Healing a Hospital’s Struggling Emergency Department

Project Charter

Project Overview

Executive Summary

The struggling 205-bed general medical and surgical hospital that serves a community in Chicago is experiencing a decline in performance because of the huge demand that it is unable to meet. The parent firm is keen on implementing a project model that had been introduced at a different institution and proved useful. It involves the introduction of additional staff, expanding the working space, redesigning the facility, improving communication, and ensuring that supplies are easily accessible to the staff. The aim is to reduce the time it takes to serve patients in need of emergency services, eliminate or significantly reduce cases where patients leave without service, and enhance the general satisfaction levels of patients at the facility.

The performance of a healthcare facility is often defined by, among other factors, the efficiency and speed with which they attend to patients. Some patients may need emergency medical attention, which means that forcing them to wait for over one hour before they can get the needed medical attention may cause the death or worsening of their condition. In this case study, the 205-bed general medical and surgical hospital is registering poor performance primarily because of the time it takes to attend to patients. Some are forced to leave without getting treatment because of the delays. The problem has led to the facility registering poor satisfaction levels as patients feel it lacks the capacity to meet their expectations. In this project charter, the primary goal is to find a way of addressing this problem using the available resources to enhance patients’ satisfaction.

Background

The general medical and surgical hospital was established with the primary goal of serving the medically underserved community in the city of Chicago. The management realized that there was a gap that needed to be addressed. However, the huge demand for the services has overstretched the facility. The majority of the patients have to wait for two hours before they can get to be served by a doctor. Reports also indicate that the number of those leaving without treatment (LWOT) currently stands at 8%. The parent network is concerned about this issue because the facility is no longer meeting its primary goal. Instead of bringing hope to the targeted community, it has become a source of frustration to many patients who need its services.

The parent network had addressed a similar problem at a different branch using Integrated Project Management, Inc. (IPM) to optimize the performance of the emergency department. There is hope that by using the same model, problems being experienced at this facility can be addressed effectively. The strategy will involve a complete redesign of the emergency department structure. The floor design will need to be expanded, the medical staff will be expanded, and additional nurses’ stations will be added. There is also a need to ensure that communication is improved and the location of supplies redefined to enhance their accessibility when needed.

Purpose

The purpose of this project is to heal this hospital’s struggling emergency department. As the name suggests, an emergency department is expected to deliver emergency services to patients. A significant number of those who visit the facility need emergency services to ensure that their condition is put under control to save their lives. When such a patient is forced to wait for over one hour before getting the attention of the relevant doctor, then the purpose of this facility is lost (Iqbal, 2020). The fact that some patients leave without service demonstrates the fact that they believe it has failed to meet their expectations. They have to rush to other facilities to get the services they need. These weaknesses have to be addressed to ensure that all patients who need the services are attended to at the right time.

Description

The project sponsor has already implemented a similar plan, Integrated Project Management, Inc., which has proven successful at a sister branch. The goal is to replicate the same project at this facility to address the identified challenges. The process will involve specific activities. First, the facility intends to redesign the structure of the ED to ensure that there is a smooth and simple flow of patients from the triage to the point where they get the necessary medication. Secondly, it will have to increase its staff size to help meet the increased demand. The management also feels that it is necessary to expand the floor to create more space for the additional staff. Having additional nurses’ stations will help ensure that patients are attended to within the shortest period possible. Improved data sharing and communication systems will be necessary for the facility.

Pre-Project Documentation

This project charter identifies the documentation that will be relevant for the effective implementation of the project. Clearly documented in this report include the project scope, cost estimates, and a budget. The document also outlines key assumptions that will have to be made, project risks that may affect the implementation process, project decision-making, and approvals that will be needed before initiating the project. The information will be essential for the decision-making organ for it to ensure that the investment made is worth the expected outcomes.

Project Team and Stakeholders

Project Team

The success of this project will require close coordination between all the stakeholders who will play different roles. The project manager will be the emergency department medical director, who will be assisted by the hospital’s chief nursing executive. The two will be responsible for coordinating all the activities that will be carried out in the hospital. The medical director will ensure that additional doctors and clinical officers are hired to help bridge the identified gap. On the other hand, the hospital’s chief nursing executive will be responsible for the hiring of additional nurses needed in the emergency department. The new staff will need some training, and the two leaders will need to facilitate the same.

