Tuesday, April 13, 2021

Getting from A to B : Project Management for Clinical Leaders

 Hi fellow CMIOs, CNIOs, #HealthIT, and #Informatics leaders and friends,

Change is important. As a clinical leader, you'll want to know how to make workflow changes, either to help fix a workflow that's not ideal, update a workflow that needs updating, or build a new workflow. (As long as there are new journal articles and conferences, there will be necessary updates to clinical practice to stay current.)

So this week, I thought I'd write about a topic that can help a clinical leader to feel comfortable with making changes in their area: 

"How to get from Point A to Point B"

I once alluded to a problem with making changes back in 2016, when I blogged about the Red Sneaker Problem - And How To Fix It. To help avoid frustration for you and your team, it's helpful to understand 'How does anything change?'. Without understanding the change process, it can be hard to make change

Although clinical leaders often need to focus primarily on clinical services, functions, and expertise - it's still helpful to know the basics about two important things, related to 'how things get done' : 

  1. Project Intake / Scoping - Helps you secure necessary people, time, and resources before you start a change project.
  2. Project Management - Helps you effectively use those people, time, and resources to get things done (accomplish the change)

Without understanding these two steps, it can be very hard to accomplish much change. And without regular, smooth, and predictable changes, clinical leadership can seem more daunting than it needs to be. 

So as a brief introduction for new clinical leaders, let's review these two items in a little more detail. Borrowing some slides from a recent presentation I did for a group of clinical leaders, I present some high-level overview below. 


Making change is work. It takes people, time, and resources, to move your CURRENT state (Point A) to your desired FUTURE state (Point B). 

Ideally, to make sure you have the 'gas' needed to drive your 'car' to where you want it to go, you'll first need to understand the scope ('size'of your project. Conceptually, think of this as collectively driving your car (with your team inside it!) from :
  • Your CURRENT state (Point A)
  • Your desired FUTURE state (Point B)
This is why I always advise people to formally map the current and future states. The distance between these two points is what will determine the scope (size) of your project,  and the work effort (and resources) needed to accomplish your goal.
  • If you have the time, people, and resources necessary to get from Point A to Point B - Great
  • If you don't... Then you may feel frustrated.
So to make sure you have a thorough, well-documented analysis that you can share with your project team - it's very helpful to formally document, in a folder, your CURRENT state, and also formally design your ideal FUTURE state, one that is formally signed off by the clinical leaders who oversee the clinical staff who will live in this new future-state workflow

People sometimes ask me : "Do I need to do this much for every change I want to make?" My advice : You only need to apply as much rigor as you need to get the change accomplished. E.g. : 
  • For small changes (e.g. making some small changes to a documentation template) --> Usually, less rigor is required
  • For large changes (e.g. implementing electronic med reconciliation at all transitions of care) --> Much more rigor is required
This exercise will not only help you scope your project, and identify the people, time, and resources you will need to secure - It will also help you formally plan a project, estimate the return on investment (ROI), and secure the necessary approvals before beginning your project. 


Once you have secured the necessary people, time, and resources, and have the approvals of your leadership to move forward - It's helpful to identify a formal, trained, and experienced project manager to plan, orchestrate, and lead your project. For a high-level overview, you can see the Wikipedia piece : https://en.wikipedia.org/wiki/Project_management 

For planning purposes, many experienced project managers might develop a Gantt Chart ( see https://en.wikipedia.org/wiki/Gantt_chart ), a sort of ordered series of steps, with time estimates and dependencies, that will be needed to finish the project and achieve the desired outcome. Similar, but also helpful is a Responsibility Assignment Matrix, sometimes called a RACI Chart

Experienced clinical leaders, especially those who have worked with good project managers, can often help a project by anticipating steps and helping to answer questions before they arise. While there are different types of project management (from the more traditional waterfall model, to newer agile methodologies), I've stripped down some bare essentials that are helpful to think about before starting any clinical update or improvement project : 

These are the ten steps (above) that I commonly plan and follow for clinical projects, where the rigors of step two (2) above are often necessary to help adequately scope and plan clinical projects, and help ensure that there are no unanticipated surprises later in the project. Note: Clinical Informatics professionals often work in steps 2, 4, 5, 6, and 9 above, working closely with end-users, analysts, educators, and project managers.

As a clinical leader, you will want to help champion change and updated practices. While there is much more to be said about project intake, scoping, planning, and execution, I hope this little introduction will help my friends in clinical leadership see the value of good project managers, and good project planning, and the role they play in getting things done.

Remember, this blog is for educational purposes only - Your mileage may vary. Always ask your local Project Management and Clinical Informatics professionals for guidance, and work closely with your clinical leadership to review, prioritize, and approve your projects before initiating any changes.

Have any stories to share about clinical leadership in supporting clinical projects? Have any tips or tricks to share from your own clinical project management experiences? Feel free to leave them in the comments section below!

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