Project: PsyHoC (Psychiatric Home Care)

Table of Contents
Introduction ............................................................................................................................................................... 2 Profile of the Clinic ................................................................................................................................................ 2 PsyHoC Project .................................................................................................................................................... 2 Project Charter ........................................................................................................................................................... 3 Executive Summary ............................................................................................................................................... 3 Project Purpose ..................................................................................................................................................... 3 Business Objectives ............................................................................................................................................... 3 Project Description................................................................................................................................................ 3 Stakeholders ......................................................................................................................................................... 4 Project Objectives ................................................................................................................................................. 5 Requirements ........................................................................................................................................................ 5 Constraints ............................................................................................................................................................ 5 Preliminary Scope Statement ................................................................................................................................ 6 Risks ...................................................................................................................................................................... 6 Project Deliverables .............................................................................................................................................. 6 Milestone Schedule ............................................................................................................................................... 7 Budget ................................................................................................................................................................... 8 Project Approval Requirements ............................................................................................................................ 8 Project Team ......................................................................................................................................................... 8 Feasibility Study ......................................................................................................................................................... 9 Introduction .......................................................................................................................................................... 9 SWOT analysis ....................................................................................................................................................... 9 Driving forces ...................................................................................................................................................... 10 Feasibility Analysis and Alternative Scenarios..................................................................................................... 10 Alternative Scenarios .......................................................................................................................................... 11 Risk Management .................................................................................................................................................... 11 Identification of risks........................................................................................................................................... 11 Propability/Impact of Risks ................................................................................................................................. 12 Potential Cost Impact / Probable Risk Cost ......................................................................................................... 12 Risk Response Planning ....................................................................................................................................... 13 References ............................................................................................................................................................... 14 APPENDICES ............................................................................................................................................................. 15 Appendix A. WBS of the PsyHoC project ........................................................................................................... 15 Appendix B. Critical Path Method ....................................................................................................................... 16 Appendix C. Gantt chart (time schedule) ............................................................................................................ 17

1|Project Management

Project: PsyHoC (Psychiatric Home Care)

Introduction
Profile of the Clinic
The Ippokrateio Neuropsychiatric clinic provides treatment services to patients with mental or neurological disorders since May 2000. The purpose of the clinic is diagnosis and therapy of patients with mental and neurological disorders so as social reintegration of people with diversities. Services provided are medical treatment, nursing care, occupational therapies, social service, and psychological support. Most of the expenditures are covered by sickness insurance funds. The workforce of the clinic consists of psychiatrists, neurologists, general practitioners, physiologists, nursing staff, physiotherapists, psychologists and occupational staff. Since the clinics reputation expanded over the limits of Larisa, the strategy planned is to increase its reputation beyond the borders of the region of Thessaly and become well known on a national level. In order to achieve this goal, 3 criteria must be met. High quality of clinics services, customer support and diversified services provided.

PsyHoC Project
Under these circumstances and in the strategic framework of obtaining competitive advantage, directors board grabbed the opportunity given by the Ministry of Health and the Ministry of Labor which fund the provision of health care at home to patients with mental or neuropsychiatric disorders after they have been hospitalized and received treatment. The CEO of the Ippokrateio decided to add this new element to the health services provided by the clinic and assigned to the EvoProjects team, our team, to design, control, implement and deliver this project we named PsyHoC (Psychiatric Home Care). Specifically, PsyHoC will be a service funded by the sickness insurance funds, which will include patients with serious and persistent mental illness as well as high risk for repeated hospitalizations, a recent release from hospital care and need of follow-up to prevent relapse, Alzheimers Disease and other types of dementia, alcohol and other drug abuse or dependence and families so as caregivers in need of psychosocial support and education. Services will be based on a comprehensive psychological, mental, cognitive, family and environmental assessment of the patient within the context of his/her home. Interventions will be provided by licensed, certified, clinical psychiatric nurses and psychiatrists. PsyHoC will be covering at start the region of Thessaly with plans for national expansion. Patients must have a pre-existing psychiatric diagnosis and have been hospitalized for this reason.