There is the non-medical staff who will also be active members of the team. The contractor, responsible for expanding, redesigning the triage and other areas, and installing necessary fixtures and fittings will lead his team of experts. The contractor will be reporting directly to the project manager. The project team will also have to include the nurses who will be expected to attend to patients. Involving them will help in ensuring that they understand what is expected of them under the new system after the changes have been introduced.

Stakeholder Groups

The stakeholders involved in this project can be classified into several groups. The first group is the sponsor, which is the parent firm of the hospital. The sponsor will be responsible for releasing the resources needed to make this project a reality. The sponsor is also responsible for the development of this project charter that implementers have to follow. Upon initiation of this project, the sponsor will be in charge of the supervision and approval of the project. The second group is the project manager and his team. They will ensure that the actual construction to expand the capacity of the facility is conducted. They are also responsible for the recruitment and training of additional staff meant to expand the capacity of the hospital. The third group includes all the staff whose roles will be redefined once all the expansion activities are completed. The last group of stakeholders are the patients who are expected to enjoy improved services once the new system is operational.

Project Scope

In Scope

The scope of this project is to expand the capacity of this emergency department to ensure that it can handle more patients because of the increase in demand. The activities within the scope of this project include the expansion of the triage and redesigning of the emergency department structure. The goal is to ensure that there is the ease in the movement of patients and that more clients can be handled within a given period. The project will also involve adding more registered nurses and care providers in the triage area to improve the speed of service delivery. The project will ensure that there is a smooth flow of supplies at all the relevant units to enhance efficiency in service delivery.

Out of Scope

At this initial stage of the project charter, it is necessary to state what is out of scope of this project. Enhancing the quality of service delivery, although critical for the success and sustainability of this facility, is out of the scope of the project. It is necessary to note that the complaint made by clients was the time it took for a patient to be attended to by a doctor. Some were forced to seek services elsewhere. The quality of the services delivered was not an issue raised. Hence the firm will strive to maintain high-quality services as it does at the moment. Activities within this hospital that are not directly related to the emergency department will be out of the scope of this project.

Project Deliverables Planned

The team responsible for the implementation of this project would need to know the project deliverables planned. One of the important deliverables needed is a clear plan on how specific activities in the project will be undertaken, including individuals involved, the cost, and a timeline of the specified activities. Meeting minutes that indicate what the team agreed upon and what needs to be addressed is another important project deliverable. Project reports indicating the progress made against the time set should also be included.

Product Deliverables Planned

The product deliverables planned in this case would be the outcome or the output of the project once it is completed. They will include the completed redesigned and expanded triage and emergency department structure. Others will be the expanded workforce, especially the additional registered nurses. A new structure of doctors, nurses, clinicians, and technical staff will also be part of the deliverable. Improved service delivery to patients will be the overall outcome of this project.

Project Estimates: Schedule and Cost

Summary Level Schedule

The identified problem has a major impact on the image and reputation of this hospital not only in the specific community in Chicago but also in other cities around the country. As such, the parent company has set a timeline of 12 months, starting January 1, 2022. It means that all the activities scheduled in this project should be completed by December 31, 2022. Within this period, the new facility should be fully equipped and functional.

Detailed Schedule

The activities will have to be completed within 12 months, as explained above. A new design for the triage and the entire emergency department structure has been proposed, based on a similar project, but will have to be approved within the first month of January. Actual activities of construction will begin in February and are expected to last till the month of October. Recruitment of additional nurses should be done by the end of the month of September. They will then start training immediately, which will last till the month of December, when they are expected to start their work. Fixtures and fittings, including the new communication system, will start from November to December.

Managing Schedule Estimates

The project sponsor will rely on the project manager to ensure that activities are completed in a cost-effective manner and within the time stated. Close monitoring of activities will help avoid delays and inflation of the cost of the project. Based on the cost of a similar project at a different facility, the project sponsor has set aside $ 2 million to ensure that all the stated activities are completed. The following items detail the specific activities that will define the implementation of the project:

1. Launching the project by the sponsor.
2. Definition of requirements.
3. Design development.
4. Acquisition of resources by project manager.
5. Construction activities.
6. Acquisition and installation of new communication systems.
7. Data migration from the old to the new system.
8. Documentation of the system.
9. Testing of the new ED system.
10. Training of the staff.
11. Handover.

