Physical & Pulmonary Rehabilitation - Research Proposal Example

Physical & Pulmonary Rehabilitation 1. Abstract The following project plan is based on studies and surveys conducted at the Katholieke Universiteit Leuven, Belgium. The plan examines how to set a pulmonary rehabilitation infrastructure for patients with Chronic Obstructive Pulmonary Disease (COPD). The project methodologies have been addressed from management algorithms and clinical techniques. Some of the notable points covered in the project are planning and scoping, project governance, stakeholder management, risk management, budget finalization, performance appraisal, project closing and recommendations. The basic aim of the project is to present a guideline regarding how to infuse life and vigor to the patients who are susceptible to morbidity due to deteriorating health conditions. Keywords: Pulmonary rehabilitation, COPD, management projects, management programs, dyspnea, exercise training. 2. Introduction Patients with acute COPD and chronic lung ailments are normally referred for pulmonary rehabilitation programs (Gershwin and Albertson 2001: 225). These programs are meant for educating outpatients about the benefits of regular exercising and other activities under controlled and monitored setups. The basic purpose of such rehabilitation projects is to provide a comprehensive guidance for better and healthy living (American Thoracic Society 2009 and UpToDate Inc. 2009). Bellamy and Booker (2004) argue that pulmonary rehabilitation focuses primarily on restoring normalcy into an otherwise impaired and restricted way of living following unsuccessful medical interventions (112). In essence, pulmonary rehabilitation can be grouped under interventional clinical management and health maintenance programs that are undertaken by various governmental and non-governmental organizations (Clinical Trials 2009). Additionally, patients with recurring and symptomatic respiratory problems are served better through psychosocial and behavioral counseling (Medscape 2009). The commonest of health complications include obstructive diseases, restrictive diseases and some other conditions that prevail after standard medical intercessions (American Association of Cardiovascular & Pulmonary Rehabilitation 2004: 12). Literature studies on this activity-based therapeutic branch postulate exclusivity because it is related to the “ethical and legal considerations surrounding decisions to undergo ventilatory support and to request the withholding and withdrawal of life-supportive care” (Heffner and Byock 2002: 77). Hence, planning a pulmonary rehabilitation project requires a macro-level initiative that should effectively be based on a multidisciplinary management approach covering a wide array of processes (Department of Premier and Cabinet, Tasmania 2005). Starting from planning to performance reviews via stakeholder analysis, this pulmonary rehabilitation project aims at setting up a sound platform for patients seeking further medical assistance after routine treatments. The planning model addresses a matrix of correlated activities that are designed and implemented in a sequential manner to deliver a comprehensive guideline for medical practitioners and patients alike. The project particulars are presented in such a way that the concerned organization may find resolves in bridging the gap between the common shortages and the intended outcomes in similar rehabilitation programs. 2.1 The Life of the Project Considering the primacy of the pulmonary rehabilitation program for COPD patients, the lifespan of the project follows a preset pattern. In order to effectively establish a rehabilitation center with all the necessary equipments and human resources, it is imperative that the planning should be cost-effective yet systematic. Since the primary objective of the program is to induct manual therapeutic techniques whenever feasible, the expenses are likely to be on the higher side, if compared to generic medication processes (Free Physical Therapy Dictionary 2007). Being a specialty project with unique identifiers and goals, the project requires specific management planning, business planning, risk assessment methodologies, and performance evaluations (Fishman 1996). Moreover, depending on the response from outpatients, it is also compulsory for the concerned officials that they should make amends for the loopholes as and when they might show up during the continuation of the project. And being a custom project, it doesn’t entail any predefined working module which promises to pay off in the long run (Martin and Tate 2001: 8). Therefore, it’s only meant for a unique outcome which is short-spanned in terms of closure but lasting enough to provide curative measures for pulmonary disorders. 2.2 Key Elements of the Project It is suggested that the current project should, to start off with, embrace key elements such as planning and scoping, governance, and organizational change management. As the project furthers to later phases, the management should consider other components including the outcome realization planning, stakeholder management, risk management, budget planning, and performance analysis. 