Bringing Value: Use Project Teams to Direct Change

The principles, rules and tools of project management can help a leader initiate new projects or change existing processes. Change management and project management are intimately linked.

The ability of a physician leader to successfully manage a project in his or her organization is critically important. Legendary companies such as General Electric and Boeing are known for managing their projects and processes well. One primary factor behind successful project management is systematic, consistent and aligned development and deployment across the entire organization. The health care industry, however, has had difficulty with the systematic use of process management techniques because of its historically fragmented organizational structure and silo mentality.

The terms process and project sometimes are used interchangeably, so let’s define what we mean here. A process is a series of organizational steps that define a specific method of doing something or accomplishing work. For example, a process might be the act of admitting a patient to the hospital. A project, on the other hand, is a special unit of work that consists of the application of knowledge, skills, tools and techniques and is intended to create a new process or improve an existing process.1 For clarity, we will use the term project in this article, recognizing that a project is a process and that not all organizational processes are projects. In the above example of the admission process, an organization could have one or more projects ongoing within the admissions department intended to improve or change the admitting process.

From a structural perspective, organizations must decide upon a working framework for their project improvement efforts. In other words, senior leaders should systematically deploy a project improvement approach for the organization and stick with it over the long haul. A project management system should have three overarching principles that define it: design, manage and improve.

MORE BRINGING VALUE: Read Previous Articles in the Series

Think of a project management system as having four components:

  • Acquisition and application of process management knowledge.
  • Acquiring the organizational skills of project management.
  • Training the workforce in the tools of project management.
  • Applying the knowledge, tools and skills systematically across the entire enterprise so there’s consistency in how an organization manages change.1

Before discussion of the tools of project management can begin, it is important to realize that project management is about improving an existing process or developing a new process. Project management ultimately is about change in the organization, something that many people might not like or want. Change is difficult and uncomfortable to most people — including those in power.

PROJECT IMPROVEMENT

To fulfill the overarching principles — design, manage and improve — that define a project, many organizations use project improvement approaches. Here are a few of the most popular ones.

Six Sigma: A data-driven approach and methodology for eliminating defects in any process, from manufacturing to transactional and from product to service. Its name is derived from driving toward six standard deviations between the mean and the nearest specification limit.

Lean: A systematic method for minimizing waste within a manufacturing system without sacrificing productivity. It focuses on waste through overburden and steady workloads. It’s designed to make obvious anything that adds value by reducing everything else that doesn’t.

Statistical process control: A statistical method to measure and control quality during the manufacturing process. Its key tools include run charts, control charts, a focus on continuous improvement and the design of experiments. It emphasizes early discovery of problems, rather than corrections later.

PDSA: Short for “plan, do, study, act,” this approach allows participants to prepare for a change, carry out the test, observe and learn from the consequences, and determine what modifications should be made. It often is used as a cycle for continuous improvement.

Physician leaders should have a good grasp of the principles of change management before attempting to initiate a new project or change an existing process. Change management and project management are intimately linked in terms of a successful outcome. Not understanding the framework and psychology of change can jeopardize the success of specific project management efforts. 

Principles of Success

Several key principles frame successful change management efforts. Probably the most important principle for any leader to understand is that organizational culture is paramount.1,2 Failure to sustain change is thought to be largely because leaders fail to consider existing organizational culture or overcome cultural resistance to change.

RELATED: Some Ground Rules for Overcoming Resistance to Chance

The second principle is that change must first start at the top. Senior leaders must be committed to the change, support the change, provide the resources for change and be actively involved in the change process. Engaging everyone in the change process significantly improves the odds that the change will be sustained.1,2

Engaging everyone in the change process leads to the third principle: Midlevel and frontline employees can make or break a well-designed project, and it is imperative to engage this level of the organization in the planning stages of the change process.1,2

The fourth principle is that senior leaders must not only engage the workforce with the rationale for the change, but also engage the workforce on an emotional level. Human beings respond to actions that make them feel important and that they are part of something of value. Creating this emotional linkage with the workforce is a critically important leveraging tool for a successful change to occur.1,2

Next, senior leaders must model the new behavior they want the workforce to engage in. Employees will begin to believe that senior leaders are serious about the change when they see them model it from the start.1,2

Once the project is defined, senior leaders must continually communicate the major elements of the plan to the workforce using multiple techniques and channels. This keeps the message alive throughout the organization. And once the project is planned, senior leaders should make every effort to identify formal and informal leaders throughout the organization to engage these leaders early in the life of the project.1,2

Next, senior leaders should leverage formal and informal components of the organization, such as its rewards system, training and development, mentoring and messaging to support the proposed project. Finally, senior leaders should continually assess the project’s success using surveys, focus groups, organizational metrics and open-ended comments from their customers and workforce alike.1,2

RELATED: Leaders Who Get Change Right Know How to Listen

Successful Management

The key to a successful project outcome is how it is managed.1 Project management is the application of knowledge, skills, tools and techniques to project activities to meet the project’s requirements. This is accomplished by using project management processes, such as initiating, planning, executing, controlling and closing the change process.1

What does “application of knowledge” mean? There are key elements of business knowledge that need to be mastered by an organization if it is to be consistently successful in project management. These key elements of business knowledge1,3 include the following:

