Collaboration and Governance Structure for Data Driven Projects
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Transcript of Collaboration and Governance Structure for Data Driven Projects
Collaboration and Governance
Structure for Data Driven Projects
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Context, Purpose, Outcome
1) Context: Successful projects driven by data are critical to improving performance in Navy Medicine
2) Purpose: Johns Hopkins University APL will describe successes and challenges seen in forming and navigating various collaboration and governance structures for data driven projects
3) Outcome: Critical success factors will be communicated and continuing challenges discussed to promote future achievement of performance improvement teams
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Agenda• Project Governance Background• Industrial Engineering Approach at
BUMED• Example Project Governance
• MTF• MTF Collaboration• Program
• Lessons Learned• Discussion
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Project Governance
Purpose Outline the relationships of all groups
involved Establish roles and responsibilities, decision
process Monitoring risk Provide plan for information flow to
stakeholders
Components Team structure Clear charter or scope Information flow & communication plan
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Project Governance
Key Principles Clear accountability for the success of
project Project ownership independent of process
ownership Stakeholder management ≠ project decision
making Project governance ≠ organizational
governance
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IE ApproachCollaborative approach
Consultant industrial engineers Working hand-in-hand on site with local clinical
subject matter experts
Data driven Bottom up analysis Combining automated data from several sources
and observational data collection on site
Implementation focused Near-term (days/weeks) Solutions developed locally Not lengthy reports / recommendations
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Project TimelineProcess at the activity following request & region
approval:
Scoping – determine issues and lines of work
Diagnostic – 8 to 10 weeks. Define current state, desired future state and detailed implementation plan
Implementation – 16 to 20 weeks. Implement the needed changes
Sustainment – 6 months or more. Insure hand-off to local staff and standard reporting of metrics
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Typical Team Structure: MTF Project
Meeting Frequency
Kick-offDiagnostic
Implementation
Diagnostic: Bi-Weekly Implementation:
Monthly
Diagnostic: Weekly
Implementation: Bi-Weekly
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Example MTF Project
Situation Surgery backlog and deferrals from Orthopedic
specialty
Example Task Reduce delays and cancellations on Day of
Surgery (DoS) related to chart preparation and test results
Project Actions Edit chart paperwork
― Clarify patient test requirements― Revise roles and responsibilities
Create tracking system to make chart status visible
Example MTF Project: Ortho Surgical Flow
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Lead data analysis, measure gap and pilot changes to move from current state to desired future state future state:
Change policy for case sequencing, software settings, permissions, and requirements
Revise paperwork, patient test routing, and morning start up times
Develop visual communication tools and create aligned specialty teams
Create and define performance measures; allow for drill down to root cause and trending
25%23%
6% 6%0%
5%
10%
15%
20%
25%
30%
Patient Charts Missing Prior to DoS
Printed H&Ps Missing from Chart DoS
Pre-Operative Chart Review EffectivenessOrthopedics Only
September 2009
February 2010
Example MTF Project: Ortho Surgical Flow
588
368
243
0
100
200
300
400
500
600
700
Jan-Feb '09 Jan-Feb '10
PEC Patient Visit and Chart Volumes
Charts Only
Ortho Patients
Results
0
20
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60
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100
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160
180
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Case
s Sc
hedu
led
Ortho Case Schedulers by Role
Nov 2009
Feb 2010
