Creating the Results that Matter: Portfolio Management and Execution. Objectives
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1 Creating the Results that Matter: Portfolio Management and Execution Carol Haraden, PhD APAC Forum Objectives Differentiate between projects, portfolios, and big dots and the role each plays in improvement work. Outline what is needed in each of the three tiers of a portfolio management system. Use a portfolio approach in your planning.
2 Components for Effective Improvement Will Ideas Execution Execution of Improvement Work in Very Large Systems s Very Large System
3 The Intuitive Structure Very Large System Tier 1 Tier 2 Tier 3 Example: System Medication Safety SYSTEM Medication Safety Tier 1: Big Dot Hospitals Rehab Offices Tier 2: Portfolio Med. reconciliation Standardized dosing Self med Family Capacity Correct list Patient capability Tier 3: s availability
4 Example: Hospital Medication Safety Hospital Medication Safety Tier 1: Big Dot Med Surg Pharm Tier 2: Portfolio Med. reconciliation IV pumps Admix Standardized dosing availability Tier 3: s Tier 3: s Issues Team organization and capacity matter. Front-line leadership is critical. Measures tracked over time and visible. Senior leaders remove obstacles. Clear changes important. Ability to run PDSA cycles.
5 Tier 2: Portfolio Issues Middle Management key. What are the drivers of the outcomes we want? Outcomes tracked over time. Connecting the Dots Putting the learning together. Continual readjustment of portfolio. Strong linkage to finance. Tier 1: Big Dot Issues Aims of strategic importance to the system as a whole. Big Dot measure of progress. Executive, Board and Senior Leader engagement. Vision and the associated structural changes. Strong linkage to finance. Managing the learning, the politics, and the risks.
6 A Source: J. Reinertsen, 2005 Moving a Big Dot! June 6, 1944 Source: J. Reinertsen, 2005
7 What s the Difference? A Source: J. Reinertsen, 2005 Moving a Big Dot! The Differences Are Level of ambition Commitment: hearts pounding Core strategy: staying alive Clear measure of daily success: territory Clear overarching goal: Berlin People are shooting live ammo! Will, Ideas and Execution!
8 Leading the Whole System to Provide Highly Efficient and Effective Results The Ground Level View (Staff) The Big Picture View (Management) Large System Metrics (Big Dots): Three Examples Example #1: Patient Experience. Example #2: Reliable Evidence- Based Care. Example #3: Hospital Adverse Events per 1,000 Patient Days (Using IHI s Global Trigger Tool).
9 Developing a Portfolio of s Portfolio What would a portfolio of projects look like for various units/departments/areas? 1. Patient experience 2. Outcomes that matter (reliability) 3. Safety 4. Staff s joy in work
10 The Intuitive Structure Very Large System Tier 1 Tier 2 Tier 3
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