To do the project, we must have clear concept about Project Management, which consists of two concepts-project, and management. Usually project means a one-time activity with a well-defined set of desired end results 1. The project is complex enough that the subtasks require careful coordination and control in terms of timing, precedence, cost, and performance. Every project has some elements that are unique and which make the projects different. On the other hand management means coordinating work activities so that they are completed efficiently and effectively 2. So the concept of project management indicates the means, techniques, and concepts used to run a project and achieve its objectives. The project management directly affects the project and how it should be managed. The main difference between project management and general management (Or any other form of management for that matter) relates to the definition of a project and what the project intends to deliver to the client and stakeholders 3. Project management environment consider the following issues:
Stakeholders (all interested parties).
Rules and regulations (Health and safety) 4.
Since strategic plans are usually developed at the executive level, implementation by middle level managers is often a problem due to poor understanding of the organization’s capabilities and top management’s expectations. However, bottom-up development of departmental goals and future plans invariably lacks the vision of the overall market and competitive environment. At King Faisal Specialist Hospital and research center, this problem was avoided by closely trying project management tools to the organizational strategy. The resulting system provided a set of checks and balances for both BC/BS executives and project managers.
An Overview of King Faisal Specialist Hospital and health care system: Before talking about the project management of the mentioned organization, it is needed to know about the background of the organization and the past and existing health care system. Because it will be helpful to understand the problem, used techniques and methods of project management.
The Infrastructure of King Faisal Hospital completed in 1991. Originally it has served as a polyclinic at the beginning and later a general hospital due to lack of Medical Specialists. During the Genocide and war of 1994 it was a refugee camp and medical center for thousands of displaced persons. Specialist services only offered from 1998 after involvement of Net care South Africa and the Government of Rwanda. Since 1998 KFH has been providing a high level of general medical care 5.
We KFSH, are committed to provide cost-effective and self-sustaining high quality health services in partnership with our clients. We do this with an empowered workforce in an environment that values professionalism, respects patient\'s rights and upholds human dignity at all times 6.
With our partners in research and education, within available resources, we contribute to the development of health services in Rwanda.
King Faisal Hospital, Kigali is growing and changing rapidly. Patient admissions grew 60% in the past two years and have grown another 40% in 2005. We have a new non-profit corporate charter and a new Board of Directors. In the 12 months starting with March 2005 we have more than US$ 6 million of capital resources for equipping the hospital and renovating its buildings; these resources come from the Government of Rwanda and the Saudi Development Fund.
The Council on Health Service Accreditation for Southern Africa engages us in a Quality Improvement effort that aims to achieve and sustain accreditation. We are the only private healthcare provider of international standard in Rwanda. Our vision is to be a center of excellence in health services provision and clinical education in Africa 7.
We said that we started providing high level of general medical care since 1998. Before that we didn’t have a good project management by which we could accomplish our goal. At the end of 2001 we started to face some severe problems for what it was not possible to provide up to the mark services to the clients. And chances of wrong treatments and client’s dissatisfaction started to emerge then. As a result the existing authority started to think of providing high or quality health service for the clients under customer care unit. For that reason the implementation of processes of identifying problems, selecting models by using project management came to our consideration 8.
After analyzing the background, we can find out the major problems that King Faisal Research Hospital had in the field of customer care. We can mention the following problems from that:
Lack of high or quality service from hospitals and physicians.
Increased operating costs.
High patient expectation.
Lack of focusing on the cultural sides of the organization, which helped to provide a high standard of customer care in the past.
External pressure like changeable political condition, imposing new governmental regulations etc.
Strong competition between national and international health care providers.
Need for patient satisfaction program.
Service education or training for the employees who are engaged in different important sectors of the hospital.
High employee turnover rate.
Overseeing the system is a newly created Corporate Project Administration Group 9 that helps senior management translates their strategic goals and objectives into project management performance, budget, and schedule targets of customer care or health service system. These may include new product development, upgrading information system, or implementing facility automation systems. CPAG also works with the project teams to develop their plans, monitoring activities, and reports so they dovetail with the strategic intentions.
