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Project Background
A cross-functional collaboration among professionals in various fields of practice is essential to improve the quality of their work. Particularly, this statement is relevant for integrating project management skills in healthcare where the role of process planning is obscured with the sense of urgency and the need of supporting patients based on sporadic requests. Meanwhile, referring to the case described by Kiisel (2011), it is obvious that implementing even basic project management techniques such as using checklists appears to be positive for improving surgery operations and practices, even if some surgeons remain unsatisfied. Hence, this report provides details for the training project aimed to improve surgery practices by using project management techniques in hospitals.
Project Scope
The formal requirements for the project scope are outlined as follows:
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To explore how standard project management techniques could be applied to the case of surgery operations in a chosen hospital
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To develop a set of practices such as using checklists, quality assurance planning, team collaboration, and reporting to ensure that surgeons are able to share best practices and consult each other as productive team members
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To address the great struggle in medicine related to ignorance and uncertainty, as mentioned by Kiisel (2011)
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To contribute to a new healthcare paradigm such as surgery management that would eventually improve the quality of healthcare services delivered by surgeons
Project Deliverables
The following deliverables were identified for the described project:
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The success rate of each complex surgery in a chosen hospital setting is improved by 5% in three months from the initiative implementation, and 10% consecutively within 1 year.
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The average time for completing surgery operation is reduced on average by 1 hour for basic surgery operations, and by 30 minutes for more complex surgery operations
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All surgeons in a hospital recognize the importance of using proposed project management tools and report a 90% satisfaction rate in a survey analysis
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Surgeons operate as a team and share their examples of work as best practices through the lessons learned session conducted bi-monthly.
Project Constraints
The following constraints were identified for the described project:
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The integration of project management practices is limited to the surgery department of the chosen hospital only based on the approval by the head of cardiology. However, it is possible that these practices will be expanded to other departments if project deliverables are met.
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The training of surgeons will require their presence in remote location; hence, it will be scheduled per their availability during three months. However, if there is a consecutive no-show of training participants, the company will not guarantee the extension of training sessions
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Project training will be based on PMBOK standards and does not assume any alternative methodologies proposed or insisted by the surgery department
Stakeholder Analysis
Training needs for the described project require the involvement of several stakeholders to ensure that knowledge acquisition helps to improve surgery management. Based on the preliminary analysis, the main stakeholder groups are hospital administration, the team of surgeons, patients, and project management trainers. The roles and contribution of identified stakeholders is described in the following subsections, capitalizing on training planning and delivery specifications that would optimize project success.
Hospital Administration
To ensure that surgeons receive a complete training in project management, it is important to liaison with hospital administration in terms of schedule planning and budgeting. As previously mentioned, it might be complex to arrange the project management training with surgeons depending on their availability, which requires shortlisting participants based on their schedule and designing a flexible schedule that addresses individual needs while respects the importance of non-disturbance during surgical operations (Ajmal, Malik and Saber, 2017). Considerably, hospital administration could be helpful in managing the training schedule based on their individual awareness of surgeons availability, while also controlling the aspect of patient care and managing surgery planning on a higher level.
Alternatively, hospital administration representatives could be engaged as co-trainers or facilitators to participate in group training sessions. It would be also wise to consider involvement of highly experienced surgeons from other hospitals, while this assumption is yet to be validated based on the organizational practices and policies for cooperation, as well as potential budgeting constraints. Nevertheless, the engagement of local hospital administration representatives as trainers would still contribute to the team motivation aspect, since surgeons as training participants would be eager to learn about past experiences of their supervisors.
Team of Surgeons
The team of surgeons is a main stakeholder group that is targeted as information receivers. Because of the nature of their work, surgeons are highly unlikely to participate in training sessions fully, having some of the team members assigned to urgent surgeries or having a day-off because of the previous tight schedule. Therefore, the schedule for the training is extended to three months to ensure that there is enough time to assemble several groups scheduled per availability of team members (Gandhi, 2013). Meanwhile, a single session for the lessons learned should be arranged for all surgeons to ensure that learning material is well comprehended by all participants regardless the group they were assigned to (Bengston, Havila and Aberg, 2018). Finally, any of surgeons is not considered as co-trainer assuming that surgery management training is for surgeons who are equal learners and have to develop project management skills as equal team members.
Patients
The inclusion of patients as stakeholders is particularly important from methodological perspective. Primarily, it is valuable to include patients as a source of feedback, which could be either negative and positive while in both cases provides orientation regarding the training effectiveness. Furthermore, the feedback collected through the patients survey is helpful to determine if surgeons are successful in applying project training material in practice, as well as whether trainers are successful in delivering training content completely (ul Musawir, Abd-Karim and Mohd-Danuri, 2020). Hence, patients as stakeholders are considered useful from training validation perspective, while certainly it is assumed that depending on the surgery complexity and health condition some patients will not be able to provide a constructive feedback.
