WHITE PAPER APRIL Leading an Implementation Campaign to Address the Convergence of Healthcare Reform Initiatives

Transcription

1 WHITE PAPER APRIL 2012 Leading an Implementation Campaign to Address the Convergence of Healthcare Reform Initiatives

2 New healthcare reforms have created an unprecedented impact on hospital systems operations. Specifically, the Meaningful Use (MU,) Value-Based Purchasing (VBP), and Accountable Care Organization (ACO) model programs have forced systems to manage several complex and unique initiatives simultaneously. To complicate issues further, many of the above mentioned programs are still pending fully defined requirements. With all of these issues at play, utilizing a traditional PMO that manages initiatives as disparate projects is no longer sufficient. If a traditional PMO is employed as the sole management tool for the implementation of an initiative within a hospital system, then inefficiencies and stressors for clinicians, business departments, clinical departments, and IT departments will likely be created. Also, using only traditional PMOs in the current environment can severely risk a system s financial bottom line. At best, traditional PMO techniques result in added dollars, time, and staff frustration; at worst, project failure and financial loss. To succeed in this ambiguous environment, hospital systems must develop new techniques that can supplement traditional PMOs. In the search for new techniques, hospital systems can learn a great deal from the methods of management employed by the United States Army. In the Army, units are continually challenged to successfully execute and control multiple engagements across an ever changing battlefield. In this demanding environment, military commanders utilize a campaign management approach to achieve superior results. In much the same way, hospital systems must address the dynamic convergence of MU, VBP,and ACOs as a campaign. If hospital systems can properly establish a campaign approach to management, then, like in the military, superior results will be attained. What is a campaign? The current challenges within the healthcare sector are not unlike the challenges faced by military leaders. Like in healthcare, military leaders are challenged to accomplish multiple complex missions simultaneously. In the military, a proven method to manage the accomplishment of these missions is to break them into smaller objectives called campaigns. In his book, Hope Is Not a Method, retired Army General Gordon R. Sullivan argues that a campaign approach to mission accomplishment is vital to an organization s success. In his book, Sullivan defines a campaign as a series of subordinate objectives oriented to a larger objective, and argues that leading a successful campaign hinges on the importance of a common vision and the effective integration of the campaign s subordinate objectives. Additionally, Sullivan highlights the importance of building flexibility into a plan to accommodate for unexpected change. These concepts draw clear parallels with the charter of a Campaign Program Management Office and can be directly applied to the challenges now faced in the healthcare environment. When organized properly, a Campaign PMO offers healthcare organizations the tools to successfully accomplish the complex nature of projects demanded by healthcare reform. The Campaign PMO offers leadership the ability to direct planning and ensures the integration of disparate healthcare reform initiatives. The following table highlights the key elements of a campaign plan, followed by an application of those principles by a PMO tasked with executing a healthcare reform campaign: DEVELOPMENT OF A CAMPAIGN PLAN, Hope Is Not A Method, General Gordon R. Sullivan, MU VBP ACO Hospital systems must address the dynamic convergence of MU, VBP and ACOs as a campaign. If hospital systems can properly establish a campaign approach to management, then, like in the military, superior results will be attained. Intent Approach Objectives Integration and Synchronization Branches and Sequels Trigger Points A translation of the campaign s vision into specific terms that guide actions and staffing Defining the leader s focus by identifying the main effort and outlining subordinate objectives The quantifiable, point-to-point series of major actions on the campaign execution path The arranging of events so that they are mutually supporting (integration), which allows their effects to be realized at the most advantageous point and time (synchronization) Options built into a plan that anticipate situations that may alter the plan (branches) and the subsequent actions based on possible outcomes (sequels) Set of conditions and controls for branches and sequels that allow for rapid decision making White Paper: Leading an Implementation Campaign to Address the Convergence of Healthcare Reform Initiatives 2