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Special Case: MTF Collaboration
Situation Two DOD hospitals are integrating into one
Example Task Identify the instrumentation required to meet the
future surgical volumes for the integrated facility
Project Actions Optimize and consolidate instrumentation from
both facilities Predict/prioritize storage based on frequency of
usage Combine inventory into one surgical instrument
tracking system
Collaboration Example: WRAMC-NNMC Surgical
Sets
1 common
name
745
Unique Sets NNMC
987
Unique SetsWRAMC
14,421
Unique Instruments
WRAMC
5502 (18%)
common catalog codes
15,731
Unique Instruments
NNMC
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Example Team Structure – Surgical Set Consolidation Workstream
Oversight Committee
Steering Committee
WorkstreamProcess Improvement Analyst
SPD Rep
OR Rep
WRAMC Command
Integrated Service Chief
General SurgeryIntegrated
Service Chief
Cardio-ThoracicIntegrated
Service Chief
Plastics
Charge Nurse
Charge Nurse
Technician
Technician
Integrated Service Chief
Orthopedics
SPD Rep
OR Rep
NNMC LeadershipDSS (Director of Surgical
Services)Sterile Processing Department
(SPD) HeadOperating Room Chief Nursing
Officer
WRAMC LeadershipDSS (Director of Surgical
Services)Sterile Processing Department
(SPD) HeadOperating Room Chief Nursing
Officer
Charge Nurse
Charge Nurse
Technician
Technician
Charge Nurse
Charge Nurse
Technician
Technician
Charge Nurse
Charge Nurse
Technician
Technician
NNMC Command
Results
Documented plan of set standardization with clinical ownership
Plan for migrating WRAMC inventory into Censitrac instrument tracking system
Collaboration Example: WRAMC-NNMC Surgical
Sets Decreased variability between sets
and instruments Prioritization of set requirements for
flexible storage constraints Clinical staff is now familiar with
surgical sets from both facilities
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Program Example: WOFT
Situation A decision tool, a deliverable of an MTF level
project, been requested for enterprise wide roll-out
Example Task Augment the Weekly Obstetric Forecasting Tool
(WOFT) to encompass enterprise wide Obstetric needs
Program Actions Gather design requirements from 8 MTFs and the
Perinatal Advisory Board (PAB) Develop the tool and pilot at 2 MTFs Transition tool ownership to M6-NAVMISSA Implement tool at 8 MTFs with highest OB
volume
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Program Governance Structure
M8- FinanceM6- IT
M81Contractors
Subcontractors
NAVMISSA
BUMED Headquarters
M3- Operations
Advisory Board(Project
Requestor)
MTF OB StaffBUMED Rep.
NAVMISSAProgram Manager
IT Finance/PI Operations
MTF Command
OB Dept. Leadershi
p
MTF Staff
Navy Medicine East/West
FM Dept. Leadershi
p
MID Leaders
hip
Coordination Required for the WOFT Project to come to Fruition:
1. MTF Command requested/completed a MTF level project
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Program Governance Structure
M8- FinanceM6- IT
M81Contractors
Subcontractors
NAVMISSA
BUMED Headquarters
M3- Operations
Advisory Board(Project
Requestor)
MTF OB StaffBUMED Rep.
NAVMISSAProgram Manager
IT Finance/PI Operations
MTF Command
OB Dept. Leadershi
p
MTF Staff
Navy Medicine East/West
FM Dept. Leadershi
p
MID Leaders
hip
Coordination Required for the WOFT Project to come to Fruition:
1. MTF Command requested/completed a MTF level project
2. Perinatal Advisory Board (PAB) reviewed past projects and identified WOFT for enterprise wide roll-out
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Program Governance Structure
M8- FinanceM6- IT
M81Contractors
Subcontractors
NAVMISSA
BUMED Headquarters
M3- Operations
Advisory Board(Project
Requestor)
MTF OB StaffBUMED Rep.
NAVMISSAProgram Manager
IT Finance/PI Operations
MTF Command
OB Dept. Leadershi
p
MTF Staff
Navy Medicine East/West
FM Dept. Leadershi
p
MID Leaders
hip
Coordination Required for the WOFT Project to come to Fruition:
1. MTF Command requested/completed a MTF level project
2. Perinatal Advisory Board (PAB) reviewed past projects and identified WOFT for enterprise wide roll-out
3. PAB requested an enterprise wide WOFT project
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Program Governance Structure
M8- FinanceM6- IT
M81Contractors
Subcontractors
NAVMISSA
BUMED Headquarters
M3- Operations
Advisory Board(Project
Requestor)
MTF OB StaffBUMED Rep.
