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 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 2 FOR OFFICIAL USE ONLY
Agenda • • • Project Governance Background Industrial Engineering Approach at BUMED Example Project Governance • • • MTF Collaboration Program Lessons Learned Discussion 3 FOR OFFICIAL USE ONLY
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 4 FOR OFFICIAL USE ONLY
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 5 FOR OFFICIAL USE ONLY
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 6
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 7 FOR OFFICIAL USE ONLY
Typical Team Structure: MTF Project Meeting Frequency Sets objectives Clears obstacles, provides direction, leads communication plan Assists with data collection and validation, drafts policy, pilots change Oversight Committee: MTF Command Leadership, BUMED Leadership Steering Committee Departmental Leadership from Command Workstream 1 Workstream 2 Workstream 3 Working level analyst/MTF staff Kick-off Diagnostic Implementation Diagnostic: Bi-Weekly Implementation: Monthly Diagnostic: Weekly Implementatio n: Bi-Weekly 8 FOR OFFICIAL USE ONLY
Example MTF Project Situation § Surgery backlog and deferrals from Orthopedic specialty Example Task § Reduce delays and cancellations on Day of Surgery (Do. S) 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 9 FOR OFFICIAL USE ONLY
Example MTF Project: Ortho Surgical Flow Defined objective: Improve flow through Orthopedics in MTF Executive Committee: CO, XO, M 8, M 3/5 Refined scope: Reduce Ortho backlog, deferals Communicated to all DSS, standardized practices Directorate of Surgical Services Prioritized and approved suggested changes: Modify roles and responsibilities and policies Ortho Leadership Team: Ortho Dept Head, Specialty Advisor, Clinic Mgr, Workstream Leads Scheduling Lead data analysis, measure gap and pilot changes to move from current state to desired future state: Change policy for case sequencing, software settings, permissions, and requirements Pre Arrival & DOS Revise paperwork, patient test routing, and morning start up times Room Turnover Develop visual communication tools and create aligned specialty teams Data Diagnostics Create and define performance measures; allow for drill down to root cause and trending 10 FOR OFFICIAL USE ONLY
Example MTF Project: Ortho Surgical Flow Results
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 12 FOR OFFICIAL USE ONLY
Collaboration Example: WRAMC -NNMC Surgical Sets 987 Unique Sets WRAMC 1 common name 745 14, 421 Unique Sets NNMC Unique Instruments WRAMC 5502 (18%) common catalog codes 15, 731 Unique Instruments NNMC
Example Team Structure – Surgical Set Consolidation Workstream Oversight Committee NNMC Command WRAMC Command Steering Committee NNMC Leadership WRAMC Leadership DSS (Director of Surgical Services) Sterile Processing Department (SPD) Head Operating Room Chief Nursing Officer Workstream Process Improvement Analyst SPD Rep OR Rep Orthopedics Integrated Service Chief SPD Rep OR Rep Plastics Integrated Service Chief Cardio-Thoracic Integrated Service Chief General Surgery Integrated Service Chief Charge Nurse Charge Nurse Technician Technician 14 Technician FOR OFFICIAL USE ONLY
Collaboration Example: WRAMC -NNMC Surgical Sets Results Ø Decreased variability between sets and instruments Ø Prioritization of set requirements for flexible storage constraints Ø Clinical staff is now familiar with surgical sets from both facilities Ø Documented plan of set standardization with clinical ownership Ø Plan for migrating WRAMC inventory into Censitrac instrument tracking system
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 M 6 -NAVMISSA Implement tool at 8 MTFs with highest OB volume 16 FOR OFFICIAL USE ONLY
Program Governance Structure Coordination Required for the WOFT Project to come to Fruition: MTF Command requested/completed a MTF level project 1. Navy Medicine East/West BUMED Headquarters M 6 - IT NAVMISSA Program Manager IT Finance/PI M 8 - Finance M 81 Contractors Subcontractors Operations M 3 - Operations Advisory Board (Project Requestor) BUMED Rep. MTF Command OB Dept. Leadership MTF OB Staff FOR OFFICIAL USE ONLY FM Dept. Leadership MID Leadership MTF Staff 17
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 1. 2. Navy Medicine East/West BUMED Headquarters M 6 - IT NAVMISSA Program Manager IT Finance/PI M 8 - Finance M 81 Contractors Subcontractors Operations M 3 - Operations Advisory Board (Project Requestor) BUMED Rep. MTF Command OB Dept. Leadership MTF OB Staff FOR OFFICIAL USE ONLY FM Dept. Leadership MID Leadership MTF Staff 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 PAB requested an enterprise wide WOFT project 1. 2. 3. Navy Medicine East/West BUMED Headquarters M 6 - IT NAVMISSA Program Manager IT Finance/PI M 8 - Finance M 81 Contractors Subcontractors Operations M 3 - Operations Advisory Board (Project Requestor) BUMED Rep. MTF Command OB Dept. Leadership MTF OB Staff FOR OFFICIAL USE ONLY FM Dept. Leadership MID Leadership MTF Staff 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 Process Improvement Analysts collaborated with PAB and MTF OB Leadership to design/develop an enterprise wide tool 1. 