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One Sick Project


      This commentary expands upon points made in a post on April 12, 2010 at JimMillikenProject.blogspot.com.


      Never underestimate the power of routine. It controls our focus until we are startled by a flaming eruption of the obvious.

      Maybe the matter can be just glowing and simmering at first, so we proceed along our customary habit pattern until the aberration we hadn't accounted for “suddenly” breaks into the open. By the time we notice it, it is inflicting damage that must be stopped, then repaired before we can resume progress toward the original intent.

      Prevention requires examining the assumptions prior to the launch of any activity. We must identify its character and the factors that will determine its success.

      Here is a case in which the manager of a department within a healthcare facility persuaded the organization to invest in equipment that would do most of the work in lifting and turning patients who couldn't do it themselves.

This would reduce or eliminate the serious problem of neck and back injuries to the healthcare professionals who had been handling the procedure manually. It also would enhance patient care and reduce costs from lost work time, insurance and workmen's compensation.

      The equipment was installed in the department that was to pilot the new process, and things started to slide off the track. Everyone was very busy, so training was fragmentary and uneven. This was especially true of the professionals in the department – it was the support staff members who were to be the main users of the new process, so it was up to them to find the time to get the training.

      There was noplace to post the reminder instructions near the equipment, so the information was added to the blizzard of material hanging in the lounge. Parts of the equipment were stored in separate locations.

      The project manager, who was from a different department, spent a lot of time trying to set up the process and clear out the problems, but she really wasn't getting much of a hearing. Meanwhile, the facility's administration, as well as some of the other departments, remained interested in getting going with the full implementation. They kept asking when the rest of the equipment was going to be installed.

      Then the patient care leadership of the facility announced an initiative to re-emphasize direct, personal attention to patient care at the bedside. Perfect, the project manager told herself. She visited the chief of patient care services to suggest that the new equipment would be a fine vehicle for demonstrating this initiative.

      The executive thought for a moment. “No,” she said, “I don't think that relates to our new program.”


      OK, what's the ailment that afflicts this project, and what's the cure?

      More to the point that's being made here: What difference would it have made if the project manager had recognized that her idea actually constituted a project, rather than the simple importation of a handy new tool?

      Start with this: A project plan doesn't open with the technical or process solution – its first step is a thorough description of the situation in which the solution is to be applied, as well as identification and analysis of the factors that can influence or affect this particular kind of project. All the key stakeholders must be involved from the beginning, including this foundational examination.

      Without running through the whole Project Overview and Risk Management Plan in this little commentary, we can put our finger on a few big points in our case.

      First , this was a culture-and-process-change project, not just hauling in and setting up a neat new machine. The “people” issues would be paramount in making it happen.

      Second, when busy people simply can't interrupt the vital routines of patient care, there needs to be direct involvement of higher authority to devise processes to introduce the change without damaging patient care.

      Third, when the key operational decision-maker openly dismisses the project, you know you're already in deep trouble, and it's obvious why the workplace-level essentials haven't been met.

      Fourth, when senior leadership as well as peer units of the organization express impatience to participate in a project that's going nowhere, you have to know you've missed a very important boat somewhere back there.


      Shining up the cart before signing up the horse puts the trip in the ditch before it starts. Project management is front-loaded with research, analysis and alliance-building. This project was sick, not because it was infected with a disease, but because it lacked proper nutrition.


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