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Healthcare Project Management

Barbara Van de Castle / Patricia C. Dykes

INTRODUCTION

It is difficult to read a newspaper, magazine, or Web page today without hearing about the impact of information technology. Information in all forms is traveling faster and being shared by more individuals than ever before. Think of how quickly you can buy almost anything online, make an airline reservation, or book a hotel room anywhere in the world. Consider how fast you can share photos or video clips with your family and friends. This ubiquitous use of technology is permeating the healthcare industry as well, and the future of many organizations may depend on their ability to harness the power of information technology. Today there is good evidence that technology can decrease medical errors and adverse events in healthcare settings, but the complexity of these settings can make technology implementation challenging. Poor implementation can contribute to unintended consequences ranging from work-arounds that do not deliver promised value to increasing the rates of medical errors. Implementation of technology in a healthcare setting is a “project”; e.g., a “temporary endeavor undertaken to create a unique product, service or result” (PMI, 2017, p. 4). Unlike routine operations, projects have well-defined start dates, end dates, and associated resources. Good project management is needed to accomplish the work, to facilitate the change, and to deliver the desired improvements facilitated by health information technology (IT) implementation. Project management is a systematic process for implementing systems on time, within budget, and in line with customer expectations of quality. Project management is essential to delivering on the promise of health IT, and the Standards of Nursing Informatics Practice (American Nurses Association, 2015) states that Project Management Skills are essential for successful projects. Health IT innovations improve patient care, but these same innovations can drive up the cost of healthcare when what is needed is a better value.

Consistent project management methodologies will maximize benefits while decreasing the costs associated with inadequate or failed health IT projects (Sellke, 2018). Project management is not a new concept—it has been practiced for hundreds of years, as any large undertaking requires a set of objectives, a plan, coordination, the management of resources, and the ability to manage change. Today, however, project management has become more formal with a specified body of knowledge, and many healthcare organizations have adopted the projectoriented approach as a technique to define and execute on their strategic goals and objectives.

Good project managers for health IT projects are in high demand. Academic programs have responded by establishing courses in project management and making them part of the health informatics’ curriculums for continuing education, certificate, and degree programs. This chapter provides a high-level look at the methodology behind project management to provide a framework for the project manager skills’ development, structure for the implementation work processes, and organization of the projects’ tasks.

Project Management

This chapter augments the Systems Life Cycle chapters, as it outlines the project management phases, called Process Groups. Project management process groups organize and structure the Systems Life Cycle to ensure successful project completion. This introduces project management, project definitions, and project manager skills. Each subsequent section will review each of the five project management process groups. The last section describes some additional considerations for health information technology projects, such as governance and positioning of project management in the healthcare organization.

What Is a Project?

There are many different definitions of what a project is, but they all have the same components—a project is temporary, has a defined beginning and end, and is managed for time, budget, and scope. Distinguishing features of a project are specific objectives, defined start and end dates, defined funding limitations, and how they consume resources (human, equipment, materials); they are often multifunctional or cross-organizational by design (PMI, 2017). Schwalbe (2014) differentiates a project from operations by defining operations as ongoing work done to sustain the business. Projects are different from operations in that they end when the project objectives are reached, or the project is terminated whereas operations are daily services to support the business of the organization (Garcia-Dia, 2019).

What Is Project Management?

Project management is facilitation of the planning, scheduling, monitoring, and controlling of all work that must be done to meet the project objectives. The Project Management Institute (PMI) states that “project management is the application of knowledge, skills, tools and techniques to project activities to meet project requirements” (Project Management Institute [PMI], 2017, p. 10). Project managers must not only strive to meet specific scope, time, cost, and quality project goals, but also facilitate the entire process to meet the needs and expectations of the people involved in or affected by project activities.

Introduction to the Five Process Groups

The project management process groups progress from initiation activities to planning activities, executing activities, monitoring and controlling activities, and closing activities. Each of these will be described in detail in ensuing sections of this chapter. However, it is important to note here that these groups are integrated and not linear in nature, so that decisions and actions taken in one group can affect another. Projects use inputs, defined by PMI as “Any item, whether internal or external to the project, which is required by a process before that process proceeds” and outputs, defined by PMI as “a product, result, or service generated by a process” (PMI, 2017, pp. 708,712). Figure 15.1 shows the five groups and how they relate to each other in terms of typical level of activity, time, and overlap. The level of activity and length of each process group vary for each project and guide project managers throughout the progression (Garcia-Dia, 2019).

• FIGURE 15.1. Level of Activity and Overlap of Process Groups Over Time. (Republished from Schwalbe K. (2006). Information technology project management (4th ed., p. 73). Cengage Learning Inc. Reproduced by permission. HYPERLINK “http://www.cengage.com/permissions” www.cengage.com/permissions.)