NAVMISSAProgram Manager
IT Finance/PI Operations
MTF Command
OB Dept. Leadershi
p
MTF Staff
Navy Medicine East/West
FM Dept. Leadershi
p
MID Leaders
hip
Coordination Required for the WOFT Project to come to Fruition:
1. MTF Command requested/completed a MTF level project
2. Perinatal Advisory Board (PAB) reviewed past projects and identified WOFT for enterprise wide roll-out
3. PAB requested an enterprise wide WOFT project4. Process Improvement Analysts collaborated with PAB
and MTF OB Leadership to design/develop an enterprise wide tool
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Program Governance Structure
M8- FinanceM6- IT
M81Contractors
Subcontractors
NAVMISSA
BUMED Headquarters
M3- Operations
Advisory Board(Project
Requestor)
MTF OB StaffBUMED Rep.
NAVMISSAProgram Manager
Coordination Required for the WOFT Project to come to Fruition:
1. MTF Command requested/completed a MTF level project
2. Perinatal Advisory Board (PAB) reviewed past projects and identified WOFT for enterprise wide roll-out
3. PAB requested an enterprise wide WOFT project4. Process Improvement Analysts collaborated with PAB
and MTF OB Leadership to design/develop an enterprise wide tool
5. M6-NAVMISSA Governance Process was initiated
IT Finance/PI Operations
MTF Command
OB Dept. Leadershi
p
MTF Staff
Navy Medicine East/West
FM Dept. Leadershi
p
MID Leaders
hip
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Program Governance Structure
M8- FinanceM6- IT
M81Contractors
Subcontractors
NAVMISSA
BUMED Headquarters
M3- Operations
Advisory Board(Project
Requestor)
MTF OB StaffBUMED Rep.
NAVMISSAProgram Manager
IT Finance/PI Operations
MTF Command
OB Dept. Leadershi
p
MTF Staff
Navy Medicine East/West
FM Dept. Leadershi
p
MID Leaders
hip
Coordination Required for the WOFT Project to come to fruition:
6. Process Improvement Analysts worked with local commands to pilot tool
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Program Governance Structure
M8- FinanceM6- IT
M81Contractors
Subcontractors
NAVMISSA
BUMED Headquarters
M3- Operations
Advisory Board(Project
Requestor)
MTF OB StaffBUMED Rep.
NAVMISSAProgram Manager
IT Finance/PI Operations
MTF Command
OB Dept. Leadershi
p
MTF Staff
Navy Medicine East/West
FM Dept. Leadershi
p
MID Leaders
hip
Coordination Required for the WOFT Project to come to fruition:
6. Process Improvement Analysts worked with local commands to pilot tool
7. Process Improvement Analysts, PAB and MTF OB Leadership briefed BUMED M Codes
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Program Governance Structure
M8- FinanceM6- IT
M81Contractors
Subcontractors
NAVMISSA
BUMED Headquarters
M3- Operations
Advisory Board(Project
Requestor)
MTF OB StaffBUMED Rep.
NAVMISSAProgram Manager
IT Finance/PI Operations
MTF Command
OB Dept. Leadershi
p
MTF Staff
Navy Medicine East/West
FM Dept. Leadershi
p
MID Leaders
hip
Coordination Required for the WOFT Project to come to fruition:
6. Process Improvement Analysts worked with local commands to pilot tool
7. Process Improvement Analysts, PAB and MTF OB Leadership briefed BUMED M Codes
8. M3/M6/M8 presented the project to the Capabilities Management Working Group (CMWG)
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Program Governance Structure
M8- FinanceM6- IT
M81Contractors
Subcontractors
NAVMISSA
BUMED Headquarters
M3- Operations
Advisory Board(Project
Requestor)
MTF OB StaffBUMED Rep.
