Project Management

Rather than separating themselves from the day-to-day work flow of their parent organization as some research and development groups did, the CFI adopted an internal consultancy model in which they planned their projects in conjunction with various medical practices or technical groups within the clinic. In its first years of operations, the center looked to build its project management abilities and recruited a number of experienced project managers to help keep each engagement on track. The center also developed a number of tools, including project charters, timetables, and status check points for each engagement. As much as they could, new projects would commit to a set of deliverables.

Most projects were completed in six months or less. The deliverables were not always implementable new procedures. Sometimes, center projects were devoted to identification of problems or delineation of new areas of technology. When the staff did engage with a practice to implement a new physical setting or interaction design, the staff of the CFI worked closely with all members of the practice to “co-create” prototypes. Practices were not financially charged for CFI services, but they often devoted considerable staff and physician time to projects.

CFI staff members were quick to acknowledge that no two projects were alike. However, most engagements with practices unfolded according to a predictable set of stages:

• In the first stage, brainstorming, CFI staff met with all of the staff of the practice, including doctors, physician assistants, nurses, technicians, and desk attendants, to solicit their ideas of how to improve the practice.
• Then in the second stage the CFI team did extended observations of the practice. The design group had access to every area of Mayo Clinic, and they were permitted to observe every part of the health care delivery process. Typically, they followed a doctor or nurse for half a day, recording the flow of their work and the time spent in each activity. In particular, they looked for “pain points,” or the special frustrations of each role, and for “rabbit holes,” or those times in the day when something unusual would take place, causing a job that should be five minutes to take 30 minutes. The result of this process was a series of stories that revealed the highs and lows of each person's experience with health care delivery.
• The third stage was a process of synthesis, in which the CFI team presented their findings and discussed with the members of the practice possible solutions to common problems.
• These first three stages culminated in the fourth stage, prototyping, an important process in which ideas were put to the test for a short time and then evaluated for their effectiveness. For example, members of the practice might try a new type of technology, or they might give patients a new educational brochure, or they might rearrange the physical layout of their workspace.
• Finally, in the fifth stage, the CFI led a process of debriefing, in which the practice selected successful prototypes to put into long-term use.