George Foundation: PHC Project


Improving Quality in Health care Services in PHCs


Task and Risk Management


Quality has been a topic of attention in American health care since the early years of this century (Donabedian, 1989). Although quality has not been neglected in the intervening years, the focus on quality is a fairly recent phenomenon, beginning in the late 1980s (O’Leary and Walker, 1994). Since then, quality has become a front-and-center issue for providers, payers, and patients.


One of the largest influences on the current environment is the growth of quality-management programs, which began to diffuse after World War II in the industrial sector (Laffel and Blumenthal, 1989). During the 1980s, the focus on quality spread beyond the shop floor to the upper echelons of management in manufacturing and white collar businesses (Gehani, 1993).


Concerns about the growth of health care costs and rising utilization also spurred interest in quality as a means of controlling spending growth and improving service (O’Leary and Walker, 1994). The article by Burner and Waldo (1995) in this issue suggests that overall health care spending growth may be slowing somewhat, but still keeps the United States on its long-term, trajectory of devoting increasing shares of the Nation’s output to health care. In addition, the rising number of uninsured, the rapid acceleration of government health spending, and the sheer economic force of the health care sector have stimulated an interest in quality as a way to control costs and increase access to care (Teisberg, Porter, and Brown, 1994).


Employers, providers, governments, and consumers are becoming more vocal about their opposition to paying more for health care, facing restricted access to care, or receiving less appropriate care. Public payers in particular are insistent on the quality and accountability of the services they finance (Lansky, Butler, and Waller, 1993). This has brought quality concepts to the forefront of health care, in terms of ensuring value for the dollar spent and customer satisfaction, suggesting the relationship between quality and system efficiency.


Dynamic changes in the health care industry also have contributed to the rise of the health care quality movement. Continued mergers, consolidation of health plans, and growth of managed-care arrangements have created a highly competitive environment. In order to compete and survive, health plans must provide high-quality, low-cost care (Furse et al., 1994).


At the same time, the changes in health care markets, providers, and sites of care also present other kinds of quality issues. For example, rapid emergence of new health care markets creates opportunities for entrance of entities, including payers, with limited skills or firms that are too overextended in startup phases to provide appropriate, high-quality care (Teisberg, Porter, and Brown, 1994).  


George Foundation, in example, attempts to implement a project on the improvement of the quality healthcare services in the PHCs in India. Implementing a plan is not an easy job. There such things to consider before a project can be implemented. A project plan should first be done. In addition, tasks and risks of the project initiation to project implementation should be carefully identified, assessed and mitigate appropriately.


Below is the list of the tasks that George Foundation is to do when starting their project.


Tasks


  • Infrastructure Restoration

  • Ø      furbish existing PHCs


    Ø      connection of electricity


  • Staffing

  • Ø      Hiring of staff including paramedics, trained nurse or physician’s assistant, laboratory technician, and qualified medical doctors


    Ø      Training of staff


  • Technology enhancement

  • Ø      Installation of solar panels or diesel generators


    Ø      Installation of software system called EDPS2000 on computers


  • Capability Testing

  • Ø      Testing on-site medical laboratory capability


  • Health Education

  • Ø      Posters and audio-visual demonstrations


    Ø      Community programs


    6. Diagnostic capability enhancement


    Risk Management


                Risks are defined as the possibility of loss or injury, a dangerous element or factor, or a degree of probability of loss (Webster’s New Collegiate Dictionary, 1980). Risks imply an element of action or process that might result in negative result. According to Allen (2004), risks arise because of limited information and uncertainty about the future.


                Risk management involves identifying all risks faced by a company, analyzing and quantifying these risks, and then determining the optimal means of limiting, absorbing, or transferring these risks. Managing risk effectively, especially with major transportation projects, requires implementing a structured, well-thought-out risk management plan (Allen, 2004). Although managers cannot eliminate risk entirely, they can minimize uncertainties by monitoring a project’s risks, developing strategies to mitigate them, and establishing fallback positions and contingencies. Risk management also can lead to more creative and efficient management techniques.


