Chest Pain Accreditation: A Project Management Perspective

The cardiovascular service line at Norman Heart Hospital in Norman, Okla., has been successful in several project management efforts. Becoming Chest Pain Center accredited through the Society of Cardiovascular Patient Care (SCPC) was one of those projects.

Norman Heart Hospital is housed at the HealthPlex, a specialty 150-bed facility that specializes in cardiology, orthopedics and women’s care. In 2009, the cardiovascular specialty hospital was built and a Chest Pain Emergency Department was established. The hospital lacked a formal chest pain program, a cohesive cardiovascular service line and methods to assess service line performance.

To address that gap, we applied an accepted project management process to the cardiovascular service line that aligned with the hospital’s culture of innovation and cooperation. We used methodology cited in the Project Management Book of Knowledge, which offers widely proven traditional project and program management practices. 

Integration management was necessary for this project and included making decisions and dealing with issues before they became critical. Elements of this stage of management included: develop a program charter; develop a preliminary program scope; develop a program management plan; direct and manage program execution; monitor and control; change controls; and closure procedures.

Accreditation as a goal

The vision and strategy for the cardiovascular service line included developing a quality plan and framework for improving patient care. The hospital’s board of directors recognized that Chest Pain accreditation from the SCPC provided a valuable process to drive improvements in quality, cost and efficiency.

In December 2012, the hospital made an organizational change that led to the development of the cardiovascular service line. This change was imperative for the success of obtaining accreditation.

A strict project timeline was established for accreditation application submission with appropriate milestones identified. Opportunities for process improvements required developing a critical path and timeline with milestones for implementation, data reporting and revisions. The cardiovascular service line director was responsible for time management and project completion.

The hospital created a dedicated Chest Pain coordinator position to manage and organize this project and continue the efforts toward re-accreditation. An initial gap analysis identified the specific quality elements that required attention and alignment with evidenced-based medicine. Quality planning, assurance and control occurred through the data aggregation and abstraction process in order to achieve positive outcomes.

Early in the process, a Chest Pain Council was created, which included hospital administrators, physicians, stakeholders and various department heads to ensure that each aspect of the cardiovascular patient’s care experience was included. The HealthPlex extended the Chest Pain Council invitation to all surrounding emergency medical service providers who transport patients to the facility as well as the City of Norman’s 9-1-1 dispatch services. 

Communication channels

Consistent and constant communication of the planning process, information distribution, performance efforts and overall stakeholder management occurred in the Chest Pain Council venue. Stakeholders were updated and proper communication facilitated reliable engagement and cohesive teamwork.

We approached project risk management by assessing resistance to the plan and enacting tactics to assure success. Many tactics centered around the concept of implementation in order to avoid a negative alternative and/or outcome.

Since this project was supported by the hospital board of directors, initial funding was known and approved prior to project start. Signage was the first additional funding request due to known regulations.

Early this year, the hospital received Chest Pain Center accreditation from SCPC. Accepted project management process greatly improved the overall plan success and subsequent attainment of accreditation.

Phillip G. Regas is service line director of the cardiovascular service line at Norman Heart Hospital. Brittni McGill is Chest Pain coordinator.