Project Management Trainers
Project management trainers are responsible for developing training materials, delivering presentation, and coaching surgeons in effective using of project management techniques. Their roles as stakeholders is to ensure that project management practices are integrated with surgery management as close as possible, which requires initial sensing of employee needs and close collaboration with hospital management. Trainers are also responsible for collecting feedback from patients as the second-level stage of training delivery to ensure that the project meets its objectives as an educational intervention. It implies that trainers should be educated in healthcare area and be aware about surgery operations, which assumes the need of preparation and collaboration with surgeons and hospital management to ensure that project scope and its objectives are met.
Critical Analysis of the Training Content
The Principles of Project Management
The basic principles of project management include several critical aspects that should be evaluated in terms of applicability for surgery management practices. Based on this assumption, it is proposed to include the modules of project structuring, goal setting, project status transparency, risk recognition, managing project disturbances, roles management, and project success tracking (Rosenbaum, More and Steane, 2018). However, these areas are a subject for revision by hospital administration depending on the budget constraints and surgery team availability.
The first principle intended to be covered as a part of the training course is project structuring. Specifically, it covers the aspects of defining project goal, project timeline, and project milestones. For the surgery management, the tentative goal is to save the patient with the optimal use of resources at a lowest cost in terms of particular case of surgery, while the overall objective stems from the healthcare delivery principles of reducing human mistakes while undertaking a surgery process. Another important component is project timeline planning, which will be designed to explain how surgeons should plan their working plans to avoid heavy workloads and delegate responsibilities to nurses and other surgeons if appropriate (Khan and Sandhu, 2016). Project charting examples from other industries would be helpful to get surgeons familiarized with common approaches for the timeline estimations. Finally, trainers are supposed to reflect on the importance of milestone planning in terms of time and resources involved. For instance, surgeons are supposed to evaluate the time for surgery preparation, the deadline for the actual surgery based on the complexity of patients health conditions, and the post-surgery actions required for the patients recovery.
The second principle included in the training module relates to the goal setting. Since surgery management is not related to commercial success alike start-up projects or customer-focused efforts, it is assumed that the goal setting training should be tailored to the overall deliverables of surgery management and individual contribution of surgeons to healthcare services. Therefore, these principles will replicate the idea voiced by Kiisel (2011), where surgeons are advised to use checklists to understand the purpose of activities they undertake. Furthermore, the goal setting principle will be described in terms of team collaboration, where it is important to control and distribute project activities based on the skills and experience of the surgery department team members.
The third principle is the project status transparency, which is assumed to be vaguely comprehended by learners and therefore will be mostly used as an overarching idea for managing individual practices. It is fair to assume that under the project status we see either the success rate of all surgeries undertaken by the department during a fixed period, or a productivity of acknowledging new methods of surgery planning. Furthermore, based on the stakeholder analysis and hospital management practices overall it is important to consider the supervising and, to some extent, the regulatory role of hospital administration, which assumes that surgery results reporting is controlled and reported case by case (Khan, 2014; Smith, 2014). Therefore, the purpose of this training section is limited to enforcing the idea of project status reporting using computerized systems, documents, and participation in group meetings rather than using formal methods of project reporting status such as daily stand-ups and additional documentation management apprehended by agile practitioners.
The fourth principle important to be covered as a part of the training is a risk recognition. This part assumes the importance of using feedbacks and checklists to ensure that surgeons learn on both successes and failures of their colleagues. The rule of using risk management and risk mitigation plans will be used to ensure that learners are well trained to avoid issues related to the healthcare practice misuse (Parker et al., 2013). However, there is a limitation related to overconfidence in providing urgent surgeries, where personal experience and dedication dominates over the formal project planning guidelines.
The fifth principle relates to managing project disturbances caused by either internal or external factors. Internal factors relate to interpersonal conflicts, overtime work, personal issues, and pressure from the hospital management team in terms of reporting and following the formal standards of healthcare delivery practices. External factors relate to budgeting, the pressure of tight schedules depending on the availability of surgeons, as well as team contribution to the work undertaken by the hospital specialists. The suggested approach is to seek for the available opportunities for managing tasks and rights delegation, where highly experienced surgeons are supposed to share their experiences with younger individuals to avoid burnout, while also developing new healthcare specialists through the use of coaching and motivation practices.
The sixth principle that will be covered in the section is roles management. The initial plan is to use a common example of roles distribution in software development teams and replicate this example for the hospital management setting. For instance, since formally surgeons do not require a project manager, the example of shift supervisor who manages schedules, patient flows, and financial reporting will be considered instead. Alternatively, for the project sponsor role we will consider the head of cardiology who has approved project initiation. However, the explicit role differentiation typical for software development project will not be required here, hence the rest of roles such as surgeons, nurses, and assistants will be briefly informed about the means of reporting and data recording in line with project management standards.
