The Nursing Process and Project Management

     Life is a series of projects.  Because all projects have a beginning and an eventual end, the process one undertakes through this cycle dictates it success or failure.  Interesting enough, a close look at the principles suggested in project management, one with a keen eye can see many distinct parallels to the nursing process.  Just like a project manager, the nursing professional structure is built on cultural values that reflect a system of cooperation; it provides a supportive and protective system that members can depend on for a sense of belonging and help when needed.  The nursing process is what sits at the fabric of every nurse’s decision making approach, allowing them to distinguish the difference between personal and social values and what is truly necessary to lead a patient down a healthier path.  Likewise, a project manager, whose job is to be an objective arbitrator and lead a firm in its successful implementation of projects.  Just as is required of a nurse, I am also of the opinion that no project manager should let personal and social values influence business decisions.  A good project manger should have the sophistication to understand the subtle difference between an objective and subjective decision, yet intuitive enough to use personal and social values as a guide in the decision making process rather than an influencing factor.  The process utilized by both project managers and nurses can be used as a tool in any profession, allowing one to incorporate logic and objectivity into every decision at hand.   

     I have learned earlier on in my nursing career that, in order to lead my patient toward wellness, I have to apply the nursing process as a method of problem solving which enables a nurse to organize and deliver nursing care.  It is an element of critical thinking that allows nurses to make decisions and intervene based on reason.  The nursing process is used to diagnose and treat human responses to health and illness by utilizing five steps:  assessment, diagnosis, planning, implementation, and evaluation (ADPIE).  ADPIE provides a blueprint for critical thinking which allows the nurse to individualize care and respond to a client’s need in a timely and reasonable manner therefore improving or maintaining the client’s level of health. The purpose of the nursing process is to identify the client’s health care needs (assessment), determine priorities (diagnosis), establish goals and expected outcomes of care, establish and communicate a client-centered plan of care (planning), provide nursing interventions designed to meet client needs (implementation), and appraise the effectiveness of nursing care in achieving expected client outcomes and goals (evaluation).  As laid out, these principles can easily be applied in parallel to project management.

     Project Management according to Lewis (2007, Chapter 1) is, “a temporary endeavor undertaken to produce a unique product, service, or result.” Similarly, project management follows the same basic tenets as the nursing process of ADPIE.  Every project manager needs to define the project (assessment), develop solution options (diagnosis), plan the project (planning), execute the plan (implementation) and finally monitor, control progress and close out the project accordingly (evaluation).  Just as a nurse ensures that the patients transitions from health to wellness, Lewis (2007, Chapter 2) quips, “the primary responsibility of the project manger is to ensure that all work is completed on time, within budget and scope, and the correct performance level.”  A project manager will develop a work breakdown structure, (WBS) to pictorial represent to team members and stakeholders all the components that are necessary to deliver the project.  The nurse in return has a similar tool the equivalent of a WBS called the Care Plan, which is the documentation of a plan identified by a nurse as all the necessities required to assist a patient (a nurses project), move from illness to wellness. Just as every project team member utilizes the WBS to gain a big picture perspective, all nurses involved in patients treatment regimen will look to the care plan.

     With healthcare reform currently at the center of our nation’s political debate, what has been overshadowed is The Health Information Technology for Economic and Clinical Health Act (HITECH) enacted into law by President Obama in February of 2009 with the basic premise of providing healthcare organizations with stimulus dollars and emphasizing on quality and efficiency and utilizing information technology to affect changes the healthcare industry desperately needs.  In a struggling economy it was only natural for the organization I work for then, a not for profit, faith based community hospital, to strategically align itself to realize the full profit potential the stimulus funding can provide.  In our usual annual fashion my Chief Nursing Officer (CNO) provided me with a report on projects approved by the organization’s Executive Team.  In reviewing these approved projects, it became apparent to me that the strategic plan for the year will be without complications.  Utilizing the process of ADPIE I quickly realized that my organization was asking me to do the equivalent of building a roof without the basic structure a home needs to support it.   In order for our organization to sustain the yearly requirements for stimulus funding, certain prerequisite projects were needed to scale our system to the desired end point.  Furthermore, I knew building the system without the prerequisite architecture would fragment data and therefore ultimately affect how the clinicians provide patient care and, subsequently affect patient outcomes.  As a health care provider I became quickly cognizant of the demands that have been overlooked, but I also knew I could not merely respond by saying it cannot be done.  I then embarked on a process of analysis, using ADPIE as my basic framework, to foresee how I could continue with the approved projects and at the same time reinstate the previously dismissed projects and build a business case that still aligned itself with the organization’s strategic plan for the year.  Apparently, I was organically utilizing project management principles in the process as well.  With a business plan the equivalent of a work breakdown structure (WBS) and risk analysis in place, I then engaged my CNO in a crucial conversation in which I asked her to re consider reinstating the previously dismissed projects.  Following a principle provided by Verzuh (2008, Chapter 11), “the best way to communicate difficulties to customers and managers is simply to present them the facts.”  I went on to articulate crucial components of a plan, in essence the critical path, which included reallocation of funding and resources to support the end goal.  The plan had a slight caveat, the need for additional funding with an amount that I felt was reasonable and minimal in quantity considering the funding and returns on investment that would be realized.   Clear and transparent communication being the key, my CNO was in agreement that certain items may have been overlooked by the Executive Team, and felt I had equipped her with enough information to confidently go back to the leadership team and request additional funding.   Approval was ultimately obtained and I came to the realization that in the process I had learned to advocate for the needs of the healthcare consumer as well as our healthcare providers.

     Project Management however goes beyond the day to day managing of task and deliverables.  If projects were that easy, then we would not see a failure rate of 83%, which basically suggest that a project is bound for failure the minute it is started (Lewis, 2007).  There is a crucial component to project management which I like to call the people management. These include the managing of the project team and the crucial conversations that must take place between the project team and the project stakeholders.  As a project manager, assumptions can be a dangerous thing, even detrimental.  As a people manager, a project manager has the difficult job of ensuring all parties are moving towards the ultimate goal, which is the successful implementation and completion of a project.  It is not just completing the project that determines success.  It is doing so in such a way that meets your stakeholder’s original intent, along with being on time and on budget.  Clearly there are three major moving parts; people, timeline and budget that ultimately will define if a project is indeed a success.  Lewis (2007, Chapter 10) explained the difficult task of a project manager the best when he stated, “a manager should try to satisfy the needs of the organization, while simultaneously helping individuals satisfy their own needs through participation in the project.” 

     In my years working in Healthcare Information Technology I have leveraged the use of the nursing process not realizing I have also been utilizing project management concepts.  Both of these principles have been an objective tool that has been so ingrained in me that I have used it often.  In the almost seven years that I have been in a managerial role, managing the electronic medical record implementation for hospitals, what has enabled me to thrive and manage such a complex implementation with multiple moving parts and sometimes conflicting priorities, is my very own knowledge and utilization of the project management process which has allowed me to achieve, and has been instrumental in, realizing my managerial potential.  Clearly whether it is patient care, or project oversight, structure and proper methodology is needed in order to be successful.  The process of ADPIE is such a universal concept that it can be an instrumental tool versatile enough that it can be used in business practices as well as in life decision making processes.  By using this blue print one can prioritize and approach critical situations with ease and confidence.

 

References

Lewis J P 2007 Fundamentals of project managementLewis, J. P. (2007). Fundamentals of project management (3rd ed.). New York, NY: AMACOM.

Verzuh, E. (2008). The fast forward mba in project managment (3rd ed.). Hoboken, NJ: John Wiley & Sons, Inc. 

 

 

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