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Using simulation, the project team was able to model system performance, running what-if scenarios to determine how long patients would have to wait to check in for a clinic visit and what it would cost if they added additional staff during specified shifts It s important to realize that redesigning the process meant redesigning all aspects of the patient management system, including work flows, process performance measures, information systems, facilities and space, roles and job descriptions, and organizational culture Computers don t simulate the social system components, so stakeholder involvement was designed into the process every step of the way The communication plan consciously chose a variety of mediums to keep the information flowing, including a newsletter, all-hospital forums, and presentations to the Hospital Steering Committee STAGE FOUR: IMPLEMENTATION In January 1998 the team began to prepare for stage four of the project: implementation.

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Significant changes were required for the hospital computer systems New software was selected to meet the requirements of the new system design New services were planned for rollout Detailed comparisons of the current process were made against the new design so that changes would be identified and documented Sequencing of dependent activities was determined and tracked on a master project plan With implementation under way, the hospital has already begun to reap the benefits of its new Encounters patient management system A more streamlined admissions process, including patient/family valet parking, is producing increased customer satisfaction The segments of referral processing installed so far are already producing enhanced efficiencies during the patient check-in process..

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In a rapidly changing business environment, projects are the means by which companies develop new products and services. Part 5 looks at the ways in which project management techniques are being adopted by a growing number of organizations. 13 describes how the tools presented in this book can be leveraged by organizations as well as project managers. And finally, 14 looks at the kind of problems that project managers are likely to face and the best tools and techniques to deal with them.

Table 4.3 VALUE IN MW 39 mw 78 mw 156 mw EQUIVALENT VALUE IN DBM 15.91064 dBm 18.92094 dBm 21.93124 dBm

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At step 5, then, you always have a choice: whether to accept the construct as rst offered, or whether to take and repeat step 6, looking for more detail. The procedure by which you do so is quite simple, and if you look again at the 10point procedure, or glance again at Exercise 4.1, you ll see that what you re doing, in effect, is adding an additional substep (call it step 6b) to step 6 of the procedure. 6b Put a how question to the interviewee. How can I tell or in what particular way or can you give me an example of the kind of thing you mean about the emergent pole of the original construct. (When the elements are people, what kind of person is like that is a useful form of words.) Write the answer down below the emergent pole of the original construct. Put a how question to the interviewee about the implicit pole of the original construct. Write down the answer below the implicit pole of the original construct. Stop at that point, or repeat the how question in more detail still, about the construct you ve just written down. Apply the remaining steps of the basic grid procedure to the nal construct you arrive at using step 6b, and not to the original one you obtained in step 5. The result, if you were to write each step down before writing the nal one into the grid, looks a little like a ladder the contrasts provide us with the rungs , and the superordinate subordinate relationships at each successive step constitute the uprights of the ladder. See Figure 4.1. Hence the term, laddering down .

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