
existing, out-of-the-box starter set and uses
that to show baseline functionality of the
sepsis outcome improvement application
using the client’s own data.
From there, users will come up with a set
of enhancements to make the application
more tailored to their organization.
This is called fingerprinting and is usually
done in the second iteration.
Pragmatic Application of Healthcare
Practice Management

Once the users have been using the application
for several months, the third iteration might
include a new set of improvements based on a
deeper understanding of the process and how it
could be improved.
All three of those iterations would be shown
within the context of a Gantt chart and details
of each of those iterations would be expressed
as “sprints” within an agile process.
Practice Management

A final note in terms of pragmatic application is
that having the right tools is critically important.
For effective healthcare project management,
having software that helps lay out the project,
allows multiple users to make changes, and
measures progress is another aspect of having
the right tools and framework that helps
improvement teams do their jobs effectively.
Practice Management

Project management skills and good
project managers are needed in
healthcare now more than ever.
Project management techniques such as
waterfall and agile can offer structure and
discipline. A hybrid approach is a
pragmatic way for teams to accomplish
more in less time.
Practice Management

For more information:
“This book is a fantastic piece of work”
– Robert Lindeman MD, FAAP, Chief Physician Quality Officer

More about this topic
Link to original article for a more in-depth discussion.
Healthcare Project Management Techniques: A Pragmatic Approach to Outcomes Improvement
7 Features of Highly Effective Outcomes Improvement Projects
Brant Avondet
The Top Seven Healthcare Outcome Measures and Three Measurement Essentials
Ann Tinker, MSN, RN, Professional Services, SVP
A Framework for High-Reliability Organizations in Healthcare
Health Catalyst Editors
How to Achieve Your Clinical Data Analytics Goals – Elaine St. James, BSN, RN, CPHQ, Patient Safety Services
Josh Ferguson, Clinical Outcomes Improvement, Director;
Nancy Casazza, BSN, MMI, RN , Clinical Outcomes Improvement, Director
Why Health Systems Must Use Data Science to Improve Outcomes
Taylor Larsen , Data Scientist

Other Clinical Quality Improvement Resources
Click to read additional information at www.healthcatalyst.com
Curt joined Health Catalyst in May, 2015 as a Senior Director/Engagement Leader. Prior to coming to
Health Catalyst, Curt worked for MD Revolution as a Regional Vice President. Curt has an
undergraduate degree in Business from Western Illinois University, a Masters in Computer Science
from DePaul University, and is currently pursuing a Masters in Health Informatics from Indiana
University, Purdue University at Indianapolis (IUPUI).
Curt Sellke

Healthcare Project Management Techniques - A Pragmatic Approach to Outcomes Improvement

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