2|Project Management

Project: PsyHoC (Psychiatric Home Care)

Project Charter
Executive Summary Ippokrateio neuropsychiatric clinic during its 11 years of existence has treated over 4000 patients with mental or neurological disorders. The main problem for the patients so as for the clinic was the follow-up treatment. Patients, after hospitalization and treatment, were exiting the clinic with most of them not following instructions/medication and not appearing for reexamination in the clinic. That was resulting failure of follow-up, failure of therapy and for the organization unloyal patients which meant reduced revenues. In addition to the need of treating with this loss of follow-up, the organization was looking to invest in order to achieve further expansion and alignment to its strategic objectives. The opportunity of funding by the sickness insurance funds the psychiatric home care and follow-up if applied correctly in the clinics day-to-day activities will become a competitive advantage for the organization. The project PsyHoC will integrate current capabilities of the services provided already by the clinic with our knowledge on setting health care programs in order to establish a new, innovative, robust service provided by the private health care. Project Purpose The PsyHoC project will be created to increase the success of therapy on patients with mental or neuropsychiatric disorders. There will be better follow-up treatment and less hospitalization. In addition patients will be assisted in maintaining community living and improving their quality of life. On the other hand, the clinic will retain loyal clients and avoid further expenses by continuous hospitalization. As a result revenues will increase. Apart from the financial point of view, the brand name Ippokrateio will be identified as an innovative psychiatric health care clinic with rapid expansion. Business Objectives In summary the main business objectives to be accomplished are Design, control and implement PsyHoC project within the next 230 days Better prognosis for mental and neuropsychiatric patients through increase in therapy success by 20% in the 1st year after release Increase loyal clients, that is increase in number of follow-up patients by 40% in the 1st year after release Increase revenues by 10% in the 1st year after release Project Description The PsyHoC will be a new robust and innovative health care service provided by the private clinic. Experienced, certified psychiatric nurses and psychiatrists from the workforce of the clinic will train nursing and occupational staffs in order to create a high value human resource which will participate to the project. Medical equipment aligned to the latest medical technology so as genuine medication programs will be implemented to achieve the best of results. A new management section will be created in the clinic in order to monitor and control PsyHoC.

3|Project Management

Project: PsyHoC (Psychiatric Home Care) A fleet composed of transportation cars so as ambulances will be added to the assets of the clinic and will serve the logistics (Appendix A. WBS). Finally, connections between the clinics new service, the health care centers of the region (private and public) and the respective municipalities will be established to increase response and sensitivity to the psychiatric patient. Stakeholders The stakeholders are identified and presented below. There are three main categories. First, there is the internal category in which the clinics personnel are included. As second we have the external category in which all the groups of people that are outside the clinic are included. Finally the project team composes the third category. Category
Internal Project team Project team Internal Internal

Stakeholder
Project Sponsor Project Manager Project members Managerial staff of the clinic Medical, nursing and occupational staff of the clinic Ministry of Health Ministry of Labor Health centers in the region of Thessaly Suppliers of vehicles Suppliers of medical equipment Families of patients Patients

Major Benefits
Reputation, expansion, increased revenues Reputation, revenues Reputation, revenues Increased wages Increased wages, ethical satisfaction Less hospitalization, less expenditure Less hospitalization, less expenditure

Attitudes

Win Conditions
Success of project Success of project Success of project Success of the project Better treatment and prognosis of patients Success of project Success of project Failure of the project

Comments

+ + + +++ + + + +++ ++

Work overload Work overload

External External External

Increasing competition, negative attitude

External External External External

External

Local Municipalities

External

Local people

Maximize revenue from sales Maximize revenue from sales Better prognosis, family support Better prognosis and treatment, social rehabilitation Saving costs for respective service , humanistic point of view Humanistic point of view Financial

Realization of the project Realization of the project Implementation of the project Implementation of the project Success of the project