Techniques of project management that were followed: King Faisal Specialist Hospital considered some techniques in the field of project management of their organization. The techniques that were followed by the group of working people who were engaged in the project of health service system:
Project Selection Model: The main purpose of this model is to aid decision-making leading to project selection 10. Under this model, to select the project management model, hospital authority considered some aspects. For example:
Method of implementing the project model.
Cost of power requirements.
Safety of decided system.
Number of potential users.
Impact on current or existing system.
Ability to control quality information.
Cost of new system.
Impact on company cash flow.
Cost of training the employees.
Level of financial risk.
Impact on working conditions.
Cost of upgrading the system to keep pace with new technology.
We used this technique while we were selecting plans and alternatives for developing our project of customer care or health service system:
Numeric Model: Numeric model is the model by which technique we could make a prediction of our cost, profit and other relevant matters through mathematical or numerical presentation. This model includes the financial models like:
Payback period: Payback period which is time taken to gain a financial return equal to the original investment.
Return on investment: Return on investment is another popular investment appraisal technique that does look at the whole project 12.
Net price value: Net present value let us look at compound interest, which is commonly used in saving accounts.
Basically we used this technique to gather knowledge about our financial or account section.
Scoring Models: Scoring models are also known as factor model. It simply lists a number of desirable factors on a project selection pro-forma along with columns for selected and not selected.
We used this technique to weight the alternatives and to have an idea of the factors which should be selected for developing the project and which should not be.
Before we implemented project management tools, we considered some assumptions by which we selected a project management model of customer care or health service system of our hospital:
We gave emphasize on reflecting the reality of the managers decision situation, including the multiple objectives of both the firm and its managers. Without a common measurement system, direct comparison of different projects is impossible. The model should take into account the realities of the firm’s limitations on facilities, capital, personnel etc 13.
But the techniques had limited application in some cases where it was not possible to consider the realities of the firm’s limitations on facilities, capital, personnel, project risks, technical risks, cost, and time as well as the market risks of client rejection and other implementation risks.
We considered the sophistication of the model to deal with multiple time period internal and external situations, strikes, income etc. But if major risks and constraints on the projects are not considered properly, then it is not possible for any organization to select the best overall project or set of project.
As a result we had to consider all these things to get the best output in the field of health service system of our hospital. But unfortunately in few cases it was not possible for some shortage of specific elements like lack of knowledge about internal and external factors or situations.
We gave emphasize on the ability to be easily modified; or to be self-adjusting in response to changes in the firm’s environment.
But our team of worker didn’t have enough knowledge about this assumption. And they overlooked these things while planning or selecting models and working as well, which caused the technique towards limited application.
Ease of Use:
We tried to make the model reasonably convenient, not take a long time to execute, and be easy to use and understand. The model did not require special interpretation, data that are difficult to acquire, excessive personnel, or unavailable equipment. Other than that the application of the project can’t be satisfactory and fruitful.
But for some internal and confidential reasons it was not possible all the time to make it convenient for the working people and this reason sometimes made a little bit hamper in working.
Data gathering and modeling costs were low relative to the cost of the project and less than the potential benefits of the projects. But if all the costs were not considered, including the costs of data management and of running the model, then it wouldn’t be a fruitful technique. For that reason the organizations that are very conscious about their costing, pay an attention to this sector most.
This assumption was not quite familiar to our working people as there were very few workers coming from commerce background. They did not know about including all the costs while selecting models. For this reason we had to organize training for them where they came to know how to count costs of any model or project. It was a costly attempt for our organization.
Now, in modern days it is impossible to think of any big organization without computer. For some people it is much important than the employee in some cases. But it must be easy and convenient to gather and store the information in a computer database, and to manipulate data in the model through use of a widely available, standard computer package 14.
In accordance with other expenses we had to consider this cost. But in some cases the purchasing cost of computer and installing package cost seemed excess and burden for us. Usage of computer also made the working people dependent and lazy as the computer could do the job faster.
