Practical Project Management for Informatics

How to manage a project without losing your mind!

Pathology Informatics 2014

API Session

J Mark Tuthill, MD
Division Head, Pathology Informatics
Department of Pathology & Laboratory Medicine
Henry Ford Hospital
Detroit, MI
[email protected]
 Disclosures

In the past 12 months, I have not had a significant

financial interest or other relationship with the
manufacturer(s) of the product(s) or provider(s) of the
service(s) that will be discussed in my presentation.

J. Mark Tuthill, MD, Henry Ford Hospital

 Goals and Objectives

• Review key concepts in project management

• Discuss the phases of the project life cycle
• Present our HFH Project Planning packet
• Provide tips for project team creation and
communications
• Present practical Considerations in real world project
management for systems implementation in relationship
to institutional planning

J. Mark Tuthill, MD, Henry Ford Hospital

 The project manager walks into his boss' office
and says, "Here is the bottom line budget
needed for the success of the project."

The boss says, "What can you do for half the

money?"

The project manager says, "Fail."

The boss says, "When can you get started?"

The project manager says, "I think I just did."

from Jokester.com

J. Mark Tuthill, MD, Henry Ford Hospital

 Introduction to Project Management

J. Mark Tuthill, MD, Henry Ford Hospital

 What is a Project?

• A Focused effort that is temporary

– Leads to an operational entity…
• Begins, ends and has duration
• Requires resources and planning
• Based on accomplishing a goal for a customer team
• Our discussion will be focused around laboratory
software selection and implementation

J. Mark Tuthill, MD, Henry Ford Hospital

 What is Project Management?

• A Science:
– Project Management is a formal profession with
degrees available
• Often businesses will fund training for
professionals such as engineers or software
developers to become Project Managers
• Certified project managers
• NOT a computer program
– People plan and manage projects not software
– Software can help manage complex projects, but so
can simple planning and communication strategies
• More than a project plan!
– The plan is one part of the project management

J. Mark Tuthill, MD, Henry Ford Hospital

 Managing the Project

• Scope
• Time
• Money
• Quality
• Communications
• Human Resources
• Procurement of materials and services
• Risk awareness and mitigation
• Coordination and management

J. Mark Tuthill, MD, Henry Ford Hospital

 The Project Life Cycle

• Initiating the project

– Often customer driven
– Leadership approval and support
• Planning
– Includes capital financial and resource plan
• Execution
– Monitor and control
– Iterative cycle of effort
• Project closure
– Training, Operations, Support

J. Mark Tuthill, MD, Henry Ford Hospital

 Initiation

Selecting a System

J. Mark Tuthill, MD, Henry Ford Hospital

 Initiation Activities

• Requirements
– Customer needs
– Leadership’s desires
• Project definition, description, and scope
– An overview document
• E.G. Rough order of magnitude
– May include an early description of project plan and
execution as well a budget guestimates
• The is where the RFI/RFP process fits into a project

J. Mark Tuthill, MD, Henry Ford Hospital

 Initiation Activities

• Project proposal
– The business case
– Budget analysis, required
– Rough order of magnitude (ROM)
• Project “charter”
– An agreement or statement of work
– This term is often used by project managers to set the
rough “rules of the road”
– Signatures from authorizing individuals on the part of
the system provider and the customer

J. Mark Tuthill, MD, Henry Ford Hospital

 Initiation Activities

• Project planning process and may over lap and be an

iterative process
– Initiation will lead to a plan
– Planning informs initiation
• When is capital obtained?
– I have seen projects funded prior to a formal initiation
process
• This is dangerous as planning is not often deep
enough to understand budgets or resource
requirements
• Initiation without planning and capital leads to disaster
J. Mark Tuthill, MD, Henry Ford Hospital
 Purchasing an LIS: The RFI

• Submit a Request For Information to vendors

• In the RFI ask for:
– System description
– List of features
– List of instrument interfaces
– Client list
– List of system interfaces
– Database description
– Support policies
• Eliminate all but 3 (or so) vendors

J. Mark Tuthill, MD, Henry Ford Hospital

 Purchasing an LIS: The RFP
• Submit a “Request For Proposal” to the vendors
chosen
• In the RFP ask for:
– A full system user manual
– A detailed description of features
– Hardware and software support details
– Hardware and software specifications
– Customizations you would like to have made
– Interfaces you would like to have written
– Printout of all reports
– A full quote and contract with deliverables
– Ball park costs ? RFQ ?
• Set up on-site demos
• Talk to current clients and visit some sites
J. Mark Tuthill, MD, Henry Ford Hospital
 When does the project really start?