2.3 Project Sizing Determining the project size is a challenging task, especially if the project is under financial strains (Kerzner 2009: 170). Since our budget is limited, we need to figure out the level and extent of involvement from all parties concerned. In order to provide a multidisciplinary support base for COPD patients, the management needs to accommodate for oxygen therapy, nutritional aids, breathing exercise training and the subsequent provisions for testing, and so on (UpToDate Inc. 2009). So the degree of detailing needs to be exhaustive and well organized. 3. Planning & Scoping 3.1 The Relationship between Inputs, Outputs & Benefits The proposed rehabilitative counseling practiced at the Katholieke Universiteit Leuven in Belgium attempts to extend care to a limited number of patients whose COPD symptoms continue to bother their normal lifestyle. This being the basic accusative calls for the introduction of the ITO (Input-Transform-Outcome) model, which is grounded on the conjecture that the inputs (including specialized treatment and monitoring, funding, stakeholders’ consent and contributions and other elements of the project) will lead to the wellbeing of the patients’ physical and emotional conditions, which, again following a linear progression, will meet the desired results or outcomes (Banathy 1992: 113). 3.2 Documentation Documentation plays a steering role in relation to the overall project planning. Hill (2004) argues that there are certain “contractual obligations that impact the project effort” (551). In management jargon, documentation implies the assessment metrics for the end products (Brown et al. 2006). Now in connection with our proposed project, documentation is tantamount to visualizing the scope of the project in a manner consistent with all the formalities and business protocols. Here a borderline must be drawn between the scopes of clinical pulmonary rehabilitation and that of extended care following the standard procedures. Sometimes early detection of COPD increases life expectancy and regularization of daily affairs (Nolte et al. 2009: 17). But even if the syndromes are diagnosed early, there has to be a documenting methodology for providing the patients with necessary therapeutic interventions. Hence, arranging for exercising instruments for the patients is an integral part of the project. Why documentation is crucial in this regard is that the stakeholders or any patient party may well wish to review the project terms and conditions once it is through. Now by having a clear-cut goal in the beginning should save the organization the hassles of later conflicts and misunderstandings. 3.3 Planning & Managing Project Activities This part is the most significant of all tasks associated with pulling through the project successfully. The purview of the project typically stretches from the fixation of respiratory training to the smoking cessation counseling. In addition to these activities, the team of experts should also engage in ameliorating the subjects’ psychosocial behavior and overall quality of life. Bourbeau et al. (2002) emphasize that the healthcare professionals should boost the subjects’ drooping morale by motivating them to take part in recreational activities and also to make short trips (298). Where the purpose behind planning assumes a critical role is when the organization encounters diminished funding trade-offs (ARCHI 2009). On one hand, it is important to develop a self-sustaining and reliable setup which will not impede the project deliverables. At the same time, it is equally important to keep track of the affordability issues. The planning management team basically oversees the balance between these two elements and tries to schedule specific phases of the project. Given below is a WBS model recommended by Lewis: Figure 1. Work Breakdown Structure (Lewis 2004: 202) It is clear from the above figure that incorporating a WBS in the planning module opens up many avenues that the management will in any case have to ponder over during the course of the project. For instance, it is suggested in the outline that the estimated timeline for completion of the program is about 6 months. Now if we look at the WBS, we’ll find that the Critical Path Method (CPM) resource allocation considers the utility of the purported timeline. It clearly gives a directive should the deadline be overshot or undershot. Besides, the WBS is a defining tool for work as well as resource allocation. What it also does is assessing the risks and remodeling plans/outcomes, as the case may be. 4. Governance Project governance is a subset of the business and execution planning that precedes strategy making (Renz 2007). The study at the Katholieke Universiteit Leuven, Belgium is primarily activity-based. Hence, it is imperative for the management to assign roles to its staffs. The study highlighted the