Project Budget

The cost of this project was based on the budget of a previous project, inflation-adjusted, which had similar deliverables. It is expected that all the activities outlined above will be completed at the cost of $2 million. The project manager is expected to develop a project plan outlining the cost of every activity and items that will have to be purchased. The budget in the project plan should reflect the estimates that have been outlined in this project charter.

Managing Cost Estimates

The project will have to be completed strictly following the cost guidelines provided in this document. Clegg et al. (2020) note that one of the major challenges when undertaking a project is the inflation of costs. The project manager is under strict instructions to ensure that cost estimates and the actual cost of the project are in line with the specifications provided by the sponsor. Any changes in cost must be properly justified and approved by the management of the facility.

Project Assumptions

At this stage of a project charter, it is important to define assumptions that have to be taken. As Heldman (2021) observes, it is not realistically possible to develop a project plan without making specific assumptions. One of the major assumptions is that patients are currently satisfied with the quality offered, which means that the main concern is the speed of service delivery. The management assumes that redesigning the triage and the entire ED structure will enhance the speed at which services are delivered in this company. The team assumes that the cost of construction has slightly gone up by 7% since the time a similar project was completed at a different facility that is managed by the same parent firm. The management also assumes that stakeholders will accept to implementation of this project without any major resistance that may affect its progress.

Project Risks

The project is likely to encounter some risks that may significantly affect its implementation. Identifying the possible risks makes it possible to plan how to address them when they occur (Englund, 2019). One of the major risks that this firm faces is cost inflation. The project sponsor has set a budget for the project, factoring in a reasonable rate of inflation, as 7%, based on the cost of a similar project recently completed. However, it is possible that the cost of some of the products needed for the project could be higher than what has been estimated. It means that the project may cost more than the estimates. Project delays are another common problem that often occurs when undertaking stated activities.

Poor coordination, slow implementation, and delays in delivering the needed resources are some of the major causes of delays in projects. There is also the major risk of possible resistance to change among stakeholders. The board of directors may fail to approve the planned expenses in the project. The doctors, nurses, and technicians may reject some of the changes that will be implemented in the project. Theft and pilferage of the resources is another major concern that will have to be addressed to keep in check the cost of the project.

Project Decision-Making

Decision-making in project management must be clearly defined at the project charter stage to ensure that control and coordination of activities are done effectively. Based on the nature of this project, there will be three levels of making decisions in this project. The first and senior-most level will be the board of directors at the parent company. They will review this project charter and approve the project if it feel it addresses key issues that affect the operations and image of the facility. The second level of project management is the head of the emergency department at the hospital. The head of this department will be directly responsible for supervising the activities and making major decisions to make sure that this project is a success. The last level of decision-making is at the project management stage, led by the project manager and the assistant. They will have to make daily decisions on how to implement the policies set by the top managers. They will be responsible for monitoring specific activities in the project.

Project Approvals

The project will need specific approvals before the specific activities mentioned above are initiated. The first approval will come from the board of directors of the parent firm. As the sponsor of this project, it must be convinced of the economic and social relevance of the project. The board will need to be assured that the investment made will translate into the success of the company. The government, through various local agencies, will have to approve of the expansion and ensure that it is in line with the policies and regulations set. These government agencies can propose some changes to the project if it is determined that it does not follow specific regulations. At the emergency department level, the director will need to approve specific activities proposed by the project manager regarding the implementation strategies. The head of ED will need to be convinced that the proposed strategies will yield the expected returns.

Project Management Report

Background, Purpose, and Approach

The assessment that had been conducted revealed that the ED of this facility has been overwhelmed and currently it is unable to meet the demand. Most of the locals who visit the hospital have to wait for more than two hours to see a doctor, with some forced to leave the facility without any treatment to seek help from other institutions. This project seeks to expand the capacity of this facility to ensure that it can handle the huge demand without compromising on quality. The implementation of this project is based on the plan that the project sponsor provided in the project charter. The approach involves expanding the floor space, redesigning the ED structure, and increasing the number of doctors and nurses working at the facility. The goal is to ensure that the facility has an increased capacity to handle more patients within a reasonable time that does not compromise patients’ satisfaction.

