managing projects for competitive advantage

@2016 Job Launch Accelerator

Managing Projects for Competitive Advantage

Chapters1. Projects and Deliverables2. Overview of the Project Management Life-Cycle3. Project Initiation4. Project Plan5. Work Breakdown Structure6. Scheduling7. Monitoring Project Progress8. Controlling Project Progress9. Project Governance: Structure and Support10. Project Approaches: Traditional and Agile

Overview and Project Initiation

Part II

Overview of the Project Management Life-Cycle

Chapter 2

Learning Objectives

The learning objective of this chapter is to introduce the project management process by following a simple project from beginning to end. While it is just an overview, it will provide a framework for understanding the details that will be developed in subsequent chapters.

In this chapter you will learn how writing the problem statement, writing an initiation statement, creating a project charter, executing the project, monitoring progress, and controlling the outcomes establishes a logical and systematic way to think about the project management process.

Outline Introduction Learning Objectives Orlando Center for Ambulatory Medicine Problem Statement Project Initiation Project Plan Schedules Project Execution Monitoring and Controlling Closing Summary Questions

Introduction

As you learned in the last chapter, the basics of the project management process share similarities with the process of scheduling one’s daily activities. Yet, as you are aware, organizational projects can be considerably more complex. So in this chapter you will have the opportunity to see how a systematic and orderly approach to these projects can help deliver successful outcomes.

Putting the Principles to Work

The project management process involves several steps, PMBOK calls then process groups. These groups include initiating, planning, executing, monitoring and controlling, and closing. Shortly you will learn more about them. But learning about them is not enough. Indeed frameworks, concepts, methodologies and skills by themselves, are never enough. We all know, for example, that it is one thing to watch an instructional video on golf but quite another to put those principles to work on the golf course.

Cases Provide a Context

What we do need in addition to these frameworks is an understanding of how they can be applied to the real-world.

Accordingly, an overview of the project management life cycle is presented in this chapter as a case study for two reasons. First, it introduces the basic framework of project management, but second it provides a realistic context illustrating how this framework can actually be applied.

Orlando Center for Ambulatory Medicine

The Orlando Center for Ambulatory Medicine, OCAM, located in Orlando, Florida, is committed to providing quality outpatient care to its patients at an affordable cost. Its services include ophthalmology, cosmetic surgery, general surgery, reconstructive surgery, orthopedics, podiatry, gynecology, urology, otolaryngology/ENT, and pain management.

Three months ago the president of the center, Doctor Jason Stopman, called Lisa Gonzalez, OCAM project manager, into his office.

“Lisa, I just finished reading an article on the Internet. We could be in for a tough time.”

Stopman was referring to an Associated Press article reporting a federal study of infections and infection control procedures at same-day surgery centers like OCAM.

He removed a copy of the article from his briefcase. “Lisa, take a minute and read this.”

Associated Press Article

Initiating

Associated Press Article

By CARLA K. JOHNSON

CHICAGO — A new federal study finds many same-day surgery centers — where patients get such things as foot operations and pain injections — have serious problems with infection control.

Failure to wash hands, wear gloves and clean blood glucose meters were among the reported breaches. Clinics reused devices meant for one person or dipped into single-dose medicine vials for multiple patients.

The findings, appearing in Wednesday's Journal of the American Medical Association, suggest lax infection practices may pervade the nation's more than 5,000 outpatient centers, experts said.

"These are basic fundamentals of infection control, things like cleaning your hands, cleaning surfaces in patient care areas," said lead author Dr. Melissa Schaefer of the Centers for Disease Control and Prevention. "It's all surprising and somewhat disappointing."

Centers for Disease Control and Prevention

Federal Study

The study reported in the article was conducted at 68 centers in three states: Maryland, North Carolina and Oklahoma. Sixty-seven percent of these centers had a least one lapse in infection control. In total, fifty-seven percent of those centers were cited for deficiencies. The lapses were widespread. Staff often failed to wash their hands, wear gloves and clean lab equipment such as blood glucose meters and cardiac monitors. Some clinics were even found to reuse devices meant for single-use. At others, staff used single-dose medicine vials for more than one patient.

Background Data

The study was authorized in response to a major hepatitis C outbreak in Las Vegas, an outbreak that was believed to have been “caused by unsafe injection practices at two now-closed clinics.”

When Lisa finished reading, Stopman continued the conversation. “ Lisa, what concerns me most is that the U.S. Health and Human Services Secretary has announced plans to expand control over ambulatory surgical centers.

