PMINZ National Conference 2014.

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1 Reshaping Project Management to Deliver Continuous Improvement Authors: Angela Moore PMI Authors LinkedIn profile Since the earthquakes Cantabrians have faced extraordinary levels of change in all aspects of life Although difficult in many ways, it has given us the opportunity to innovate and transform the way we solve complex problems The Information Systems that support the Canterbury Health Sector are examples of rapidly developed, innovative, adaptive solutions, delivering timely and accurate information to Health Care Professionals leading to improved patient outcomes The development and delivery of complex Information Systems in the rapidly changing Canterbury Health Sector has also necessitated changes in Professional Project Management The skills and tools of the Project Manager have been reshaped around this agile environment This paper describes the experiences and insights of a Project Manager in reshaping their own skills, tool box and processes to deliver innovation and continuous improvement Keywords: Canterbury Health Information Systems, Agile Mindset, Continuous Improvement Theme: Project Management Continual Improvement Introduction The Christchurch Earthquake was a game changer for the Canterbury Health System Christchurch Hospital itself survived, but most of the Health Systems buildings including the hospitals, were damaged On the day, 5 general practices were completely destroyed with 11 clinicians among the dead- and many other practices and pharmacies were severely disrupted One of the biggest challenges faced by clinicians was accessing complete patient information at the point of care The Canterbury Health System responded to this need with the development and deployment of escrv, its innovative health information sharing system This groundbreaking solution was made possible by the visionary work begun in 2007 to transform the way the health and social care system functioned and the environmental changes that occurred post-earthquake This paper casts a project management lens over a period of transformational change from 2007 to the current day It examines the importance of environment and culture in the Canterbury Health System The paper discusses the Project Management Dilemma and how an Agile Mindset and WHY Centered Project Management can reshape project management to deliver innovation and continuous improvement in this rapidly changing environment The Landscape A project s environment plays an important part in determining the management and success of a project To explore this in the context of the Canterbury Health System we need to understand the pre-quake environment and the changes that occurred post-quake which accelerated the development of existing information systems and permitted new innovative solutions The Pre-quake Environment In 2006 a review by the Canterbury District Health Board concluded that the current way of operating was unsustainable, becoming cost prohibitive by 2020 This analysis created a burning platform that required transformational change At the center of this change is the Integrated Health and Social Services model In this model the patient is placed at the centre of the service and the hospital on the outside It is viewed as one system, with one budget This model, which is unlike any other DHB in New Zealand, has created alliances and partnerships across the Canterbury Health System which are delivering efficient and improved patient outcomes One of the most innovative and effective initiatives is HealthPathways, which is a web based set of best practice clinical guidelines for treatment of specific medical conditions Although at first glance it appears to be a simple information system, it is integrated with the Electronic Request Management System (ERMS), which replaces the old referral system of letters and faxes with an Electronic Request System ERMS ensures referrals are directed to the right place so the right care is delivered effectively and appropriately ERMS is now being