• Once your funded

– When you get the capital your problems begin…
• Once you select a system
• When the system is purchased
• When you have time
• Once you have a plan in place

J. Mark Tuthill, MD, Henry Ford Hospital

 Planning the Project

J. Mark Tuthill, MD, Henry Ford Hospital

 Components of Project Plan

• Project budget (high level)

• Work break down structure (WBS)
• Project schedule
– Gantt Chart
• Logic diagram (Network diagram)
– PERT Chart
• Formal Project Plan
– Supporting Documents
– Project planning packet

J. Mark Tuthill, MD, Henry Ford Hospital

 Components of Project Plan

• Project budget
– Key component to success is a realistic well planned
budget
• Beyond scope to go into too much detail
• Challenge is to account for all aspects of a budget
– Capital budget
– Operational budget
– Contingency 10-20% of total budget depending on
complexity of project and overall cost
• Get help from anyone you can (mentors)

J. Mark Tuthill, MD, Henry Ford Hospital

 Components of Project Plan

• Work break down structure (WBS)

– 20th century concept (Henry Gantt,1861–1919)
• Leads to the Gantt Chart
– In project management and systems engineering, is a
deliverable oriented “decomposition” of a project into
smaller components
– It defines and groups a project's discrete work
elements in a way that helps organize and define the
total work scope of the project
– WBS is not an exhaustive list rather it is a
classification of project scope and activities

J. Mark Tuthill, MD, Henry Ford Hospital

 Components of Project Plan

• Project schedule (Gantt Chart)

J. Mark Tuthill, MD, Henry Ford Hospital

 Problems with Gantt Charts

• Gantt charts are oversimplifications

• Managers try to define the project work breakdown
structure at the same time that they define schedule
activities
– WBS should be fully defined, then the project
schedule can be designed
– No matter what we do, reality intervenes and
schedules are always impacted
• WBS can change if project changes: Scope Creep
– This changes resource requirements and timelines
• Timelines can be impacted by factors outside the project
• Focus on managing the Gantt chart versus the actual
project
– This is very common with managers who use
complex software to manage projects
– Watch out for revisionist history to the dates in the
Gantt Chart
J. Mark Tuthill, MD, Henry Ford Hospital
 Components of Project Plan
• The Program (or Project) Evaluation and Review Technique,
commonly abbreviated PERT
• a tool designed to analyze and represent the tasks
– Commonly used in conjunction with the critical path method
(CPM)
• PERT charts can better demonstrate the critical path timelines
within a project
– Aka: Logic diagram (Network diagram)
• Not all projects require PERT chart level analysis
– Depends on whether a project is mainly serial steps or
whether a project has many parallel tasks with
dependencies
– A network diagram better outlines interrelated activities
J. Mark Tuthill, MD, Henry Ford Hospital
 PERT Chart

PERT network chart for a seven-month project with

five milestones (10 through 50) and six activities (A
through F).
J. Mark Tuthill, MD, Henry Ford Hospital
 Components of Project Plan

• Formal Project Plan: “Project Planning Packet”

– Use a template that includes (available upon request):
• Narrative description
• Budget
• Team members and roles
• Schedule
• Issue tracking
• Training
• Links to all associated documents
• Activation plan

J. Mark Tuthill, MD, Henry Ford Hospital

 Project Execution

J. Mark Tuthill, MD, Henry Ford Hospital

 Project Execution

• Purchasing and contracting

– When the project really starts
• Progress “evaluation”
• Project change notices
• Project status reports
• Project plan updates
– Project plans are NOT static

J. Mark Tuthill, MD, Henry Ford Hospital

 Project Execution

• Really about managing communications

– Planning, scheduling, and working tasks is easy
– Communication across teams is a challenge
• When communication fails, projects fail
• All aspects of execution should be captured
– Use meeting minutes
– Add documents to project plan packet
– Update the project plan
– Think about training early

J. Mark Tuthill, MD, Henry Ford Hospital

 Project Closure

J. Mark Tuthill, MD, Henry Ford Hospital

 Project Closure

• Dash board, task lists (Punch list)

• As project come to completion remaining tasks
become very clear
• Training
– Easy to forget training requirements
• Many project fail do to poor training plans and
emphasis
– Training requires user involvement
• Operations
– Updating design documents, support documents
– Transferring responsibility
J. Mark Tuthill, MD, Henry Ford Hospital
 Project Closure

• The Launch
– Command and control center
– Communications plan
– Back-out and contingency planning
• Summation to leadership
– Opportunities for improvement
– Reward for team members and customers
• Celebrate success for the best future projects