               


     Table 1. Risks Identified, Assessed and Mitigation Strategy of the Project


    Risk


    Risk Level


    L/M/H


    Likelihood of Event


    Mitigation Strategy


    Project Size


     


     


     


    Person Hours


    H: Over 20,000


    Certainty


    Assigned Project Manager, engaged consultant, comprehensive project management approach and communications plan


    Estimated Project Schedule


    H: Over 12 months


    Certainty


    Created comprehensive project timeline with frequent baseline reviews


    Team Size at Peak


    H: Over 15 members


    Certainty


    Comprehensive communications plan, frequent meetings, tight project management oversight


    Number of Interfaces to Existing Systems Affected


    H: Over 3


    Certainty


    Develop interface control document immediately


    Project Definition


     


     


     


    Narrow Knowledge Level of Users


    M: Knowledgeable of user area only


    Likely


    Assigned Project Manager(s) to assess global implications


    Available documentation clouds establishment of baseline


    M: More than 75% complete/current


    Likely


    Balance of information to be gathered by consultant


    Project Scope Creep


    L: Scope generally defined, subject to revision


    Unlikely


    Scope intially defined in project plan, reviewed monthly by three groups (Project Manager and Steering Committee) to prevent undetected scope creep 


    Consultant Project Deliverables unclear


    L: Well defined


    Unlikely


    Included in project plan, subject to amendment 


    Vendor Project Deliverables


    M: Estimated, not clearly defined


    Somewhat likely


    Included in project plan, subject to amendment 


     


     


    Cost Estimates Unrealistic


    L: Thoroughly predicted by industry experts using proven practices to 15% margin of error


    Unlikely


    Included in project plan, subject to amendment as new details regarding project scope are revealed 


    Timeline Estimates Unrealistic


    M: Timeline assumes no derailment


    Somewhat likely


    Timeline reviewed monthly by three groups (Project Manager and Steering Committee) to prevent undetected timeline departures


     


     


    Number of Team Members Unknowledgeable of Business


    L: Team well versed in business operations impacted by technology


    Unlikely


    Project Manager and consultant to identify knowledge gaps and provide training, as necessary


    Project Leadership


     


     


     


    Steering Committee existence


    L: Identified and enthusiastic


    Unlikely


    Frequently seek feedback to ensure continued support


    Absence of Commitment Level/Attitude of Management


    L: Understands value & supports project


    Unlikely 


    Frequently seek feedback to ensure continued support


    Absence of Commitment Level/Attitude of Users


    L: Understands value & supports project


    Unlikely 


    Frequently seek feedback to ensure continued support


    Absence of Mid-Management Commitment


    L: Most understand value & support project


    Unlikely


    Frequently seek feedback to ensure continued support 


    Project Staffing


     


     


     


    Project Team Availability


    M: Distributed team makes availability questionable


    Somewhat likely


    Continuous review of project momentum by all levels. Consultant to identify any impacts caused by unavailability. If necessary, increase committmment by participants to full time status


    Physical Location of Team prevents effective management


    M: Team is dispersed among several sites


    Likely


    Use of Intranet project website, comprehensive Communications Plan


    Project Team’s Shared Work Experience creates poor working relationship


    M: Some have worked together before


    Somewhat likely


    Comprehensive Communications Plan


    Weak User Participation on Project Team


    L: Users are part-time team members


    Unlikely


    User Group Participants coordinated by full time employee


    Project Management


     


     


     


    Procurement


    Methodology Used foreign to team


    L: Procurement Methodology familiar to team


    Unlikely


    N/A 


    Change Management Procedures undefined


    L: Well-defined


    Unlikely


    N/A 


    Quality Management Procedures unclear


    L: Well-defined and accepted


    Unlikely


    N/A 


    Software Vendor


     


     


     


    Number of Times Team Has Done Prior Work with Vendor Creates Foreign Relationship


    H: Never


    Certainty


    A comprehensive vendor evaluation and selection process (incorporated into Project Plan) will be employed to predict and define the relationship between the department and the vendor


    Team’s Lack of Knowledge of Package


    M: Conceptual understanding


    Somewhat likely


    Comprehensive vendor evaluation and selection process incorporated into Project Plan will assist the team in better understanding the package offering(s)


     


     


    Poor Functional Match of Package to Initial System Requirements


    L: Minimal customization required


    Unlikely 


    Although a package has not yet been selected, the Consultant has compared the initial requirements with available functionality and determined that a functional match to the initial requirements is very likely. Vendor selection will be based, in part, on how well the proposed application matches defined functional specifications.


    Team’s Involvement in Package Selection Impacts Success of Implementation


    L: High involvement in selection


    Unlikely


    Comprehensive vendor evaluation and selection process incorporated into Project Plan




    Credit:ivythesis.typepad.com


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