Healthcare leaders are working hard to continuously refine and advance their processes in order to improve patient care, reduce costs, and improve the patient’s overall experience and satisfaction–the Triple Aim. Healthcare project management skills have become increasingly important to businesses, including the healthcare industry, because they help control costs, manage risk, and improve project outcomes. By applying project management techniques, from waterfall to agile methodologies, organizations can systematically plan, organize, and execute a set of tasks maximizing resources and achieving specific goals.
This article explores project management techniques and offers considerations for healthcare leaders when adapting these techniques for clinical, financial, and operational process improvement. It also provides practical and pragmatic approaches for implementing project management in a healthcare setting.
There are a variety of project management techniques developed for other industries that can be applied in a healthcare setting, but the most common and the ones this article will focus on are Agile and Waterfall project management. Although many organizations see this as an either-or decision, there are ways to use these techniques in a hybrid approach to realize the best of both methodologies.
Waterfall project management is a sequential, linear process that consists of a number of distinct phases. In waterfall, the project is mapped out with clear requirements and deliverables for each phase. Progress is regularly documented along the way and each phase is completed before the next one begins.
In healthcare, there are a lot of people who are both familiar and comfortable with a waterfall approach. This is especially true of healthcare executives who want to see a sequence of tasks laid out from beginning to end organized in a Gantt chart, which provides a visual overview of the project (see Figure 1). They can see a timeline of events and have a good idea how long each phase of the project is going to take. Senior executives within large hospital systems like to have an idea of what the work is, the effort necessary to complete a project, how the work is broken out, and a rough approximation of when each of the phases can be started and finished. Waterfall project management does a great job of communicating the overall project scope, tasks, and timeline.
Waterfall tends to be rigid in structure—for good reason. Waterfall methodology has its roots in industries such as manufacturing and construction where the rigidity arose out of necessity–a builder can’t paint a room if he hasn’t put up drywall yet. However, with the translation of waterfall to other industries, such as software development or in process improvement projects, the rigidity is often challenging and can hinder a project, both in terms of speed and effectiveness.
With healthcare process improvement projects using a waterfall-only approach, it can be difficult stick to a sequential, step-by-step process of a project from beginning to end. In fact, most improvement projects are iterative in nature and use Plan, Do, Study, Act (PDSA) cycles of iterations. These PDSA cycles allow teams to iterate and show progress earlier, the results are usually better, and the client is more satisfied with the end result.
Waterfall project management has been used successfully for decades to complete large-scale projects, but these projects are often over budget and behind schedule. Stakeholders can also be dissatisfied with the end result because they are typically not as intimately involved in the process and don’t see final results until the project is complete. With the economic pressures faced by hospital systems, it’s more important than ever to deliver faster results with continuous involvement and feedback from stakeholders incorporated throughout the process. This is where lean methodologies such as agile project management can be utilized by process improvement teams to achieve faster, high-quality results.
Agile is an iterative project management style derived from lean principles. Agile project methodology took shape from team-based software development and encourages collaboration and frequent adaptation. There are a few hallmarks of agile project management:
The focus on frequent communication, removing obstacles, and fulfilling commitments in set timeframes makes agile project management a very effective tool for process improvement teams that want to show value early and incorporate constant feedback from executives and clinicians as they progress from iteration to iteration.
Agile is increasingly popular for the benefits mentioned above: fast results, continuous improvements, and increased buy-in from stakeholders. However, there are potential pitfalls. If teams don’t have a longer-term view of the plan represented in a Gantt chart or something similar, they can easily get stuck enhancing features or doing work that provides little value to the user – sometimes called “gold plating.” While agile is a good day-to-day blocking and tackling project management technique, teams can easily get lost in the detail without keeping an eye on the bigger picture. This is where teams could benefit from having some of the structure of waterfall in place.
There are benefits and drawbacks of both waterfall and agile project management techniques. In the Professional Services organization at Health Catalyst, taking a hybrid approach to healthcare project management in hospital systems is frequently the best option.
In a hybrid approach, teams leverage the best aspects of both techniques with a heavier focus on agile, but enough waterfall planning to provide a clear roadmap to key stakeholders and senior leadership. This has been very successful in making sure that the product ultimately delivered is one that stakeholders are happy with and have been involved with throughout the process and it is completed in a reasonable timeframe.
While every organization and project is unique, this hybrid approach can be effectively applied to outcome improvement projects. What this might look like is having a team create a Gannt chart that shows the high-level timeline of the project, an overall breakdown of work in phases, and any dependencies that exist. This chart would then be presented to senior leadership and clinicians in order to get buyoff. For the improvement team, each phase of work would then be broken down into a more detailed set of tasks, typically applying agile principles with sprints outlined and team member commitments specified. If a team is working on developing a sepsis outcome improvement application, for example, they might set out to complete the effort in three months. The project might be broken down into three seperate iterations each lasting approximately one month in duration.
Health Catalyst typically begins with a pre-existing, out-of-the-box starter set and uses that to show baseline functionality of the sepsis outcome improvement application using the client’s own data. From there, users will come up with a set of enhancements to make the application more tailored to their organization. This is called fingerprinting and is usually done in the second iteration. Once the users have been using the application for several months, the third iteration might include a new set of improvements based on a deeper understanding of the process and how it could be improved. All three of those iterations would be shown within the context of a Gantt chart and details of each of those iterations would be expressed as “sprints” within an agile process.
A final note in terms of pragmatic application is that having the right tools is critically important. For effective heathcare project management, having software that helps lay out the project, allows multiple users to make changes, and measures progress is another aspect of having the right tools and framework that helps improvement teams do their jobs effectively.
Project management skills and good project managers are needed in healthcare now more than ever. Project management techniques such as waterfall and agile can offer structure and discipline. However, a hybrid approach is a pragmatic way for teams to accomplish more in less time.
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