Project Management

     You're completing your shift when your supervisor asks to speak with you in his office. When you enter you notice a new cardiac monitor on his desk. Your supervisor offers you the opportunity to lead the evaluation and potential implementation of the monitor in your department. As you ponder the decision, you wonder, Do I have the skills to succeed with such a project? You know you don't have much experience managing projects of this size. But at the same time, you're looking for new challenges to expand your skills and further your career.

     After a brief reflection, you accept the opportunity. You are then provided with a folder that contains paperwork and notes on the equipment. You learn there will be a meeting next week that will involve your supervisor, the monitor's vendor, and the department's purchasing and education managers. You are asked to bring any questions you have to the meeting. As you exit the office, those questions begin to run through your mind: How should I start? What are the exact expectations of this project? How can I track and coordinate all the work that needs to be done? You need the tools of project management.

PROJECT MANAGEMENT

     Project management can be described as the application of knowledge, skills, management tools and various resources, including human resources, in an effort to organize, coordinate and deliver a project on time and within budget, while meeting stakeholder expectations.

     Project management is usually a onetime activity that involves clearly defined start and end dates. A project may have many component tasks and involve several individuals. A critical role is that of the project manager, or PM. The PM is the individual who will oversee the project in its entirety. The PM's responsibilities include choreographing project participants, monitoring the status of deliverables, tracking risks, identifying issues, facilitating open communication among team members and conducting project update meetings.

     Given these responsibilities, a project manager should not be selected on a whim. Rather, when reviewing PM candidates, it is important to consider if there is a "fit" between the candidate, the project and the project team. Take the PM's ability to communicate effectively into consideration. This is important because the PM often has the responsibility of communicating news and developments to the project team, stakeholders and sponsor. Communications may include making formal presentations to stakeholders, delivering good and bad news, and conducting general updates.

     Throughout a project, the PM may have numerous interactions with stakeholders as well as a sponsor. A stakeholder is an individual with a personal interest in the project's result. Stakeholders can range from team members who work on the project to the company CEO to key contacts in the community. Although not all stakeholders work on the project, their input, support and guidance can be invaluable. It is important to acknowledge stakeholders, as they can be vital to the project's success.

     In addition to stakeholders, each project usually has a sponsor. This individual has the role of supporting and promoting the project. This can include assisting with the management of organizational politics and boundaries. A project manager should strive for a positive relationship with the sponsor in order to promote the project's success.

     Also critical is the identification of owners. For our discussion we will define owners in two ways. The first is the project owner. This may be an executive-level manager; it may also be the project manager. The owner has responsibilities similar to the sponsor's (promoting the success of the project) and influences the project's financing. In many projects the owner oversees the finances.

     A second use of the term owner can be applied in a more operational capacity. In this role an owner is created when deliverables are assigned to a specific individual. As an owner they are responsible for ensuring the deliverables are met. For example, if a supervisor is responsible for ensuring that all B-shift personnel are updated on the latest protocols by the first of the month, then that supervisor is the owner of that deliverable.

     Consider the opening monitor scenario. In this example, owners, sponsor and stakeholders can be identified. The owners may include the staff members involved in the project, each of whom may have been assigned tasks to complete. Each owner's ability to complete his or her tasks on time will influence the success of the project. The sponsor may be the executive who requested the project. As the sponsor, they can help influence the various political elements associated with the project and may become key in promoting "buy-in" among senior management. Finally, projects such as this may include a variety of individuals with direct interests. For example, the crews using the monitors during the evaluation phase are stakeholders in that they provide direct feedback on the devices' performance. The local hospital's staff may be included, as the patient is likely to be transferred using the same monitors. The organization's senior management team may be included, as they approve such purchases.

