1. 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

2. 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.

3. 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

4. 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.

5. 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.

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

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

8. 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.

9. 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.

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

11. 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.

12. 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.

13. 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

14. 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.

15. 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

16. 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

17. 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

18. 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.

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

20. 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

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

22. 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.

23. 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

24. Resources
1. Project Management Institute 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

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