1. Project Charter
A. General Information
Project Title:
Management of Venous Thromboembolism (VTE) Patients at Boston
Medical Center (BMC): Using Lean Management Techniques to Improve
Current General Internal Medicine Residents’ Prescribing Habits
Brief Project
Description:
The project aims to utilize Lean methodology to optimize the management of
newly diagnosed VTE in patients without malignancy admitted to Boston
Medical Center General Internal Medicine by changing residents’ prescribing
practices in order to adhere to the 2016 American College of Chest Physicians
(ACCP) guidelines. This switch has the potential to save the hospital money,
and minimize inpatient admissions.
Prepared By:
Jeanne Kircher, Nicholas Thomson, Ray Qian, Vina Pulido, Pooja Phull, Mary
Stevenson
Date: April 11, 2015 Version: 3
B. Project Objective:
Explain the specific objectives of the project. For example: What value does this project add to the
organization? How does this project align with the strategic priorities of the organization? What
results are expected? What are the deliverables? What benefits will be realized? What problems
will be resolved?
The current problem:
Many residents at BMC have not switched prescribing practices in accordance with current
recommendations to treat patients newly diagnosed with VTE. The new ACCP guidelines suggest a
switch to Novel Oral Anticoagulants (NOAC) in order to optimize patient quality of care by
reducing length of hospital stay, and decreasing adverse health complications associated with
previously prescribed agents.
Why change to the new guidelines:
The recently released update of the ACCP CHEST Guideline and Expert Panel Report on
Antithrombotic Therapy for VTE Disease reflects a paradigm shift in anticoagulation management
in patients with newly diagnosed venous thromboembolic disease without cancer. The
recommendations are based on data showing similar efficacy to older LMWH and Vitamin K
antagonist anticoagulants, with a lower risk of major bleeding events (1-13) such as intracranial
bleeding. This, in combination with the increase in convenience for patients and providers with no
need for blood level monitoring, make this new recommendation beneficial for patients for
multiple reasons.
Furthermore, BMC still admits virtually all patients with VTE, a legacy from the days of
unfractionated heparin and Coumadin that is no longer appropriate with these new advances.
Updating the treatment of VTE in BMC adds value to the organization in terms of patient
satisfaction with patients experiencing similar effectiveness in VTE treatment with reduced visits
to the hospital. Additionally, the costs of new VTE management through the use of Novel Oral
Anticoagulants are expected to be significantly lower as patient time in admission is reduced. With
potential benefits for both the provider and the patient this project could potentially be a
groundbreaking step forward in VTE treatment at BMC. Therefore, the goals of this project are:
• To optimize the medical management of newly diagnosed VTE at BMC General Internal
Medicine and Hematology departments
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2. Project Charter
• To increase awareness of the implementation of the 2016 ACCP guidelines among residents
and pharmacists
The main benefits will be:
• An increase in convenience for patients on anti coagulants because of decreased
hospitalization
• A decrease in patient complications secondary to super therapeutic Heparin or Coumadin
levels
• An alignment with BMC cost saving initiatives to minimize health care costs by decreasing
length of hospitalization
• Minimizing admission for VTE that can be safety managed as an outpatient (long-term goal)
Deliverables will be:
• A value stream map
• Root cause analysis in the form of a fishbone diagram
• Sustainable recommendations to increase compliance with 2016 ACCP guidelines to
prescribe Novel Oral Anticoagulants (NOAC) over other previously prescribed agents
C. Assumptions
List and describe the assumptions made in the decision to charter this project. Please note that all
assumptions must be validated to ensure that the project stays on schedule and on budget.
• Data will be available
• The project will meet the deadline
• There will be access to patient charts
• Charts were properly documented
• The team will work well together
D. Project Scope
Describe the scope of the project. The project scope establishes the boundaries of the project. It
identifies the limits of the project and defines the deliverables.
The project only focuses on patients admitted with new VTE’s to General Internal medicine at BMC
on floors 6 East, 6 West, and some on 7 East and 7 West.
The objective is to deliver a proposal to BMC for sustainable improvements that increase
compliance with 2016 ACCP guidelines to prescribe Novel Oral Anticoagulants (NOAC) over other
previously prescribed agents
List any requirements that are specifically excluded from the scope.
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3. Project Charter
• Anything out of the scope of General Internal medicine at BMC
• Patients with renal dysfunction
• Patients with high bleeding risk
• Cancer patients
• Post surgical patients
• Patients with reoccurring VTE’s
E. Project Milestones
List the major milestones and deliverables of the project.
.
Milestones Deliverables Date
Choice of project Project Charter
Process Observation Report from Gemba Walk
Comprehensive understanding of the
project process
Value Stream Map
Obtaining and Reviewing data Summary of data from Clinical Data
warehouse
Identifying root cause of problems RCA-Fishbone diagram
Discovering solutions Recommendations
Completion of project Presentation
Final report
F. Impact Statement
List the impact this project may have on existing systems or units.
.
