As we look ahead to 2016, let’s look for new ideas and perspectives to improve our projects. An excellent starting point is the University Health Network (UHN) in Toronto, Canada which won the 2015 PMI Award for Project Excellence – North America award from the Project Management Institute earlier this year. This project has great lessons for us to learn, even if you have never worked in the health care sector.
Project At A Glance
- Project Name: Advanced Clinical Documentation Inpatient Electronic Patient Record (EPR)
- Project Purpose: Improve health care efficiency and patient care by delivering better digital tools to UHN professionals.
- Project Duration: Two years
- Project Budget: under $1 million dollars
- Project Impact: Significant time efficiency gains for all health professionals, increased collaborative culture and improved project management at the University Health Network (4 hospital system in Toronto)
Q&A With Joanne Hohenadel
Joanne Hohenadel is a senior project manager at the University Health Network. Her focus on the project was on the build and implementation aspects of the project. Joanne shared her perspective on the project in an interview with Project Management Hacks.
1. Imagine I’m a patient and seek care at UHN. What improvements will I notice and care about as a result of this project?
You will see better tracking of your health information. There will be less time wasted hunting for paper charts and forms. As you interact with different professionals, your information will be available to each professional from any computer throughout the hospital. Overall, you will experience more consistent and effective care.
2. Delivering efficiency improvements was a major focus for the project. How was this delivered?
The biggest efficiency improvement was digitizing and standardizing patient assessments. Right from the beginning, we understood that technology cannot drive practice. It can only seek to support it in the best way possible. We used best practice from research and input from all of our professionals to define the project’s deliverables
3. Does UHN have a goal to become a paperless organization? If so, how does this project fit into that goal?
It is an ideal to reach 100% paperless. There is still a long way to go to become paperless. Our first area of focus is patient documentation digitization. At first glance, paper may seem more convenient. Unfortunately, paper is easily lost and cannot easily by shared by multiple people at the same time. On the other hand, there are limits to digital tools. I still hear comments today that some of the systems require too many clicks to enter data.
4. How does this project improve timely provision of patient care?
It comes down to connecting information to our professionals when they need it. Once patient documentation becomes digital, we have the ability to monitor and provide alerts. It helps our staff become more proactive and timely in providing care.
5. At first glance, this project appears to have a pure technology focus. In fact, developing relationships and collaboration within the organization was a key goal. Tell us about the collaboration objective of the project.
Our success in inter-professional collaboration was a key reason I think this is an excellent project. Some of our professionals perform an assessment while entirely different groups use that health assessment. I learned that there are eight ways to take a patient’s temperature! Some methods are necessary for certain patient conditions and only used in special circumstances. The digital tool needs to support this but at the same time be efficient by providing ways to easily select the most commonly used methods without scrolling through long drop down lists. Also, different health professions use different terminology for the same or similar things. It was necessary to standardize some of this language when building digital tools, helping health professionals across the organization to share common understandings of a particular term.
To foster collaboration, we designed working groups that brought representatives of the professions together. We had nurses, physicians, speech and language experts and others in conversation during this project. Through those discussions, the project team was able to better understand clinical needs and workflow across professions.
6. A key contributor to the project’s success was participation in the University of Toronto’s Educating Health Professionals in Inter-professional Care certification program. What were the benefits of this program for your program?
It was the first time that project and technical teams went through this kind of education. The first benefit was creating a culture that viewed these key supporting professions as part of the health care team, a common identity. The program also provided excellent assistance in helping our team understand different perspectives. In health care, each profession has specialized language and terminology. This specialization sometimes creates communication difficulties. Going through this education program was a key reason for our improved inter-professional collaboration.
7. The project involved many different types of stakeholders with different backgrounds. What was your approach to stakeholder management?
Our stakeholder management approach used a few principles. We took advantage and encouraged “eager beavers” who volunteered to participate – it was great to work with stakeholders who are excited about technology and innovation. However, we needed to also be strategic. We needed good representation from the hospital sites and relevant professions. We needed leaders and we needed point of care expertise. We tried to engage resistors of change as well to help them understand and eventually promote the project’s benefits. Our approach to stakeholder management was a hybrid of volunteers and nominees to ensure we had the right people at the table.
8. What was your approach to change management and control in this project?
Our project had a sophisticated change management process. For example, we had guiding principles to evaluate each change as we moved through the process. These guiding principles made a big difference in bringing clarity to change request discussions. Major change topics of discussion included how to sequence our work and what to build first. We had to make some tough decisions related to additional tools and reports that needed to be added to the scope and, if something was added, re-evaluate what had to be taken away.
9. What was your approach to “hand holding” and providing support?
In the past, we had challenges with creating a sense of ownership for the project’s deliverables. We used to have the challenge of stakeholders feeling as though projects were done TO them. It’s much better to have a partnership view where everyone is doing the project together. We certainly provided support and training during the project as needed. However, we had great success with a “train the trainer” approach where one clinician would be able to support a peer.
In addition, we ensured that project communications came from a variety of sources not just the project team. Most of the project announcements came from the project clinical sponsors. That communication approach helped to create a sense of ownership.
10. This project emphasized a “Big Bang” approach to implementation. Why did you adopt this approach?
Ultimately, we adopted a hybrid go-live approach that combined technical “Big Bang” with a staggered roll-out approach. We launched the project at each hospital and made sure to have support available. This go live approach worked out well and we had good adoption.
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