OCAM Infection Record Too High

Lisa asked, “Haven’t we had this under control? I think we are doing as well as any other clinic in the Orlando area. Why should we be concerned?”

“We should,” Stopman interrupted. “ I just checked our records and for a long time our average has stabilized at about 20 infections per month and as this article suggests we have probably just accepted this as part of our surgical risk. What is worse is that we know about the infections that have been reported to us but don’t know about others that have gone unreported. I am concerned that there may be deficiencies in our procedures and that we haven’t done enough to provide the best care for our patients.”

After a pause, he continued, “With federal and state authorities placing greater emphasis on infection rates, we need to do something and do it quickly.”

“How can I help?” replied Lisa.

Project Goal

“I need you to come up with a new infection control plan for the clinic. Considering the results of this federal study I suspect that our next audit will be tough, and I don’t want to take any chances. The last thing we need is for the Feds or State to close us down.”

“What’s our goal?” asked Lisa.

“As usual I always like to set a target for our projects, replied Stopman. “In this case it is simple. We need to reach a zero infection rate two months after your new plan is implemented.”

“That sounds way too ambitious? How can any clinic reach that goal,” Lisa responded.

Stopman, referring back to the article, read a quote from Dr. David Shapiro. “Any incident is one too many.” Then Stopman added, “We have to do whatever it takes. The consequences of non-compliance are much too high”

Project Scope

Lisa thought for a moment. “Doctor Stopman, I can understand your concern, but your target will be tough to reach.”

“I won’t compromise the goal, so lets not talk about that any more.

Lisa thought for a moment and then focusing on the scope of the project proceeded to see if she could get some concessions from Stopman. “I think you’re expecting the staff to do too much in too short a time. Infection control involves nurses, equipment, physicians, nurses aids and even administrative staff. How can we possibly solve a problem this large and get rates to Zero.”

Project Scope

“What’s the alternative, interjected Stopman.”

Lisa replied, “Why don’t we narrow the scope and first identify only one area like orthopedics? We could study the procedures they follow, determine if they just need closer compliance or if they need major revisions. If there are problems we could develop new ones. Then, once we succeed in making improvements in orthopedics we can apply the approach we used to other departments, one department at a time. If we do it that way we have a multi-phase study that will be easier to manage than a single-phase one where we do it all at once. But even more importantly we will be learning as we move from one department to the next.”

Project Scope

At this point Stopman became impatient. “Lisa, my major concern is that we will not pass our next inspection which could happen today or tomorrow. We need to make these changes and make them fast. Focusing on just the orthopedic department is not acceptable and will just waste valuable time.”

Stopman got down to business and asked Lisa to develop a formal Project Plan, sometimes called a project charter. This document would include the following:• Business Case• Problem Statement • Scope Statement• Tasks• Schedule• Resource Requirements

Problem Statement

Lisa returned to her desk and wrote a business case, sometimes called a problem statement, which she then emailed to Stopman.

Given the increased concern over infection rates nationally, the likelihood that federal and state audits will increase, and the need to improve the quality of patient care, OCAM will engage in a study to review existing infection control processes and then determine appropriate standards and quality control procedures to improve performance. The goal is to reduce infections to zero percent within two months of implementing the new system.

Project Plan

Business Case

Scope Statement

The next step would be to write a scope statement. This is a formal statement establishing what is to be considered within the bounds of the project.

Lisa had two requirements that she felt should be included in the project’s scope. The first would be the purchase of new clinical equipment that would be much easier to clean. The second was the addition of a new staff member to enforce compliance of new methods and procedures.

The request for a new position was inspired by an article she had recently read in an on-line nursing publication. In it she learned that many hospitals were now hiring an infection preventionist, a staff position created to cut infection rates.

Project Plan

Problem Statement

Scope

Scope Management

While the article that Lisa had read did not focus on ambulatory centers like OCAM, it did conclude that hospitals suffer 1.7 million healthcare-acquired infections a year, adding $20 billion to health care costs. Infection preventionists, the article concluded were proving to be instrumental in slashing these infection rates and saving money.

Lisa thought that hiring such an individual would be essential in enforcing new procedures and in reaching her ambitious project goal of zero percent in two months.

Project Plan

Problem Statement

Scope

Tasks

The development of a reliable schedule would be an important step in creating the project charter. But in preparation for creating this schedule it would be necessary to decompose the project into smaller tasks or deliverables.

