December 5th, 2011 by Anastasia Vogt
I recently attended the Lean Healthcare Certification Program at the University of Michigan’s College of Engineering. During one of the classes, a question came up from one of the participants about the use of a project charter for process improvement initiatives. Apparently, the purpose of a charter or even whether a process improvement initiative could be considered “a project” had been a hotly debated topic back at their facility amongst the project managers. What’s the difference between them and does it really matter? To paraphrase, Dave LaHote, President of Lean Education at the Lean Enterprise Institute and a speaker during the certification program, “Everyday, people are faced with a moment of truth where they have to make a decision. Will they choose to make their decision by design or do they make it by default?” I’ve come to the conclusion that there are important reasons to delineate between projects and process improvement.
Process improvement initiatives are like projects in many ways. They make use of many of the same analytical tools such as fishbone and pareto diagrams, swim lanes, decision trees (and are often tracked using the same methods of monitoring scope, budget and schedule). More importantly, they share the same practice around dedicated and advance planning, defining requirements and setting objectives prior to initiating or executing activities. In fact, many people define additional activities above day-to-day operational duties a “project,” especially when it has a specific objective.
The Project Management Institute’s definition of a project is “a temporary endeavor undertaken to create a unique product, service or result.” While I will accept there is substantial flexibility in how to define a project. For example, our seven year-old’s concept of a project is to make a robot out of empty cereal and shoe boxes with tape and glue. And while superficially process improvement initiatives and projects feel similar in many ways, their overarching objectives are substantially different, and I believe it is good that they are.
Process improvement initiatives are fundamentally all about change and the creation of new behaviors that support problem solving and continuous improvement within an organization. It’s risky to define these initiatives as projects because, no matter what definition you subscribe to, projects inherently have an end and by design they run out of time and resources. Process improvement initiatives may require several trials over long periods of time and patience while the organization strives to widen its circle of alignment around improvement practices. Projects, with their temporary resources and mandated timelines, may not have enough stamina to endure a change process. You definitely don’t want the change you’ve initiated to cease when the project is over, the goal here is continuous improvement.
So, if a process improvement initiative can’t be a project, can a project be “lean”? Sure. The successive processes by which a project are performed can be improved upon and often are through examining lessons learned and conducting a debrief at the close-out phase. These processes provide an opportunity to reflect and document what can be improved upon in the next project and serve as a valuable resource for the organization and for the project manager. As of late, more standardized “lean” project management methodologies such as “The Last Planner” are becoming more popular. These systems have surfaced to respond to a need in the industry to increase the value of project management processes and eliminate the wasted steps that frequently occur in projects either due to over-planning or through attempts to meet the needs of project stakeholders.
At the root of it, projects are finite. Process improvement is infinite. Both have their appropriate applications in the effort to create change within a system.
Anastasia Vogt, PMP, is a Senior Healthcare Consultant at Blue Cottage Consulting.
Tags: Dave LaHote, lean, Lean Enterprise Institute, Lean Healthcare Certification Program, President of Lean Education, Process Improvement, Project Management, The Last Planner, the Project Mangement Institute, the University of Michigan College of Engineering
Posted in Process Improvement, Project Management | No Comments »
December 2nd, 2011 by Andrew Mychkovsky
It is official. The highest court in all the land will decide the fate of health care reform! One can only hope it is from a purely constitutional and not partisan perspective. Arguments are expected in March, with a decision in late June, 2012. Here is why the Supreme Court of the United States of America should uphold the constitutionality of the Patient Protection and Affordable Care Act individual mandate:
The individual mandate functions not only as a punitive measure, but also a means of raising revenue otherwise lost to uncompensated care. It is a direct interpretation of the 16th Amendment. The Necessary and Proper Clause grants Congress the right to make all laws necessary and proper for carrying into execution the foregoing powers. The individual mandate provides funding for the entire law. That is the definition of necessary and proper.