3 Intent: Organizational transformation under healthcare reform The risks inherent in healthcare reform initiatives and the potential problems created by running MU, VBP, and ACO projects independently are daunting. To focus the campaign s intent and concept on financial objectives, either winning incentives or averting penalties, is shortsighted. The timelines and elements within projects overlap so significantly that delay or failure of an element in one project likely means delay or failure of that element in another. The sequential alignment of initiatives, such as the Meaningful Use stages, means that failing or meeting the bare minimum of elements in one stage only worsens as the roadmap progresses. As the timeline lengthens to correct problems, the organization may face reworked cost, vendor cost overrun and lost revenue due to a lag in productivity. The intent and concept of a healthcare reform campaign must focus on transformation to ensure success. Without a campaign approach, a health system may still satisfy the requirements of its disparate MU, VBP, and ACO projects. However, a system will do so at a high cost to the organization and in a manner that will likely frustrate stakeholders and negatively impact personnel. But, by utilizing a campaign management approach, a health system will realize a qualitative transformational change that will ensure superior results. A PMO that sets forth a campaign enables the C-suite to realize the following benefits: CEO: COO: CMO: CIO: Empowers and establishes accountability for stakeholders impacted by required change Objectively creates a case for change and a sense of urgency within an organization Campaign builds an enterprise view and helps eliminate stovepipe systems and duplication of effort across the organization Interruption of daily operations is minimized Productivity decrease due to go-live is minimized Able to oversee clinical transformation and physician and provider community engagement Can easily ensure that adoption is accelerated IT resource usage is optimized and well managed Clinical and business units are engaged at the right level at the right time CNO: CFO: Impacted stakeholders own the adoption of the required changes Interruption of daily operations is limited Nursing retention is maintained or improved through clinical transformation Investment is adequately forecast Incentives are maximized early Penalties are avoided or minimized Campaign Concept: Transformation will be driven by healthcare reform s initiatives: MU, VBP, and ACO (The Subordinate Objectives) The reform initiatives are subordinate objectives to the healthcare reform campaign. As a campaign plan develops, these initiatives will not translate to independent projects. Furthermore, as a PMO examines these initiatives, it can logically identify workflow design, technology, quality metrics, revenue, synergies and adoption as shared goals, while the subordinate objectives unique goals lie in the specific initiatives requirements. Campaign Objectives: MU, VBP, ACO and their associated events, and the systems and people they touch (initial work breakdown) A PMO, using the senior leader s intent, facilitates the development of a campaign s objectives. It is critical that the point-to-point series of actions and their assigned human resources clearly understand the intent and approach of the overall campaign. Roles and responsibilities of the resources are focused on capabilities and accountability is established. Resources: People, budget (total transformation and subordinate objective breakdown) and time A PMO that effectively uses a campaign approach is positioned to utilize resources judiciously and reallocate proactively. In examining human resource capabilities at the campaign level, a PMO can easily recognize the demand placed on critical individuals, to include clinical subject matter experts, operational subject matter experts, IT staff, and leadership. The thoughtful utilization of these human resources across subordinate objectives mitigates the impact to daily production and minimizes the risk of rework associated with independent projects. When budget tracking and timelines are measured together, the PMO can manage variations by adjusting resource utilization. White Paper: Leading an Implementation Campaign to Address the Convergence of Healthcare Reform Initiatives 3

