Administration and Leadership, EMS Insider

Key Steps in Implementing a Project

By the nature of their work, EMS providers are problem solvers. They see opportunities to improve care to patients or to simplify operations, and they want to help make things better.

So why is it that good ideas often fail to materialize into projects? Many of us ask these questions when we come home from conferences—and then we hit a wall of resistance. Using some of the suggestions outlined in this article may help you gain senior management’s consideration of your next big idea, and help you successfully implement projects.

Case Study: Resuscitating a Lifeless Project

When she boarded the plane to attend a conference, Captain Jenny Shatz understood the history of her department’s stalled resuscitation project. Organizational changes and competing projects had slowed progress to a crawl. She considered her boss’s approval for her to attend a resuscitation leadership workshop as a positive sign. She also knew she’d have a small window of opportunity to convince leadership to prioritize the project.

When she returned home from the workshop, Captain Shatz began to formalize her proposal. She organized her approach into two phases: influencing and implementing.

The plan to influence key decision makers required research. Captain Shatz envisioned her community being able to realistically improve survival via training programs for 9-1-1 telecommunicators and law enforcement officers.

She learned that a compelling proposal should resonate with the minds and hearts of leaders. With this in mind, she enlisted the help from the department’s quality improvement manager to get historical data on cardiac arrests in the community.

Even with her proposal containing abundant facts, Shatz knew that it would be tough to convince leadership to take on a new project. She referenced the department’s goal to improve inter-agency cooperation as a project objective. She also outlined how achieving this objective would benefit both her department as well as the community.

Captain Shatz also developed a timeline that included several short trials, including an initial Proof of Concept phase, knowing that leaders in her department would be receptive to a small commitment with clearly defined outcomes.

Lastly, Shatz included details about how she would manage implementation—a topic that would resonate with her leadership as they recalled other projects lacking this crucial detail.

The department’s leadership were impressed with Captain Shatz’s proposal. While they made small edits to the project plan, they complimented Shatz for her objectivity and attention to detail. The evidence supporting change and the linkage to an existing organizational goal were the deciding factors in the project’s approval.

Getting Things Done

Part of getting things done is knowing how to negotiate for resources when those resources are in high demand. Organizations being asked to do more with less likely aren’t fertile ground for implementing new ideas.

The keys to gaining support are 1) aligning your idea with existing organizational goals; and 2) asking for temporary access to resources.

Aligning an innovation or improvement activity to existing goals avoids friction.1 In fact, it may improve the velocity of your idea. Study your organization’s strategic plan—if one exists. Be creative when describing how your idea fits.

Goals and initiatives contained in strategic plans are usually funded and the results are expected at a high level. Bringing ideas that conflict with established goals may not be well received.

Asking for temporary resources is the second key to getting things done. Start by identifying the specific help you need. Then, make an estimate of how long you’ll need the resource. The typical approach for budgeting temporary human resources is to estimate the number of hours it will take to complete the task.

Asking for 40 hours of work time from two people is perceived very differently than simply asking your manager for two people. The latter approach implies that you’ll need two people indefinitely—a costly, unplanned expense that is asking for a denial.

Building a Compelling Case

1. Define the problem. Describe the stakeholder’s pain and get data to support your assumption. Where does the problem occur? How often? What are the consequences of the problem? Are there implications if the problem isn’t solved?2

2. Define the future state. Describe the solution. Is there evidence the solution works? Speak with other agencies about their experiences and outcomes. How will your organization deliver the solution? Who benefits, and how much, when the problem is solved?3

3. Set realistic, measurable goals. The importance of clarity on the expected outcomes and how they’ll be measured cannot be overstated. For example, “The system will provide a 85% compression fraction on cardiac arrest calls at least 90% of the time” is better than “Implement a Pit Crew CPR training program.” Measure your current performance and be careful to avoid promising big gains too quickly.

4. Link the innovation to an existing organizational goal. Look to your department’s strategic plan for goals related to your idea. Often, strategic documents contain very high-level goals. It’s implied when writing such documents that, in order to achieve the goal, additional work will be needed to more clearly define things.