Higher costs, increased stress Bad family climate, insecure

Implementation of the project Implementation of the project

Stress for having diversified people near them

External

Banks

4|Project Management

Project: PsyHoC (Psychiatric Home Care) Project Objectives The objectives which mutually support the milestones and deliverables for this project have been identified. In order to achieve success on the PsyHoC project, the following objectives must be met within the designated time and budget allocations: Create a management team with people from the clinic that will cooperate with the project team and will be responsible for PsyHoC after the project completion within the next 10 days Perform Quality Function Deployment method to meet patients requirements within the next 30 days Develop a training program for the nursing and occupational staff referring to the psychiatric home care within the next 40 days Link up with the health centers and municipalities of the region within the next 60 days Run the training program within the next 130 days Order and acquire medical equipment, transportation vehicles and ambulance within the next 30 days Run a pilot test of PsyHoC within the next 215 days Deliver PsyHoC project within the next 230 days to the project sponsor Requirements This project must meet the following list of the high prioritized requirements in order to achieve success. Staff must be trained in psychiatric home care and include psychiatrists, nurses and occupational staff Patients will be in the region of Thessaly 24/7 high quality psychiatric treatment and occupational support Pilot test of PsyHoC prior to deployment Project must be implemented without disruption to the day-to-day activities in the clinic A website must be constructed for PsyHoC Patients must have a diagnosed neuropsychiatric disorder and hospitalized for this reason In order to meet patients and their families requirements Quality Function Deployment method will be applied. Constraints The following constraints pertain to the PsyHoC project. All the staff that will be used as crew for the project must be already working in the clinic. No one new will be hired 1 psychiatrist and 3 certified nurses will compose the management team from the clinic Medical service advertisement in press and on television is forbidden by the law New medical equipment, medication and transportation vehicles must be purchased in accordance with the allocated budget and timeline

5|Project Management

Project: PsyHoC (Psychiatric Home Care) Budget is 160000 (budget overrun up to 10% acceptable without executive review) Timeline is 180 days

Preliminary Scope Statement The PsyHoC project will include the design, control, testing and delivery of a psychiatric follow-up home care service provided by the clinic. All personnel, including doctors, nurses and occupational staff will be managed by the project team. The project process will be independent of daily operations of the clinic. The pilot test of PsyHoC will be performed in 10 patients. Project funding will be managed by the project till a budget overrun up to 10%. The project will conclude when the final report will be submitted within 20 days after the pilot trial version and all documentation will be complete and distributed to the appropriate personnel.

Risks The following risks for PsyHoC project have been identified. It is up to the project manager to deploy any avoidance or mitigation strategies in order to minimize the possibilities of the risks to occur. No of Risk R1 R2 R3 R4 R5 R6 Description
Need to hire new staff Legislation change on funding Low Quality of training Financial crisis/debt crisis QFD procedure delayed Vehicle/medical equipment suppliers unreliable Clients priorities changed Few key individuals Scope increase(project beyond Thessaly)

Probability 6 4 2 6 7 2

Impact 7 10 4 8 3 5

Risk Type of risk indicator(PxI) 42 Potential 40 8 48 21 10 Unpredictable Potential Potential Potential Unpredictable

R7 R8 R9

1 9 2

8 4 8

8 36 16

Unpredictable Known Unpredictable

Project Deliverables The following deliverables must be met upon the successful completion of the PsyHoC project. Any changes made must be approved by the project sponsor. 1. Fully trained medical, nursing and occupational staff 2. Management team as part of the clinic workforce responsible for PsyHoC 6|Project Management

Project: PsyHoC (Psychiatric Home Care) 3. Technical documentation as for the PsyHoC processes (staff, schedule, timeline, procedures, responsibilities, finance) 4. Website for PsyHoC 5. An innovative, robust health care service for patients with mental and neuropsychiatric disorders

Milestone Schedule The projects Milestone schedule is presented below. The schedule may be modified as the project procedures move on and requirements are more clearly defined. Any changes on this schedule will be communicated through communication between the project team, the clinics management team and the project sponsor Appendix B. CPM, Appendix C. Gantt chart).

Date 31-7-11 1-8-11 2-8-11 6-8-11 8-8-11 24-8-11 5-9-11 12-12-11 9-1-12 5-3-12 19-3-12 20-3-12

Name Approval by the Ministry of Health Project proposal approved Management team inside the clinic formed Medical equipment vehicles ordered Medical equipment and vehicles acquired QFD analysed Training program developed Training program completed Pilot test of service designed Pilot test of service successfully ends Website constructed Project delivered