Methods that are followed in the field of project management:
There are different methods for project management. But the most common approach to project scheduling is the use of network techniques. The combination of all activities (often drawn as arcs) and events (often drawn as nodes at the beginning and end of each arc) defines the project and the activity precedence relationships. Networks are usually drawn starting on the left and proceeding to the right. Before an event can be realized-that is, achieved-all activities that immediately precede it must be completed. These are called its predecessors. Thus, an event represents an instant in time when each and every predecessor activity has been finished. They are merely points on the network, conditions of the system that can be recognized 15.
Work Breakdown System:
The hierarchical approach to project planning is most appropriate and can be aided by a tree diagram of project subsets, called a work breakdown structure (WBS). The WBS relates the details of each subtask to its task and provides the final basis for the project budget, schedule, personnel, and control 16. There are two methods of presenting the WBS - graphically in boxes
Critical Path Method: Path is the series of connected activities (or intermediate events) between any two events in a network. And critical implies activities, events or paths, which, if delayed, will delay the completion of the project. A project’s critical path is understood to mean that sequence of critical activities (and critical events) that connect project’s start event to its finish event 17.
To transform a project plan into a network, one must know what activities comprise the project and, for each activity, what its predecessors (and /or successors) are 18.
Risk means uncertainty. So risk management is one method of project management, where risk is the main consideration of planning or solving the problem. It includes maximizing the results of positive events and minimizing the consequences of adverse events. However in the real world most decisions are based on incomplete information with an associated level of uncertainty about the outcomes-it is the uncertainty that leads to risk. So risk has always been an intrinsic part of project management.
Which method/methods were chosen and why?
Under the circumstances we choose networking method and work breakdown structure for the project management of our organization’s customer care or health service system unit. Because, these two methods have taken into account all the elements and techniques that are needed in the field of project management. The work breakdown structure provides a structured breakdown of the scope of work into manageable work packages that can be further developed into a list of activities. The next process is to establish a logical relationship between the activities using a network diagram. The network diagram may be defined as a graphical presentation of the project’s activities showing the planned sequence of work. There are interrelations or interdependencies among the subtasks of the project, which also help in working. As we see work breakdown structure and networking- both method are interrelated. One method helps the work of others.
Basically our project was on providing customers or clients or patients an up to the mark service. And for that reason we preceded our work through project management. Under that situation many types of techniques, methods and assumptions were followed. The major part by which we tried to solve our problem, we choose work breakdown and network system. Both of them were interrelated and it helped us to do the work efficiently and effectively and to accomplish our objective.
Though there was a good assembling of techniques, assumptions and other requirements, but unfortunately there were some inconsistencies that we found while working and afterwards. They are:
Delays in the completion of the project: While we were at the end of our project of developing the standard of customer care or health service system, we found that it will not be finished within the due date. And it will take ten days more. Unfortunately the project completed after ten days. After that we tried to find out the reasons behind the late completion. And finally we found the following reasons:
Lack of enough employees.
Lack of enough capital.
Late delivery of advanced technology or machinery.
Higher cost than the expected one: While we found that our incurring cost is getting higher than the expected cost, and then it was too late to replant the cost analysis. So we had to finish the work anyway. But after finishing the work we tried to find out the reasons behind this mismanagement. And we found:
Some untrained employees who were recruited after the training, which was organized by our hospital before their coming to make the existing employee more effective about the costing concerns.
Specification intended: Our intention was quietly fulfilled except some problems. The main reason behind those problems was the lack of major concluding step in the termination process, which is known as audit. Audit means a thorough examination of the management of a project. That means there was no furnishing of:
Technical specialty areas.
At the end, we can say that it was more or less a successful project. Behind this success, we can mention some major issues, like selecting right techniques considering the situation, assumptions that are realistic and related with our project, time and situation oriented methods that suits with the project etc. An addition to these factors the cooperation of the working people, hospital authority and clients as well helped directly and indirectly to accomplish our goal. Even though we succeeded in this project but we had some failures, like late completion, exceeding cost, the matter of specific indentation etc. But we were not disheartened of that. Because we believe, these failures will lead us towards perfction. And when we will develop project in future, we will give more emphasize on these matters so that no more failure can occur anymore.
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5. King Faisal Hospital-Rwanda webs: http://www.kfh.rw/