First‐case on‐time‐start accuracy at Fond‐du‐Lac Medical Center
The Problem Statement
Ideal state: First‐case on‐time start accuracy should be above the 50th percentile of cohort performance. One hundred percent of the causes of delay should be appropriately documented in our EMR.
Current state: Data from Surgical Compass® Cohort Benchmark analysis shows a first‐case on‐time‐start accuracy rate of 16 percent (160/1000) (< 25th percentile of cohort performance) in our operating room. Delayed on‐time‐start is the cause of decreased quality, loss of productivity, and ongoing dissatisfaction among our patients, surgeons, and OR staff. Preliminary data reveal that in up to 65 percent (546) of the delays, the appropriate cause is not well documented, which is preventing our efforts to address the situation.
Gap: 25 percent difference between ideal state and current state, with 546 causes not being fully documented.
THE PROJECT CHARTER
What Is a Project Charter?
After the problem has been clearly defined with a Problem Statement, it is time to agree on the nature and specifics of the project. The Project Charter is the most important document of your project.
The Project Charter is a document that serves to gain agreement between the Primary Sponsor and the QI team as to the nature, scope, goals, and timeline of the project. The Project Charter concisely delineates the who, what, when, where, how, and why of the project.
The Project Charter is key to helping the QI team achieve the goal of the project because
It helps everyone understand the aim, scope, and goals of the project.
It serves to gain agreement between all parties.
It authorizes the project’s initiation and use of resources by the QI team.
The Project Charter serves as an informal contract between thePrimary Sponsor and the project team as to the scope, roles, responsibilities, and nature of the project. An initial draft of the Project Charter must be complete at the beginning of the project. It must also specify who the Project Sponsor, physician sponsors and project manager / leader are. Once the team is formed, the Project Charter can include the project team members, team leader, and key stakeholders when they become known.
The Project Charter can be referred to throughout the project’s life cycle when questions arise regarding expected project performance, deliverables, and timelines. It is a living document that should be updated throughout the project as new information becomes available.
A Project Charter is not a project management plan. It is not a comprehensive document detailing all the steps and actions necessary to complete the project. Instead, the Project Charter is the compass that sets the direction for the QI team, clearly outlining the participants, scope, metrics, and goals of the project.
Quotable quotes: “To solve a problem or to reach a goal, you don’t need to know all the answers in advance. But you must have a clear idea of the problem and the goal you want to reach.” W. Clement Stone
The Project Charter “Must‐Haves”
The Project Charter must have the following six important components:
1 A Problem Statement. A Project Charter must have a problem statement to clearly define the focus of the project; What’s the problem? Reasons for action? What’s the background? A burning platform may be a part of the problem statement. The problem statement provides the reasons for prioritizing the project at this time, the anticipated consequences if the project is not undertaken, and the project’s financial or clinical implications if known.
2 The scope and boundaries. What are we going to improve?, and very importantly, what is not going to be addressed now? What is in‐scope and out‐of‐scope? The scope and boundaries of the project help the team focus on the work that needs to be done, the areas or issues that will not be addressed at this time, and the expected deliverables.
3 Key metrics. What are we going to measure? How will we know we have improved? This section describes what will be measured and how the project success will be defined and evaluated.
4 Goals and objectives. What do we want to achieve? What will success look like? This section defines the proposed project goals. Remember, goals should be SMART: Specific, Measurable, Attainable, Realistic, and Time‐Bound. If the current baseline performance is not known, specific project goals can be set at a later date after the current process performance is defined (see Chapters 14–17). Project goals should be agreed upon with the Primary Sponsor and Key Stakeholders.
5 Milestones and timeline. By when do we want to achieve it? Estimate the dates when specific deliverables will be produced. There are numerous tools to estimate timelines. A great way to visualize a project’s timeline is by creating a Gantt chart, a type of horizontal bar chart that outlines all the tasks involved in a project shown against a timescale that serves to give the reader an instant overview of the entire project, together with information on the order of the tasks and when each task needs to be completed.
6 Signatures. Who are the parties involved? A Project Charter should bear the signature of the key parties:as a sign the project has been approved by the Primary Sponsor;as a sign of commitment by the team leader and the members of the QI team; andto establish a clear agreement on the nature, scope, goals, and timeline of the project.
The Project Charter is a valuable tool to provide direction to a QI team as well as to establish performance expectations of both the Project Sponsor and the QI team that senior leadership can use to track performance of all parties.
Example: The patient arrival‐to‐departure time at the PCP clinic
Figure 4‐1 is an example of a Project Charter for you. The charter includes the Primary Sponsor, project team members, reason for action, project scope and boundaries, key metrics, goals of the project, timelines, and electronic signatures. We have created our own template, but, of course, you can build your own.
FIGURE 4‐1 The patient arrival‐to‐departure time at the PCP clinic.
EXERCISE: A PROBLEM STATEMENT AND PROJECT CHARTER FOR YOUR QI PROJECT
Think of a problem you would like to address and the project you would launch. Using what you have learned so far
Write a short paragraph describing the problem you aim to address, reasons why you should address the problem, the consequences of not addressing the problem, and the “why now?” you are addressing the