Conferring with staff, Lisa was able to put together a list of tasks necessary to complete the project.

Project Plan

Problem Statement

Scope

Tasks

Tasks

With the tasks identified, Lisa then grouped them into intermediate deliverables. The final deliverable would depend, of course on the successful completion of these intermediate deliverables.

Lisa defined seven intermediate deliverables. They included interview data obtained from the nursing staff; Interview data from the medical staff; best practices from leading clinics across the country; data summary report, group meeting reports; draft of new procedures; and a formal training plan.

Intermediate DeliverablesInterview data - Nurses

Interview data - Physicians

Industry best practices

Data Interpretation

Group meeting reports

Draft of new procedures

Training plan

Schedule

Lisa then created a schedule around those tasks. Some would have to be completed before others could be started, and others, like data collection, could be undertaken simultaneously with other tasks.

She then concluded that the earliest the project could be completed would be nine weeks from the date it was started. Further, she identified several tasks, such as interviews with physicians and nurses, which if delayed could delay the completion of the entire project. Those activities comprised the Critical Path of the OCAM project.

Problem Statement

Scope

Tasks

Schedule

Project Plan

Project Plan

In three days the project charter was on Stopman’s desk. Stopman immediately called Lisa. “You’re asking for too much. I can’t approve it. We need to talk!

Scope Creep

When they met two hours later Stopman insisted that Lisa had succumbed to scope creep. “I know that replacing some of the older equipment and hiring an infection-preventionist is tempting, but you are adding to the complexity of this project, adding to the time it will take us to get it done, and adding to its cost. Let’s resist the temptation to increase the project scope and fall victim to scope creep. How about just getting it done with the resources we have?”

Schedule Contested

Stopman then turned his attention to the schedule.

“You schedule calls for completion in nine weeks. What would it take to shorten it to eight weeks? I am sure you can eliminate some delays.”

Lisa replied. “I suppose we could work some overtime. The big problem will be to get the staff and physicians to understand the importance of this project and to give it a high enough priority so that they will be available to help us put it together. I worry that they will push it aside given their clinical responsibilities”

Top Management Support

“The stakes are too high, we have to do it” replied Stopman.

Lisa added, “It might help if you make it absolutely clear that this project is top priority and has your full support. Will you speak to them?”

“Absolutely, consider it done. But if I do this, can you promise me that you will have it done in 8 weeks? ” Stopman asked.”

“You have a deal,” answered Lisa.

Top Management Support

Two days later, Stopman called a staff meeting for key stakeholders. He started by reading excerpts from the Internet article that initially raised his concern. Then he opened the meeting to discussion.

There were several in the group that were reluctant to initiate what appeared to be a major change in how they performed their work, but about half of the staff expressed support for the project.

When the meeting came to a close, Stopman asked everyone to give Lisa their full cooperation.

Project Execution

Project execution started immediately. Several meetings were scheduled. The first included physicians. The second included registered nurses, licensed practical nurses and nurses aids. The third included housekeeping and maintenance workers. No one was left out.

There was still some resistance expressed by a few nurses and physicians but Lisa responded by reading from the Associated Press article and then summarizing the infection problems that had occurred at OCAM in the past. Eventually, as in the meeting with key stakeholders, staff began to realize that their standard operating procedures needed to change.

Project Plan

Project Initiation

Project Execution

Project Execution

Lisa then initiated a review of the procedures followed by other clinics across the country as well as a review of state and federal guidelines.

As part of her review she placed several calls to leading hospitals in the United States and learned how they dealt with this problem. A few had all but completely eliminated infections and had been cited in the press for their near-perfect record. She learned a lot from these conversations and came away with a better understanding of the problems, roadblocks and solutions related to to the successful design and implementation of new procedures.

Project Plan

Project Initiation

Project Execution

Project Execution

Once data collection was complete, Lisa called another meeting with each of the three groups where she summarized what she had learned. She then asked for reactions and suggestions.

After an hour of discussion it became clear that almost everyone was receptive to the external data she had collected and its implications. One person said that if others could do it so could they.

Project Plan

Project Initiation

Project Execution

Project Execution

Once these meetings were complete and the staff had a chance to participate in discussions, Lisa began to formalize the new infection control program including the new procedures that would be put into place once the plan was approved by Stopman.

Project Plan

Project Initiation

Project Execution

Project Execution

Evidence clearly suggests that hands are the most common vehicle for transmission of infections and “hand hygiene” is the single most effective means of preventing transmission. While the infection processes that were identified by Lisa were complex, the following summarizes the hand washing procedures that would be followed.