Traditionally, the Commerce Clause has granted Congress the right to broadly regulate business with significant interstate commerce. During the landmark case Wickard v. Filburn, the Courts decided Congress could regulate a farmer’s personal wheat production based on the threat of every other farmer following suit and lowering national wheat consumption. Health care has an even larger national component. Not only do citizens constantly travel interstate, uncompensated costs result in billions of dollars, but almost all medical supplies, drugs, and equipment have significant interstate commerce.
Most constitutional dissent focuses on the right to compel persons deemed “inactive” in the current health insurance market. Often conceding interstate commerce, opponents argue Congress cannot compel the uninsured to purchase health insurance because they are not actively participating in healthcare commerce. This is flawed. No person is inactive when deciding how to pay for health care whether it is self-insurance, private, or public insurance. Those intentionally uninsured cannot guarantee abstinence of incurring exorbitant medical debt and burdening society. Inaction is action.
This concept is incredibly exciting and nerve-wracking all at the same time. As most political junkies know, the current Supreme Court definitely leans to the right. With Chief Justice John G. Roberts Jr. at the helm, I sometimes become cynical of political coercion and judges. However, the conservative base lost a huge ally when George W. Bush appointed Circuit Judge Jeffrey S. Sutton, who opinioned the ACA was constitutional a month ago. Who really knows what will happen.
Andrew G. Mychkovsky is a Healthcare Consulting Intern at Blue Cottage Consulting.
Tags: Chief Justice John G. Roberts Jr., Circuit Judge Jeffrey S. Sutton, Commerce Clause, Necessary and Proper Clause, Patient Protection and Affordable Care Act, Supreme Court of the United States of America, the 16th Amendment, Wickard v. Filburn
Posted in Healthcare Reform, Uncategorized | No Comments »
November 14th, 2011 by Andrew Mychkovsky
In 2009, Camden, New Jersey was listed the most dangerous city in America by CQ Press survey. And despite the FBI-compiled crime data and negative perception associated, I view them as thee progressive model for improving quality of care and cutting healthcare costs. Thanks to the Camden Coalition of Healthcare Providers, you should too.
Earlier this year, PBS FRONTLINE correspondent Atul Gawande delivered the story, “Doctor Hotspot,” about Dr. Jeffrey Brenner. A local Camden physician, Dr. Brenner created a model to address the issue of high-cost patients over utilizing the emergency department. Under-insured or uninsured patients receive insufficient coordinated care that they cannot afford and society is burdened with the leftover costs, leading to a double negative.
Inspired by a traumatic neighborhood experience, Dr. Brenner soon devised a plan to statistically map out neighborhoods with high crime rates and the most costly medical patients. The results were astonishing. 1% of the city population accounted for 30% of the total healthcare costs. With this data, Dr. Brenner created colored cost data graphs and maps of the city to locate “hotspots” for high health costs. These would be the areas he would focus on.
To offer some perspective, Camden had 12,000 ER visits for non-emergent issues such as head colds, ear infections, sore throat, asthma, and stomach viruses. To start, Dr. Brenner only asked for the highest-cost patient referrals from the emergency department. Establishing relationships outside the hospital, he developed a high degree of acuity to the level of complexity of each individual. Soon thereafter, Dr. Brenner founded the Camden Coalition of Healthcare Providers. The Coalition now provides in-home organized care for 300 of the highest-cost patients within the city.
Implementing such system into a larger metropolis will be challenging. Replacing a competent and passionate advocate such as Dr. Brenner will be difficult, but we the have responsibility to at least try. At Camden, this approach has revolutionized the coordination of care to a small subset of the most frequent ED patients who cost $10 million a year. Although comprehensive and time consuming, one cannot ignore the legitimacy of hotspot mapping and statistical analysis. Various hospitals and communities have implemented programs to address the concerns of high-cost patients, including Massachusetts General Hospital and Atlantic City Special Care Center.