importance of placebo regulation, patient-investigator-result study, and parallel assignment and feasibility study. So the governance of project should be aligned with apportioning roles for placebo grouping as well as for carrying out communication with patients and their family members. Moreover, there should be specific units for investigating the past medical history and functional activity history of the patients. In order to get rid of habits such as smoking, the doctors and other healthcare staffs need to know the subject’s social history and hobbies as well (Fishman 1996: 482). Such communicative approaches will generally facilitate the organization’s understanding of impairments like dyspnea and hypoxemia and accordingly it can prescribe specific exercise schedules for the COPD patients (Howley and Franks 2007: 323). Stein (1998) discusses at length how to allocate human resources for building a team of professionals catering to management as well as clinical roles. The core of this model includes a director who is an experienced physician with specialization in respiratory diseases, and a team of nurses with proven track record of handling COPD patients sympathetically and responsibly. The tertiary unit is going to comprise a physical therapist appointed for coordinating the training and disciplining programs and breathing exercises. The therapist will also take care of the secondary morbidity types including asthma, chest blockage, bronchiectasis, cystic fibrosis, lung cancer, interstitial lung disease and others. Installing clinical accessories for upper and lower extremity drills is another task to be assigned to the therapist. Psychosocial counseling of the patients for increasing their endurance and appeasing their cognitive dysfunctions may be marshaled by a team of occupational therapists. Moreover, this team should also ensure proper usage of financial and physical resources of the clinic by regulating power consumptions. The respiratory therapist under the aegis of the director may take charge of teaching and management tasks, especially for the peripheral units of the clinic (433). This way, the cost-to-company for a small-scale and one-time project may be kept in check. 5. Stakeholder Management Establishing a mutually trustworthy relationship with the stakeholders is a solemn prerequisite for the fruitful materialization of the project. In order to effectively forge a strategy for crisis management and risk analysis, it is imperative that the authorities must strike a concord of opinion regarding the course and direction of the entire project. There are three main elements in this task – planning, analysis and communication strategies. 5.1 Stakeholder Management & Planning Planning the stakeholder management comes to the fore when there is a bunch of stakeholders from medical, environmental, political, social and financial domains of the country. Each one of them may have different suggestions and demands and it is a sine qua non that each suggestion and demand should be met with a positive and prompt feedback. Judgmental approaches are often helpful in stakeholder management and planning. Kerzner (2009) mentions a case when the contribution of a group of external stakeholders proved priceless for organizational profits (986). 5.2 Stakeholder Analysis The key aspect is to identify the premium stakeholders who will be contributing to the intended outcome of the project. In other words, the most reliable stakeholders ought to be prioritized in the initial life, and later to be reviewed and retained, if justifiable according to scaling parameters. Justiniano and Gopalaswamy (2005) rightly point out that “not all stakeholders’ wants and needs are directly linked to the product that is developed by the project team” (45). Similar opinions are expressed by Snyder and Parth (2006: 222) as well. Whosoever has an explicit and measurable role in delimiting the desired outcomes of the program must be given preference over others. To optimize the project benefits, it is the perquisite of the management to validate the genuine interests of the stakeholders in contention (Willig and Rogers 2008: 497). It should also be mandated to gauge the contribution of every stakeholder with the closing of every phase. 5.3 Communication Strategies Project managers play a decisive role in managing the expectations of the stakeholders’ and leading them to balance the cost-schedule-quality model, which is central to the success of the project (Verzuh 2003: 150-151). Now the question is how to manage and lead the stakeholders in the best interest of the clinic? According to Black (2005), structured communication with the stakeholders encourages their active participation and sharing of interests (24). If we cite an illustration from the project being dealt with here, it will be clear as to how to make a strategy for rewarding communication with the stakeholders. Let us take for example the value of electronic mailing as a medium of correspondence with the patients. Within the boundary of