Change Description

7|Project Management

Project: PsyHoC (Psychiatric Home Care) Budget The following table contains a summary budget based on the planned cost components and estimated costs required for successful completion of the project. Summary Budget List component project costs Project component Component cost Personnel Resources (Clinics 1 psychiatrist x 2500 + 3 7.000 management team) nurses x 1500 Training program Documentation & 3.000 equipment Medical equipment 8.000 Vehicles and ambulance 2 vehicles x 20.000 + 1 110.000 ambulance x 70.000 Website 500 Pilot test of PsyHoC 15 days x 250 3750 Project team Project manager x 9.000 + 27.000 project team (3) x 6.000 Total cost 159.250 Project Approval Requirements Success for the PsyHoC project will be achieved when the trained staff which will be composing the crew of the vehicles to visit and perform follow-up of the neuropsychiatric patients succeeds in the pilot trial version and when the management team formed in the clinic is ready to take over the monitoring of the project. Success will be determined of course by the project sponsor, who will also authorize completion of the project.

Project Team Michael Saunders is named Project Manager for the duration of the project. Mr.s Saunders responsibility is to manage all project tasks, scheduling, and communication regarding the PsyHoC project. His team will of 3 members, Mr. John Dawson, Ms. Laura Sanchez and Ms. Helena Andonova who will be responsible for the training program, the medical equipment/vehicles and QFD/website respectively. Mr. Saunders is authorized to approve all budget expenditures up to the allocated budget amounts. He will also provide weekly monthly updates to the project sponsor. Approved by Project Sponsor Date: 1-8-11 Mr. Papastergiou CEO of Ippokrateio Neuropsychiatric clinic

8|Project Management

Project: PsyHoC (Psychiatric Home Care)

Feasibility Study
Introduction In order to prove that the selected project is beneficial and meets the needs of the stakeholders a SWOT analysis of the organization will be presented. In that way we will see the problem and the opportunity that contributed to the idea of this project. From another perspective we will demonstrate briefly the driving forces that contributed to the project authorization. Moreover, we will demonstrate the technical, financial, risk and political factors that are used for the evaluation of our option and make our project comply with the needs of the main stakeholders and take a glimpse on alternatives.

SWOT analysis In order to understand the need of the PsyHoC project introduction we must first analyze the opportunities, strengths, weaknesses and threats of the clinic. STRENGTHS
Delivering high quality health care service to patients with mental and neurological disorders Provide high quality hospitalization Experienced staff Low cost Loyal suppliers

WEAKNESSES
No fresh, innovative ideas Far from the city of Larisa Nursing staff changes quite often Partly unloyal customers (due to their disorder)

OPPORTUNITIES
Legislation changes on national funding health care at home Many patients/clients unable to hospitalize due to family or disorder or distance Increasing number of mentally disordered patients Bad health care service provided by public institutions

THREATS
Debt crisis of Greece Competitors innovative ideas and better positioned

As we can see from the SWOT analysis weaknesses and opportunities guided the directors board of the clinic to come up to this idea; provision of psychiatric health care at home. Since the clinic was lacking innovative ideas and its patients/clients were party unloyal and the clinic is far from the city of Larisa comparing to the competition, a plan should be introduced in order to achieve organizational goals described in the introduction; expansion of the clinic over the region of Thessaly and over its borders. An opportunity aroused, that is, the fact of national funding on health care at home, which gave the idea of introducing a plan, a project that would put the clinic one step further than the competition. So the idea of PsyHoC was born.

9|Project Management

Project: PsyHoC (Psychiatric Home Care) Driving forces From another point of view, there were some forces that guided to the authorization of this project. First there was the market demand for better health care service at home with low cost, high quality, speed and dependability. Secondly, there was the business need for evolution and introduction of innovative ideas so as a need of a plan to be aligned with the strategic objectives. In addition, the legislation framework referring to the funds for home health care worked as a catalyst for the initiation of the project. At last, a social need for better follow-up treatment and prognosis of mentally disordered people was urgent.