2 rolled out across the South Island and continues to be developed to meet changing health system and patient needs The Post-quake Environment The UK based Kings Report commissioned in 2013 said that, Despite the earthquakes, the improvements in the Canterbury Health System and Social Care have continued Indeed, the response to the quake accelerated some changes that were already in place and introduced several new ones- a classic demonstration of the rule that good comes out of crisis Two major earthquakes, in September 2010, and especially the one in February 2011, destroyed much of the infrastructure of the city Buildings fell, or were inaccessible for days, weeks and even months Business and patient records, including medication lists, were unreachable In this post-quake environment the need to have Patient Information Systems that deliver timely information and accurate information to Health Care Professionals outweighed the risks associated with security or privacy The phrase that has been used to describe this change is the environment became permissive Although the security risks remained the same, the risk of not having patient information available to clinicians at the point of care was greater than the perceived security risk The environmental changes required pre-quake, to move to the Integrated Health and Social Services model, and the post-quake change to a more permissive environment, together have been highly influential in the management and continued success of existing information systems and new innovative solutions The Project Management Dilemma For a project manager working in a rapidly changing environment there are a number of contradictions and questions, including: How do you apply best practice project management in such a rapidly changing environment? How is continuous improvement managed in this environment? What is the role of the Project Manager? Although every situation is different and the answers to these questions will depend on the organisation, and the project, what we know is that project management skills are still needed! The challenge is how do we apply them? In traditional project management a project is defined as a temporary and unique endeavor with a defined beginning and end time with defined scope and resources On the flip side Agile is defined as an iterative and incremental method of managing the design, build and delivery of new product or service in a highly flexible and interactive manner These definitions appear to contradict each other, so where to from here? Let me first draw your attention to the synergy between Agile and Continuous Improvement Both are built on the Plan, Do, Check, Act cycle, which makes incremental improvements to products, services or processes In fact Agile has Continuous Improvement built in So if we can apply best practice project management in Agile, we can use it to deliver Continuous Improvement The Agile Project Manager Pegasus Health, Business Information Systems team, who are responsible for developing ERMS and escrv, has implemented Scrum for its product development and put in place the three core Scrum roles: Product Owner, Development Team and Scrum Master Although there is no Project Manager Role in Scrum, project management skills are still needed and these skills are distributed between the core Scrum roles In larger projects and programmes it makes sense to have an Agile Project Manager working with the Development Team, Product Owner and Scrum Master providing Project Management capability This works well where the Product Owner has a strong understanding of the business, but may not have the time to carry out all the Product Owner project management responsibilities or where there are a large

3 number of external dependencies that need to be managed It can be challenging for a traditional plan driven Project Manager to work in an agile environment, because the two methods contradict each other in many respects For example in traditional plan driven project management (PMP) you create a comprehensive suite of project plans during the project planning phase, which are then used during the monitor and controlling phase to deliver the project on time and to budget Whilst in Agile you plan the project using a map of progressively elaborated outcome level estimates and use adaptive planning to mitigate overruns There are a number of different ways to approach this dilemma: Change hats - Adopt the Agile or traditional stance as appropriate to the situation Hybrid - Develop using Agile and deliver using traditional methods Mind the gap - Fill the gaps with traditional Project Management Translate for the outside world - Wrap traditional Project Management around Scrum Adopt an Agile Mindset- Blend Agile and traditional Project Management using the Agile Perspective At Pegasus Health you may find all of the above, the most effective of which I have found to be the adoption of the Agile Mindset However, this is by far the hardest and takes time and training to achieve The Agile Mindset There are a lot of articles and publications written about the Agile Mindset which are available on line and I would encourage a Project Manager new to this concept to read widely on the subject Here are some key points: The Agile Mindset promotes learning at every opportunity, it acknowledges the fact that people can change, learn and grow Effort is required to master the Agile Mindset and failure provides valuable information The Agile Mindset is a mind-set that is focused on flexibility: inspect, adapt and change The Agile Mindset comprises of competencies that are related to right-brain skills such as intuition, creativity, spontaneity etc The Agile Mindset requires the two sides of the brain to work in tandem Agile Mindset is part of the 21st Century Mindset In the context of Agile Project Management this translates to: Not adopting a particular framework or process To wholeheartedly embrace change, inspect and adapt everything you do and be prepared to try, and learn from failures on the way to your goal Embrace your team, trust them completely, to get the job done and create an inclusive environment that fosters trust, courage and transparency, whilst maintaining a sustainable pace This creates and fosters high performing teams which are able to solve complex problems in a rapidly changing environment In this context the Agile Project Manager maybe more aptly described as a Project Enabler