  • Integration management: Includes the processes that ensure that a project is properly coordinated. A key element is the selection of the proper team members from across the organization. Significant time should be spent by the team leader in determining the makeup of the team before assembling the team. Its primary tool is a team charter1 that describes the project objectives, strategy and basic framework, including its scope, deliverables, duration and available resources. The charter establishes how the team will function throughout the project and keeps the team on task. 
  • Scope management. Defines the overarching definition and goals of the work to be performed by the team, the project requirements, the boundaries, the expected milestones, necessary resources and customer expectations. This work is usually performed by the team in the first couple of meetings, using a skilled facilitator. 
  • Time management. Prospectively defines the course of the project, including the sequence of the team’s activities, the project’s duration and post-project follow-up. The team leader should follow this outline to minimize lost time and reduce filibustering by team members. 
  • Cost management. This process helps ensure the project is completed within budget. This process should include resource planning, cost estimates, cost justification, budgeting, cost-benefit analysis and cost control. 
  • Quality management. This includes the organizational processes required for the project to satisfy the needs of the project’s customers. These processes include quality planning, which defines the deliverables to be measured, the outcomes desired and the in-process measures of performance. 
  • Human resource management. Ensures effective use of the team members, such as planning availability, staff acquisition and team-building techniques. 
  • Communication management. Promotes the timely and appropriate generation, collection, dissemination, storage and distribution of the project’s progress. This requires development (and use) of a thorough communication plan to distribute information to the entire organization. Development is an early team task. 
  • Risk management. This systematic process includes planning for and identifying risk, risk analysis, and risk monitoring and control. This should be an ongoing effort by the project team. 
  • Procurement management. Outlines how to procure the goods and services the team needs to complete the project. This process might be internal, external or both. If external, the process might be more complicated; it can mean a bidding process for external vendors, contract development and contract follow-up.

RELATED: Using Lean Manufacturing to Improve Patient Care in a Rural Urological Practice

Familiar Territory

Physician leaders already should be familiar with many of the tools a project manager uses. Those tools can be organized in four general categories:

  • Generating and gathering ideas from the project team.
  • Organizing the ideas so they can be acted upon efficiently.
  • Evaluating marginal ideas.
  • Deciding on the best approach(es) to use for the project.1,3

Generating and gathering ideas require a skilled facilitator to manage the team and keep it on track. A good facilitator uses three specific tools:

  • Brainstorming. A method to generate many ideas in a short time. Start with team members generating and recording individual ideas on notecards, etc., to minimize groupthink and to allow the facilitator to categorize similar ideas into groupings for discussion. 
  • Nominal group technique. A method to allow an entire team to express individual ideas using a round-robin group interaction.
  • Clarifying. Used to discuss ideas generated from the first two tools and create a smaller, manageable list.1

Once the team has generated the ideas, the next step is to organize the ideas. An experienced facilitator might use five techniques to do so:

  • Eliminating duplicate ideas.
  • Grouping previously generated ideas into logical categories.
  • N/3 voting, a technique used to prioritize an idea list into an order of importance.
  • Multivoting with weighting, in which individual team members may use multiple votes for a given idea, thus giving certain ideas more weight for consideration of team action.
  • Advocating, a technique in which an individual team member may campaign for specific idea that he or she believes hasn’t been given adequate discussion and consideration.1

Evaluating Ideas

Once ideas have been generated, the facilitator typically uses one or more of four techniques to help the team evaluate and decide which idea should be considered by the team. These include:

  • Absolute criteria rating. A group technique in which a team takes each idea and lists specific criteria thought to be important for it to have. On a spreadsheet, ideas are listed vertically and criteria are listed horizontally. This allows the team to visualize which of the ideas might best serve the team going forward.
  • Criteria rating. Might be used after the absolute criteria are generated. It gives the team the ability to numerically weigh each criterion. In many instances, criteria assigned to an idea might have more or less importance; listing just the criteria without assigning weights may distort the final ranking of ideas.
  • Payoff matrix. Used to compare alternative ideas using two measures. For example, a 2-by-2 grid might be constructed, rating an idea’s difficulty (“easy” or “hard”) on the vertical axis and its impact (“low” or “high”) on the horizontal axis. This can help teams evaluate whether an idea is worth the effort.
  • Consensus taking. This is sometimes referred to as taking a straw poll. This technique can help identify ideas that can be considered low-hanging fruit or identify simple solutions to the problem being considered.

Project management techniques are essential to efficiently manage and direct a team. A trained facilitator and a well-constructed team are essential for good team outcomes.

Physician leaders should ensure their organizations have well-trained project management facilitators. For small organizations that cannot afford to have a full-time facilitator on staff, consider partnering with an outside facilitator.     

Eugene Fibuch (1945-2017) was professor emeritus at the School of Medicine and co-director of the physician leadership program in the Henry W. Bloch School of Management at the University of Missouri in Kansas City. This article is part of an ongoing series he submitted in 2016.

Arif Ahmed, BDS, PhD, MSPH, is chair of the public affairs department and an associate professor of health administration in the Henry W. Bloch School of Management at the University of Missouri in Kansas City, where he also is academic director of the physician leadership program.

REFERENCES

  1. Hurta D. Project Management Fundamentals. 2008. Advanced Manufacturing Specialist Training Program. Rolla, Missouri. 
  1. Aguirre D, Alpern M. 10 principles of leading change management. 2014. Strategy+Business. June 6, Issue 75. 
  1. Project Management Institute. A guide to the project management body of knowledge. 5th ed. 2012. Word Press.

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