field research at the Katholieke Universiteit Leuven, Belgium, it is not as important to communicate virtually as it is to face-to-face interactions. It might be noted that this is for the external stakeholders such as NGO members, staffs from some local fitness schools and drug stores and so on. Now it is almost a de facto rule that leaving one or two documented e-mails at regular intervals, along with status reports, is sure to count for the better. The patients will be benefited just as much as the organization and its financiers (Luckey and Philips 92). Moreover, our project should, from a broad perspective, attempt to build a collaborative basis of ongoing interactions between consumers, stakeholders, healthcare units, and administrators. The basic objective behind formulating a consistent communication plan is to analyze the potential hindrances for exercise programs and to rectify them as swiftly as possible. 6. Risk Management Risk management, as stated by the Inter Agency Policy and Projects Unit, Department of Premier and Cabinet, Government of Tasmania, involves policies that are taken beforehand during the signing phases of a project, to consider all the probable factors likely to have a detrimental effect on the successful completion of the project. It is in essence a part of the planning management, and appends to the rear end of our pulmonary rehabilitation program. It is advisable to maintain a risk register which should be cross-checked from time to time, so that each process is evaluated and re-graded as per the necessity (Tasmanian Government Project Management Framework 2008). Being an activity-based management project, the exercise programs plan requires decision making at crucial junctures and at a fair clip, in tandem with risk realization and removal. More about whom to assign customized roles to mitigate risks is discussed in the Governance section. 7. Budget Planning It was estimated in the project outline that the working budget may be $3700 for the project. But only the accessory costs were considered in the working budget. Now let us consider some of the key elements in the budget planning before deciding on the final budget. First, there are two horizontal offshoots of the end budget – financial resources and physical resources. 7.1 Financial Resources The financial elements in the final budget are derived from calculating the staff salary, team accommodation expenses, and commission and other fees related to the program infrastructure. 7.3 Physical Resources While estimating the physical resources of the budget, it should be remembered that this project strives not to follow the cost-driven model which is perfectly alright for high-end assignments. The project is basically geared toward activity-based costing, which, in turn, reduces the budget considerably (Raz and Elnathan 1999). Many factors need to be accounted for while planning the budget for physical resources. First, the total number of patients that the clinic plans to serve along with the number of deliverables in the end is a matter of prime consideration. Second, official sanctioning of the budget plays a pivotal role in the eventual planning. The more financial and corporate stakeholders, the better the chances are for funding. Third, the management must make sure to include expenses as the infringement budget for securing intellectual property rights and patent rights (Kuratko 2008: 179). As for the project accessories such as treadmill, bicycle ergometer, arm elevator, weight bar, and pulse oximeter, securing the patent laws is very important, for any kind of breaching may lead to legal issues. 8. Performance Analysis Houston and Bove (2007) provide a list of factors that are normally responsible for project failures. They agree upon the fact that many healthcare organizations stumble to systematically organize data collection, which results in subsequent failures. It is important for the project managers and other personnel to cautiously analyze the performance outputs at fixed time gaps and with regular morass of details. What also mandates performance analysis is the likelihood of communication lapses across various vertices of the human resource management. These lapses may occur among leaders, stakeholders and target consumers, e. g., the patients. Stringent analytical measures must be adopted for guarding against organizational immunity to change and repositioning of organizational priorities (52). 8.1 Project Performance Measures The overall performance should be measured from a twofold perspective – what was planned in the initial drafting and what has been achieved. These two indices must include all elements of the project life, including methodology, outcomes and costs (Department of Premier and Cabinet, Tasmania 2005). 