Goals/Objectives

The project team has initiated the implementation of the project with the primary goal of healing the hospital’s struggling emergency department. The team believes that the quality of services at this facility can be compromised significantly if something is not done to address the problem identified. The following are the specific goals that the project manager and members seek to achieve:

• To redesign the ED structure in a manner that makes it easy for the patients to receive medication within the shortest time possible;
• To expand the flow by constructing additional space for nurses’ station;
• To increase the number of the medical staff at the triage area and other departments where there is a need for additional staff;
• To train the new staff recruited to ensure that they have the capacity to deliver services required.

Scope

The team implementing this project has to meet specific goals based on the scope that had been defined in the project charter. As explained in the charter, the aim the primary goal is to expand the capacity of the facility to ensure that it can attend to all the patients within the shortest time possible. The first activity that the team is involved with is redesigning the structure of the ED. The team is developing a design that allows for the smooth movement of patients, medical staff, and supplies. The team is involved in the physical construction of additional space at the facility, which will provide an additional nurses’ station. The team will make sure that additional doctors, nurses, and technicians are recruited and trained to equip the with skills necessary for them to work effectively to help expand the capacity of the facility. It is the responsibility of the project manager to maintain regular communication with the sponsor to provide updates on the milestones made in the implementation process.

Deliverables

Deliverables in this project are the specific items that should be made available upon the completion of this project. The first deliverable is a redesign of the ED structure to meet the requirements set by the sponsor. This team will redesign and construct the new space. The second deliverable is the additional space that is meant to be occupied by nurses, whose number is expected to increase to help meet the increasing demand. Additional medical staff that has been taken through the necessary training and is capable of working effectively for this facility is another major deliverable. The project manager will be handing over a facility that has an improved communication system allowing doctors, nurses, and technicians to communicate with ease. The new system will also have a smooth flow of supplies throughout the facility to limit the time it takes to serve customers.

Constraints/Assumptions

When starting this project, the project manager and members made specific assumptions. The primary assumption was that the cost of this project will be within the limits that had been set by the sponsor, believing that the inflation rate in the country will stay at 7%. This was important to help in planning specific activities throughout the project. The team assumed that the sponsor will provide all the needed resources at the right time to avoid delays in the project. The other assumption was that the government had approved this project and that there will be no legal battles that may slow or halt the implementation process. The team has encountered a few constraints that threaten to affect the implementation process. The cost of some of the materials needed for the project is higher than what had been proposed by the sponsor. The team has been forced to find alternative suppliers to manage costs. The proposed design that was unique to the other facility had to be slightly adjusted to fit into the current design of this facility.

Related Projects/Critical Dependencies

When undertaking this project, it was necessary to take into consideration related projects or any critical dependencies. The project team noted that at the time of initiating this project, the hospital was upgrading its tendering system to introduce an integrated communication system. The facility was creating a system that would enable the suppliers to monitor how their products are consumed at the facility and the best time to make deliveries before their products are depleted to avoid delays. Catalano (2020) explains that using technology in supply management enhances efficiency and eliminates cases where activities are halted because supplies have been depleted. The project manager decided that it was necessary to test the effectiveness of this new system by ensuring that most of the supplies used in the project are delivered through the system.

Schedule and Milestones

It is important to note that the schedule in this project plan is slightly different from that provided in the project charter because of the minor changes discussed above and the realities that the team faced, which had not been anticipated at the initial planning stage. However, it is important to note that the activities are planned in a way that they will be completed within 12 months, as had been recommended by the sponsor. The project manager has already received and reviewed the project charter and assembled the team that will be responsible for the implementation. These first two activities have already been completed, as shown in Table 1. The team has already started reviewing the design with the aim of making appropriate changes. Other activities of constructing additional space, recruiting staff, testing the system, and handing over are yet to be started. The table also outlines a schedule of specific activities that the team will undertake in the project and those that have already been completed.

