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Collaboration and Governance Structure for Data Driven Projects

Collaboration and Governance Structure for Data Driven Projects. Context, Purpose, Outcome. 1) Context: Successful projects driven by data are critical to improving performance in Navy Medicine

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Collaboration and Governance Structure for Data Driven Projects

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  1. Collaboration and Governance Structure for Data Driven Projects

  2. 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 FOR OFFICIAL USE ONLY

  3. Agenda • Project Governance Background • Industrial Engineering Approach at BUMED • Example Project Governance • MTF • MTF Collaboration • Program • Lessons Learned • Discussion FOR OFFICIAL USE ONLY

  4. 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 FOR OFFICIAL USE ONLY

  5. 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 FOR OFFICIAL USE ONLY

  6. IE Approach Collaborative 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 FOR OFFICIAL USE ONLY

  7. Project Timeline • Process 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 FOR OFFICIAL USE ONLY

  8. Typical Team Structure: MTF Project Meeting Frequency Kick-offDiagnostic Implementation Diagnostic: Bi-Weekly Implementation: Monthly Diagnostic: Weekly Implementation: Bi-Weekly FOR OFFICIAL USE ONLY

  9. 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 FOR OFFICIAL USE ONLY

  10. 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 Develop visual communication tools and create aligned specialty teams Create and define performance measures; allow for drill down to root cause and trending Revise paperwork, patient test routing, and morning start up times FOR OFFICIAL USE ONLY

  11. Example MTF Project: Ortho Surgical Flow Results

  12. 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 FOR OFFICIAL USE ONLY

  13. Collaboration Example: WRAMC-NNMC Surgical Sets 987 Unique Sets WRAMC 14,421 Unique Instruments WRAMC 5502 (18%) common catalog codes 15,731 Unique Instruments NNMC 745 Unique Sets NNMC 1 common name

  14. Example Team Structure – Surgical Set Consolidation Workstream Oversight Committee NNMC Command WRAMC Command Steering Committee NNMC Leadership DSS (Director of Surgical Services) Sterile Processing Department (SPD) Head Operating Room Chief Nursing Officer WRAMC Leadership DSS (Director of Surgical Services) Sterile Processing Department (SPD) Head Operating Room Chief Nursing Officer Workstream Process Improvement Analyst SPD Rep SPD Rep OR Rep OR Rep Orthopedics Cardio-Thoracic General Surgery Plastics Integrated Service Chief Integrated Service Chief Integrated Service Chief Integrated Service Chief Charge Nurse Charge Nurse Charge Nurse Charge Nurse Charge Nurse Charge Nurse Charge Nurse Charge Nurse Technician Technician Technician Technician Technician Technician Technician Technician FOR OFFICIAL USE ONLY

  15. Collaboration Example: WRAMC-NNMC Surgical Sets Results • 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 • Documented plan of set standardization with clinical ownership • Plan for migrating WRAMC inventory into Censitrac instrument tracking system

  16. 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 • Coordination Required for the WOFT Project to come to Fruition: • MTF Command requested/completed a MTF level project BUMED Headquarters Navy Medicine East/West M6- IT M8- Finance M3- Operations MTF Command M81 Contractors Subcontractors Advisory Board (Project Requestor) NAVMISSA OB Dept. Leadership MID Leadership FM Dept. Leadership NAVMISSA Program Manager BUMED Rep. MTF OB Staff MTF Staff FOR OFFICIAL USE ONLY IT Finance/PI Operations

  18. Program Governance Structure • Coordination Required for the WOFT Project to come to Fruition: • MTF Command requested/completed a MTF level project • Perinatal Advisory Board (PAB) reviewed past projects and identified WOFT for enterprise wide roll-out BUMED Headquarters Navy Medicine East/West M6- IT M8- Finance M3- Operations MTF Command M81 Contractors Subcontractors Advisory Board (Project Requestor) NAVMISSA OB Dept. Leadership MID Leadership FM Dept. Leadership NAVMISSA Program Manager BUMED Rep. MTF OB Staff MTF Staff FOR OFFICIAL USE ONLY IT Finance/PI Operations

  19. Program Governance Structure • Coordination Required for the WOFT Project to come to Fruition: • MTF Command requested/completed a MTF level project • Perinatal Advisory Board (PAB) reviewed past projects and identified WOFT for enterprise wide roll-out • PAB requested an enterprise wide WOFT project BUMED Headquarters Navy Medicine East/West M6- IT M8- Finance M3- Operations MTF Command M81 Contractors Subcontractors Advisory Board (Project Requestor) NAVMISSA OB Dept. Leadership MID Leadership FM Dept. Leadership NAVMISSA Program Manager BUMED Rep. MTF OB Staff MTF Staff FOR OFFICIAL USE ONLY IT Finance/PI Operations

  20. Program Governance Structure • Coordination Required for the WOFT Project to come to Fruition: • MTF Command requested/completed a MTF level project • Perinatal Advisory Board (PAB) reviewed past projects and identified WOFT for enterprise wide roll-out • PAB requested an enterprise wide WOFT project • Process Improvement Analysts collaborated with PAB and MTF OB Leadership to design/develop an enterprise wide tool BUMED Headquarters Navy Medicine East/West M6- IT M8- Finance M3- Operations MTF Command M81 Contractors Subcontractors Advisory Board (Project Requestor) NAVMISSA OB Dept. Leadership MID Leadership FM Dept. Leadership NAVMISSA Program Manager BUMED Rep. MTF OB Staff MTF Staff FOR OFFICIAL USE ONLY IT Finance/PI Operations

