The Centre For Addiction And Mental Health's PMO Gives Staff The Power To Provide Better Care
From left, Carrie Fletcher, PMP, Damian Jankowicz and Jacqueline Phan, PMP
BY TEGAN JONES
PORTRAITS BY JONATHAN BIELASKI
Size: 47 full-time employees, 13 students
Annual budget: CA$12.2 million
Average project value: CA$421,896
Just as with physical problems, mental health issues can't be left to heal on their own. Yet many people are hesitant to seek professional help. Only 1 in 3 Canadians who experience mental health challenges in any given year seek treatment, according to the Mental Health Commission of Canada. This is due, in part, to long wait times in the country's publicly funded healthcare system. In the province of Ontario, wait times of at least six months are common for mental health patients.
The Centre for Addiction and Mental Health (CAMH) wants to change this. As Canada's largest mental health and addiction teaching hospital, CAMH has 550 inpatient beds in Toronto, Ontario and sees 476,000 outpatient visits each year. It's also one of the world's leading research centers, educating the next generation of mental health professionals.
“[The PMO was] quickly known as the place to go to get things done across the organization.”
—Carrie Fletcher, PMP, CAMH
CAMH also has a mandate “to drive social change and help to advance systemic change at the national level,” says Damian Jankowicz, vice president, information management, CIO and chief privacy officer, CAMH.
That's why CAMH launched a project management office (PMO) in 2012. The organization wanted to develop more efficient and effective ways to serve patients—and it wasted no time doing so. One of the PMO's first projects was Access CAMH, which aimed to improve CAMH's process for managing the more than 20,000 external referrals it receives each year.
“It allows a patient or care provider in the community to pick up a phone and speak to a live person to ensure that the patient can get the care they need in the program they need in a very timely manner,” says Carrie Fletcher, PMP, senior director, health information management and enterprise project management office (EPMO), CAMH.
The new process streamlined a system of more than 30 different referral forms into a single access point that more than 80 outpatient clinics can use as a front door to CAMH's services. It reduced referral delays in general—and cut patient wait times in the child, youth and family service by three full months. The PMO has used that early success to build buy-in and cultivate relationships with clinicians, researchers and administrators who would support future projects.
“In a relatively short amount of time we grew to a centralized model,” says Ms. Fletcher. “[The PMO was] quickly known as the place to go to get things done across the organization.”
Effective project delivery is particularly important for a hospital like CAMH, where more than CA$313 million of its CA$408 million in funding in 2017 came from national and local government. The hospital measures success through outcomes in clinical care, patient experience, and patient and staff safety, as well as the efficient use of government funds.
“We have very strict guidelines in terms of spending, because they're tax dollars primarily that we are using,” Ms. Fletcher says.
But with 3,000 staff, 395 physicians and close to 900 medical residents and students working with CAMH each year, project needs and requests vary wildly. So the PMO helps make sure that each new initiative aligns with the organization's strategic plan.
When a leader suggests a project, the PMO's first step is to identify which of CAMH's six strategic goals the project supports. A description of the benefits it expects to deliver is then reiterated in the project charter and clarified in the scope document so that no information is lost along the way.
“You can't achieve your strategic goals without having that infrastructure to build the organization on,” says Ms. Fletcher.
The PMO also compiles and analyzes data to help CAMH's executive team stay on top of the 40 to 55 projects going on at any given time across the organization. Organizational dashboards, heat maps and project dashboards are just a few of the tools that drive decision making and showcase the value the portfolio is working to provide. This allows leaders to create integrated project delivery plans—and prioritize deliverables when there's too much on the table, Mr. Jankowicz says.
“When the organization feels stretched, we can use these tools to see what's actually happening and where we need to reallocate resources or realign initiatives,” he says.
Becoming the single source of project information also has allowed the PMO to consolidate project communications that go out to clinical teams. This reduces the amount of time it takes for the teams to understand what the project will change and how it will impact their jobs.
“There's a real connection with clinical teams to ensure ... true adoption, not just implementation.”
—Jacqueline Phan, PMP, CAMH
The PMO's role in centralizing communication also streamlines the adoption of new tools and processes. For instance, in recent years CAMH has embraced electronic medical records to become an almost entirely paperless organization. By accessing patient information online, clinicians can now take a more comprehensive approach to care—and are less likely to make mistakes. But to effectively implement new technologies at the hospital, the project team had to create tight integration among portfolios in different clinical areas. That meant putting people first—and spending the time to understand how technology changes would impact how teams provide patient care.
The Centre for Addiction and Mental Health is Canada's largest mental health and addiction teaching hospital.
“It's not enough to deliver the technology. The PMO has been instrumental in delivering the value that the technology brings.”
—Damian Jankowicz, CAMH
“There's a real connection with clinical teams to ensure adoption—true adoption, not just implementation,” says Jacqueline Phan, PMP, senior manager, EPMO operations and proposal management, CAMH.
