The importance of good Project Management for public hospitals: the case of E.S.E. Hospital Local de Candelaria

Juan Sebastián Cortés Delgado, Master's student in Project Management. Credit: Édgar Bejarano, Communications Office, Faculty of Engineering.

In Colombia, several public institutions providing health services are facing a prolonged crisis that has significantly deteriorated the quality and access of the communities that need to be served. This crisis is attributed largely to the low percentage of execution of institutional projects, which does not reach the minimum required by current regulations. Inefficiency in the management of these projects not only limits the capacity to respond to the needs of the population, but also increases the risk of intervention by the National Superintendence of Health and/or the Ministry of Health and Social Protection, resulting in the possible definitive closure of these institutions. 

In view of the risk it represents for the surrounding populations, research opens the door to a new approach that seeks to use knowledge and methodologies of industrial engineering to improve the internal processes of the E.S.E., with the objective of guaranteeing the fulfillment of all institutional projects and preventing possible closure scenarios in the future. 

Lea el artículo en español aquí.

The importance of good project management within an E.S.E. 

The problems that plague health care institutions under the General System of Social Security in Health, known as State Social Enterprises (E.S.E., in Spanish), often go beyond their financial limitations. The lack of a formal methodology and inadequate management of projects designed to ensure their growth and optimal operation become obstacles that prevent the effective use of resources, resulting in poor management and ineffective delivery of services. 

For the E.S.E., this situation represents a double-edged sword, since it can lead to the intervention of control entities such as SuperSalud and MinSalud, who make sure that the projects comply with the margins established by law, and if the difficulty persists, they have the power to close these institutions, which would harm the population that depends on primary health care services. An example is the E.S.E. Hospital Local de Candelaria, which in the last periods (2021 and 2022) has had a significant decrease in its management and institutional performance indexes, mainly due to the non-compliance of key projects within the Institutional Development Plan, which puts at risk the populations of the north of the department, such as Pradera, Florida and Candelaria (municipalities that together total more than 200,000 inhabitants, according to the most recent information of DANE), due to the imminent possibility of a definitive closure of its operations. 

Given this scenario, the industrial engineer Juan Sebastián Cortés Delgado and the Financial Administrator Javier Armando Salamanca decided to join forces in a research project that took advantage of their knowledge in their respective areas in favor of a proposal to improve the situation of said E.S.E. The project, developed within the framework of the Master's Degree in Project Management, offered jointly by the Faculty of Management Sciences and the Faculty of Engineering at the Universidad del Valle, under the direction of the professor and researcher of the School of Industrial Engineering, Camilo Andrés Micán Rincón, is presented as a roadmap for institutions that, like the E.S.E., face difficulties in developing and successfully executing their projects, face difficulties in developing and successfully executing their projects. 

"The decision to embark on the research entitled "Proposal of methodological adaptation of project management for the E.S.E. - Local Hospital of Candelaria" is due to a deep personal and professional conviction. Although my experience is not directly linked to the health sector, my experience in structuring social projects has consolidated a strong commitment to the improvement of processes that positively impact the welfare of communities. Applying my knowledge in project management to a sector which is new to me represents a stimulating challenge. Far from being a disadvantage, this becomes an additional motivation, allowing me to approach research with a fresh and objective perspective, which I consider essential to develop innovative solutions adapted to the specific needs of the hospital," says researcher Juan Sebastián Cortés Delgado.  

The choice of this E.S.E. was due to the close relationship of his research partner, Javier Armando Salamanca, who belongs to the municipality of Candelaria and worked for a season at the hospital, which allowed him to know first-hand the situation faced by the institution. "This collaboration not only enriched the project, but also reinforces my conviction that interdisciplinary synergies are essential to address these challenges," adds researcher Cortés Delgado. 

For Cortés and Salamanca, this process has required not only creativity and flexibility, but also rigorous analysis to ensure that the adaptations are relevant and effective. The lack of clear precedents in this type of research has meant that they have had to chart much of the path themselves, a circumstance that, although challenging, has been extremely enriching. 

Proposal for a roadmap for project management in E.S.E.