J. Mark Tuthill, MD, Henry Ford Hospital

 Real World Experiences

Some Practical Concerns and Examples

J. Mark Tuthill, MD, Henry Ford Hospital

 Managing Change

• All project have changes; it is inevitable

• Changes need to be managed or it can kill a project
• The most common changes is increased scope or
“scope creep”
– This can be due to poor project planning and analysis
– Often due to a desire to increase functionality during
a project
– Sometime due to new technical or regulatory
requirements
The Iron Triangle
Work

Scope
Increase the Size of the
Project, all legs
increase…

Work
Scope
 Decrease the duration of the project, but
scope remains the same=increased cost
Schedule

Time

Work

Scope
 You Can Have It!

• Design something quickly and to a high standard, but

then it will not be cheap.
• Design something quickly and cheaply, but it will not be
of high quality.
• Design something with high quality and cheaply, but it
will take a relatively long time.
 Evaluating Your Needs

• Assumption: we know now what we need in the future

Wrong!

J. Mark Tuthill, MD, Henry Ford Hospital

 Evaluating Your Needs
Guiding Thoughts

• Functional needs
– needs analysis
• Operational needs
– Operations review; may relate to LEAN process
• Workflow and work process mapping can highlight
needs!
• Service delivery: tracking for outreach
– interface requirements
• Performance needs
– Number of users
– Number of institutions, geography
– IT environment
J. Mark Tuthill, MD, Henry Ford Hospital
 Evaluating Your Needs

• Feature driven approach

– Will resonate with end users
• What features does your current LIS lack?
• What features would improve your lab process?
• Technology driven approach
– What technologies will work in our environment?
– What technologies can improve LIS operations,
management, functionality?

J. Mark Tuthill, MD, Henry Ford Hospital

 Evaluating Your Needs

• SWOT Analysis (Strength, Weakness, Opportunity,

Threats) “Needs Analysis”
– Generic approach
– Gather information from each area that uses or will
use the LIS
• Get to the dirty laundry
– Meet with users outside selection team meetings
– Share information with team members

J. Mark Tuthill, MD, Henry Ford Hospital

 Evaluating Your Needs

• Key factors that need to be evaluated in the needs

analysis and that will drive system selection
– System functionality
– Compatibility and synergy with other systems and IT
environment
– Scalability
– Cost
– Interaction with other vendors systems and health
system vendor portfolio
– Support and maintenance costs and human resources
– Vendor stability

J. Mark Tuthill, MD, Henry Ford Hospital

 Evaluating Your Needs
Challenges

• Needs analysis is poorly understood process for most

labs
• Workflow and SWOT analysis of current system can help
focus thinking
– Don’t perpetuate current bad practices
– Involve other departments and understand their needs
• Usually this is not done!
• Technophobia can hamper progress!
• System is often blamed for poor operations or workflow
design

J. Mark Tuthill, MD, Henry Ford Hospital

 Evaluating Your Needs
Details

• System Selection-General Issues

– Lab Environment
• Volume of testing
• Number of users
• Number of sites (geographic)
• More than one hospital
• Inpatient, Outpatient, Outreach mix
• Billing processes
• Support team
• User sophistication

J. Mark Tuthill, MD, Henry Ford Hospital

 Evaluating Your Needs
Details

• System Selection-General Issues

– IT environment
• Data center vs. department hosted vs. ASP
• Support process
• Interface engine
• EMR vendor
– Orders versus results only
• Hardware platform expertise
• Software platform orientation
• Network topology, protocols

J. Mark Tuthill, MD, Henry Ford Hospital

 Evaluating Your Needs
Details

• Clinical Pathology System Selection

– List of instrument vendors and interfaces
– Areas of laboratory currently on system
• Desire to expand support?
– Current vendor
(Strength, Weakness, Opportunity, Threats)
– Get into the mud!
– Number of users
– Number of locations
• Single versus multiple hospital

J. Mark Tuthill, MD, Henry Ford Hospital

 Evaluating Your Needs
Details

• AP System Selection
– Are you using an AP system?
– Data conversion issues
– Interfaces to equipment
• Less of a challenge than CP system
– Interfaces to other systems
– Need for outreach?
– Imaging support

J. Mark Tuthill, MD, Henry Ford Hospital

 Practical Concerns

• Advanced functional requirements

– Web accessibility
– Remote support and operations
– Advanced interfaces to instruments
– System monuments: back end systems
– Tracking of samples
– Automation
• What works well in our current LIS?
– What doesn’t? What are we looking for?

