The concurrent management of a multitude of projects competing for scarce resources in a changing regulatory and economic environment poses a serious challenge to many healthcare organizations. Clearly, doing a proper job of managing requirements, including their development and tracing from ideas to specifications, to conceptual designs, and then to “as built” designs, is important.
What goes into a sensible estimate?
Many project management methodologies exist. Regardless of the methodology followed, well-grounded estimates of effort, schedule, cost, and the forecasting of additional resources all need to be based on several things, including:
- proper characterization of the work
- detailed enough granularity of tasks and sub-tasks
- adequate reporting time-frame.
It all starts with the work. Being unable to characterize the work is truly a showstopper, and admitting to it is equivalent to saying planning is futile. It never ceases to surprise me how managers will regularly commit to a deadline with scant understanding of the work involved and no grasp of the capabilities and limitations of the resources at their disposal. This may speak to the need for greater formal education and the consistent adoption of methodologies in the area of project management.
Also, project management is meant not only to report on activities but also to enable intervening to correct matters if necessary. In this sense, one of the worst situations is when 1) the work has been only summarily defined and 2) the reporting time-frame is inadequate (too long, for example). In this instance, interventions will lag deviations from the project plan excessively, they will not be focused enough, and project deadlines will quite likely be impacted.
Not paying enough attention to the above aspects is likely to produce estimates that have no basis in reality and result in great waste — remember, one of the banes of healthcare — including missed and constantly readjusted deadlines, blown budgets, throwing resources at a project in an attempt to catch up and succeeding only in making coordination even harder, holding additional meetings of dubious value, futile reporting of hours for its own sake, and endless wheel-spinning and frustration as one grapples with something one does not quite understand as well as one could and should.
Unfortunately, deficient estimates of work are an instance of waste and, as in the late or faulty implementation of a project to improve safety measures for patients, can translate into harm.