project management healthcare
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Project Managementand Healthcare
Daniel B. McLaughlin
Center for Health and Medical Affairsv7
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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 andOpportunities for PM
Discussion
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The Best Health Care Systemin the World
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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
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Paradox GeographicPractice disparity
Quality: over use,under use, misuseand safety
Acute care modelfor Chronic disability
Professionsshortage
Primary care
Nursing
Emerging public healthproblems
Access problems:
uninsured,underinsured,bankruptcy
Insurance: pre existingconditions, deductibles& co-pays, lifetime limits
Welfare payment foraged and disabled
Most costly system inthe World 17% ofGDP
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Total National Health Expenditures (NHE), 20092020Current Projection and Alternative Scenarios
NHE in trillions
Cumulative redu ction in NHE thro ugh 2020: $3 tr i ll ion
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).
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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
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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
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Project Management Elements
Initiation
& Charter
Scope
Requirements Project Plan
Scope management
and Work Breakdown
Schedule management
Cost Management
Quality Control
Communications
Risk management
Procurement
Stakeholders
Close out
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Improve Efficiency/Reduce Waste
Measure Analyze Improve ControlDefine
Process Map
Checksheet
Pareto
Run Chart
C&EDiagram
Scatter Plot
StatisticalTools
Basic Six Sigma Tools
Courtesy of Marshfield Clinic
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Lean Tools for Improving Flow
Value stream mapping
Geographic mapping (spaghettidiagrams)
5 Whys (better to use C and E
diagram) 5 S
Standard work
Visual Management
Takt time
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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 forchange
Necessary resources available immediately PDCA on changes
Many Kaizen events per year
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The A3Summary 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
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Agile
Charter Project
Determine
expected time
frame, cost and
performance
Collaborate
with customers
to define andrefine
requirements
Build prototype
service or
process
Does it meet
expected
performance?
Implement - go
to scale.
No
Yes
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Institute for Healthcare Improvement
Set Aims
Establish
Measures
SelectChanges
TestChanges
Do
Act
Plan
Study
More is not number and soon is not a date Dr. Don Berwick, CEO IHI
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Health Care A SystemsView
Professional - Patient
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Health System Core
Professional - Patient
Illness Burden
Consumer Behavior
Knowledge
Tools Dx & Rx
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Health System Tools
Professional - Patient
Tools Dx & Rx
Facilities
Medical
Technology
Health
Care
Workers
Information
Technology
PMNewer products
- less cost- more efficacy
PM$18 Billion for HealthInformation Technology(Stimulus bill)
PM- Improved payment forprimary care services- More funding for trainingprimary care providers
PM - structureAccountable CareOrganizations
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Health System Consumer
Professional - Patient
Illness Burden
Consumer BehaviorTools Dx & Rx
Past
Experience Personal,
networks
Information
Market/Clinical
Financial
resources
& goals
Knowledge
Environment:
- Air, food,
water
-Economic
- Cultural
Genetics of
the Individual
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Consumer Behavior and Illness
PM - Disease Management
ChronicDisease 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)
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Health System Education & Research
Professional - Patient
Illness Burden
Consumer Behavior
Knowledge
Tools Dx & Rx
Primary
Education
Continuing
Education
Research
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Education and Research
PM Research
Funding for ComparativeEffectiveness Research (Stimulus)
Evidence Based medicine projects
Clinical Decision support Data Mining
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Health System Financing
Professional - Patient
Illness Burden
Consumer Behavior
Knowledge
Tools Dx & Rx
FinancingSources
&
Structure
Individuals
Employers
Government
Financial
resources
& goals
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Employers Remain Primary Sponsor of CoverageDistribution of 307 Million People by Primary Source of Coverage
Employer
Direct
164m
53%
Uninsured
49m16%
Medicare
39m
13%
Medicaid
42m
14%
Medicare
41m
13%
Individual
Direct
14m5%
Employer
Direct
55m18%
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).
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PM - Insurance
Health Information Interchanges
Simplified and standardized
billing
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Total Health System Model
Professional - Patient
Illness Burden
Consumer Behavior
Knowledge
Tools Dx & Rx
Facilities
Medical
Technology
Health
Care
Workers
FinancingSources
&
Structure
Information
Technology
Primary
EducationIndividuals
Employers
Government Continuing
Education
Past
Experience Personal,
networks
Information
Market/Clinical
Genetics of
the Individual
Environment:
- Air, food,
water
-Economic
- Cultural
Financial
resources
& goals
Research
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Americans
always do
what is r igh t ,bu t only
after try ingeverything
else.Winston Churchill
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Discussion
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Thank You
Dan McLaughlin