9. Project Closure/Timeline for Completion Following the performance analysis and the required alterations/reviews by the concerned units, it is proposed that the project should come to a formal closure. As a one-off attempt to run a clinic for extended care to patients suffering from COPD, the program is expected to be a success by medical standards. Once all the accessories are bought and set up, relevant studies are to be made for obtaining data related to patient responses and feedbacks. So the timeline for completion of the entire project goes up to 6 months. 10. Recommendations & Conclusion It can be safely stated in the end that governing a medical project requires more than just funding and management insights. The study made at the Belgium institute goes to show that positive and lively responses from each and every person involved in the program, along with the enthusiasm and drive to bring about changes, are capable of realistically transforming the miserable lives of many COPD patients into what can be called as self-sustainable and healthy living. As for future recommendations, it is proposed that similar projects should try to develop a network of non-profit healthcare support groups. List of References American Association of Cardiovascular & Pulmonary Rehabilitation (2004) Guidelines for pulmonary rehabilitation programs. Champaign, Illinois: Human Kinetics American Thoracic Society (2009) Patient Information: Pulmonary Rehabilitation [online] available from [2 October 2009] ARCHI (2009) Maintaining the Benefits after Completing Pulmonary Rehabilitation [online] available from [3 October 2009] Banathy, B. H. (1992) A systems view of education: concepts and principles for effective practice. Englewood Cliffs, New Jersey: Educational Technology Bellamy, D., and Booker, R. (2004) Chronic obstructive pulmonary disease in primary care: all you need to know to manage COPD in your practice. London: Class Publishing Ltd. Black, R. (2005) The Complete Idiot’s Guide to Project Management with Microsoft Project 2003. Hudson Street, New York: Alpha Books Bourbeau, J., Nault, D., and Borycki, E. (2002) Comprehensive management of chronic obstructive pulmonary disease. Lewiston, New York: PMPH-USA Brown, M. K., Huettner, B, and James-Tanny, C. (2006) Managing virtual teams: getting the most from wikis, blogs, and other collaborative tools. Plano, Texas: Wordware Publishing, Inc. Clinical Trials (2009) Physical Activity Counseling During Pulmonary Rehabilitation (PAC) [online] available from [2 October 1999] Department of Premier and Cabinet, Tasmania (2005) Tasmanian Government Project Management Guidelines. New York: Crown Fishman, A. P. (1996) Pulmonary rehabilitation. London: Informa Health Care Free Physical Therapy Dictionary (2007) Cardiovascular and Pulmonary Rehabilitation [online] available from [2 October 2009] Gershwin, M. E., and Albertson, T. E. (2001) Bronchial asthma: principles of diagnosis and treatment. Totowa, New Jersey: Humana Press Heffner, J. E., and Byock, I. (2002) Palliative and end-of-life pearls. Philadelphia: Elsevier Health Sciences Hill, G. M. (2004) The complete project management office handbook. Boca Raton, Florida: CRC Press Houston, S. M., and Bove, L. A. (2007) Project Management for Healthcare Informatics. New York: Springer Howley, E. T., and Franks, B. D. (2007) Fitness professional’s handbook. Champaign, Illinois: Human Kinetics Justiniano, J. M., and Gopalaswamy, V. (2005) Six Sigma for medical device design. Boca Raton, Florida: CRC Press Kerzner, H. (2009) Project Management: A Systems Approach to Planning, Scheduling, and Controlling. New York: John Wiley and Sons Kuratko, D. F. (2008) Entrepreneurship: Theory, Process, and Practice. Mason, Ohio: Cengage Learning Lewis, J. P. (2004) Project Planning, Scheduling, & Control: A Hands-on Guide to Bringing Projects in on Time and on Budget. New York: Tata McGraw-Hill Luckey, T., and Phillips, J. (2006) Software project management for dummies. Hoboken, New Jersey: Wiley Publishing, Inc. Martin, P., and Tate, K. (2001) Getting started in project management. New York: John Wiley and Sons Medscape (2009) Pulmonary Rehabilitation [online] available from [2 October 2009] Nolte, E., Knai, C., and McKee, M. (2009) Managing Chronic Conditions: Experience in Eight Countries. Copenhagen: WHO Regional Office Europe Raz, T., and Elnathan, D. (1999) ‘Activity based costing for projects.’ International Journal of Project Management 17, (1) 61-67 Renz, P. S. (2007) Project governance: implementing corporate governance and business ethics in nonprofit organizations. New York: Springer Snyder, C., and Parth, F. (2006) Introduction to IT project management. Vienna, Virginia: Management Concepts Stein, J. H. (1998) Internal medicine. Burlington, Massachusetts: Elsevier Health Sciences Tasmanian Government Project Management Framework (2008) Project Management Fact Sheet: Developing a Risk Management Plan [online] 1.4, 2-7. Available from [4 October 2009] UpToDate Inc. (2009) Pulmonary rehabilitation in COPD [online] available from [12 September] Verzuh, E. (2003) The portable MBA in project management. New York: John Wiley and Sons Willig, C., and Rogers, W. S. (2008) The SAGE handbook of qualitative research in psychology. Thousands Oaks, California: SAGE Read More