  21. Program Governance Structure • Coordination Required for the WOFT Project to come to Fruition: • MTF Command requested/completed a MTF level project • Perinatal Advisory Board (PAB) reviewed past projects and identified WOFT for enterprise wide roll-out • PAB requested an enterprise wide WOFT project • Process Improvement Analysts collaborated with PAB and MTF OB Leadership to design/develop an enterprise wide tool • M6-NAVMISSA Governance Process was initiated BUMED Headquarters Navy Medicine East/West M6- IT M8- Finance M3- Operations MTF Command M81 Contractors Subcontractors Advisory Board (Project Requestor) NAVMISSA OB Dept. Leadership MID Leadership FM Dept. Leadership NAVMISSA Program Manager BUMED Rep. MTF OB Staff MTF Staff FOR OFFICIAL USE ONLY IT Finance/PI Operations

  22. Program Governance Structure • Coordination Required for the WOFT Project to come to fruition: • Process Improvement Analysts worked with local commands to pilot tool BUMED Headquarters Navy Medicine East/West M6- IT M8- Finance M3- Operations MTF Command M81 Contractors Subcontractors Advisory Board (Project Requestor) NAVMISSA OB Dept. Leadership MID Leadership FM Dept. Leadership NAVMISSA Program Manager BUMED Rep. MTF OB Staff MTF Staff FOR OFFICIAL USE ONLY IT Finance/PI Operations

  23. Program Governance Structure • Coordination Required for the WOFT Project to come to fruition: • Process Improvement Analysts worked with local commands to pilot tool • Process Improvement Analysts, PAB and MTF OB Leadership briefed BUMED M Codes BUMED Headquarters Navy Medicine East/West M6- IT M8- Finance M3- Operations MTF Command M81 Contractors Subcontractors Advisory Board (Project Requestor) NAVMISSA OB Dept. Leadership MID Leadership FM Dept. Leadership NAVMISSA Program Manager BUMED Rep. MTF OB Staff MTF Staff FOR OFFICIAL USE ONLY IT Finance/PI Operations

  24. Program Governance Structure • Coordination Required for the WOFT Project to come to fruition: • Process Improvement Analysts worked with local commands to pilot tool • Process Improvement Analysts, PAB and MTF OB Leadership briefed BUMED M Codes • M3/M6/M8 presented the project to the Capabilities Management Working Group (CMWG) BUMED Headquarters Navy Medicine East/West M6- IT M8- Finance M3- Operations MTF Command M81 Contractors Subcontractors Advisory Board (Project Requestor) NAVMISSA OB Dept. Leadership MID Leadership FM Dept. Leadership NAVMISSA Program Manager BUMED Rep. MTF OB Staff MTF Staff FOR OFFICIAL USE ONLY IT Finance/PI Operations

  25. Program Governance Structure • Coordination Required for the WOFT Project to come to fruition: • Process Improvement Analysts worked with local commands to pilot tool • Process Improvement Analysts, PAB and MTF OB Leadership briefed BUMED M Codes • M3/M6/M8 presented the project to the Capabilities Management Working Group (CMWG) • M6-NAVMISSA assigned a Program Manager BUMED Headquarters Navy Medicine East/West M6- IT M8- Finance M3- Operations MTF Command M81 Contractors Subcontractors Advisory Board (Project Requestor) NAVMISSA OB Dept. Leadership MID Leadership FM Dept. Leadership NAVMISSA Program Manager BUMED Rep. MTF OB Staff MTF Staff FOR OFFICIAL USE ONLY IT Finance/PI Operations

  26. Program Governance Structure • Coordination Required for the WOFT Project to come to fruition: • Process Improvement Analysts worked with local commands to pilot tool • Process Improvement Analysts, PAB and MTF OB Leadership briefed BUMED M Codes • M3/M6/M8 presented the project to the Capabilities Management Working Group (CMWG) • M6-NAVMISSA assigned a Program Manager • … TBD BUMED Headquarters Navy Medicine East/West M6- IT M8- Finance M3- Operations MTF Command M81 Contractors Subcontractors Advisory Board (Project Requestor) NAVMISSA OB Dept. Leadership MID Leadership FM Dept. Leadership NAVMISSA Program Manager BUMED Rep. MTF OB Staff MTF Staff FOR OFFICIAL USE ONLY IT Finance/PI Operations

  27. Ideal Team Structure – Program FOR OFFICIAL USE ONLY

  28. 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 FOR OFFICIAL USE ONLY

  29. 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 FOR OFFICIAL USE ONLY

  30. 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 FOR OFFICIAL USE ONLY

  31. 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 FOR OFFICIAL USE ONLY

  32. 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 FOR OFFICIAL USE ONLY

  33. Implementation Example Implementation 1: OR Dashboard 3rd party reliance No single point of ownership Relatively low visibility, sustained interest Implementation 2: Scheduling Template Local ownership Immediate feedback Complete authority within project governance FOR OFFICIAL USE ONLY

  34. 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 FOR OFFICIAL USE ONLY

  35. Discussion Remaining challenges • Leadership changes • Maintaining visibility • Identifying local ownership • Holding accountability • Determining when to move on FOR OFFICIAL USE ONLY

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