Finally, the seventh principle included in a training scope is project success tracking. In this part, training participants will be introduced to the use of metrics as a common methodological approach. In this section, trainees will be provided with recommendations on what metrics is applicable in surgery management, such as time for operations, the post-surgery occupancy rate, time to recover, and surgery success rate (Serrador and Turner, 2015). Furthermore, trainees will be guided on the importance of designing and distributing survey to collect and analyze feedbacks from the team using quantitative methods of analysis.
The Importance of Agreeing Project Scope and Responsibilities
To ensure that trainees understand the importance of agreeing project scope and responsibilities, all participants will be invited to participate in a practical exercise. Specifically, trainees will be provided with a fictional project scope that outlines functionality requirements, data requirements, service delivery requirements, and cost estimations. Furthermore, research participants will be provided with a summary of project findings, assuming that overall it was not successful based on the final report and learnings from the lessons learned session. Based on the above materials, trainees will be asked to provide a group report, where they identify why the project failed and provide recommendations for the better roles management and distribution of tasks based on the project scope and budget (Choi, Raymond, and Margit 2018). It is assumed that such effort will contribute to developing better planning skills in surgery department, managing time, costs, and collaborate as a team of specialist where experience sharing is essential to avoid human mistakes and meet the requirements of quality healthcare service delivery.
Planning
In a section devoted to planning, trainees will be introduced to the aspect of envisioning project success through the use of project charter. Project planning part will be essential for hospital administration and shift supervisors, since they are responsible for task delegation and process effectiveness control, while surgeons will also find the planning part useful to determine their capabilities for performing highly effective surgeries and balancing time for work and life. First, trainees will be familiarized with the importance of project objectives setting to ensure that standards of quality healthcare services are followed. Second, trainees will be introduced to the concepts of project assumptions and constraints, which is essential to assist the team of surgeons with effective time management practices and focus on executing their primary roles as specialists in performing surgeries rather than additional roles delegated to then informally (Svata, 2015). Finally, the planning section will cover the importance of risk management and contingency planning, which is probably the most important for surgeons in terms of coping with risks of unsuccessful surgery, changes in patients conditions, and dealing with colleagues who fail to deal with basic tasks or feel fatigued.
Methodologies
To ensure that trainees are effective in integrating project management principles in surgery management practice, one of the training modules will be devoted to the use of methodologies. The module will be based on statistical concepts of quantitative and qualitative methodologies that are used for data collection and analysis. For the quantitative part, trainees will be introduced to the importance of distributing surveys among team members and patients required to develop numerical models for tracking service delivery progress and search for the gaps and human mistakes frequency. For the qualitative part, trainees will be introduced to the principles of content analysis and thematic analysis required to be used for coding interview data and finding common themes and patterns in responses of stakeholders after completing interviews. Finally, trainees will be introduced to the concept of data triangulation, which assumes that project findings are most effective when qualitative and quantitative approaches are used together, since it contributes to better awareness of the problem and allows developing more constructive mitigation strategies.
Tools and Techniques
The next part of the training will introduce several tools and techniques that might be useful for the surgery team:
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Project planning software: trainees will be introduced with Microsoft Project as the main software tool used for project planning and tracking to understand how resources, times, and cost constraints could be managed through the use of reporting and diagramming
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Checklists: surgery team will be trained how to use checklists to ensure that all stakeholders are prepared for the surgery based on their main responsibilities and experience
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Team meetings: trainees will be advised on the importance of using regular meetings to share their experiences or concerns based on the recent events or new requirements for the service conduct approved by hospital management
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Lessons learned session: trainees will be introduced to the technique of documenting essential steps of the project that could be used by other colleagues in the future to avoid mistakes made by project team members in the past (McLeese, 2015)
Building and Leading Teams
The final part of the training will familiarize trainees with the principles of building and leading effective teams. Since these activities are initiated from the beginning of the project and further are monitored and controlled through the course of the project by various groups of stakeholders. Recruiting project team members is the fist stage required to be comprehended by trainees. Specifically, surgeons and hotel administration will be advised on the importance of using both internal recruitment among available team member, and external recruitment, when internal resources are scarcely available or not available at all. Building teams in surgery management will also assumes that teams are built through coaching and regular learning, which helps to share critical knowledge among the other team members and develop the culture of continuous learning in healthcare through both research and practice (Sunindijo, 2015). Finally, for the leading teams section trainers will focus on defining and explaining leadership theories and skills essential in surgery management based on the principles of transformational and participative leadership. These principles will help to change team practices that they identify as less effective and learn how to participate in team problem solving.
