Triage for Project Managers

The Very Model of a Modern Surgeon-General

In the opening credits for the TV series M*A*S*H, helicopters swoop in low over the hills carrying their precious cargo of gravely wounded soldiers.  Hawkeye Pierce, surgeon-saint in a Hawaiian shirt, leans over one soldier, a serious expression on his face. He quickly assesses the soldier’s condition, signals a waiting nurse, and soon a line of stretchers is carrying the wounded down Helicopter Hill and into surgery.

If you’ve ever waited in a hospital emergency room, you know what triage is. As its pronunciation suggests, triage is a French word, deriving from trier, to sort or select. It’s a formal way to prioritize medical patients based on the severity of their condition.

Both M*A*S*H and triage have their origin in the work of the same man: Baron Dominique-Jean Larrey, MD, surgeon-in-chief to Napoleon’s armies. Napoleon described Larrey as “the worthiest man I ever met,” and there’s some justice to the categorization. He invented the ambulance (inspired by watching Napoleon’s famous “flying artillery” maneuver around the battlefield), and was a pioneer in the enormously complex logistics for providing care in mass-casualty settings. 

Along with other pioneers such as Florence Nightingale and Major Jonathon Letterman, medical director of the Army of the Potomac under General McClellan, Larrey helped transform the face of military medicine, and as a side note changed the way people think about how to utilize limited resources effectively.

Modern medicine is of surprisingly recent vintage. Even the basic idea of the germ theory of disease (see Semmelweis in the cloud tag to your right) only originated in the first half of the 19th century. Medical care for soldiers was appallingly primitive, and throughout all the wars of history far more soldiers died from disease than from combat. It was not until World War II that a combination of more terrible weapons and greatly improved medical care tipped the balance in the other direction.

Military medicine doesn’t just involve the treatment of wounds. To handle mass battlefield casualties requires an enormously complex logistical and administrative apparatus. It’s not enough to be a good doctor; you also have to be a good project manager.

That’s why the concept of triage is so powerful. There is nothing new about the concept of prioritizing, of course. People have sorted, selected, and chosen for as long as there have been choices to make. But priorities are frequently established by a “best guess” method, rather than through a real and meaningful assessment process. An assessment methodology distinguishes real triage from simple prioritizing.

The Hierarchy of Triage

You don’t need to do triage of any sort if you have a single patient (or project), or if there are plenty of resources to go around to accomplish all the work. But that’s seldom the case. You need to perform triage from two different perspectives: not only for the project or projects for which you are responsible, but also so that you understand your relationship to the projects that may potentially compete for the same resources. Both relative and absolute importance have implications for what you do and how you do it Sometimes, your job is to assert the right of way for your projects; other times the right organizational choice is to yield to others.

Initially, you want to make the minimum necessary decision so you can take the minimum necessary action required right now. (You can always do more later.)

Degree of triage required ranges from basic to advanced depending on what’s at stake and what the issues are. Start with the basic process level, and continue as far along the journey as necessary until not only the current project, but also all the projects in your environment, have been accounted for.

Basic Triage

The first stage of medical triage for mass casualties is to separate the victims into three categories:

1.         Those who are likely to live, regardless of what care they receive

2.         Those who are likely to die, regardless of what care they receive

3.         Those for whom immediate care might make a positive difference in outcome.

In project management, Category 1 projects can be identified by large degrees of freedom in the triple constraints of time, performance, and cost. If the schedule is very flexible, performance requirements are modest, and the budget not at issue, there’s not a lot of project management challenge. We often describe smaller Category 1 projects as “tasks. The difference between a task and a project is, after all, merely perspective. Both have the same fundamental characteristics of “temporary and unique.”

Category 2 projects fall are "operationally impossible," meaning they can't be done under the current conditions and constraints. That's not the same thing as saying they're absolutely impossible, of course. Sometimes, current conditions and constraints can change.

Placing a project in Category 2 isn’t something to take lightly. Signs that a project may be in this category include: over-constrained in terms of budget or time, sky-high performance requirements, and high levels of uncontrollable risk. In such cases, you may abandon the project altogether, or perhaps do the very minimum exploratory activities to confirm your analysis. Of course, you may not be the only person whose opinion counts. If you think it’s a Category 2 project but the boss disagrees, you may have to do it anyway — but it's wise to think about self-protection when things go south.

Each triage determination requires an assessment of the specific current situation. Advances in medicine mean that injuries that once were solidly in Category 2 now enjoy remarkable recovery rates.  Similarly, projects once thought impossible also must be reviewed in light of new technologies and circumstances. Relying on outdated paradigms will result in misclassification with corresponding catastrophic results. While miracles are possible, the best doctors and project managers can do is make an informed situational decision using the most current information and technology to achieve the best result.

Category 3 projects need additional analysis, but they also need action. It is in this category that most projects fall.

[Continued next week]

Adapted from Creative Project Management: Innovative Project Options to Solve Problems On Time and Under Budget, by Michael Dobson and Ted Leemann; published by McGraw-Hill and copyright © 2010 by The McGraw-Hill Companies; all rights reserved. Used with permission.