PROJECT MANAGEMENT: A Foundational Skill for Developing a Solid Medical Home Cynthia Fisher, MD Theresa Peters, BA William Beaumont Hospital, Troy Family Medicine Residency STFM 4/27/2010

William Beaumont Hospital, Troy Family Medicine Residency Picture of new facility Map of MI with “star” Group picture 3 hospital system, 1of 2 Family Medicine programs (at community hospitals) In the midst of change (which means lots of projects to complete and keep track of) 666 to an 888 program currently 21 residents, Recently dually accredited EMR instituted 18 months ago (and still a work in progress) Goal to become a “medical home” Would like to share with you some tools we have borrowed from the business world which are helping us to accomplish our goals.

Agenda Why Project Management? Review Project Management Principles Review the basic skills and steps Review a process to manage multiple concurrent projects in a residency setting Discussion

Why Project Management? Changing environment Patient Centered Medical Home Open Access Scheduling Group Visits EMR Chronic Disease Management ACGME requirements Medical advances In 8/2003 at our annual faculty retreat, we realized that many of the issues and ideas for residency improvement were the same as in prior years. Why weren’t we able to bring these important ideas/projects to fruition? We also discovered that several faculty were working independently on similar projects.

Why Project Management? Existing challenges Resistance to change Scheduling meetings Accountability Communication Too many projects at the same time Shifting priorities Faculty burnout munication Competing priorities Shifting or expanding goals Fortunately for us, our Administrative Director was interested in teaching and our Program Director, Paul Misch, had the foresight to include her as part of our residency faculty. She introduced the rest of the faculty to the concept of Project Management. Over time, through her role-modeling, coaching, instructing, and practical application, we have learned and utilized the processes of Project Management and greatly improved our ability to get things done.

Why Project Management? Ability to meet strategic objectives Academic Administrative Institutional Ensure completion of short and long term goals. Sense of Accomplishment!!!

Project Management Principles What is a “Project” Development of Project “Scope” Key Project Phases

What is a “Project”? Projects should be oriented toward a single goal. (outcome/end in mind) Projects have a finite duration Projects require the coordination of interrelated activities. Characteristics of a “project” – it is important to define your projects in these terms – if there is not a clear “end in mind” and time frame, it is very difficult to be successful in it’s completion. By nature a true “project” requires coordination of various activities performed by various individuals/entities.

Development of Project Scope The Problem Relevant History Proposed or preferred solutions Cost/Benefit Proposed Implementation Schedule Budget Conclusion Project Summary All of these items are typically contained within the scope of a project – some may be more relevant for different projects, but each of these areas should be considered in developing the project.

Key Project Phases Develop Goal Communicate Identify stake Holders Negotiate for resources Plan Recruit and Train Implement Monitor – Check/Act

Key Points in Setting a Goal Specific Measurable Attainable Responsibility (Roles) Time Frame Want to spend a moment on goal setting. A clear/proper/realistic goal for the project is key to being successful (similar to developing a clear research question, as the first step in developing a research project). It must contain each of these elements.

Key Project Phases Develop Goal Communicate Identify stake Holders Negotiate for resources Plan Recruit and Train Implement Monitor – Check/Act After developing a clear goal, the following steps can be followed. Some will be done concurrently and overlap, but communication (ongoing and vital), identification of all stake holders(within and outside of dept), negotiation for resources (within and outside of dept), and developing a comprehensive implementation plan must be done before training and implementation. A plan for follow up assessments and making changes is also vital.

OAS Project: Develop Goal Specific – Improve access for patients Measurable – Scheduling Metrics, Patient Satisfaction scores Attainable – Completed research Responsibility – Developed multidisciplinary team Time Frame –implement August 2009 An important element of a Patient Centered Medical Home – is accessibility After much research, we decided that establishing OAS would improve patient access. First, we developed a clear goal of improving access for patients. We established metrics for measuring success Completed research that verified that Open Access Scheduling would be a good tool for us to meet our goal Developed a multidisciplinary team representing the various stakeholders in the FMC (phone, front desk, clinical staff, nursing and administrative directors, residents and faculty) Set a “go live” date

OAS: Key Project Phases Develop Goal – Implement OAS as a tool for improving patient access Communicate – Shared within the department and externally Identify the stake holders – Patients, staff, physicians, managers After developing the goal we went through the key project phases.

Key Project Phases Continued Negotiate for resources – Management Engineer Plan – Developed an action plan Recruit and Train – Identified team members, Training Implement – Went “live” with open access We utilized resources within our hospital system including a Management Engineer (they are very good at project management!!) and IT to help set up the metrics. Recruiting the implementation team (expansion from original Project Team) – think about including some members who may not normally be your “early adapters” of change – if they can be convinced the change is a good thing and be part of it, it will help a lot with successful implementation. See reference articles at the end powerpoint

Key Project Phases Continued Monitor – Developed pre-open access scheduling metrics 3 months post implementation evaluated and shared metrics Made adjustments to schedules Ongoing monitoring As stated before, monitoring is very important after implementation of project is completed

Multiple Project Planning Process Annual Strategic Planning Session – (faculty, residents, office leadership) Identify/prioritize goals for coming year Identify those projects that are dependent and connected with each other for natural synergy and maximum benefit This is our process for identifying, prioritizing and tracking the multiple projects at the residency

Project Planning Process Cont. Rank projects based on benefits and resource requirements Establish timelines for project completion Assign responsibilities that include accountability Rank/prioritize projects and decide as a group which ones to pursue for the year.

This is a sample of a page from our strategic planning document

Process for multiple projects Incorporation of projects into the Project Tracker Faculty Meetings Project Tracker “hardwired” with faculty meeting agendas Monthly Faculty Leader Forum Meeting - in-depth discussion of projects and skill development

This is a sample of a weekly faculty meeting agenda incorporating scheduled items from the Project Tracker

Once a month the faculty meets for a morning to review items as a group that require more discussion than available at the faculty meetings. Again, reviewing action items from the Project Tracker is part of the agenda.

What has contributed to success: Department chair support Multidisciplinary faculty, resident involvement Buy-in and commitment from faculty Utilization of hospital resources Group development of strategic plan Learning to set reasonable project goals Adjusting the Project Tracker when needed Developing team spirit and energy Involvement of Residents and other stake holders Individual monitoring and championing the tracker

Resources 1. Project Management Institute - www.pmi.org  - This website has a lot of valuable information. 2. Project Management, Memory Jogger - A pocket guide for Project Teams 3. Essentials of Project Management by Dick Billows, PMP

Questions/Discussion What aspects might be helpful in your programs Other helpful tools you have used