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Project Management Healthcare Powerpoint document sample
Document Sample
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 • Emerging public health
problems
Practice disparity
• Access problems:
• Quality: over use, uninsured,
under use, misuse underinsured,
and safety bankruptcy
• Acute care model • Insurance: pre existing
conditions, deductibles
for Chronic disability & co-pays, lifetime limits
• Professions • Welfare payment for
shortage aged and disabled
– Primary care • Most costly system in
– Nursing the World – 17% of
GDP
Total National Health Expenditures (NHE), 2009–2020
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 don’t want change
– Market failures abound
• Compassion
– Hippocratic oath
– Technological Imperative
• It’s Personal
– Everyone is part of the system
– Strong feelings about my health, my family’s 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 Scope –
Requirements Project Plan
& Charter
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 ½” by 11” pages)
Issue Target Condition
Background Countermeasures
Current condition Implementation Plan
Problem analysis Financial analysis
Test
Follow up
Agile
Collaborate
with customers
to define and
refine
requirements
Build prototype
Charter Project service or
Determine process
expected time No
frame, cost and
performance
Does it meet Implement - go
expected Yes to scale.
performance?
Institute for Healthcare Improvement
Set Aims
Establish
Measures
Plan Do
Select
Changes
Test Act Study
Changes
“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
Health
PM
Facilities
Care - Improved payment for
Workers primary care services
Medical
- More funding for training
Technology Information primary care providers
Technology
Tools – Dx & Rx
PM
Professional - Patient
$18 Billion for Health
PM Information Technology
Newer products (Stimulus bill)
- less cost
- more efficacy
PM - structure
Accountable Care
Organizations
Health System – Consumer
Information Financial
Market/Clinical resources
& goals
Past
Experience –
Personal,
networks
Consumer Behavior
Tools – Dx & Rx
Environment:
Professional - Patient - 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
Consumer Behavior
Tools – Dx & Rx
Professional - Patient
Continuing
Knowledge Education Illness Burden
Primary Research
Education
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
Consumer Behavior
Tools – Dx & Rx
Financing
Sources
& Professional - Patient
Structure
Government
Knowledge Illness Burden
Employers
Individuals
Employers Remain Primary Sponsor of Coverage
Distribution of 307 Million People by Primary Source of Coverage
Employer
Uninsured
Direct
49m
55m
16%
18%
Medicaid Employer
42m Medicare
Direct 41m
14% 164m 13%
53%
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
Health Information Financial
Care Market/Clinical resources
Facilities
Workers & goals
Medical Information Past
Technology Technology Experience –
Personal,
networks
Consumer Behavior
Tools – Dx & Rx
Financing
Sources Environment:
& Professional - Patient - Air, food,
Structure water
-Economic
Government - Cultural
Continuing
Knowledge Education Illness Burden
Employers
Primary Research Genetics of
Individuals Education 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
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