Pre Project Steps Tutorial

2.1 Module-2 Pre-Project Steps

Let us begin with the first topic of this module in the next screen.

2.2 Topic 1 How To Recognize a Potential Project

How to recognize potential projects ? (Show image 1 on the slide) Have you ever been frustrated because you had to do something over again because it wasn’t done right the first time? (Show image 2 on the slide) Have you ever check a chart only to notice a co-worker must have forgotten to enter the patient’s vitals they would have already checked? (Show image 3 on the slide) Have you ever reach for latex gloves as you enter an examination room only to find that the box was empty? These are all signs of opportunities to improve processes. We literally encounter dozens of such scenarios every single day. So, how do we decide which to tackle?

2.3 Topic 2 How To Get Buy-In

So now that you have a potential project, you need to make sure that everyone who is impacted by the process is on board to fix it, and you need their commitment to support you in your improvement efforts. This implies 2 things, firstly, you know who those people are and secondly, you have a way of clearly communicating your project description and objectives to them so that you can obtain their endorsement to do the project and support to move ahead with the improvements. In order to accomplish this, we’ll be covering 2 useful tools; the WIIFM and the Project Charter in the coming screens. The next screen will focus on WIIFM.

2.4 Topic 3 How To Scope a Project

The term scope has to do with defining limits or boundaries. As we clearly see from a SIPOC, each process has a defined beginning and end. It starts with an input and ends with an output. Some processes have many steps in between while others have very few. Determining the scope of a project is simply a matter of deciding what will be the boundaries or limits of the improvement effort. For example, let’s say that the hospital has an objective to reduce discharge times. This is a rather large process that impacts many departments. The maternity ward decides to embark upon a project that will have an impact on this objective.   Their project will obviously be scoped in such a manner as to be limited to the discharge of patients from within the maternity ward. A project may be even scoped further to a particular subset of patients or processes, for example, those who have undergone a C-section.   The reason a project is scoped is to clarify as much as possible and develop a common understanding of what the project is all about, who is involved, what is impacted and excluded, and what the expected results will be.   A good way to visualize what the scope of a project should be is to think of a picture frame. Anything inside the frame is within the scope of the project while anything outside the frame is not.   We can then consider the People, Processes, and Technologies related to the process and determine whether or not they go inside or outside the frame.   Continuing with our maternity ward example, the staff has decided that only the patients who have undergone a C-section are within the frame. All others are outside the frame. The process under improvement starts from the moment the Doctor gives the order to discharge the patient and ends when the patient actually vacates the room. Anything prior to or after that is outside the scope of the improvement project.   The staff also determined that for this project, they would not look at medical practices, only administrative ones. Finally, the project team is to limit themselves to existing information systems as the hospital is not about to approve any new IT projects.   Framing a project in this manner makes it very clear what the project is about, who and what it impacts, and what the limitations are.   This helps manage expectations and also keeps everyone focused on what the intent of the project is. Now let’s look at how this fits into the Project Charter on the next screen.

2.5 Topic 4 Importance of Project Management

As with any projects Lean Six Sigma projects also follow the typical project lifecycle; Initiation, Planning, Execution, and Closure. The 5 steps of the DMAIC process improvement are simply overlaid on the project lifecycle.   The key point here is that without proper project management techniques, a Lean Six Sigma project leader will face significant challenges to successfully complete the project.   Typical challenges include, dealing with uncertainty, managing and motivating the team, dealing with obstacles, and communication.   These are all common to projects of any nature, not just Lean Six Sigma projects.   Effective project managers learn how to manage and deal with these challenges, and so should Lean Six Sigma project leaders. The better prepared you are to deal with them, the greater the likelihood of success but there will always be uncertainty and/or risk in some form or another.   Uncertainty can be encountered throughout the entire project. At the beginning, the project team can be uncertain of the objective or of their role on the team. The people involved in the process may be uncertain of what the project is about (and apprehensive to cooperate). Stakeholders may be uncertain of what it has to do with them or unsure of the magnitude of the problem.   As was illustrated earlier, the project charter can be an extremely useful document to take some of this uncertainty away. Communicating the key messages from the charter can serve to explain what the project is about and why it’s important.   In essence, the key to overcoming uncertainty is to communicate openly and effectively to all stakeholders.   Lean Six Sigma projects require the involvement of people. As such, project leaders must be proficient at managing and motivating their project teams. If a team is ineffective, the project will stagnate.   As with any project, Lean Six Sigma projects will encounter obstacles along the way. Some people thrive on adversity while other run from it. At times like these, it’s important not to lose site of the objective. Tenacity, problem-solving, and a certain amount of stubbornness on the part of the project leader and members of his or her team will go a long way from turning obstacles into challenges. Don’t underestimate human potential and resilience to overcome.   Communication is a necessity and a constant challenge in any project. Unfortunately, many projects underestimate how much they should communicate and treat it as an afterthought. This can lead to much larger issues later such as resistance to change.   In addition to carrying out the DMAIC steps, an effective Lean Six Sigma project leader will communicate effectively, openly, regularly, and strategically to ensure a successful project.