     In a scenario like this one, the project manager has critical responsibilities. One will be to coordinate everyone's efforts. The PM may also be responsible for collecting feedback on the product and presenting it to senior management. In this case, the PM might consider sending the stakeholders a survey in which they indicate which functions of the monitor are most important to them. If there are functions the stakeholders request that cannot be incorporated, this should be noted, and feedback should be provided to the stakeholders. If, however, requested project features can be added, be sure to thank the stakeholders for their input. When possible, acknowledge them publicly.

PROJECT SCOPE

     A critical element of any project is to define its scope (i.e., how large it will be). This includes defining the human resources and time that will be involved in the project. It also determines what the final product or deliverables will be. Taking the time to define items such as these is critical to a project's success.

     If a project is in progress and begins to exceed the projected hours, resources or agreed-upon requirements, the project's scope has expanded. This is scope creep, and it may result in failure of the project. To help avoid scope creep, make sure the expectations and requirements of the project are defined, in writing, prior to the project commencing.

     The importance of defining scope cannot be overemphasized. Imagine your agency has been working with a software company to develop a billing program specific to your organization. During the initial design it was determined that a certain screen layout would be used for data entry. Three months into the project, a modification in the screen layout is requested. After reviewing the request for change, you find it would impact the project's completion time, change the function of the software and require additional staff to implement. This request exceeds the initial project's scope. If pursued, it will result in additional costs and delay the project's completion. This is an example of scope creep. It can impact any element of the project and result in a project that is late, over budget or a failure.

MILESTONES, RISKS & LESSONS LEARNED

     Milestones, or significant deliverables that occur during the project, should be identified. In the monitor example, a goal may be to complete all training by a certain date. A milestone could be the approval of the training by the training manager. Reaching a milestone indicates a key achievement in the project.

     Risks and issues are any obstacles or pitfalls that may impact the completion of the project. In the software example, a request to change the data entry method just prior to implementation of the software is a risk that may impact the project's outcome. An issue may develop if the lead developer leaves the software company. Milestones tend to indicate accomplishments; risks are potential hurdles.

     Lessons learned are events, positive or negative, that were not anticipated prior to the project. Lessons learned should be shared, both inside the organization and, when appropriate, out. It is important for all participants to be aware of what worked and what didn't, so as to avoid reinventing processes or repeating mistakes.

DOCUMENTATION & BENCHMARKING

     Successfully managing a project may include tracking the people or man-hours invested in it. Tracking man- and project hours from the beginning is an effective method to determine the actual investment of time and money in a project. It can also be used to help forecast staffing and labor costs for future projects.

     As the PM, if you find yourself grasping for answers on how to initiate, implement or conclude a project, consider using a process called benchmarking. In general benchmarking involves looking at other departments, companies or industries that have done similar things successfully, and reviewing their project management techniques. Depending on the detail desired, it may include reviewing a variety of organizations' processes, including policy and procedure creation/implementation, information technology, process flows, and contingency and strategic planning. Questions to consider include: "How did they do it?" "What tools did they use?" "How did they create their project team?" and "What were their lessons learned?"

     Given the numerous aspects of project management, it is important that a record of participants and overall status of the project be created and maintained. This can be accomplished with good project documentation. Documentation should include defining the various team members, listing tasks, chronicling events and tracking resource utilization.

ADDITIONAL PROJECT MANAGEMENT TOOLS

     There are several additional tools that may prove valuable when tackling a project, regardless of its size. The first is the work breakdown structure, or WBS. The WBS is essentially the identification and distribution of tasks that need to be completed during the project. While the exact format used for this may vary, it is important to ensure that basic task elements are included and addressed in the WBS. Information should include identification of the specific task, its duration, start and end dates, resources, dependencies and milestones.

     The use of a Gantt chart may be helpful. This is a chart that graphically represents key elements of the project. Gantt charts often specify each task or "to-do," the amount of time to complete each, and the task's owner or needed resources. Gantt charts may also be used in conjunction with the WBS. For an example, see Table I.