Budget and Cost-Benefit Assessment

In every project, it is necessary to conduct a cost-benefit analysis to understand if the deliverables are worth the cost. This project is estimated to cost about $ 2 million. They include the cost of designing the new ED department, purchasing suppliers, and paying the labor. Other costs include recruitment and training of new employees, legal fees, and miscellaneous expenses. The total estimated cost is $ 2 million. The cost is inflation-adjusted, which means that the actual cost may be slightly lower than the estimates. The benefits that will be generated from the project significantly outweigh the cost. The service delivery at this facility will significantly improve. Patients will be served within the shortest period possible as soon as they visit this facility. Cases, where patients leave without being served, are also expected to drop significantly at this facility. The general image of the hospital, especially the ED, will improve, enhancing its competitiveness in this industry within the region. The monetary returns that the improved image brings is immense and it will also enhance its sustainability.

Risk Assessment

The team has been keen on identifying, assessing, and managing risks that may affect the effective implementation of this project. One of the risks that has already been identified is the inflation of prices of some of the products. The team has already been forced to find alternative suppliers who can offer the same products at reasonable costs. The team is keen on assessing the impact of the unpredictable weather patterns that may affect the normal activities of the project. Excessive rainfall and flooding are major concerns that the team is keen on monitoring and finding ways of managing. Pilferage is always a major cause of concern that may affect the overall budget of a project (Spalek, 2019). The project manager has put in place measures meant to limit any form of theft of materials used in this project.

Work Breakdown Structure

It was necessary to define the activities that will be conducted using a work breakdown structure. The WBS structure, shown in the network diagram in Figure 1, identifies the activities involved in the project. The first step will be the initiation process where goals are defined and the charter handed over to the project manager. The second stage is the planning process where project manager is expected to put in place systems and structures for the implementation. The third stage is the actual execution of the planned activities. The control team will supervise the project to identify and facilitate the correction of any mistake identified. The last stage is the handover, where the project manager officially presents the new facility to the owner.

Quality Management Approach

The project manager was given clear instructions on the level of quality that was expected in this project. It is essential to ensure that the stipulated quality standards are met effectively to make sure that the project is successful. The team will be using the concept of total quality management (TQM) to ensure that high-quality standards are met from the stage of acquiring raw materials to the actual construction process. The project manager and the assistant will be directly responsible for assessing all the activities to ensure that quality standards are not compromised. The sponsor has also created an independent quality assurance unit to help in inspecting the project. The project manager and the independent quality assurance unit will work closely to help monitor the progress made and the standards of the output.

Tools and Techniques to Be Used

The management needed to use specific project management tools to ensure that the intended goal is realized. As mentioned above, TQM was one of the tools that the team is using to ensure that the expected standards are maintained throughout the project. It will help in ensuring that every activity undertaken and product used in this project meets the required quality standards. A work breakdown structure (WBS) was used to ensure that activities were clearly defined and then assigned to specific individuals based on their roles in this project. The team used a Gantt chart to ensure that activities were clearly planned. These tools will facilitate the effective implementation of the project.

Resource Estimates

The project manager and the entire team will need specific resources to ensure that there is an effective implementation of the specified activities. The team will need the financial resources from the project sponsor to facilitate buying of the materials needed. The resources can be released after a given period based on the progress made. The team will also need human resources to facilitate the activities of this project. A team of experts in design and construction will be part of the project members. The project also needs specialists in recruitment and training of employees.

Standards

The project has to be completed as per the quality standards defined in the project charter. The team will ensure that quality is monitored from the stage of sourcing the materials to the actual process of construction. TQM will be utilized to ensure that quality standards are maintained. The assessment of standards will be conducted in two different ways. First, the project manager will have an internal quality assurance team responsible for the activities undertaken in the project. The team will focus on identifying and guiding the process of eliminating mistakes. The second quality assurance team will be from the sponsor. This independent unit will assess the progress made in the project and make regular reports directly to the sponsor. In the case where a change is necessary, the team can advise the project manager accordingly.