4 Integration and Synchronization: The alignment of common events (integration) and planning so that their effect is realized at the most advantageous point (synchronization). A natural starting point for aligning common events and resources across subordinate objectives is to orient those events and objectives onto shared goals. For the MU, VBP, and ACO objectives, workflow design, technology, quality metrics, revenue, and adoption are all shared goals. In applying a campaign approach, integrating events also integrates resources. To follow through on the quality metrics example, quality metrics are a shared goal across objectives. The actions, events and human resources associated with the development of these metrics are common across objectives. Without integration of the MU, VBP, and ACO initiative, valuable opportunities to redesign workflow for process improvement may be missed. The number of workarounds and exceptions that are commonly developed in a single project can quadruple if not examined in an integrated campaign. Additionally, rework may be required to resolve contradictory policies and procedures developed for new process implementation or to resolve differing data structures for common reporting metrics across programs. Campaign PMO unique features In this new and challenging environment, current project management methods employed by hospital systems have been ineffective and inefficient. At present, heath care systems utilize Project Management Offices as one stop shops for operational tracking purposes. In this traditional method, Project Management Offices are often tasked with the enormous assignment of reporting on countless projects and initiatives across an entire expanse of a hospital system. Although this management method has great value in terms of operational tracking and command oversight, when utilized as a sole tool, the result is often a collection of disparate projects charging toward a narrow, individualized goal and the opportunity for integration and synchronization is lost. CAMPAIGN PMO Technology Workflow Design Quality Metrics Revenue Adoption MU VBP ACO The best way to address this gap in synchronization is to utilize a Campaign PMO concurrently with an existing PMO. A Campaign PMO is established specifically for the implementation of an initiative and its purpose is to utilize existing PMO tools into a cohesive and synchronized management method that will ensure the succesful implementation of an initiative. Below is a explanation of some of the unique features of a Campaign PMO that will assist in the implementation of an initiative. EXISTING PMO EXECUTIVE ENTERPRISE GOVERNANCE CAMPAIGN PMO Planning Intent and approach are embedded in all actions and are the denominator against which all events are measured. Scope Management Controlled through trigger points/ branches/sequels and shared allocation of resources. Schedules Not only one dimensional task schedules but also a condition-based synchronization matrix illustrating cross project dependencies. Resource Tracking Ensures that the required resources (skill, experience) are planned for with sufficient lead time to ensure availability at the required time. Internal Reporting Aggregating the status and progress of the individual initiatives to ensure the campaign timeline, goals and desired outcomes are tracked to achieve the campaign s intent. Analysis of the aggraded initiatives data provides senior leaders an accurate picture of the current and future state of the campaign and provides actionable recommendation if required. Project Manager Support The capability to monitor, guide or manage the campaign s subordinate initiatives or supporting efforts. Campaign Governance A campaign governance model is integral in developing the intent, approach, objectives and resource availability within an initiative. Based on the overarching vision, a Campaign PMO incorporates stated intent into its approach. A PMO develops White Paper: Leading an Implementation Campaign to Address the Convergence of Healthcare Reform Initiatives 4