     Additional project management tools include the Program Evaluation and Review Technique (PERT) chart and the Critical Path Method (CPM). PERT has numerous functions, including calculation of the probability that an event will occur, the time needed to complete a task, and the task's relationship to the overall project. This system also utilizes a comparison of the best, worst and most likely scenarios when determining the project's completion.

     The CPM approach addresses the critical project tasks that must be sequentially performed to complete the project in the shortest time. Delays in this critical path can result in missed deliverables, additional costs and a project not completed on time.

CONCLUSION

     The project manager's ability to create and develop a successful project team is an invaluable asset. Together, a motivated staff and an effective project manager will help ensure a successful project. This in turn will lead to optimal program performance and can positively influence patient care.

     The authors would like to thank Capt. Matt Jepkes of the Aurora, CO, Fire Department for his assistance with this article.

Real-World Application of Project Management: Scene management of cardiac arrest patient

     As a healthcare provider, you participate in some form of project management with each patient contact. Consider the management of a cardiac arrest.

• Project manager:As the lead provider of your crew, you are the project manager.
• Project:Helping the patient in cardiac arrest.
• Deliverable:If transporting, your deliverable is to bring the patient safely to the hospital.
• Project team:Each crew member involved in the cardiac arrest.
• Tasks to accomplish:Coordinate efforts of each provider; CPR, airway control, establish IV.
• Stakeholders:The crew providing patient care, the patient, family members and bystanders.
• Scope creep:You suddenly realize you've been on scene too long and should already be transporting.
• Lessons learned: After the call the crew (project team) reviews the interaction and identifies areas that could have been handled differently. This information is then applied during your next resuscitation.

Real-World Application of Project Management: Scene management involving multiple patients

     Project management concepts can be applied to medical or trauma scenes that involve multiple patients. Consider the following example:

• Project manager:The individual coordinating the scene.
• Project:Coordinating the overall management of the scene.
• Deliverable:Ensuring that any injured/ill patients are transported to appropriate medical facilities.
• Project team:The staff from response and support agencies.
• Tasks to accomplish:Coordinate apparatus staging, staff activities, patient care and transportation from the scene, media activities.
• Stakeholders:Crews involved in the incident, patients, family members, bystanders, media.
• Lessons learned: After the call the crews review the outcome of the incident. Things that could have been done differently are considered in future events and planning.

Real-World Application of Project Management: Teaching

     If you are involved in education, you most likely use components of project management.

     Planning:

• A plan for the lesson to be taught (documentation)
• A timeframe for the lesson (to-dos or deliverables)
• Materials/resources to be used

     Delivery:

• Track attendance (documentation)

     Feedback:

• Distribute and collect course evaluations (documentation)
• Thank participants for attending (acknowledge stakeholders)

Bibliography

     4PM. Project Management Training & Certification, www.4pm.com.

     Baker K, Baker S. The Complete Idiot's Guide to Project Management, 2nd ed. Indianapolis: Alpha Books, 2000.

     Catalani-Davies W, Vieth C. Guidelines for Six Sigma Healthcare Project Selection, https://healthcare.isixsigma.com/library/content/c040218a.asp.

     Englebardt S, Nelson R. Health Care Informatics: An Interdisciplinary Approach. St. Louis: Mosby, 2002.

     Glover S. Business Intelligence in Healthcare: Project Management 101, www.dmreview.com/article_sub.cfm?articleId=1361.

     Nicholas J. Project Management for Business and Technology: Principles and Practice, 2nd ed. Saddle River, NJ: Prentice Hall, 2001.

     Project Magazine, www.projectmagazine.com.

     ProjectManagement.com, www.projectmanagement.com/pm/pmArticles.cfm.

     Paul Murphy, MA, MSHA, EMT-P, has clinical and administrative experience in healthcare organizations.

     Scott Nelson, BS, NREMT-P, has been involved in EMS for nearly 20 years. He currently teaches in Colorado and works in remote areas throughout the country.

     Bill Spialek, BS, EMT-P, has been involved in clinical and management roles in EMS. He currently works as a critical care paramedic in Colorado.