Inside the Briefcase
How to Ensure Healthcare IT Projects Deliver Quality Results
June 1, 2023 No Comments
By Michelle LaBrosse, PMP, CVL, CAC, PMI-ACP, RYT
Quality is not the natural outcome of projects. Quality must be planned for and executed upon to happen.
Healthcare IT projects that are ill-defined, under resourced, poorly managed and badly designed almost always fail to produce quality results. This might seem self-evident, but how else to explain the multitude of projects undertaken with the above problems except to attribute them to managers’ blind faith that everything will work out in the end?
The good news is that quality can be achieved with the right leadership, tools and systems. While quality is, to a degree, dependent on every member of the team, it is the responsibility of the project manager to create the conditions, expectations and processes that will allow team members to do their best work.
Projects as process
Quality healthcare IT project management begins with using a process-driven approach that includes:
– Frequent quality and review steps
– Recurring retrospectives that identify the root causes of problems
– Producing small batches of work so quality issues are identified before a greater investment in production
– Incremental deliveries to uncover quality issues earlier when the cost of change is lower
The result of the above is less rework, higher productivity, lower costs and increased stakeholder satisfaction. It also makes it less likely that the customer will discover quality defects – the worst possible outcome.
Quality standards, systems and tools
Luckily, healthcare IT project managers don’t have to invent their own processes to improve quality. There are multiple standards and systems which can be adapted. Here are the principal ones:
ISO 9001 – An international standard and guideline for building a quality management system. Its seven principles are: customer focus, leadership, engagement of people, process approach, continual improvement, evidence-based decision making and relationship management.
Kaizen – A Japanese philosophy to involve all employees in continually, gradually and methodically improving operations. It relies on five elements: teamwork, personal discipline, improved morale, quality circles and suggestions for improvement.
Organizational Project Management Maturity Model (OPM3) – Aligns project, program and portfolio management practices with organizational strategies.
Capability Maturity Model Integration (CMMI) – A process and behavioral model that streamlines process improvement and encourages productive, efficient behaviors that decrease risks in software, product and service development.
Malcolm Baldrige National Quality Award – Established by Congress to promote improved quality of goods and services in companies and organizations. It focuses on performance in five key areas: product and process outcomes, customer outcomes, workforce outcomes, and financial and market outcomes.
PDCA – Attributed to Dr. W. Edwards Deming and statistician Walter Shewart, PDCA stands for Plan, Do, Check and Act:
– Plan – Identify the problem or goal, collect data, understand the root causes, develop hypotheses, and decide which one to test.
– Do – Develop and implement a solution, decide how to gauge its effectiveness, test the solution and measure the results.
– Check – Confirm results through before-and-after data comparison. Determine whether the hypothesis is supported.
– Act – Document the results and make recommendations for future PDCA cycles. Implement the solution if it was successful.
Other quality systems include TQM, Six Sigma and Lean Six Sigma, all of which meet ISO 9001 standards.
Implementing quality systems and standards is easier with the use of tools to create robust processes. These include discovery tools, such as affinity diagrams, cost benefit analysis, quality audits etc., as well as data collection and display tools such as matrix diagrams, statistical sampling, control charts and more.
Project initiation
The purpose of project management processes is to help the team meet expectations. It starts with the project charter, which includes quality standards. These standards are documents that provide requirements, specifications, guidelines, or characteristics that can be used consistently to ensure that materials, products, processes, and services are fit for their purpose.
Quality standards, measures and techniques are specific to the deliverables being produced.
Project Initiation in healthcare usually starts with having a kickoff meeting that involves hospital leadership and IT managers, tech vendors, clinicians doing the work, and project managers. This meeting ensures that each level of the organization understands the project quality metrics. Additionally, it helps the team understand the circumstances that may lead to project termination, such as if patient outcomes are not being met or if there are not enough front desk or clinician resources to achieve the level of quality needed for the clinical outcomes.
Incorporating quality
Don’t wait to test for quality until the end of the project. It must be integrated into the work throughout the project.
This begins with a quality management plan, which details such things as how the team will implement the organization’s quality policies in every aspect of the project, what is required to manage and validate quality, process improvement plans and more.
This should include calculating the costs of assuring that quality standards are met. The primary cost here is the expense associated with training, reviews, planning and preventing non-conformance. While these can be substantial, they are less than the cost of failure, which can include waste, rework, liabilities, warranty work and lost business.
Developing quality metrics
What gets measured, gets improved and what gets paid for, gets done.
The team must develop quality metrics that define acceptable performance for the product and project characteristics. This is done by collecting and analyzing data and process audits to verify process compliance. Meeting quality metrics requires both precision and accuracy, which are not the same: Precision is about exactness and accuracy is about correctness.
Project execution, monitoring and control
As the team implements its quality management plan, it should perform the following three activities to ensure the intended results:
– Quality audits – These are often performed by someone outside the project. Their purpose is to identify procedures and processes that need improvement, identify best practices being implemented, find gaps, correct to reduce cost of quality and increase acceptability, and measure subsequent performance.
Using a year-long primary care project as an example, this could mean monthly data audits to ensure accurate data mining of clinicians’ documentation of patient medication adherence.
– Process analysis – Follow the steps in the process improvement plan to identify organizational or technical improvements and review problems, constraints and out-of-scope activities. Root cause analysis can determine the cause of problems.
After the external audits of the data mining of the medication adherence, project stakeholders look for the cause in any deficits in the data-mining techniques. Were the end-users (clinicians) using the proper selectors? Was the data ending in the intended data repository? Did leadership abandon this initiative in favor of a different focus for the clinicians?
– Quality control – Verify that the deliverable meets the customer’s requirements and standards. The team implements the quality control procedures to meet the metrics detailed in the Quality Management Plan.
Starting with the end in mind is key to process analysis. If the healthcare IT team understands the degree to which a clinical metric needs to be accurate, the measurement tools can be built accordingly. For the primary care example, if the stakeholders had determined that 95% accuracy was acceptable for measurement of clinical outcomes, this is the metric they will compare the external auditor’s results against.
Healthcare IT projects are too complicated and too vital to be left to chance. Applying proven quality processes are the best way to ensure the desired outcome.
About the author
Michelle LaBrosse, PMP, CVL, CAC, PMI-ACP, RYT, is founder and CEO of Cheetah Learning, a leader in Accelerated Exam Prep for the Project Management Professional (PMP)® exam. She has authored four books: Cheetah Negotiations, Cheetah Project Management, Cheetah Know How and Cheetah Agile Projects. The Project Management Institute (PMI) selected LaBrosse as one of the 25 Most Influential Women in Project Management in the World. She is a graduate of the Harvard Business School’s Owner President Managers program, holds an aerospace engineering degree from Syracuse University and a mechanical engineering degree from the University of Dayton.
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