5 recommendations for the main and supporting objectives and outlines and prioritizes those supporting objectives. Once that is accomplished, the roles and responsibilities of the allocated resources are focused on capabilities and accountability within the established initiative. As the PMO develops its campaign objectives, it is vital that the assigned resources clearly understand the intent and concept of the overarching campaign. Developing the Campaign Sullivan in Hope Is Not a Method, describes the relationship between branches, sequels and trigger points. As he defines them, Trigger Points are a set of conditions for making decisions. Some are inherent to the campaign plan while others are developed on an as needed basis to accommodate for branches and sequels. Branches are the options built into a plan to anticipate situations that call for change and sequels are the subsequent actions that satisfy those requirements. For example, Stage 2 MU is an example of a campaign branch. In this case, the sequel to that branch is the subsequent actions that satisfy those determined requirements. This approach provides the PMO with a decision-making processes for issue resolution that provides flexibility without clouding roles and responsibilities. With knowledge of intent, flexibility in the plan for branches and sequels and proper integration of subordinate objectives, a PMO can now manage the expectations of the initiative and furnish a clear execution path. At this stage, a PMO is equipped to set priorities and monitor activities for an aligned, integrated series of objectives. A successful PMO models its common activities (schedules, resource management, budget tracking, compliance tracking and reporting) on a campaign approach. Integration and synchronization are critical in schedule management in this challenging healthcare reform environment. Given the many common attributes across the healthcare reform initiatives and the high demand on the same resources, an integrated schedule including all subordinate objectives provides the PMO with a structure for effective management. Resources are equipped with knowledge of intent, concept and trigger points, and are empowered to make decisions at the point of action while the PMO continues to monitor progress of the objective toward the campaign. The alignment of the objectives allows the PMO to be flexible and to shift the level of effort as required. The transparency and integration of the process highlights deviations from the PMO standards and allows the PMO to evaluate its tools and track the effectiveness of the stated trigger points, branches and sequels. The PMO uses these observations to proactively guide and manage its project managers. Communications are oriented toward intent and approach and the internal reporting framework is designed to monitor each subordinate objective against the intent of the campaign. External communications are then developed to manage stakeholder expectations. In designing a healthcare reform campaign, the PMO aligns the common elements of the subordinate objectives. In highlighting these common elements, the PMO can capitalize on finite resources, minimize scope creep and minimize duplicate work and rework. A successful PMO shifts its perspective of its usual processes in order to apply the campaign approach. Information sharing within the program (reporting, meetings, and other communications) must be oriented to the integrated approach and measure information against the campaign intent and approach. Planning must be built on a foundation of concept, integration, synchronization, branches and sequels. In designing a healthcare reform campaign, the PMO aligns the common elements of the subordinate objectives. For example, both workflow redesign and data center configuration is one common event addressing MU, VBP, and an ACO. In highlighting these common elements, the PMO can capitalize on finite resources, minimize scope creep and minimize duplicate work and rework. Campaign Benefits, Delivered Regulatory driven Initiatives must be perceived by the clinicians and staff as being about quality improvement and better patient outcomes or being compliant with new regulatory requirements, not about the financial incentives to be gained by the institution. Regulatory-driven Initiatives cannot be perceived by the clinicians and staff as being about financial incentives. Rather, clinicians and staff it must accept that the initiatives are focused on quality improvement, better patient outcomes and compliance with new regulations. White Paper: Leading an Implementation Campaign to Address the Convergence of Healthcare Reform Initiatives 5

6 The Campaign PMO serving as a singular point of coordination and integration for the workflow improvement (redesign), project management, organizational change adoption, and value management is needed to ensure your success. A Campaign PMO needs to develop a deep understanding of what most physicians and practices view as the value of the change to them; i.e. What s in it for me? To demonstrate value, the campaign needs to incorporate baseline process activity and performance in order to develop value improvements and metrics to communicate the impact. The implementation of the healthcare reform campaign will also depend on leveraging areas where there is great support and addressing the areas where skepticism exists. This may include organizational barriers, as well as individual resistance to change. To create buy-in, there is a delicate balance between creating value, engaging physician and staff involvement, and not becoming consumed by the endeavor. When change fatigue associated with the constant deployment of new requirements is minimized, adoption results improve. Given the known barriers and challenges going into major regulatory change initiatives, the PMO must have an implementation strategy that structurally integrates technical solutions with clinical and business operations. Varying technology and inconsistent workflow, policies between stakeholder groups will mean that the process of implementation will be the critical differentiator. The healthcare reform campaign approach is the best solution because it will ensure that the decisions and actions of all the initiative s activities are synchronized for maximum success. The Campaign PMO serving as a singular point of coordination and integration for the workflow improvement (redesign), project management, organizational change adoption, and value management is needed to ensure your success. About the Author Celwyn Evans is a Senior Partner at Greencastle Associates Consulting. Celwyn is a retired US Army Ranger with over 20 years of military service. His military experience ranges from leading small specialized units to staff planning at the task force level. Greencastle was founded with the intent of combining military and commercial industry best practices to create implementation methodologies that address the dynamic high risk environments where project failure is not an option. Celwyn can be contacted at evansc@greencastleconsulting.com White Paper: Leading an Implementation Campaign to Address the Convergence of Healthcare Reform Initiatives 6