Feasibility Analysis and Alternative Scenarios Several factors in realism can be used to evaluate the feasibility of PsyHoC project. Technical factors Referring to this factor we should focus on the workforce of the clinic and its abilities. The human resource of the clinic consists of psychiatrists, nursing staff and occupational staff experienced in mental disorders. Not all of the staff though is trained and certified in order to provide psychiatric health care at home. But with the guidance and training that they will be receiving from their experienced superiors the human resources will be ready to undertake the challenge. No new staff will be hired. As for the materials needed for the implementation of the project, there will be few adds to the existing medical equipment and to the fleet composed by transportation cars and ambulances. Financial factors The cost of the project comparing to the profit gained both from the national funds and the new loyal customers is rather low. Less hospitalization means less expenses comparing to the health care at home. In the first set of finance, the development the budget required is 160.000. Most of this money will go to transportation vehicles and an ambulance. There are cost savings from the fact that no new staff will be hired and the training will take place in the clinic from its experienced staff. In the second set of finance, production, the costs of the increased wages of the crews, medication and the maintenance of the vehicles will be the only expenditure and the profit from the insurance funds will be increasing. Political factors The legislation framework for funding clinics to provide health care at home fits perfectly to the scope of the organization. Risk factors As described in the project charter the main risks that this project may confront is the political/debt crisis, the possible legislation changes on funding and the need to hire new staff (mainly drivers and nurses) since the key individuals are few. The mitigation/avoidance of the risks will be discussed later on.

10 | P r o j e c t M a n a g e m e n t

Project: PsyHoC (Psychiatric Home Care) Alternative Scenarios 1. Do nothing. In that way the business objectives wont be met, there will be no competitive advantage, customer needs wont be fulfilled. The only advantage is the safety of not investing in such an unstable political and financial period. 2. Cooperate with public health care institutes. The option of cooperating with public institutes in order to achieve better follow-up treatment is a costless idea but in that way the risk of patients/clients leakage is big. No one wants to lose customers! 3. Invest in more efficient psychiatric therapies in clinic. A good idea but the technical factor of having people who miss the know-how for state of the art medical and nursing practice in a major disadvantage and training or hiring to that direction will be costly and not a value for money. Also, expensive medical equipment will be needed and patients may not want to change their medication and way of therapeutic treatment they were receiving so far. This last alternative may be a target plan for the future when political and financial factors permit bigger investments.

Risk Management
Identification of risks In order to identify the risks that arise in PsyHoC project we must check and study business objectives, service requirements and project boundaries. The sources of risks in our case are organizational, financial, technical, political, legal, market and human.

Financial

Technical

Legal

Political

PsyHoCproject

Organizational

Market

Human

11 | P r o j e c t M a n a g e m e n t

Project: PsyHoC (Psychiatric Home Care) Specifically, Financial/debt crisis in Greece so as a possible legislation change compose the financial/political risks. The possible need of hiring new staff to cover the crew needs, bad quality of equipment and vehicles so as low quality of training are technical risks. Market risks include the change in clients/patients priorities such as preference for hospitalization. Human risks include few key individuals that if are absent are difficult to replace and project will probably fail and low documentation and research that has to do with patients may be delayed, such as QFD method process, because of the clients unwillingness to participate. Last but not least, the scope increase, such as project expansion beyond Thessaly, is an organizational risk. Probability/Impact of Risks We rated probabilities and impacts of risks on the project from 1 to 10 with the help of expert judging, brainstorming, document analysis and interviews. The risk indicator, which was computed by multiplying probability with impact for every risk (PxI), set the prioritization of risks. As a result, the most crucial in order are financial/debt crisis, legislation change on funding and need to hire new staff. The risk table is deployed again to refresh the list of risks and their risk indicators. No of Risk R1 R2 R3 R4 R5 R6 Description
Need to hire new staff Legislation change on funding Low Quality of training Financial crisis/debt crisis QFD procedure delayed Vehicle/medical equipment suppliers unreliable Clients priorities changed Few key individuals Scope increase(project beyond Thessaly)

Probability 6 4 2 6 7 2

Impact 7 10 4 8 3 5

Risk Type of risk indicator(PxI) 42 Potential 40 8 48 21 10 Unpredictable Potential Potential Potential Unpredictable

R7 R8 R9

1 9 2

8 4 8

8 36 16

Unpredictable Known Unpredictable

Potential Cost Impact / Probable Risk Cost According to the cost importance of its requirement and business objective, risk will have respective probable risk cost and cost impact on the project. No of Risk R1 Description
Need to hire new staff

Risk Probability(%) 60

Potential risk Probable risk Risk cost (K) cost priority 20 12 Medium

12 | P r o j e c t M a n a g e m e n t

Project: PsyHoC (Psychiatric Home Care) R2 R3 R4 R5 R6

Legislation change on funding Low Quality of training Financial crisis/debt crisis QFD procedure delayed Vehicle/medical equipment suppliers unreliable Clients priorities changed Few key individuals Scope increase(project beyond Thessaly)