NAVMISSAProgram Manager
Coordination Required for the WOFT Project to come to fruition:
6. Process Improvement Analysts worked with local commands to pilot tool
7. Process Improvement Analysts, PAB and MTF OB Leadership briefed BUMED M Codes
8. M3/M6/M8 presented the project to the Capabilities Management Working Group (CMWG)
9. M6-NAVMISSA assigned a Program Manager
IT Finance/PI Operations
MTF Command
OB Dept. Leadershi
p
MTF Staff
Navy Medicine East/West
FM Dept. Leadershi
p
MID Leaders
hip
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Program Governance Structure
M8- FinanceM6- IT
M81Contractors
Subcontractors
NAVMISSA
BUMED Headquarters
M3- Operations
Advisory Board(Project
Requestor)
MTF OB StaffBUMED Rep.
NAVMISSAProgram Manager
IT Finance/PI Operations
MTF Command
OB Dept. Leadershi
p
MTF Staff
Navy Medicine East/West
FM Dept. Leadershi
p
MID Leaders
hip
Coordination Required for the WOFT Project to come to fruition:
6. Process Improvement Analysts worked with local commands to pilot tool
7. Process Improvement Analysts, PAB and MTF OB Leadership briefed BUMED M Codes
8. M3/M6/M8 presented the project to the Capabilities Management Working Group (CMWG)
9. M6-NAVMISSA assigned a Program Manager10. … TBD
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Ideal Team Structure –
Program
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Program Example: WOFT
Results A OB management tool designed by the Perinatal
community that incorporates: Weekly birth forecast for future weeks Data driven accept/defer decision based on
forecast Automated patient database On demand standardized reports
Immediate Benefits Reduced variability
in weekly birth volumes
Reduced manual processes to manage OB patients
Increased accuracy of patient database
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Lessons LearnedCollaboration
Participation All relevant commands and M codes must be
engaged from the beginning and agree upon project priorities
Leadership must prioritize additional project workload
Engage appropriate team members from start
Buy In Create a burning platform Secure individual buy in prior to formal
presentation Include local team in data collection and analysis Encourage local team to present
recommendations/status
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Lessons Learned Project Structure &
Timeline
Size of scope Scope creep is inevitable Definition of scope may be clarified in diagnostic
phase Follow on engagements may be necessary
Timeline challenges Data Usage Agreements (DUA) approval can be
slow Data needs can be intensive Scoping timeline condensed; need appropriate
skill level Coordination among all stakeholders difficult but
necessary Meetings: getting informed vs. making decisions
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Lessons LearnedGovernance
Critical decisions Built-in decision points work better than ad hoc
meetings Before Diagnostic & Implementation phases Proceed? Adjust scope? Formal documentation is best
Path for issue escalation must exist Specificity of deliverables – clear and documented
Conflicting interests of team members Analysts can minimize bias or influence by
understanding all points of view and using data to drive decisions
Separate stakeholder role from project governance role
Team mission statement guides work
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Lessons Learned Implementation
Ownership of the implementation plan Analysts should not own the plan Project analysts provide on-site guidance Documentation is necessary but does not
stand alone Task owners must agree to deadlines
Leadership through implementation Project leadership supporting local
leadership Adapting implementation approach to the
individual Understanding culture and broader context
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Implementation Example
Implementation 1:OR Dashboard3rd party relianceNo single point of ownershipRelatively low visibility, sustained interest
Implementation 2:Scheduling TemplateLocal ownershipImmediate feedbackComplete authority within project governance
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Lessons Learned Sustainment
Continued monitoring of metrics Structure for reviewing metrics Dashboards for ongoing monitoring
Self sufficiency of local team Built understanding of metrics and process
improvement Roles and responsibilities aligned to support
sustainment
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DiscussionRemaining challenges
Leadership changes Maintaining visibility Identifying local ownership Holding accountability Determining when to move on