Project Plan
Table 1 provides draft project plan which highlights the work breakdown structure and resource breakdown structure for the training along with a draft budget.
Table 1. Project plan for the surgery team training in project management.
Learning Reflection from the Course
The need for well-trained project managers is highly demanded on the market. The traditional approach used for training project manager comprises new separate directions such teaching the appropriate body of knowledge based on the Project Management Principles (PMP) and further continuing with training certified managers on the job. Teaching the appropriate knowledge is followed by exam which conforms to certification, while training on the job is mostly expensive and requires significant time investments from project management to manage ongoing project and learn of the fly. Investments in job training were recently reported as those which could be minimized through use simulations performed like trainings in a lab setting Taher, Krotov, and Silva, 2015). The Project Manager Trainer (PMT) course is specifically devoted to the use of tools, techniques, and methodologies that could address the gap of project management learning in uncommon but dynamic environment, such as surgery management. Hence, this personal reflection outlines the importance of PMT course to acquire critical skills and competences for the well-trained project manager.
First, it is important to describe what skills and competencies I consider the most important for me as a future project manager personally. The first group of skills and competencies are people skills, leadership, and listening. Being people-centric skills and competences, they require time to be developed as project managers mature and become involved in more complex projects (Mathews, Tan and Marzec, 2015). However, the choice of these skills and competences does not suggest that they preferred over the other skills. For instance, let us consider the case of three projects: a project with a very large scope, a project with high uncertainty, and novel project that seeks for innovative thinking. For the first project, leadership will be probably the most important to manage it effectively, while listening and people skills might be less important comparing to other skills such as planning (Khosravi, Rezvani and Ashkanasy, 2020). A project with high uncertainty will also require less people-centric skills instead of being confident in risk management. However, for a novel project all three skills and competences should be conspired as priority to ensure that team communication fosters innovation and requires extensive opinion sharing.
The second group of skills outlined as the most important for my future career are building trust, building teams, and integrity. Building trust is needed to minimize project conflicts and develop productive relationship based on the principles of transparency in action (Hetemi, E., Jerbrant, A. and Mere, 2020). Building trust could be a sensitive topic for some project managers who tend to succeed in early stages of their careers with smaller project teams where building trust is relatively easy, while further being assigned for a larger project that requires more effort in building trust among diverse team members (McLaren and Loosemore, 2019). Integrity refers to the ability to manage actions and consistency in project activities. Building team has something in common with building trust, since trust is a prerequisite for accepting the leadership style of a project manager. However, in many cases building trust occurs after building team, when the newly assembled team starts to report frequent interpersonal conflicts and fails to resolve assigned problems without strict supervision.
Finally, the third group of skills I would reflect on are planning, critical thinking and problem solving. Planning is important to monitor and control project success after the launch. Critical thinking is primary needed for highly technical projects with a lot of documentation and system involved, while it is also required to analyze project input information and data as thoroughly as possible to avoid conflicts and rework. Alternatively, problem solving is typical for any project, since basically any project teams experience problems with planning, communication, resource optimization, and budgeting at some stage of the project, where it is role of project manager to resolve these issues through communication and critical thinking (Berggren, 2019). Problem solving and critical thinking are also highly related to listening competence, since problem resolution and considering opinions of others through interview, team meeting, and feedback sessions. However, as previously mentioned, the importance of these skills varies from project to project while should be developed in parallel.
Some of the key challenges to manage projects effectively depending on the project nature and complexity, and the choice of appropriateness in structuring skills and competencies based on the project nature were identified above. However, there is also a set of factors where the use of identified competencies and skills together could be helpful:
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Conflicts of interests or conflicts in requirement specification provided by the customer, which requires major rework in the middle of the project and requires negotiating changes in project scope while also remain professional and constructive (Cerimagic, 2010)
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Personal matters of team members that forces them to quit the project and requires project crashing, searching and onboarding new members, a redistribution of tasks without hiring new team member (Darrell, Baccarini and Love, 2010)
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External shocks such as economic crises, military conflicts, pandemics, and weather shocks that require flexibility in meeting revised project objectives and eventually operate under short timing (Mac Donald, Rezania and Baker, 2020)
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Highly demanding customers that are not satisfied with project deliverables are require constant revision of deliverables and criticize team members for unprofessionalism (Mainga, 2017)
Skills and Competences Self-Assessment
Based on the critical reflection for skills and competence, identified for myself as a future project manager, the self- assessment is further provided and summarized in Table 1. The self-assessment was based on the PMI standard for assessing project managers, requiring the evaluate to assess each competence from 0 to 3, where 0 indicate no training and experience at, 1 indicates training with no experience, 2 indicates experience and knowledge without training, and 3 indicates that the respondent is both trained and educated. Further, the self-
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