The current healthcare system is unsustainable. The ED is not equipped nor designed to handle patients who could be treated at a primary care clinic too. As Dr. Brenner so eloquently states, “It’s like arriving at a major construction project with nothing but a screw driver and a crane.” We must explore and expand on all options that show significant gains. And by the way, preliminary results show 40-50% decrease in hospital visits and costs for the patients served by Camden Coalition of Healthcare Providers. I would say at the very least, it is worth looking into.
Andrew G. Mychkovsky is a Healthcare Consulting Intern at Blue Cottage Consulting.
Tags: Atlantic City Special Care Center, Camden, Camden Coalition of Healthcare Providers, CQ Press, Doctor Hotspot, Dr. Jeffrey Brenner, high-cost patients, hotspots, Massachusetts General Hospital, New Jersey, PBS Frontline
Posted in Performance Excellence | No Comments »
October 7th, 2011 by Anastasia Vogt
As consultants offering a wide range of healthcare planning services, we often act as project managers for our clients through our efforts working with them to create their future plans, monitor their projects or coach them through rough waters when things don’t go as expected. Over the past decade, however, project management has become something of its very own discipline, where standards and a governing body have been established to provide guidelines for the work of project managers.
Though at first Project Management Professionals (PMP) were largely focused in the IT industry, and then it spread to the construction industry, hospitals and other healthcare organizations are increasingly seeing the value of engaging formally-trained project managers to plan, facilitate, monitor, communicate, in a word – manage – their project activities. Likely due to the project-based nature of the construction industry, healthcare organizations are increasingly looking to PMPs to run their redevelopment projects.
While PMPs develop work plans and schedules and budgets and monitor the health of the project against scope, time and cost, most of the time of a project manager is spent communicating with the project team and the projects stakeholders. And most of that communication is focused on keeping everyone informed and engaged in the work. Can you get away with not having a PMP on your team for your next project? Of course you can, and many do.
Having a solid project plan in place and resources to monitor the project will remain a key to success. With large scale projects, involving multiple consultants and millions of moving parts, bringing on project managers to work with your teams increases your chances for a truly successful project. By assigning responsibility to one or more people to plan, communicate about and monitor the health of the project, your team is in a better position to anticipate and react proactively to challenges, not to mention, perform their work.
Anastasia Vogt, PMP, is a Senior Healthcare Consultant at Blue Cottage Consulting.
Tags: construction industry, healthcare systems, PMP, Project Management Professionals, redevelopment
Posted in Project Management | No Comments »
October 3rd, 2011 by Meghan Schmansky
As I prepared for my first Blue Cottage team conference call on Monday morning, I wasn’t sure what to expect. Having spent my career in academic medical centers, the world of consulting and working remotely is new to me.
During the team call I learned more about the amazing opportunities at Blue Cottage. I was impressed by the ongoing engagements and the potential new engagements. I am looking forward to continuing to work with academic medical centers and the new prospect of working with community hospitals. The variety of the engagements were intriguing, from operational readiness planning and transition planning in large academic medical centers to strategy and operations in rural community hospitals. The diversity of the engagements at Blue Cottage speak to the depth and breadth of knowledge possessed by the team.
Most notably, I have been struck by the intelligence, humor, and excitement of my new co-workers. While interviewing at Blue Cottage, I had no doubt they were different than anywhere I had worked. The passion of the employees is magnetic. While they are located throughout the United States & Canada, they are none-the-less extremely well connected and synergized. Everyone brings something unique to the team and their backgrounds complement each other perfectly. I look forward to learning from them, collaborating with them, and certainly laughing a lot.
As I enter this new phase in my career, I am re-energized by the team at Blue Cottage and remember the reason I entered healthcare – to improve healthcare, ensure patients receive the best care possible and are delighted by their experience. At Blue Cottage, I look forward to transforming healthcare one project at a time.
Meghan Schmansky, MHSA, is a Healthcare Consultant at Blue Cottage Consulting.
Tags: academic medical centers, improve healthcare, operational readiness, operations planning, strategy, Transition Planning
Posted in First Impressions | No Comments »
