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Project management in healthcare

Reimagining Patient Care: Lessons from Project Management for Healthcare

Project management is a well-established discipline across many industries, from construction to technology, and even event planning. Effective project management involves coordinating multiple elements—resources, timelines, personnel, and quality assurance—to achieve a successful outcome. But when we look at healthcare, the landscape is quite different. In this field, doctors are often seen as the default project managers for patient care. However, the tools, processes, and support systems that make project management successful in other sectors are often lacking in healthcare.

What Makes a Good Project Manager?

In most industries, a good project manager is not necessarily an expert in every technical aspect of the project. Instead, they are skilled coordinators who understand how to bring together the right people, at the right time, to deliver a successful outcome. They have access to comprehensive information about all aspects of the project and are adept at managing resources, timelines, and communication among stakeholders.

Key elements of effective project management include:

  • Clear Communication: Ensuring all stakeholders have the information they need.
  • Resource Allocation: Coordinating the necessary resources and personnel.
  • Risk Management: Identifying potential issues and having plans to address them.
  • Quality Assurance: Regular checks to ensure standards are being met.
  • Adaptive Planning: Flexibility to adapt to changes and new information.

These principles are supported by a range of tools, from project management software to standardised processes and methodologies like Agile or Six Sigma, all designed to facilitate smooth coordination and delivery.

Project Management in Healthcare: The Doctor as the Project Manager

In healthcare, the role of the project manager often falls to the doctor, particularly the GP. The doctor is responsible for diagnosing conditions, creating care plans, coordinating with other healthcare professionals, and ensuring that the patient follows through with their treatment. While this might sound like effective project management, there are significant gaps in the support and systems available to doctors compared to other industries.

The Limitations of the Doctor as Project Manager

  1. Limited Access to Information: Unlike project managers in other fields who have access to comprehensive project data, doctors often work with fragmented health records. They may not have access to a patient’s complete medical history or information from other providers involved in the patient’s care, making it difficult to coordinate effectively.
  2. Lack of Coordination Tools: In most industries, project managers use sophisticated tools to track progress, allocate resources, and communicate with team members. In healthcare, such tools are often absent, and coordination relies heavily on phone calls, faxes, and fragmented electronic health record systems.
  3. Overwhelming Workload: Project managers typically focus solely on managing the project. In contrast, doctors juggle multiple roles, including clinician, diagnostician, and project manager. This burden can lead to burnout and compromised care coordination.
  4. Undefined Roles and Responsibilities: In other industries, roles within a project are clearly defined, and there is a structured hierarchy. In healthcare, the delegations and responsibilities between doctors, nurses, allied health professionals, and support staff can be blurred, leading to confusion and inefficiencies.
  5. Lack of Training in Project Management: While doctors undergo extensive training in medical practice, they often receive little to no formal education in project management. This lack of training can hinder their ability to effectively coordinate care, especially in complex cases involving multiple healthcare providers.

The Patient as the Expert Project Manager

In complex and chronic health conditions, it is often the patient—or their caregiver—who becomes the true project manager. They are the ones living with the condition every day, gathering information, managing appointments, and navigating the healthcare system. Patients frequently accumulate a depth of knowledge about their condition that surpasses that of any individual healthcare professional.

For example, in my own experience with my son, who has a very rare bone disease, I have read every academic paper on the topic and understand the evidence around its progression. Yet, during a multidisciplinary team meeting chaired by a medical specialist whose expertise was not in this specific condition, I was presented with new and conflicting information. When I expressed my surprise and offered the knowledge I had gathered, there was no space for my expert view as a caregiver. The specialist’s professional view overshadowed my insights, despite my extensive research and lived experience.

This dynamic reflects a significant flaw in the current healthcare project management model. Unlike in construction or other industries, where the project manager has the authority and tools to integrate all relevant expertise, the healthcare system often fails to recognise the patient or caregiver as a valuable source of knowledge. This can lead to miscommunication, fragmented care, and suboptimal outcomes.

The Problem of Fragmented Records

An ongoing challenge in healthcare is the fragmentation of health records. My son underwent numerous, expensive diagnostic tests at a top tertiary hospital, yet none of these results were accessible in his GP’s medical record, despite my explicit request for them to be shared. When he later experienced what we believed to be an acute flare of his condition, we rushed him to the local emergency department, only to find that they, too, could not access his records from the tertiary hospital. This lack of integrated information not only complicates care but also results in unnecessary repeated testing, increased healthcare costs, and potentially delayed diagnosis. Remarkably, the tertiary hospital advised me that if I wanted access to my son’s medical records, I would need to submit a formal freedom of information request.

A New Approach: Patients as Custodians of Their Health Records

Perhaps it’s time to rethink who holds and manages health records. Instead of relying on a patchwork of systems that lack interoperability, what if patients themselves were the custodians of their health information? With integrated APIs that link all health records, patients could have a comprehensive view of their own health data, accessible to any healthcare provider, anywhere, at any time. This model would empower patients, reduce redundancy, and enable more coordinated care.

Not All Conditions Require Care Coordination

It’s important to recognise that not all health conditions require the level of care coordination typically expected of a project manager. Many of the most common reasons for presenting to general practice, such as musculoskeletal issues and mental health concerns, can be managed effectively by patients choosing to see the appropriate practitioner directly. This is analogous to consulting an architect for a house design without the need for a project manager. Allowing patients to decide when and which practitioner to consult saves time and reduces healthcare costs by avoiding unnecessary secondary referrals. In these cases, the cumbersome processes associated with care coordination may actually hinder rather than help effective care delivery while increasing service costs and delaying access to care.

A New Approach: Integrating Project Management Principles into Healthcare

To bridge these gaps, healthcare could benefit from integrating proven project management principles and tools into clinical practice. Here are a few suggestions:

  • Dedicated Care Coordinators: Just as project managers oversee construction projects, dedicated care coordinators could manage the logistical aspects of patient care, allowing doctors to focus on clinical decision-making.
  • Integrated Health Records: A unified, accessible health record system—or better yet, patient-managed records—would ensure that all healthcare providers involved in a patient’s care have the necessary information to make informed decisions.
  • Project Management Training for Healthcare Professionals: Introducing basic project management training into medical and allied health curricula could equip healthcare professionals with the skills they need to coordinate care more effectively.
  • Recognising the Patient’s Role: Healthcare systems need to create space for the patient or caregiver’s voice in the decision-making process, especially in cases where the patient has acquired significant expertise.
  • Use of Project Management Tools: Implementing tools and technologies designed for healthcare settings could streamline communication, scheduling, and follow-up, much like project management software does in other industries.
  • Patient-Centered Care Teams: Similar to construction teams that bring together various specialists, healthcare teams could include diverse professionals—GPs, specialists, allied health professionals, support workers, and the patient—each contributing their expertise to a shared care plan.

Conclusion: Rethinking the Role of the Doctor as Care Manager

While the doctor has traditionally been seen as the project manager of patient care, it’s clear that this role needs to be reimagined. Effective healthcare requires coordination and communication among many players, supported by systems and processes that enable seamless care delivery. By looking to project management practices in other industries, empowering patients as custodians of their own health records, and acknowledging the patient as an integral part of the team, we can develop a more cohesive, efficient approach to patient care—one that recognises the unique contributions of every stakeholder and ensures that patients receive the best possible outcomes.

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