2.6 Topic 5 Case Study

The Board of Directors at Mercy West regional hospital have a problem. They are overflowing in the ED and have no more bed capacity. People are in the hallways on gurneys waiting for a bed, the staff is overworked, there is higher risk of infection and errors, and it’s not getting any better.   As a matter of fact, recent data shows that the average wait time in the ED has steadily increased by at least 10% a month for the last 14 months and ED walk-outs have also increased.   The problem is that there are no other primary care facilities for 50 miles and there is no capital available to increase the number of beds, so a more economical solution must be found.   The board decided to launch a lean Six Sigma project to try and find a way to improve the situation.   They have a certified Green belt on staff named John who just came on board from another hospital in the city to work in the ED.   The board appointed John as the project leader. Being new to Mercy West, John wasn’t familiar with the hospital processes, so he decided to do his own, “go and see” so he could witness the problem first-hand.   Starting in the ED, John witnessed dozens of people waiting to be seen by a doctor, and then about a dozen more waiting to be admitted. He noticed that many procedure rooms were occupied, but not all.   In the hallways, he confirmed there were people on gurneys waiting to be transported to the other departments.   In radiology, he saw another queue.   The ORs seemed busy as well, but 3 of the 6 were not used.   The rooms in the wards were completely full.   Finally, the administrative offices were closed when John walked past 8 pm.   John’s walkabout seemed to confirm what had been shared with him by the Board. Since it’s not clear what the problem is, nor how to fix it, John decided that he needed to do some data gathering in order to properly identify the problem because as it stood, the scope of the project was much too large.   John created a high level Value Stream Map to represent the process (or flow) of the patient from arrival at ED until discharge.   From there, he identified the bottlenecks and decided to scope the first project to alleviate the bottleneck at the back end of the Value Stream first – discharge cycle time.   John decided to work on this part of the overall process first because if he made an improvement here, it may unblock the flow upstream. As opposed to making admissions more effective and just increasing the backlog of patients waiting for space in the wards.   John then prepared his SIPOC for the discharge process, identified the stakeholders, determined the WIIFM, created his Project Charter sections including the Problem Description, Process and Project Scope & Boundaries, Project Goal & Benefits, Resource Requirements, and Timeline.   He then approached the process owner with his proposal and obtained his Sign-off to commence the project with his team.   Finally, John communicated the project to his team and to other stakeholders in the hospital by using the information contained in the project charter. He explained that he would be tracking progress of the project against the planned timeline because it was important to stay on track so that the benefits can be realized and they can make further improvements up the value stream.

2.7 Quiz

Following is the quiz section to check your understanding of the module.

2.8 Summary Conclusion

In this module we discussed some of the important foundational elements that are necessary to start an improvement project on the right foot. We saw that without these preliminary considerations and steps, projects can encounter roadblocks, or worse yet, never get realized, which is a complete waste of everyone’s time and effort.   First we reviewed how to recognize potential improvement opportunities and then how to check if they are good candidates for actual Lean Six Sigma projects. Then, we looked at how to get the buy-in to commence the project. From there, we learned how to properly scope the project and set the stage to manage the improvement effort in the best way possible.   We concluded the module with a case study in a hospital setting that served to illustrate how these elements all fit together in a practical setting. In the next module, we will start the DMAIC process by Defining the problem.

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