Project management maturity in hospitals

Project management is divided into project definition, project implementation and project completion. According to DIN 69901, project management is understood as "the totality of management tasks, organization, techniques and resources for the execution of a project". The task of a project manager is therefore to plan and control projects correctly. In this way, risks are to be limited and opportunities exploited. In addition, the project goals are to be achieved in the required quality, on schedule and within the defined cost framework.

As with many other "scholastic" definitions, the real complexity here lies in the practical implementation. Organizations need a certain "maturity" for this, according to the basic thesis in the research work of students at the Business School Lausanne. As part of the Master's degree in "International Business" (program "Management of Projects and Programs"), they investigated the project management maturity level in Swiss hospitals in cooperation with QRP International and Profeo AG. Claudia Kary was the lecturer and at the same time the coach in this program. She was also the one who identified the initial projects (structuring of a hospital event for the presentation of the results and for the exchange of experiences, elaboration and evaluation of the survey, marketing and implementation of the survey at the hospitals). She also installed a student as program manager for the program, who put together the project teams. Claudia Kary guided the students through the steps of project management to completion and presentation of the final results. The "client" - it needed someone to define the requirements - was QRP, an international training company in project management, among other areas. This company had built up a portfolio of dedicated training courses for hospitals, regularly runs hospital events and exchanges of experience, and is very successful in Belgium as a result. It wanted to develop this market in Switzerland as well and thus had an interest in the results in order to implement similar activities in Switzerland as well.

Initial situation and questions

Why hospitals in particular? The reason lies in the fact that the 281 Swiss hospitals - both public and private - are facing extensive challenges. More and more initiatives have to be implemented that require a high degree of competence in project, program and portfolio management. For example, the development and introduction of sophisticated and complex devices for diagnostics and therapy, the introduction of the SwissDRG per-case flat rate system with the new hospital financing linked to it, or the use of AI systems for prevention. The data required for the study were collected by the students between the end of May and the end of July 2019 and processed in an initial analysis. In order to obtain even more meaningful results, the survey was extended until September 2019. The company QRP and other experts provided support in the preparation of the overall data.

A six-stage model based on P3M3® was developed to assess the maturity level:

1. 0 Initial: No awareness of the difference between project mode and business as usual.
2. 1 Awareness of Process: The organisation recognises that specific competencies, standards and procedures are required for the successful delivery of projects.
3. 2 Repeatable Process: The difference between project and business as usual is widely understood. A number of aspects of project management are most likely to be carried out successfully, but the organisation still lacks consistency and the application of a consistent approach is not fully enforced.
4. 3 Defined Process: The standards, process descriptions and procedures are clearly defined, documented and integrated into the company.
5. 4 Managed Process: The overall organization focuses on managing processes quantitatively. In addition, top management is seen as a role model, always trying to further explore its needs and potential for improvement of processes and employees.
6. 5 Optimized Process: Optimization of quantitatively managed processes by the overall organization to address forecasted business requirements and external factors.

Based on this, a questionnaire was developed and then submitted to the hospitals. The survey consisted of both multiple-choice and open-ended questions. Models were applied to prevent bias in the results and to avoid any possibility of influencing the results positively or negatively. 102 representatives from 46 hospitals in all parts of Switzerland completed the survey.

Larger hospital - better developed project management The evaluation of the results shows that the project management maturity level correlates with the size of a hospital: The larger a hospital, the better developed its project management. This is probably due to the fact that larger hospitals have more resources and are in a position to establish their own competence centre for project management. Some large hospitals have their own training departments or make project management training mandatory for project managers. In addition, there is a pool of professional project managers: 44 percent of the respondents alone had the title of project manager, but the figure for medium-sized hospitals was also 41 percent. This suggests that project management is also well developed, but less mature compared to larger hospitals.

Small hospitals have a lower score in most aspects than hospitals in the other categories, the study authors further note. The main reasons they cite are that small hospitals have fewer project management professionals in their resource pool. So they must rely on specialists from within the organization to manage projects, such as health care workers and other medical staff. Only two of the 15 respondents from small hospitals held the title of "project manager." It is likely that this is not the only role held by the staff in question, but that they are also tasked with other responsibilities. However, the understanding of roles and responsibilities is higher in the small hospitals. A possible reason given is that communication channels are shorter and more efficient.

Private hospitals: focus on stakeholder and benefit management

The present study also differentiates between private and public hospitals. Private hospitals perform worse than public hospitals in all aspects. They may be more business-oriented and invest less in building structures that do not directly contribute to the hospital's success and seem to create unnecessary and costly overhead, according to the study authors' interpretation. But in other areas, such as stakeholder engagement and benefits management, private hospitals achieve nearly the same results as public ones. This probably has to do with the stronger external orientation of private hospitals: Marketing is more natural for them and this is reflected in a good engagement of different stakeholders. Furthermore, based on the results, the study authors observed that private hospitals have a stronger focus on how projects contribute to the business. In other words, projects at private hospitals may be more likely to be commercially focused than those at public ones. Conclusion: do more root cause analysis The study discussed here shows mixed results on the maturity of project management in hospitals. The average maturity level is 1.53; for comparison: in other industries, the value is between 2 and 3. It is also noted that all results show a large scatter - even within individual hospitals. The reasons for the differences must now be further investigated. The authors of the study suggest reviewing project management documentation, workshops or interviews. The results of these could then also be used to draw up concrete recommendations for action for hospitals.

The students also experienced for themselves how complex project management is as a management task within the framework of this project. Dealing with changing requirements, conflicts within the team, deadline pressure and much more were all part of the process, as Claudia Kary reports. "The students had never before had the experience of working together in a team in this way. Some hated it, some loved it, but in the final one-on-one meetings, it was absolutely amazing what each of them had learned." The program continued to implement initiatives to improve project management maturity based on the results.