2. 3. 4. Navy Medicine East/West BUMED Headquarters M 6 - IT NAVMISSA Program Manager IT Finance/PI M 8 - Finance M 81 Contractors Subcontractors Operations M 3 - Operations Advisory Board (Project Requestor) BUMED Rep. MTF Command OB Dept. Leadership MTF OB Staff FOR OFFICIAL USE ONLY FM Dept. Leadership MID Leadership MTF Staff 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 M 6 -NAVMISSA Governance Process was initiated 1. 2. 3. 4. 5. Navy Medicine East/West BUMED Headquarters M 6 - IT NAVMISSA Program Manager IT Finance/PI M 8 - Finance M 81 Contractors Subcontractors Operations M 3 - Operations Advisory Board (Project Requestor) BUMED Rep. MTF Command OB Dept. Leadership MTF OB Staff FOR OFFICIAL USE ONLY FM Dept. Leadership MID Leadership MTF Staff 21
Program Governance Structure Coordination Required for the WOFT Project to come to fruition: Process Improvement Analysts worked with local commands to pilot tool 6. Navy Medicine East/West BUMED Headquarters M 6 - IT NAVMISSA Program Manager IT Finance/PI M 8 - Finance M 81 Contractors Subcontractors Operations M 3 - Operations Advisory Board (Project Requestor) BUMED Rep. MTF Command OB Dept. Leadership MTF OB Staff FOR OFFICIAL USE ONLY FM Dept. Leadership MID Leadership MTF Staff 22
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 6. 7. Navy Medicine East/West BUMED Headquarters M 6 - IT NAVMISSA Program Manager IT Finance/PI M 8 - Finance M 81 Contractors Subcontractors Operations M 3 - Operations Advisory Board (Project Requestor) BUMED Rep. MTF Command OB Dept. Leadership MTF OB Staff FOR OFFICIAL USE ONLY FM Dept. Leadership MID Leadership MTF Staff 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 M 3/M 6/M 8 presented the project to the Capabilities Management Working Group (CMWG) 6. 7. 8. Navy Medicine East/West BUMED Headquarters M 6 - IT NAVMISSA Program Manager IT Finance/PI M 8 - Finance M 81 Contractors Subcontractors Operations M 3 - Operations Advisory Board (Project Requestor) BUMED Rep. MTF Command OB Dept. Leadership MTF OB Staff FOR OFFICIAL USE ONLY FM Dept. Leadership MID Leadership MTF Staff 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 M 3/M 6/M 8 presented the project to the Capabilities Management Working Group (CMWG) M 6 -NAVMISSA assigned a Program Manager 6. 7. 8. 9. Navy Medicine East/West BUMED Headquarters M 6 - IT NAVMISSA Program Manager IT Finance/PI M 8 - Finance M 81 Contractors Subcontractors Operations M 3 - Operations Advisory Board (Project Requestor) BUMED Rep. MTF Command OB Dept. Leadership MTF OB Staff FOR OFFICIAL USE ONLY FM Dept. Leadership MID Leadership MTF Staff 25
Program Governance Structure Coordination Required for the WOFT Project to come to fruition: 9. Process Improvement Analysts worked with local commands to pilot tool Process Improvement Analysts, PAB and MTF OB Leadership briefed BUMED M Codes M 3/M 6/M 8 presented the project to the Capabilities Management Working Group (CMWG) M 6 -NAVMISSA assigned a Program Manager 10. … TBD 6. 7. 8. Navy Medicine East/West BUMED Headquarters M 6 - IT NAVMISSA Program Manager IT Finance/PI M 8 - Finance M 81 Contractors Subcontractors Operations M 3 - Operations Advisory Board (Project Requestor) BUMED Rep. MTF Command OB Dept. Leadership MTF OB Staff FOR OFFICIAL USE ONLY FM Dept. Leadership MID Leadership MTF Staff 26
Ideal Team Structure – Program -Ultimate decision maker BUMED -Coordinator between codes, participating commands WOFT Program Owner -Subject matter experts providing advice to Program Owner Perinatal Advisory Board MTF Commands WOFT Working Group MTF Leadership -Provides guidance to codes and participating commands -Comprised of representatives from all M codes -Provide specialty support in areas required for program success -Provide specialty services M 6 - IT M 8 - Finance M 3 Operations MTF Staff 27 FOR OFFICIAL USE ONLY
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 28 FOR OFFICIAL USE ONLY
Lessons Learned Collaboration 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 29 FOR OFFICIAL USE ONLY
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 30 FOR OFFICIAL USE ONLY
Lessons Learned Governance 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 31 FOR OFFICIAL USE ONLY
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 32 FOR OFFICIAL USE ONLY
Implementation Example Implementation 1: OR Dashboard 3 rd 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 33 FOR OFFICIAL USE ONLY
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 34 FOR OFFICIAL USE ONLY
Discussion Remaining challenges § Leadership changes § Maintaining visibility § Identifying local ownership § Holding accountability § Determining when to move on 35 FOR OFFICIAL USE ONLY
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