Learning about the inner workings of different clinical areas has helped the PMO reduce the stress that comes with tech rollouts. That, in turn, has improved the quality of care and increased organizational efficiency. In June, CAMH became the first mental health and addiction hospital to earn Stage 7 certification from the Health Information and Management Systems Society—the highest rating the North American agency gives for electronic medical records adoption.
“It's not enough to deliver the technology,” Mr. Jankowicz says. “The PMO has been instrumental in delivering the value that the technology brings.”
Cross-functional partnerships have been at the core of the PMO's appraisals of how tech and process changes impact end users, including clinicians, researchers and students, Ms. Phan says.
“The PMO listens and provides that objective safe space to bring forward new ideas and also identify pain points in adoption,” she says.
PMO team members, including project managers, project analysts and portfolio managers, are actively engaged in working groups and steering committees made up of key stakeholders across the organization. (Project analysts support project managers by gathering requirements, coordinating meetings and following up on action items, among other things.) During these smaller conversations, ideas and concerns come up that would likely not be raised in a larger group meeting. And building relationships with individuals across teams means project team members are better equipped to tell when an unspoken issue may be bubbling up.
“They are looking at body language and tone,” Ms. Fletcher says. “They're identifying those that are not speaking up in group meetings and following up with them to ensure that they're on board with what is being proposed for the project.”
The PMO has also earned the respect of its clinical colleagues by limiting the documentation it requires from its project partners. In the heavily regulated healthcare sector, these clinicians are responsible for completing reams of paperwork, which already takes time away from patient care.
“Our PMO is focused on delivery rather than policing,” Mr. Jankowicz says. “It's focused on value rather than templates and focused on removing barriers rather than delegating.”
Yet the team still relies on some formal checks and balances that help keep projects on target. The PMO draws on PMI's A Guide to the Project Management Body of Knowledge (PMBOK® Guide), making sure projects pass through all the major phases. But it also scales its processes to fit the project's complexity, size and budget. Focusing less on gatekeeping and more on enabling change, the PMO's standards have helped deliver on project goals.
“Even though we're not touching the patients and their families’ and friends’ lives in a direct way, the work that we are doing is improving the care that they are receiving.”
—Carrie Fletcher, PMP
Supporting the implementation of a clinical information system and earning the highest certification from the Health Information and Management Systems Society has helped the Centre for Addiction and Mental Health's project management office (PMO) improve patient outcomes across the enterprise. Although data since earning the Stage 7 rating in June isn't available, the CA$65 million, four-year project to earn the Stage 6 rating—achieved in June 2016—produced the following results:
■ Lab results are delivered 41 percent faster.
■ Reported patient visits increased 144 percent in just two years.
■ Submitted claims are up by 40 percent.
■ Realized revenue jumped by 35 percent.
■ Digital documents are now available within 24 hours of a patient visit—down from 63 days for outpatient services and 39 days for inpatient care.
“Having the mechanisms to raise early flags around risk and being able to then mitigate them early gives us confidence that we'll get there in the end,” Ms. Phan says.
Picking objective success measures that can be tracked from the outset of every project keeps work focused on the intended outcome. And the team will generally not close a project until that desired result has been delivered—especially when that work is related to clinical process improvements and patient safety, says Ms. Fletcher.
“We're monitoring the data that we're getting from the project and the implementation of changes ... to ensure that the goal has been met before a project is closed off.”
EXPERIENCE AND EXPERTISE
Developing specialized project talent has also been a major success factor for CAMH's PMO. Prior to the PMO, many project managers were subject matter experts in areas such as technology, psychology or pharmacology—but they didn't have a background in delivering projects.
In its first year, the PMO looked at the number of milestones achieved by experienced project managers compared to those reached by project managers not formally accountable to the PMO. The results were clear: The PMO's project managers were hitting their milestones over 70 percent of the time, while the subject matter experts were reaching their goals between just 30 percent and 35 percent of the time.
“Being able to invest in a PMO and properly trained project management professionals has been huge,” Ms. Fletcher says.
The PMO offers a variety of internal professional development opportunities. These include brainstorms where team members troubleshoot each other's problems and monthly courses that cover topics like presentation skills, change management, business case development and writing.
Staff members are also allotted three education days per year to pursue development opportunities they're interested in, including preparing to earn their Project Management Professional (PMP)® certification. The PMO covers a portion of the costs associated with these sessions. The investment ultimately pays off by boosting expertise, Ms. Fletcher says.
“When somebody has PMI certification, it automatically brings credibility to our team and credibility to the work that we do,” Ms. Fletcher says. “They know that things are going to get done because we've got a professional working on this.”
The momentum for PMO buy-in keeps building year over year. While teams were once reluctant to have the PMO run their projects, they are now looking at ways to turn all types of work into projects so the PMO can help them produce better results for their clients. Those results are what keep the team looking for new opportunities for growth, Ms. Fletcher says.
“Even though we're not touching the patients and their families’ and friends’ lives in a direct way, the work that we are doing is improving the care that they are receiving,” she says. “And that puts a smile on my face when I leave the office at the end of the day.” PM
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