4 Reshaped Project Management delivering Continual Improvement I would like to share with you an example of how I have reshaped my project management skills in this agile environment I was appointed into a full-time Project Manager and Scrum Master role for the Electronic Request Management System (ERMS) with Pegasus Health ERMS was launched in 2010 and continues to be rolled out to new customers and continually improved to meet the changing needs of patients and the health care system Although an established product, there had been recent changes in the development team The team closely followed the Scrum processes, but they often had carry over stories, which made planning unpredictable There appeared to be many reasons for this including: too many stories in the Sprint, testing started late in the Sprint, lots of bugs to fix and a high number of production support tickets that took time out of Sprint I was able to blend my newly acquired Agile facilitating skills, to create an environment for the team to work through the issues I worked hard to adopt an Agile mindset that built trust in the team and I used my traditional project management processes and techniques to help the team commit to and deliver stories at a sustainable work rate There is still a place for all my old favorites including lessons learnt, risk management, planning and monitoring and action tracking However often these are hidden from the team When the team is directly involved they have a different look and feel The feedback from the team is that they feel they are improving each Sprint If you ask them what I do, they really don t know, but they do know it feels better If you asked the Product Owner what I do, he knows! He has more visibility and I am there to help him plan and manage the product WHY Centered Project Management Traditional plan driven project management focuses on HOW and WHEN The WHY has already been determined and once a project has been kicked off focus can be lost on the WHY WHY centered leadership takes a number of different forms in the Canterbury Health System For example, the mantra of the Canterbury Clinical Network, an entity formed to deliver the system s required innovation is Best for Patient, Best for System In another context it s called Clinically Lead Projects In the development environment, Scrum builds the team around the Product Owner, who is the voice of the customer At Pegasus Health, executive and company meetings start with a patient story which reinforces their mission statement: That we achieve improved health through high performing teams and innovative community and primary health care There are many examples of how WHY centered leadership has improved patient outcomes I would like to give you an example of a small change I made in this environment which has made a difference Remember we are in an agile environment, which gives you permission try something new This is another example from ERMS On taking on my new role, I saw the opportunity to create a broader team, which includes the customer facing application support roles with the development team The support team now share their experiences with the development team and this is one way we reinforce the WHY at the center As a result the scrum team has looked at how it can have a higher customer focus One initiative the team put in place is the allocation of two scrum team members every Sprint to respond to production support requests The feedback from the application support team is that they feel more supported and this has helped reduce the turnaround times for incident request This has resulted in better customer support and job satisfaction for everyone This is an example of how small changes can have a significant impact on Continuous Improvement, but it often needs someone who has a different perspective to identify the change required The Project Manager often has this perspective together with the skill to successfully implement the change

5 Figure 1: WHY Centered Project Management Conclusion At 1251pm on Tuesday 22 February 2011 the lives of Cantabrians changed Most would find the changes difficult and challenging For many, coping with the aftermath would be devastating The problems we had to solve then, and continue to grapple with today, are complex However, this has given us the opportunity to innovate and make system changes that are being recognised on a global stage The Information Systems that support the Canterbury Health Sector are examples of rapidly developed, innovative, adaptive solutions, delivering timely and accurate information to Health Care Professionals leading to improved patient outcomes The work begun in 2007 to transform the way the health and social care system functioned in Canterbury continued post-quake and gave the opportunity to accelerate some changes and introduce several new ones I have shared with you my insights on how Project Management has shaped and been shaped by this environment Project Managers and Business Leaders, please consider this: The environment created by leaders is the biggest influence on project success and putting WHY at the center is key to delivering the best business outcomes Project Management can be reshaped by adopting an Agile Mindset thereby enabling you to deliver Continual Improvement in a complex and rapidly changing environment In today s challenging environment, the Agile Project Manager is well placed to reshape their skills, so they can deliver both projects and continual improvements References Philippus, E (2013) First there was the Agile Mindset, The Agile Mindset: part of the 21 st Century Skillset Timmins, N & Han, C (2013) The quest for integrated health and Social Care: A case study in Canterbury, New Zealand The King s Fund