J. Mark Tuthill, MD, Henry Ford Hospital

 Practical Concerns
Vendor Selection Issues

• Application features are important but may be less so

than:
– Integration across systems
– Support
– Innovation and creative partnering
• Single vendor versus “best of breed”
– Complex question driven by many different players
• Historical relationships
• Upgrade versus replace
– Hardware, software, infrastructure

J. Mark Tuthill, MD, Henry Ford Hospital

 Practical Concerns
• Workflow Design and System Implementation
– Outweigh any single application feature
• Good application will be lost in poor system implementation
– User’s must design workflow
• To do so they must understand opportunities available to them
in the “new” system
– Develop champions for each lab area and train them!
– Prioritize what will be addressed over time
– Plan for the future!
• You can’t do everything at once
• Things will change
• Choose a vendor and system that will grow with you
– TEST, TEST and TEST some more!

J. Mark Tuthill, MD, Henry Ford Hospital

 Project Teams

Selection, Implementation, Operations

 Evaluating Your Needs
“Needs Inventory”

• Create a process: Team Building

– What information needs to be gathered?
• Dependent on species of system you’re selecting
– Who needs to be involved?
• Key stake holders
• What level of the organization?
– Deeper than system implementation team
– How long do you want to take?
• Process is never complete
• Laboratory is very complex
• Needs change

J. Mark Tuthill, MD, Henry Ford Hospital

 System Selection Team

• Create a formal team to participate in system selection

– Will be different than implementation team
– Make sure there is some overlap with implementation
team
• As you form this team make sure you consider
who would be involved in implementation
– Participants should be able to marshal end user’s
– Look for members who are committed to the process
– Include the “nay sayers”

J. Mark Tuthill, MD, Henry Ford Hospital

 System Selection Team

• Engage team for selection at the beginning of the

process
– Many times system selection is “done to you”
• This a bad way to start a long, hard process
– Create buy in to process
• Make these folks stake holders in selection
• Pay off at implementation!

J. Mark Tuthill, MD, Henry Ford Hospital

 System Selection Team

• Capture work!
– Process is irrelevant if data is not captured
– Plan for administrative support
• Meeting minutes
• Schedules
• Communication of status
– Use spreadsheet, word processing documents
PowerPoint
• More on this in evaluation of need and data gathering
– Put data online for easy communication and storage
• Website for system selection

J. Mark Tuthill, MD, Henry Ford Hospital

 System Selection Team

• Educate the team

– Selection process
– Technology issues
– Feature selection issues
– Don’t assume anything
• People bring great ideas and talent
– Work to separate technology, system features and
workflow issues
– Demo’s and site visits

This is a great time to “raise the floor” on computing

skills and IT

J. Mark Tuthill, MD, Henry Ford Hospital

 System Selection Team

• Who?
– Get the chairman involved!
• Kick off speech
– Pathologists
– Medical technologists
– Clerical staff
– Lab administration
– IT teams: IT steering committee? IT Integration Committee?
– Consultant
– Health System leadership?
• Participants can drive data collection from other personnel
– Not every person needs to be on the team

Watch out for becoming top heavy

– Get people who use the current system daily and really know
what works and what doesn’t
J. Mark Tuthill, MD, Henry Ford Hospital
 System Selection Team
Consultants

• The right consultant is invaluable!

– The wrong consultant will create a train wreck
• Use consultants judiciously
– What is your internal capacity?
• Expert consultants can save you a lot of time and money
– Bring professional approach to process
– Keep you on track
– Can bridge planning and implementation
– Can assist in compiling data gathered in response to
proposals
• There are valuable expert consultants out there!
• Don’t be embarrassed to use a consultant!
J. Mark Tuthill, MD, Henry Ford Hospital
 System Selection Team

• Plan who will have final say in selection

– Process should be formal
• Decide in advance how vendors and systems will
be ranked, compared
– Objective
– Subjective
– Use both

J. Mark Tuthill, MD, Henry Ford Hospital

Project Meetings
 Kinds of Meetings

• Administrative
• Working
• Communication
• The concept of “scrum”
• “Touch points”
 Meeting Guiding Points

• Schedule meetings
– Plan how long you expect to engage in pre-planning
– Schedule meetings formally in advance
• Weekly or bi-monthly minimum
– Adhere to the schedule
• Canceled meetings send a message!
– Keep and publish minutes

J. Mark Tuthill, MD, Henry Ford Hospital

 Meeting Guiding Points

• Over communicate process issues

– Committee charge
– Where in the process are we?
– What have we done?
– What is next?
• Time and attendance will be a problem, plan on it
• Use the correct meeting format for the task at hand
– Don’t include administrative layer in technical
meetings!
• Why Scrum?
– The value of small focused teams working specific
aspects of a project

J. Mark Tuthill, MD, Henry Ford Hospital

Budgeting and Institutional Planning
 Budgets
• Budgeting and resources
– Capital budget for initial systems purchases
• Plan and budget for ancillary systems (SLAM’s Middleware)
• Contingency
– Operations budget
– Development budget
– Human Resources
• Deployment
• Operation
• Continued development
• Training resources
• Subject matter experts
• Time and human resources are your most precious commodities
– How will implement and design and still get the day’s work done?