The investigation revealed crucial findings that underscore the urgent need to restructure and strengthen project management within the hospital. From the outset, it was evident that the situation was critical: in the last two evaluations conducted by the Administrative Department of Public Management, the ratings of the Candelaria Public Hospital were below par average, and the management's management rating showed that it only executed 70% of its institutional projects, far below the 90% required by the Ministry of Health, which generated deep concern for them. 

"Throughout the research, we found that the lack of a methodological approach adapted to the hospital's reality was one of the key factors that prevented efficient management. There was no organizational culture of projects, and the ways of carrying it out were not adjusted to the specific needs of the hospital nor to the particular challenges of the health sector in a local context such as Candelaria. This misalignment led to inefficient execution, inadequate prioritization of resources and, ultimately, management that was not aligned with the strategic objectives established in the hospital's Development Plan," says Cortés Delgado. 

The proposal presented by researchers Cortés Delgado and Salamanca was divided as follows: 

As a first objective, they elaborated a diagnosis through the application of a project maturity tool, in order to reveal the current state of the projects in the E.S.E. Hospital Local de Candelaria, identifying the critical points in their areas of knowledge and obtaining the necessary inputs to develop a guide to facilitate their improvement. From the research carried out in different bibliographic sources, they identified that the OPM3 tool is used in all the articles investigated and is the one selected by many experts in project management. Subsequently, it was applied through personalized interviews with the 16 process leaders of the institution: scientific assistant management, administrative assistant management, quality, legal and contracting, information service and user care, external consultation, emergency, hospitalization, health promotion and maintenance, clinical management, diagnostic support, human talent, financial management, physical environment, information and communication technologies and technology management. Finally, the results obtained were consolidated, which made it possible to address the different project management methodologies and determine the one that best fits the hospital's context. 

"The diagnosis reveals that in the Local Hospital of Candelaria there is no organizational culture that promotes project management, and upon analyzing the results it was revealed that the deficiencies were not only specific anomalies but are symptoms of projects that lacked the necessary tools and techniques to ensure their implementation. In addition, the level of implementation or maturity in project management in the institution's processes is basic, with an average score of 32.25, which indicates that the entity has a limited understanding of project management and lacks a clear and structured methodology to develop such management. This is validated by each of the process leaders, who expressed that there is no standardization of the procedures related to the projects, which makes it difficult to standardize them. Therefore, measurement, control and continuous improvement are not carried out according to established guidelines but rather according to the criteria of each coordinator or, failing that, they are not carried out at all", says the researcher Cortés Delgado.  

"This lack translates into inconsistent processes that are hardly aligned with the institution's strategic objectives, which generates low efficiency and productivity, communication problems, insufficient value generation, absence of innovation, excessive dependence on key individuals, sub-optimization of results and dissatisfaction among stakeholders, among other problems. In addition, the implementation percentages in the knowledge areas and organizational enablers are low compared to the maximum qualification standards, indicating that the institution needs a significant effort to develop a project management and process improvement methodology to ensure a higher level of organizational maturity. Taking into account the areas of knowledge and organizational enablers evaluated, it is necessary to develop a methodological guide that addresses those factors with poor implementation, in order to raise the level of maturity in project management and ensure compliance", complements researcher Salamanca.  

The diagnosis of the entity revealed a weak level of maturity in project management, evidencing the need to implement a robust methodology that facilitates the planning, execution, monitoring and closure of projects in a systematic and controlled manner. 

For this reason, as a second objective, the researchers addressed the design of a project management methodological guide based on the results obtained for the institution in question.  

"After detecting the critical aspects and recognizing the low level of project management and administration, we proceeded to analyze the methodology presented in the Guide to the Fundamentals of Project Management - PMBOK, and thus adapt and apply it to the processes of the Empresa Social del Estado Hospital Local de Candelaria. The PMBOK Guide served as the foundation for the creation of a specific project management methodology for the entity, based in turn on the Project Management Standard of the American National Standards Institute (ANSI). This standard constitutes a fundamental reference for project management, given that the practices related to project management and administration must be adapted to the needs of the institution and implemented to obtain the results offered by these standards. This guide organizes tools and techniques that, according to their purpose, provide high-level guidelines for project management from multiple perspectives, highlighting the importance of adapting the information to the needs and particularities of each project," explains Cortés Delgado.  

