Collaboration and Governance Structure for Data Driven Projects

Collaboration and Governance

Structure for Data Driven Projects

FOR OFFICIAL USE ONLY2

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


Agenda• Project Governance Background• Industrial Engineering Approach at

BUMED• Example Project Governance

• MTF• MTF Collaboration• Program

• Lessons Learned• Discussion


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


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


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


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


Typical Team Structure: MTF Project

Meeting Frequency

Kick-offDiagnostic

Implementation

Diagnostic: Bi-Weekly Implementation:

Monthly

Diagnostic: Weekly

Implementation: Bi-Weekly


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


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

40

60

80

100

120

140

160

180

200

Case

s Sc

hedu

led

Ortho Case Schedulers by Role

Nov 2009

Feb 2010


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

FOR OFFICIAL USE ONLY

14

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


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

FOR OFFICIAL USE ONLY 17

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



M8- FinanceM6- IT

M81Contractors

Subcontractors

NAVMISSA

BUMED Headquarters

M3- Operations


Requestor)




MTF Command

OB Dept. Leadershi

p

MTF Staff


FM Dept. Leadershi

p

MID Leaders

hip



2. Perinatal Advisory Board (PAB) reviewed past projects and identified WOFT for enterprise wide roll-out



M8- FinanceM6- IT

M81Contractors

Subcontractors

NAVMISSA

BUMED Headquarters

M3- Operations


Requestor)




MTF Command

OB Dept. Leadershi

p

MTF Staff


FM Dept. Leadershi

p

MID Leaders

hip




3. PAB requested an enterprise wide WOFT project



M8- FinanceM6- IT

M81Contractors

Subcontractors

NAVMISSA

BUMED Headquarters

M3- Operations


Requestor)




MTF Command

OB Dept. Leadershi

p

MTF Staff


FM Dept. Leadershi

p

MID Leaders

hip




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



M8- FinanceM6- IT

M81Contractors

Subcontractors

NAVMISSA

BUMED Headquarters

M3- Operations


Requestor)






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


MTF Command

OB Dept. Leadershi

p

MTF Staff


FM Dept. Leadershi

p

MID Leaders

hip



M8- FinanceM6- IT

M81Contractors

Subcontractors

NAVMISSA

BUMED Headquarters

M3- Operations


Requestor)




MTF Command

OB Dept. Leadershi

p

MTF Staff


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



M8- FinanceM6- IT

M81Contractors

Subcontractors

NAVMISSA

BUMED Headquarters

M3- Operations


Requestor)




MTF Command

OB Dept. Leadershi

p

MTF Staff


FM Dept. Leadershi

p

MID Leaders

hip



7. Process Improvement Analysts, PAB and MTF OB Leadership briefed BUMED M Codes



M8- FinanceM6- IT

M81Contractors

Subcontractors

NAVMISSA

BUMED Headquarters

M3- Operations


Requestor)




MTF Command

OB Dept. Leadershi

p

MTF Staff


FM Dept. Leadershi

p

MID Leaders

hip




8. M3/M6/M8 presented the project to the Capabilities Management Working Group (CMWG)



M8- FinanceM6- IT

M81Contractors

Subcontractors

NAVMISSA

BUMED Headquarters

M3- Operations


Requestor)







9. M6-NAVMISSA assigned a Program Manager


MTF Command

OB Dept. Leadershi

p

MTF Staff


FM Dept. Leadershi

p

MID Leaders

hip



M8- FinanceM6- IT

M81Contractors

Subcontractors

NAVMISSA

BUMED Headquarters

M3- Operations


Requestor)




MTF Command

OB Dept. Leadershi

p

MTF Staff


FM Dept. Leadershi

p

MID Leaders

hip





9. M6-NAVMISSA assigned a Program Manager10. … TBD


Ideal Team Structure –

Program


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


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


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


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


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


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


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


DiscussionRemaining challenges

Leadership changes Maintaining visibility Identifying local ownership Holding accountability Determining when to move on

Documents

Collaboration and Governance Structure for Data Driven Projects