5. Start small. Be realistic. Every organization has limits. Experienced innovators know that failure is inevitable. That’s why they like to fail early and often when designing an innovation.

Costly mistakes may be avoided when a concept is explored on a small scale. Plan a pilot activity small enough to get your arms wrapped around the details. Senior leaders are much more likely to support a small pilot activity rather than a project that will engage the entire organization.

Implementing with Impact: Six Tips

Assuming you receive approval to begin a project, your next priority includes two key steps: Planning the project and preparing the organization for change.

1. Form a strategic vision and objectives. Failing to plan is planning to fail. The vision and related objectives should be clear and measurable. Senior and middle managers must be able to convey the message to the front line.

2. Organize the project team. Managing projects is a lot like making music: Sometimes a single instrument will suffice, and other times an orchestra is required.

Depending on the project’s complexity, you might be able to individually manage several tasks. Larger projects usually need several active contributors and a formal process for managing the project

3. Manage the project in stages. Similar to driving long distances, when managing projects, we’re often unable to anticipate what lies ahead. For this reason, projects are often managed in stages.4 The number of stages depends on the project’s complexity. Stages may include work about defining the problem, creating low-tech prototypes, developing solutions, testing and final approval.

Between each stage, plan a review period. The review is an opportunity to assess progress, verify the project is still relevant to users and plan the next stage in greater detail.

4. Build an alliance of supporters. Informing the organization about change is a critically important professional courtesy.

When planning this step ask yourself three questions: 1) Who are the most likely promoters for this project and how can I organize their advocacy? 2) Who will resist this project and why? and 3) How much effort is required to attain buy-in?

This last question is especially relevant when there’s substantial apathy or resistance to change. Getting buy-in from at least half of the organization helps to move the culture from a “have to” to a “want to” mindset.

5. Enable action and remove barriers. So many organizations have restrictive policies and practices that slow or prevent progress. Busting through bureaucracy is a key role for leaders and managers. Clear the path for teams to succeed.

6. Create short-term goals. If your actions inspire others to learn more, do more and become more, you’re a leader. Identify milestones along the journey. Celebrate early wins. Sustained, ongoing communication about progress helps to reinforce that change is really happening.

Summary

Many opportunities exist to improve the quality of services within an EMS system. Ideas may come from anywhere. As Captain Shatz found, getting the attention and support of senior leaders to initiate an innovation project can be difficult, and many approved projects fail to achieve the desired effect.

The next time you return from a conference filled with ideas for your organization, consider the tips contained in this article to provide you with guidance for gaining approval and achieving impact. 

Implementation Tips:

  • Leaders must walk the walk. Be visible. Roll up your sleeves. Help teams and individuals understand how their efforts will contribute to achieving the vision.
  • A cadence of ongoing and diverse communication (e.g., in-person meetings, blogs, social media, website, etc.) is necessary to build and sustain an alliance. Create opportunities for team members to participate.
  • Ask teams what stands in their way. Remove or help them navigate barriers. Once barriers are addressed, assume a coach role to help teams achieve their full potential. Sometimes, the greatest help a leader can provide to their team is the permission to stop doing things that don’t matter.
  • Create a communication plan to drive messages through the organization. Enlist senior leaders, middle managers and even informal leaders to drive messaging through the organization.

References

1. American Society for Quality. (n.d.) What is innovation? ASQ.org. Retrieved Oct. 31, 2017, from http://asq.org/learn-about-quality/innovation/.

2. Doyle C, Howe C, Woodcock T, et al. Making change last: applying the NHS institute for innovation and improvement sustainability model to healthcare improvement. Implementation Science. 2013:(8);127.

3. Sineck S. (September 2009.) Start with why: how great leaders inspire action. TED.com. Retrieved   Oct. 31, 2017, from www.ted.com/talks/simon_sinek_how_great_leaders_inspire_action.

4.  Bonnie, E. (Oct. 10, 2014.) Project Management Basics: PRINCE2 explained. Wrike. Retrieved Oct. 31, 2017, from www.wrike.com/blog/project-management-basics-prince2-explained/.