Project Management Knowledge Areas

The Project Management Knowledge Areas describe the key competencies that project managers must develop and use during each of the Process Groups. Each of these competencies has specific tools and techniques associated with it, some of which will be elaborated in following sections of this chapter. Table 15.1 shows the nine knowledge areas of project management. The four core areas of project management (bolded in the table) are project scope, time, cost, and quality management. These are considered core as they lead to specific project objectives. The four facilitating knowledge areas of project management are human resources, communication, risk, and procurement management. These are considered facilitating as they are the processes through which the project objectives are achieved. The ninth knowledge area, project integration management, is an overarching function that affects and is affected by all of the other knowledge areas. Project managers must have knowledge and skills in all of these nine areas.

PLANNING PHASE

Initiating Process Group

The Initiating Process Group (IPG) is defined by the PMI as follows: “those processes performed to define the scope of a new project or a new phase of an existing project by obtaining authorization to start the project of phase” (PMI, 2017, p. 23). The purpose of the IPG is to formally define a project including the business need, key stakeholders, and the project goals. A clear definition of the business case is critical for defining the scope of the project and for identifying the opportunity associated with completing the project. The business case includes the potential risks associated with completing or not completing the project at a given point in time. The work completed throughout the IPG builds a foundation for buy-in and commitment from the project sponsors and establishes understanding of associated challenges. During the IPG a shared understanding of success criteria emerges that includes both the benefits and the costs associated with a given project (PMI, 2017). Historical information is assembled during the IPG to identify related projects or earlier attempts at similar projects. Historical information and case studies can provide insight into potential challenges that can arise with the project and buy-in from stakeholders (Bongiovanni et al., 2015). The IPG may lead to formal project selection or it may culminate in a decision to forgo or to postpone a project.

The set of work completed in the IPG is often done directly for a business sponsor and may be accomplished without a formal project team in place. During the IPG the goals of the proposed project are analyzed to determine the project scope and associated time, costs, and resource requirements. Key stakeholders are identified and may be engaged in defining the project scope, articulating the business case and developing a shared vision for the project deliverables. The inputs needed to support the work of the IPG include tools and information that support the knowledge area of project integration management. Project integration management includes the processes and activities needed to identify, define, combine, unify, and coordinate the various processes and project management activities within the project management process groups (PMI, 2017).

Sound integration management contributes to a solid understanding of whether the project is a good match for the organization and if so, how the project fits into the organizational mission and vision. The involvement of stakeholders in the process of project integration management is fundamental to their engagement in the project and involvement in defining and working toward project success. Informational inputs such as the sponsor’s description of the project, the organizational strategic plan, the published organizational mission, and historical information on related projects support the integration work of the IPG. Examples of tools and techniques that facilitate completing the information gathering, research, and related analysis required during the IPG include the SWOT (e.g., Strengths, Weaknesses, Opportunities, Threats) analysis, stakeholder analysis, and the value risk assessment (see Table 15.2 and Fig. 15.2).

• FIGURE 15.2. Stakeholder Analysis.

Tangible outputs of the IPG include the completed project charter that formally defines the project, including the business case, key stakeholders, project constraints, and assumptions. The project charter also includes signatures of the project sponsors and team members, indicating a shared vision for the project and formal approval to move forward with planning the project. The outputs from the IPG are used to inform project planning and reused during project closure to facilitate evaluation of the project deliverables.

PLANNING PROCESS GROUP

The Planning Process Group (PPG) is often the most difficult and unappreciated process in project management, yet it is one of the most important and should not be rushed. This is the phase where decisions are made on how to complete the project and accomplish the goals and objectives defined in the IPG. The project plan is created, whose main purpose is to guide the project execution phase. To that end, the plan must be realistic and specific, so a fair amount of time and effort needs to be spent and people knowledgeable about the work need to help plan the work. The project plan also provides structure for the project monitoring and controlling process, as it creates the baseline to which the work is measured against as it is completed.

During the initiating phase, a lot of information is collected to define the project, including the scope document and project charter, which provide validation and approval for the project. During the planning phase, the approach to accomplish the project is defined to an appropriate level of detail. This includes defining the necessary tasks and activities in order to estimate the resources, schedule, and budget. Failure to adequately plan greatly reduces the project’s chances of successfully accomplishing its goals (PMI, 2017).

Project planning generally consists of the following steps:

•   Define project scope.

•   Refine project objectives.

•   Define all required deliverables.

•   Create framework for project scheduled.

•   Select the project team.

•   Create the work breakdown structure.

•   Identify the activities needed to complete the deliverables.

•   Sequence the activities and define the critical path activities.

•   Estimate the resource requirements for the activities.

•   Identify required skills and resources.

•   Estimate work effort; time and cost for activities.

•   Develop the schedule.

•   Develop the budget.

•   Complete risk analysis and avoidance.

•   Create communication plan.

•   Gain formal approval to begin work.

Some of the tools and techniques employed during the PPG are listed in Table 15.3. One of the most important is the Work Breakdown Structure (WBS). Projects are organized and understood by breaking them into a hierarchy, with progressively smaller pieces until they are a collection of defined “work packages” that include tasks. The WBS is used as the outline to provide a framework for organizing and managing the work. The deliverable of this phase is a comprehensive project plan, which is approved by the sponsor(s) and shared with the project team in a project kick-off meeting (Garcia-Dia, 2019).

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