Project Plan

Project Initiation

Project Execution

• Before touching a patient – to protect the patient from harmful germs carried on the care giver’s hands

• Before aseptic procedures – to protect the patient against harmful germs, including the patient's own germs

• After body fluid exposure – to protect staff and the health care environment from the harmful patient's germs

• After touching the patient – to protect staff and the health care environment from the harmful patient's germs

• After touching the patient's surrounding – to protect staff and the health care environment from the patient's germs.

Project Execution

A final meeting was held with the staff at which time the plan was unveiled. There were questions and concerns but most were resolved before the meeting was adjourned.

Still, a few individuals, from the nursing and medical side, found the plan and its procedures an “overkill.” But in Lisa’s words, there were always a few who would find it hard to “go along.”

Project Plan

Project Initiation

Project Execution

Monitoring and Controlling

Projects never unfold as predicted or expected. And the OCAM project was no exception. In its third week the second meeting with physicians was postponed twice because several key stakeholders were busy. Then in the fourth week attendance at a nursing staff meeting dropped to about half of what it was the week before.

As Lisa continued to monitor progress she became increasing concerned that interest and commitment to the project was flagging. Unless she actively controlled the project, on-time completion could be jeopardized.

Monitoring & Controlling

Project Plan

Project Initiation

Project Execution


What was particularly troubling to Lisa was that these meetings were on the project’s critical path and delays already threated to put the project one week behind schedule. But worse, unless she took control the delays could increase in the remaining weeks and project completion could be further delayed.


Project Plan

Project Initiation

Project Execution


Lisa called an urgent meeting with the physicians and later with the nursing staff where she raised this issue.

They all complained that the project was interfering with their clinical responsibilities and that the time available to work on the project was limited. After considerable discussion, they reluctantly agreed to make up for lost time. Future meetings would be scheduled after normal work hours. The meeting adjourned and the project was, hopefully, back on track.


Project Plan

Project Initiation

Project Execution


Her constant monitoring of the project’s progress as well as her efforts to impose controls whenever the project went off-course, proved successful.


Project Plan

Project Initiation

Project Execution

Closing

It was week seven, the project was back on schedule and only one task remained; developing a training program for the nurses, physicians, housekeeping and maintenance staff. Several key stakeholders from all sides attended three meetings. Several suggestions were made.

Lisa and two nurses then took the responsibility for preparing training materials that included a classroom segment, an on-line segment and a series of posters that would be placed throughout the facility at strategic and vulnerable locations.

Training was scheduled for the end of week eight.

Closing


Project Plan

Project Initiation

Project Execution

Closing

The project closed with the training sessions, then at the end of these sessions the team met to review the approach they had taken and to determine what had gone right and what had gone wrong. Lisa often held these Post-Implementation Audit sessions after the completion of a project to ensure that future projects would benefit from lessons learned.

Closing


Project Plan

Project Initiation

Project Execution

Summary

The OCAM case study introduced the sequence of steps normally associated with a project. While it was a relatively simple case it is still, nonetheless, representative of the steps followed in a wide variety of projects.

Here you were also exposed to the importance of understanding the context within which a case occurs. Indeed, some of the challenges in a health case like OCAM can be quite different from those in the development of an off-shore call center for a consumer product. But the project management concepts and general methodology followed for both are very similar.

Summary

Finally, you learned the role of the business case, project plan, schedules, project execution, monitoring and controlling and closing.

In the following chapters the issues raised in the OCAM case will be explored in much greater detail.

Review Questions

1. A schedule, lie the one mentioned in the OCAM case, must be included as part of the business plan. T or F

2. For carefully planned projects, like the OSAM project, it is not necessary to monitor and control progress. T or F

3. The critical path includes those activities which if delayed would delay the entire project. T or F

4. Scope management primarily focuses on the schedule. T or F5. A business plan is written before the project plan. T or F

Review Answers

1. A schedule be included as part of the business plan. F2. For carefully planned projects like the OSAM project, it is not necessary to monitor

and control progress. F3. The critical path includes those activities which if delayed would delay the entire

project. T4. Scope management primarily focuses on the schedule. F5. A problem statement is written before the project plan. T

Vocabulary

Business CaseCompetitive PositionCompetitive AdvantageCritical PathLessons LearnedMethodologyMulti-Phase Study

Problem StatementProject MangerScopeScope CreepSingle-Phase StudyStakeholderTop-Management Support