Quality-Cost Connection

Organization key to good project management

How to track the progress of quality projects

By Patrice Spath, RHIT
Brown-Spath Associates
Forest Grove, OR

Do you ever wonder what it would be like to actually complete a process improvement project both on time and with a feeling of success? There is a way to keep your organization’s improvement projects running smoothly and achieve project objectives. The key is organization. This starts with project preplanning and ends with an evaluation of the project results. In the third and final part of this series on project management, you’ll learn how to track the progress of projects to ensure deadlines are met. Then, once the improvement actions have been implemented, it’s time to measure the project success.

The team leader of each improvement project or the support staff from the quality management department should continuously track the progress of all projects against the project plan. Project tracking involves monitoring and reviewing the project accomplishments and results against documented estimates contained in the initial development plan.

The time estimates for completion may need adjusting based on the actual accomplishments and results. A documented, up-to-date plan for the project is used as the basis for tracking activities, communicating status, and revising plans. Unexpected changes in the project scope and or status can have a cascading effect on the project. That’s why it is important that the hospital’s quality council (or other oversight group) regularly review the status of all projects. This oversight group should address any issues that are impeding project completion. The project plan that was developed serves as the tracking and management tool for the project. Without a plan, you have nothing to measure activity against. The project-tracking process should allow the oversight group to anticipate and deal with problems that occur during the project. Project-tracking tools such as flowcharts, program review and evaluation technique, charts, and Gantt charts can serve as visual-planning tools as well as project-tracking tools. Computerized project-tracking software also is available.

Whatever format you use to track projects, your monitoring plan should allow you to identify:

  • differences between planned start dates and actual start dates for each activity;
  • differences between planned finish dates and actual finish dates for each activity;
  • percentage of completion for each activity and the project as a whole;
  • activities performed out of sequence;
  • milestones achieved or missed;
  • differences between estimated costs and actual costs for activities and the project as a whole;
  • activities, issues, departments, or individuals of particular importance or concern;
  • corrective actions taken when the actual results and performance of the project deviate from the plans.

Your plan for monitoring the progress of projects also should clearly spell out what groups or individuals will be kept informed. This will include the oversight committee and various managers and other interested parties. Each of these groups or individuals may have a different "need to know" level that influences the type of reports created. For example, the hospital quality council may need all of the detail listed above, whereas managers of involved departments may just need to know general information about the progress of the project.

Both extra-project status reporting (from the project team to other parts of the organization) and intraproject status reporting (from team members to the leader) is critical to project success. Status reporting need not be a tedious or time-consuming process. In fact, the simpler the better.

This is an excellent application for e-mail. Simply post a status report form and designate where it should be sent. Team members can fill it out, hit "send," and be done with it. (For a sample status report format, click here.) The key is consistency; project status needs to be collected regularly, in writing, from everyone working on the project.

Status reports form the basis for overall project monitoring. Projects usually get behind schedule a day at a time, not a month at a time. Having a means of documenting and tracking these delays is important for spotting the trends that lead to major setbacks. Weekly status reports from team members are recommended. As the project nears completion, it is important to evaluate the impact of process changes. Performance measures relating to the original goals of the project are used to measure the effectiveness of actions plans.

The following questions should be addressed when evaluating the impact of the improvement project:

  • Were project goals achieved?

It should first be determined if the goals established at the start of the project were achieved. If the goals were not achieved or were modified, then the reason or reasons should be documented. For an example of the measures used to evaluate the success of a performance improvement project aimed at improving the outpatient care of people with asthma, see table, below.

Effectiveness of an asthma care improvement project
Percent of patients seen in clinic for treatment of asthma with documentation of action plan
Percent of patients with persistent asthma who are referred for asthma education within six months of initial diagnosis
Percent of patients with persistent asthma who know when to contact primary care physician about signs and symptoms
Percent of patients with asthma who know the difference between long-term control and quick-relief medications
Percent of patients with asthma with documentation of asthma trigger assessment
Percent of patients with persistent asthma with documented flu vaccinations in previous September to January period
Percent of patients with asthma who are 12 years or older who smoke
Percent of patients with asthma under 18 years of age who live in house with a smoker
Annual unscheduled clinic visits per 1,000 asthmatics
Percent of patients presenting to ER/urgent office visit who have a pulse oximetry
Percent of patients presenting to ER/urgent office visit with FEV1 or PEF less than 70% of baseline who are given beta2-agonist
Percent of patients with asthma who seek emergency treatment or are admitted to the hospital within 10 days of calling in to clinic for treatment advice

If some goals were not met, have the project team reconvene to answer the following questions:

  • Were the goals achievable?
  • What were the limiting factors?
  • What modifications in the action plans need to be made?
  • Are the performance measures used to evaluate the success of the project still appropriate?
  • Did the project produce any unanticipated outcomes?

Sometimes there are unanticipated consequences to changing a process. Whatever the outcome, it is important to understand the benefits and/or address any new issues that may have arisen.

  • What lessons were learned?

Everyone involved with the project, including teams members and people who were impacted by the process changes, can participate in the lessons learned discussion. Ask people to identify the key factors that led to success or failure of the project. It may be difficult for people to document and openly share those things that did not work. However, sharing what worked and what was less than successful is important. The knowledge gained during all phases of the performance project should be shared with others who may benefit from the lessons learned.

Performance improvement projects require staff time and other resources that typically are in short supply in health care organizations. The use of effective project management strategies will help to ensure that project resources are not wasted. Be sure that project pre-work is done and that project teams have a clear understanding of the goals. Next, use project-planning tools to "chart the course" for the project.

Everyone should know what activities must take place, when, and who is responsible. Lastly, closely monitor the progress of performance improvement projects, objectively measure success, and pass along lessons learned to future project teams.