J. Mark Tuthill, MD, Henry Ford Hospital

 Institution Planning
• SWOT Analysis can lead to justification for capital
purchase
– Also creates raw material for bid solicitation
• LIS purchase is a capital request for a lot of money: who
do you need to convince?
– Does lab have its own IT budget?
• Chairman
– Is capital for LIS part of institutional pool?
• CEO, CIO
• Some level of lobbying for capital should precede
development of process
– No money, no LIS

J. Mark Tuthill, MD, Henry Ford Hospital

 Institution Planning

• If IT budget is part of central IT group, there may be a

desire for IT to select a system for you…
– This is not a good thing
• Get IT on the selection team
• Show IT you know what you are doing
– Meet with CIO early
– IF IT is going to lead the process, make sure lab has
a leadership role on the selection team

J. Mark Tuthill, MD, Henry Ford Hospital

 Institution Planning
• Develop a concrete budget and allocate ample funds for
system design, selection, implementation
– This may need to occur prior to submitting a request
for proposal to vendors
• Catch 22
• Use system cost of similar colleagues to get close
• RFQ: request for quotation?
– Plan to revise budget as proposals come in and
vendor is selected
• Build in significant contingency money
– Don’t forget the cost of ongoing support
• There will be budget shortfalls regardless of how you
proceed
– Contingency funds of 10-20%
J. Mark Tuthill, MD, Henry Ford Hospital
 Institution Planning
• Tie lab system replacement to other major institutional
initiatives
– EMR build
– Purchase of new hospitals and clinics
– Expansion of clinical services
• Outreach
– New centers of excellence
– Patient safety
– Customer satisfaction
– Pay for performance
– Process improvement: LEAN, Toyota, Six Sigma
– All of these at once!

J. Mark Tuthill, MD, Henry Ford Hospital

 Institution Planning

• Be aware of institution wide projects and resource

availability
– You will come up financially short
– Project will take longer than hoped for
– Do it right!
• No one remembers a system coming up a few
months late
• No one forgets a train wreck!

J. Mark Tuthill, MD, Henry Ford Hospital

 Concluding Remarks

J. Mark Tuthill, MD, Henry Ford Hospital

 Sequential List of Steps in implementing a Project

• Gather and describe goals and objectives

• Selecting a system to implement: RFI, ROM, RFP
• Financing the purchase (Capital)
• Creating a project plan ROM  PPP
• Resourcing the project as outlined
– Time, space, personnel, capital, assets
• Organizing the project team, communications, meeting schedules
• Designing and building the project, iterative design, validation and
testing
• Simulation workflow
• Training (team members, end users)
• Activation
• Operations

J. Mark Tuthill, MD, Henry Ford Hospital

 Key Mistakes in LIS Implementation
• Trying to automate too many of your existing processes
too soon
• Weighting internal lab features too high
• Weighting core system technologies too low such as
– Hardware
– Database flexibility
– Networking standards
– Open system design
• Weighting order entry and reporting too low
• Not planning enough time to do the job
• Not involving all system users in advance

J. Mark Tuthill, MD, Henry Ford Hospital

 Don’t forget to Plan for Updates!
• Updates, Upgrades, New systems
– Informatics landscape is never stable!
• Disruptive technology
– All updates and upgrades require significant
validation testing
• Involves personnel across an institution
• Lab is typically and comparatively very thorough
about this
– New systems require new resources
• Rarely actualized

J. Mark Tuthill, MD, Henry Ford Hospital

 Why do system implementations fail?

• Flawed selection process

– “decide how to decide” -Braley
• Poor planning
• Poor communication
• Wrong people involved
– Too many people involved
– Too few people involved
• Lack of alignment with institutional goals
– Budget
– Project collisions

J. Mark Tuthill, MD, Henry Ford Hospital

 The End

Questions?

J Mark Tuthill, MD
Division Head, Pathology Informatics
Department of Pathology & Laboratory Medicine
Henry Ford Hospital
Detroit, MI
[email protected]