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

Dan McLaughlin dbmclaughlin@stthomas.edu 651-962-4143