40 20 60 70 20

150 4 160 1 50

60 0,8 96 0,7 10

High Low High Low Medium

R7 R8 R9

10 90 20

80 10 50

8 9 10

Medium Medium Medium

Risk Response Planning In order to confront with the negative risks identified strategies must be designed a priori. Techniques such as avoidance, transference, mitigation and acceptance will be used according to the criticality and the nature of the risk. Avoidance. Low quality of training can be avoided by choosing the best psychiatrists and certified nurses of the clinic. If still this is not enough to maintain quality specialists should be invited. The few key individuals must be kept loyal to the project and in order to avoid any implications back-up should be ready to take over. In order to avoid unreliable suppliers, we should choose the ones that the clinic is cooperating with all these years with success. Loyal suppliers reduce the risk to minimum. To avoid QFD procedure delay we can give priority to this issue just after the formation of the management team of the clinic in order to save time and avoid any violation of the schedule. Mitigation. Scope may increase during the project process. In order to meet the budget and time requirements a solution must be made up to conform with the project sponsors new needs. The preferences of the clients can be mitigated by better explanation and more information about the project. This may reduce the loss of customers. If the need to hire new staff comes up, in order again to meet requirements some people must be hired to the point we dont exceed our targets. Acceptance. The probability of the collapse of the Greek economy is high so as changes in health care fund legislation. These are the most crucial risks and both must be actively accepted. The project sponsor must have in his mind that he may the full cost of the project without any funding. Also, if the project is finally implemented even if the crisis is on, the cost for the clients will be high. There are two solutions. The first is the delay of PsyHoC services provision and the second is to operate only in the city of Larissa with fewer patients and allocate the resources from the project to other activities of the clinic.

13 | P r o j e c t M a n a g e m e n t

Project: PsyHoC (Psychiatric Home Care)

References
1. Slack, N. Chambers, S. & Johnston, R. (2004), Operations Management, FT Prentice Hall (4th edition) 2. Gareis, (2000), Happy Projects, Chap. D3, Project Culture Handbook, Chap. 44 Managing Culture, pp. 793-814 3. Jeanne Kozlak J. and Thobaben M., (1994), Psychiatric home health nursing of the aged: A selected literature review: Geriatric and psychiatric nurses may want to explore the field of psychiatric home care, Geriatric Nursing, Volume 15, Issue 3, May-June 1994, Pages 148-150 4. Kayama M., Asukai N., Miyake Y., Tanoue M., Minakawa K. (2000), Effectiveness of home help service for psychiatric patients. The results of a model project in S city, Nippon Koshu Eisei Zasshi, 47(9):773-82 5. Parent K., Anderson M., Neuwelt B., (2000), Home Care & People with Psychiatric Disabilities. Needs & Issues. Final Report for Health Transition Fund Department of Rehabilitation Medicine, Canada 6. PMI PMBOK, Project Management Body of Knowledge, http://www.pmi.org 7. ICB 1999, http://www.ipma.ch

14 | P r o j e c t M a n a g e m e n t

Project: PsyHoC (Psychiatric Home Care)

APPENDICES
Appendix A. WBS of the PsyHoC project

15 | P r o j e c t M a n a g e m e n t

Project: PsyHoC (Psychiatric Home Care) Appendix B. Critical Path Method Activity Description A B C D E F G H I J K L M N O P Q
Approval from the ministry of health Form management team in the clinic Inform the team about the project Coordinate with the team for QFD planning Coordinate with the team for training lessons design Distribute questionnaires to clients Receive questionnaires Conclude from the application of the method Design training program Perform training lessons Order medical equipment/vehicles Acquire medical equipment/vehicles Design pilot test of service Perform pilot test Create website Deliver technical documentation and guidelines to all participants Deliver project to the sponsor

Immediate Predecessors

A B C C D F G E,H I C K J M,L N N O,P

16 | P r o j e c t M a n a g e m e n t

Project: PsyHoC (Psychiatric Home Care) Appendix C. Gantt chart (time schedule)

17 | P r o j e c t M a n a g e m e n t