Potential Impact Systems / Units Impacted
Ensuring prior authorization, insurance
coverage obtained
• Pharmacists
• Prescribing physician
Increase patient convenience by:
• Reducing adverse health effects
• Reducing the need for patient
education in the form of how to self
administer medication
• Improving discharge time
• Patients
• Physicians
• Nurses and aides
• Staff member in charge of education
patient (physician, pharmacist, nurse)
Increase awareness of 2016 ACCP guidelines in
order to increase prescribing uniformity to
optimize care
• Pharmacists
• Prescribing physician
Continued provision of medication and
monitoring of medication
• Primary care physicians
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4. Project Charter
G. Roles and Responsibilities
Describe the roles and responsibilities of project team members followed by the names and contact
information for those filling the roles. The table below gives some generic descriptions. Modify,
overwrite, and add to these examples to accurately describe the roles and responsibilities for this
project.
Sponsor: Provides overall direction on the project. Responsibilities include: approve the project
charter and plan; secure resources for the project; confirm the project’s goals and objectives; keep
abreast of major project activities; make decisions on escalated issues; and assist in the resolution
of roadblocks.
Name Email / Phone
Mark Sloan Mark.Sloan@bmc.org
Project Manager: Leads in the planning and development of the project; manages the project to
scope. Responsibilities include: develop the project plan; identify project deliverables; identify
risks and develop risk management plan; direct the project resources (team members); scope
control and change management; oversee quality assurance of the project management process;
maintain all documentation including the project plan; report and forecast project status; resolve
conflicts within the project or between cross-functional teams; ensure that the project’s product
meets the business objectives; and communicate project status to stakeholders.
Name Email / Phone
Nick Thomson njt@bu.edu
Jeanne Kircher jkircher@bu.edu
Team Member: Works toward the deliverables of the project. Responsibilities include:
understand the work to be completed; complete research, data gathering, analysis, and
documentation as outlined in the project plan; inform the project manager of issues, scope
changes, and risk and quality concerns; proactively communicate status; and manage
expectations.
Name Email / Phone
Nick Thomson njt@bu.edu
Jeanne Kircher jkircher@bu.edu
Mary Stevenson Mary.Stevenson@bmc.org
Pooja Phull Pooja.Phull@bmc.org
Vina Pulido Vina.Pulido@bmc.org
Ray Qian Ray.Qian@bmc.org
Customer: The person or department requesting the deliverable. Responsibilities include:
partner with the sponsor or project manager to create the Project Charter; partner with the
project manager to manage the project including the timeline, work plan, testing, resources,
training, and documentation of procedures; work with the project team to identify the technical
approach to be used and the deliverables to be furnished at the completion of the project; provide
a clear definition of the business objective; sign-off on project deliverables; take ownership of the
developed process and software.
Name Email / Phone
BMC Hematology & Medical Oncology (617)-638-6428
General Internal Medicine BMC (617)-414-5951
Subject Matter Expert: Provides expertise on a specific subject. Responsibilities include:
maintain up-to-date experience and knowledge on the subject matter; and provide advice on what
is critical to the performance of a project task and what is nice-to-know.
Name Email / Phone
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5. Project Charter
Mary Stevenson Mary.Stevenson@bmc.org
Pooja Phull Pooja.Phull@bmc.org
Vina Pulido Vina.Pulido@bmc.org
Ray Qian Ray.Qian@bmc.org
Lindsay Arnold Lindsay.Arnold@bmc.org
Patricia Nash Patricia.Nash@bmc.org
H. Resources
Identify the initial funding, personnel, and other resources committed to this project by the project
sponsor.
Resource Constraints
Project Budget $0
Residents/Department Time, appropriate knowledge to assist
Electronic medical records Prior authorization to access, order set, correct
documentation of records
Clinical data warehouse Data available, authorization to access, correct
documentation of records
Pharmacist-Lindsey Arnold Development of newly diagnosed VTE order set,
time,
Mark Sloan Time, appropriate knowledge to assist
Karin Sloan Can access available data, time
EPIC Personnel Time, willingness to assist, ability to assist
I. Project Risks
Identify the high-level project risks and the strategies to mitigate them.
Risk Mitigation Strategy
Time constraints Gantt Chart, completion of deliverables on time, realistic
goals
People are busy Task delegation, scheduling, Gantt Chart, assign roles
Correct knowledge about NOAC
prescribing protocol
Literature review, consulting with clinical professionals
(physicians, pharmacists)
J. Success Measurements
Identify metric and target you are trying to achieve as a result of this project. For example, overall
cost savings of $50K or reduce processing time by 25 percent.
Reduce length of stay of patients admitted to BMC General Internal Medicine for newly diagnosed
VTE by at least 2 days.
Aim to improve resident knowledge of correct NOAC prescribing practices by 25%, which will be
measured via resident survey.
Minimize admission for patients with VTE when they can be safety managed as an outpatient
(long-term goal).
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6. Project Charter
K. Signatures
The signatures of the people below document approval of the formal Project Charter. The project
manager is empowered by this charter to proceed with the project as outlined in the charter.
Customer:
Name Signature Date
Project Sponsors:
Name Signature Date
Project Manager:
Name Signature Date
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7. Project Charter
K. Signatures
The signatures of the people below document approval of the formal Project Charter. The project
manager is empowered by this charter to proceed with the project as outlined in the charter.
Customer:
Name Signature Date
Project Sponsors:
Name Signature Date
Project Manager:
Name Signature Date
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