Why Healthcare Needs Project Management

By Martin Wartenberg, UC Irvine Extension Instructor

At the dawn of the 20th century, Wilbur and Orville Wright developed the first airplane capable of sustained heavier-than-air human flight. Working from their bicycle shop, the Flyer was built of spruce, linen, and wire, and fitted with a crude engine of their own manufacture. It flew successfully on the Kill Devil Hills of Kitty Hawk, North Carolina on December 17, 1903.

But what if Orville had crashed on that first flight? Most likely, he would have been treated by a local physician, working from an office in his home, to whom Orville would have paid cash at the time of service.

Fast forward one-hundred years. Aircraft are now built in plants that resemble cities, with components and raw materials assembled from around the world. Yet air travel, even in the age of global terrorism, is still one of the safest activities in which a human being can engage, despite the myriad opportunities for a small glitch, whether in design or manufacture, to cause the plane to fall in flames from the sky.

So, what about the healthcare industry—how has it handled the process of maturing, as private practices have been swallowed by giant healthcare corporations? Indicators are that it has not done as well. A 2012 report by the National Institute of Health and the Medicare Inspector General states that as many as 440,000 deaths per year result from hospital errors… It is estimated that as many as one in three patients is affected by hospital errors and complications…” Since the initial NIH report of 1999 (“To Err is Human”), hospitals have risen from the sixth place to third place among the leading causes of death in the Unites States. Hospital costs and death rates have been doubling every decade.

These statistics are appalling. Consider the public outcry if 440,000 people died each year because of preventable errors in the aircraft industry. As the NIH report observes, the 2012 mortality rate from preventable hospital deaths was “equivalent to two daily Jumbo Jet Crashes.” When a single plane crashes, the FAA examines every possible cause to prevent further carnage. So, what can healthcare learn from the aerospace industry?

Let’s look at the years between the Wright Brothers and the Dreamliner—between the country doctor and the HMO—to find out. In both aerospace and healthcare, advances in research and technology exploded in the 20th century, spawning phenomenal growth within, and the birth of new industries to support them. But rapid deployment of new technologies came with a price tag, both in squandered money and in lost life.

While some of the blunders and tragedies can be attributed to and the growing pains of these new industries, significant blame can be traced to the preventable human errors that came from a lack of proven, systematic processes, administered by trained professionals, to shepherd projects from inception to completion. Absent this overarching administration, projects that were not well defined to begin would receive more money thrown at them, often amid a cloud of miscommunication and resentment. When the money ran out, these projects would be judged as failures, or, worse yet, they would be deployed with their flaws in place, resulting in crashed planes, or in the case for healthcare, dead patients.

So what changed in the aircraft industry that the healthcare industry might learn from? Someplace around WWII, the aerospace industry, building on methodologies that date back to the construction of the pyramids, began compiling data and practical evidence on what caused projects to succeed and fail. This grew over the years into a body of knowledge that now guides those trained in its ways through the process of initiating a project, managing its scope, risk, duration, cost, and stakeholders, and succeeding with a quality deliverable.

Using these techniques resulted in:

  • Better control of financial, physical, and human resources,
  • Improved client and stakeholder relations,
  • Shorter development times,
  • Lower costs,
  • Higher quality and increased reliability
  • Improved productivity,
  • Better internal coordination, and
  • Higher worker morale and reduced stress.

But hold on—human beings aren’t airplanes, and all the aerospace engineers on the planet couldn’t create anything so elegant or complicated as a toddler’s left foot. Perhaps not, but much of the business of healthcare doesn’t involve medicine. Healthcare will continue its astronomical growth, and provide some of the highest paying jobs, each of which plays a critical role in delivering quality, affordable patient care. But the reality is that these jobs are frequently project driven, and the success of these projects can quite literally mean the difference between life and death.

Consider just a few scenarios:

  • Information Technology, including data management, records, and artificial intelligence systems, where wrong information can kill patients and intelligent mining of data can identify lifesaving patterns on which to develop new research.
  • Facilities upgrades, where development of new standards and specializations in operating theatres, clean rooms, ICUs, and in the wards can abate the spread of resistant bacteria.
  • Process improvement projects, targeted at each critical procedure, to reduce errors and cut cost, including nursing procedures, nutrition, drug administration.

These are clearly within the domain of project manager, and the application of good project management practices may be part of the overall solution of how to make hospitals safer. Much of the research currently being developed in this field is from the USC Schaeffer Center for Health Policy and Economics, led by Professor Joel W. Hay.

Indeed, as the healthcare industry continues to grow, it is being pushed towards upping its project management game. In a report co-sponsored by Georgetown University and the National Institute of Health, it is predicted that the healthcare industry will create 5.6 million new jobs by 2020. Americans spent $2.6 trillion on healthcare in 2010, which is ten times more than in 1980, and the demand for healthcare continues to grow at a rate twice that of the national economy. Rising costs are increasing scrutiny of how healthcare providers run their businesses. An example of this can be found in a provision of the Affordable Care Act that holds providers to higher standards for their major IT functions.

While the government’s desire to reduce overall cost of care serves as an external pressure to improve processes from admittance through discharge, internal pressure is also mounting. Healthcare organizations are realizing that, to remain competitive, they must develop skills to effectively select and manage the projects they undertake. They also realize that many of the concepts of project management will help them as they execute projects in such diverse areas as Information Technology, Facilities Management and Process Improvement. In addition to project management, healthcare organizations are embracing program and portfolio management as a means to address enterprise-level needs and to balance conflicting needs and priorities among stakeholders.

What is clear is that healthcare will need to hire or train employees to serve in project management roles. These jobs will require higher levels of education, along with continuous certification. UC Irvine Extension’s Project Management Certificate Program focuses on the specific areas of project management that are necessary in the healthcare delivery environment.