Change and Control Procedures

When undertaking this project, it will be necessary to admit that some changes may be necessary to ensure that the intended goal is realized. The project manager will work closely with the team members to monitor changes that may emerge, which are relevant to this project. The goal will be to ensure that the aim and objectives of this project is realized in the best way possible. Whenever a change is unavoidable, the team will find ways of implementing it in line with the primary goal of the project charter. If it is established that the emerging change may have a major impact on the intended goal, the project manager will have to contact the sponsor and inform the board about the same. Such changes will only be introduced in the project if there is explicit approval from the sponsor.

Roles and Responsibilities

The ability to achieve the intended goal in this project depends on every stakeholder understanding their primary role and responsibilities. It makes it easy for the monitoring and evaluation team to assess and understand specific areas of weakness in the implementation project. As mentioned above, there will be a team that will be responsible for designing the new ED structure. It will be a team of architects recommended by the parent company. They will hand over their design to civil engineers who will interpret the plan and lead its implementation. There will be masons, electricians, painters, carpenters, and other experts who will be directly involved with the construction process. The project manager will have to be responsible for the following tasks:

• Overall coordination of all activities in this project from initiation to the final stage of handing over;
• To monitor the progress of the project and make sure that the expected standards are met;
• To ensure that interests of the project sponsor are met in a way that respects the interest of project members;
• To address any conflict that may emerge among members of the project;
• Communicate regularly with the sponsor and provide updates about progress made.

Work Plan

The activities that are to be completed in this project have been clearly identified. The schedule, discussed above, has identified the time within which the project should be completed. From January 1 to 10 2022, the project manager will receive and review the project charter to understand what needs to be completed. From January 12 to February 7, the project manager will assemble the right team for the project based on their expertise, and brief them accordingly based on what they are expected to accomplish. From February 11 to March 30, the architects will be expected to design the ED structure based on the proposals provided by the project sponsor.

The actual construction activities are expected to begin on April 1 and they will last until November 30. It will involve expanding the working space for nurses, doctors, and technicians. It will also involve installing new systems of communication and a redesigning of the movement of supplies. Recruiting and training of additional staff will be conducted from September 1 to December 15. The new system will undergo a series of testing from December 19 to 22 of the same month. Any issue raised will be addressed during that period to ensure that the new system is effective. The handover of the completed project will be done on December 28. The information is summarized in the Gantt chart shown in Table 1.

Table 1. Gantt Chart

Update Report

It is essential for the project manager to make sure that there is a regular update on the progress of activities, especially when the project is half-completed. Regular updates make it possible for the project sponsor to determine if the team is on the right path toward achieving the intended goals. As shown in the Gantt chart above, two activities, which are receiving and reviewing the project charter, and assembling and briefing the team, have already been completed. Designing the new system is waiting for the final approval of the implementation team. It means that the project is 5% complete. The actual construction process, which is the most complex and time-consuming part of the project, is about to begin. The team will make an effort of providing a monthly report to provide an update on the progress made.

Team Contact Directory

The team will need a clear communication system that will enable it to communicate effectively with various stakeholders. As mentioned above, the project manager will be solely responsible for communicating with external stakeholders. All the official letters and documents from any other source will use the current contact directory of this hospital but expressed directly to the project manager. During the time of the implementation of this project, there is a specific phone contact that the project manager is expected to use. The team will create an official Facebook page and a WhatsApp group page that will facilitate effective communication of team members

Approval Sign-Off Form

The project sponsor and project manager will need an approval sign-off form that will allow them to commit to this project. The project sponsor will commit to ensuring that all the needed resources in this project are made available at the right time to facilitate smooth operations of all the activities. The project manager will commit to ensuring that all the activities in this project will be completed as per the schedule provided and by quality standards set by the sponsor.

References

Catalano, T. (2020). Application of project management principles to the management of pharmaceutical R&D projects. Springer.

Clegg, S., Skyttermoen, T., & Vaagaasar, A. L. (2020). Project management: A value creation approach. SAGE.

Englund, R. B. A. (2019). Complete project manager: Integrating people, organizational, and technical skills. Berrett-Koehler.

Heldman, K. (2021). PMP project management professional exam study guide: 2021 exam update. Wiley Brand.

Iqbal, A. (2020). Project management multiple choice questions and answers (MCQs): Quizzes & practice tests with answer key. Bushra Arshad.

Spalek, S. (Eds.). (2019). Data analytics in project management. Taylor & Francis Group.