For the development of the guide, 4 areas of knowledge were prioritized: integration management, scope management, time management and cost management, which must be addressed initially considering that the institution, having a low level of maturity, is not in a position to adapt all the areas of knowledge and organizational enablers proposed by the OPM3 tool. "These areas were selected because they are necessary to establish a solid foundation in project management, and their initial implementation is crucial for the development of advanced capabilities of the Hospital's services," clarifies researcher Salamanca.  

"The creation of a methodological guide tailored to the hospital's specific processes is making it possible to standardize and improve project management. This is not only aligning the hospital's activities with its strategic objectives, but also ensuring that projects are executed more effectively and efficiently. The community will benefit from better managed projects that respond more accurately and timely to their needs," he adds.

The final stage of this research consisted in the proposal of the action plan by phases, starting with the recognition of the institution's project governance. Based on this recognition, they defined the scope of the action plan, the activities necessary to achieve it, the schedule of activities, the responsible areas, the resources required to deliver the products, and the identification of the risks associated with the implementation. 

"In the first phase, the aim is to inform and prepare the technical personnel of the E.S.E. about the action plan; the main objective is to communicate to the professionals according to the roles and functions established in the methodology. The second phase focuses on the understanding and application of the methodology. Professionals become familiar with the structure and operation of the tools and formats developed in the project, following an agenda of meetings scheduled by the project leader. As the training progresses, the knowledge acquired is applied to the different components of the E.S.E., allowing the professionals to integrate these tools in their daily work. The third phase is transversal, that is, it starts from phase one, since it focuses on the monitoring and control of the implementation carried out during the action plan. In addition, improvement rates in project management will be measured, which will allow the approach to be adjusted and refined. These are the guidelines, the basis that we propose as a flexible action plan to any health service provider institution", adds the researcher Cortés Delgado. 

Conclusions and subsequent uses of the methodological guide 

For the researchers Juan Sebastián Cortés Delgado and Javier Armando Salamanca, the detailed diagnosis of the institutional projects of the E.S.E. Hospital Local de Candelaria allowed identifying the main strengths and weaknesses of the current project management within the E.S.E. The findings obtained through the OPM3 tool reflected a limited understanding of project management, evidencing the absence of a clear and structured methodology, with procedures that are not standardized, which hinders the standardization, measurement, control and continuous improvement of projects. This situation underscores the urgency of adopting a project management methodology that fits the specific needs and characteristics of the E.S.E. 

The creation of an adapted methodological guide responds to the need to equip the hospital with adequate tools and techniques for project management. By prioritizing essential knowledge areas such as integration, scope, time and cost management, a solid foundation is laid for the development of advanced project management skills, which is essential for improving efficiency and effectiveness in the institution. For the researchers, the development of this methodological guide represents a significant advance for the E.S.E. by providing a coherent structure aligned with the hospital's strategic and mission objectives. Its implementation will not only facilitate the adoption of good practices in project management but will also foster an organizational culture oriented towards continuous improvement.  

Finally, the action plan proposal sets out a clear roadmap for the adoption of the new methodology. "Accurate identification of deliverables, planning of activities, allocation of responsibilities and resources, along with risk assessment, ensures that all aspects of the project are properly managed. This comprehensive strategy not only guarantees an orderly implementation, but also strengthens E.S.E Hospital Local de Candelaria's ability to meet its goals, aligning its activities with its strategic objectives and ultimately improving the services offered to the community," adds researcher Cortés Delgado. 

For the researcher Cortés Delgado, the proposal developed represents a significant milestone in the field of Project Management, especially due to the lack of existing literature on how to address and overcome crises in health institutions through a clear and structured roadmap. Furthermore, he concludes: "What is commonly observed is the request for more economic resources, but through this case study with E.S.E. Hospital Local de Candelaria, we identified that many of those resources are wasted due to the lack of timely and adequate implementation of projects. In this context, our proposal is innovative because it not only establishes a path to meet the projected objectives and scopes, but also ensures that resources are used efficiently, guaranteeing their continuity." 

If interested in being in touch with the Master's student or any further information about the investigation, please write the Faculty of Engineering Communications Office: comunicaingenieria@correounivalle.edu.co.