Ideally, the purpose of continuing education in the health professions is to support those who treat and cure illness and disease. And yet, humans are messy beings who create new sicknesses entirely unrelated to human physiology and infectious diseases. Sutton and Rao (2024) coined the term “addition sickness” to compellingly describe organizational incentives “for adding burdens that inflict collective harm. And weak incentives for resisting such temptations.”
Such burdens, according to Sutton and Rao, serve as distractions, or worse, cause confusion and exhaustion among staff. Though the addition of administrative and clerical processes is well-intentioned, it often detracts from the actual work of educating by serving as a proxy for the intentional and thoughtful engagement of continuous professional development (CPD) professionals. This quality improvement project aimed to treat such “addition sickness” by simplifying the project management system used across a large School of Continuous Professional Development.
Managing a Large CPD Department
The Mayo Clinic School of Continuous Professional Development encompasses three campuses (Florida, Arizona and Minnesota) and numerous staff organized across accreditation, product and product content teams. In 2024, the department offered 492 courses (online, in person/livestreamed and regularly scheduled series). The number of offerings continues to grow. Due to the large size of the department, project management across specialized and cross-functional roles is both complex and necessary. In 2020, the department implemented a new project management system to support these efforts. We use this system to retrieve data, meet accreditation needs and manage workloads and project timelines, as well as identify projects that may be at risk. However, staff found themselves spending considerable time marking tasks complete and searching for information, rather than efficiently integrating the system with their daily workflow.
Using QI Methods to Simplify
The quality improvement project team was comprised of individual contributors through administrators and representing each sub-team in the CPD department. The project team used the Six Sigma Define, Measure, Analyze, Improve and Control (DMAIC) five-step methodology to approach projects as a framework for the overall project structure. This methodology was developed outside of the healthcare field but has been shown to be a promising philosophy for process improvement within healthcare (Monday, 2022). In a review of literature, de Barros et al. (2021) noted that the DMAIC methodology is the primary tool used in healthcare quality improvement and lean healthcare.
Improvement Measure
We purposively sampled staff from each department team and conducted trials to document administrative time spent finding and marking tasks complete in the project management system. The results were not surprising; they revealed significant administrative waste. By averaging the time by team, then finding the mean of all teams, we calculated that staff spent 101 minutes per project simply recording the task completion.
Balancing Measure
While the main goal of the project team was to simplify the template, the team did not want staff to underuse the system or create a template that was too simplistic and might sacrifice the quality of project planning. Staff performance using the system was identified as the balancing measure. A survey was conducted among all department staff specifically asking if tasks were easy to find and if they were organized by their sequence in day-to-day workflows. On a Likert Scale of one to five, the average of the 45 responses was 2.45. This was used as the baseline balancing measure with the goal of ensuring that throughout the process, this did not decrease.
Potential Causes Contributing to the Quality Gap
To identify and organize potential contributing factors, the team began by surveying and conducting unstructured team discussions with staff tasked with using the system. A salient theme across teams and roles was a misalignment with the way tasks had been developed in the system and the realities of daily workflows. Some groups identified redundancies, and nearly all spoke of the large number of discrete tasks. Some teams described using the system only after a project is complete while others described confusion due to duplication of effort across systems. The team used the 5 Whys, a tool attributed to Taiichi Ohno, the creator of Toyota’s Production System (IHI, 2025) to discover several contributing factors: lack of training, ineffective task grouping and organization within the system, inability of user to effectively locate tasks in assigned projects and mark them complete, inconsistent processes across the different teams and an overabundance of tasks per project. The team determined that enabling bulk task completion and leveraging the system beyond its original intended use would significantly reduce administrative burden on staff and provide the ability to use the system more effectively.
Identifying the Root Cause
The team then performed a waste walk by observing staff processes in real time. The focus was on unnecessary steps, redundancies and delays that extended the necessary time to completion. This exercise assisted in visualizing the prior state and identifying where time and reserves were wasted due to inefficiencies. Overproduction and overprocessing appeared as constant themes. The project team reviewed survey data, unstructured group discussions, and the waste walk and then returned to the 5 Whys tool. Staff found the project management system set up to be inefficient for two main reasons, each due to having too many tasks within each template:
- Staff were unable to effectively complete tasks due to task management being confusing.
- Staff struggled to locate tasks because of task redundancy across templates and the ineffective organization and grouping of tasks.
The analysis revealed that each process step was entered as a separate task when the project management system was implemented across the department. Addressing the overall number of tasks in the system templates became the focus of the simplification efforts.
Template Triage: Addressing the Root Cause
To address the causes of the gap in quality, the team implemented Template Triage with three key interventions to simplify and streamline administrative work:
- Template simplification and standardization
- Task grouping and reorganization
- Template review and continuous improvement process
Template simplification and standardization significantly reduced the number of tasks within each template (e.g., The longest template originally contained 175 tasks. Consolidation of similar and redundant tasks yielded just 38 tasks). This reduced confusion, inefficiency and errors.
Task grouping and reorganization helped create a more intuitive and efficient workflow, making it easier for staff to follow steps and complete work efficiently. This intervention removed inefficiencies caused by poorly structured templates and allowed for a smoother process flow. This resulted in greater ability to locate tasks and complete process steps.
The project team implemented a continuous review process to ensure that the templates would remain efficient and aligned with staff needs over time. Staff training was provided as well, resulting in a reduction of administrative time and improved staff satisfaction.
Results
Following implementation of the simplified templates, additional time trials were conducted. The average amount of time spent completing items in the project management system fell from 101 to 13 minutes (see Table 1: Administrative time in project management tool pre- and post-simplification). By multiplying the 88 minutes saved by approximately 500 projects per year, simplification resulted in a total of 733 administrative hours across the department. While the goal was not to find a decrease in staff performance in the system, the survey results yielded an increase of 28%. Simply put, staff found the new process better aligned with workflow.
Table 1
|
Team
|
Average Total Time in Project/ Staff Member Pre-Simplification
|
Average Total Time in Project/ Staff Member Post-Simplification
|
Time Saved
|
|
Regulatory
|
1h 35m
|
21m
|
1h 14m
|
|
Activity Team 1
|
2h 08m
|
16.5m
|
1h 51.5m
|
|
Activity Team 2
|
1h 46.5m
|
15m
|
1h 31.5m
|
|
Instructional Design
|
43m
|
02m
|
41m
|
|
Online
|
22m
|
13m
|
9m
|
|
Global
|
3h 37m
|
15m
|
3h 22m
|
|
|
|
Average Time Saved Per Project
|
88 minutes
|
Turning Our Attention to More Important Matters
In the grand tradition of treating ailments never covered in medical journals, this QI effort successfully diagnosed and treated a chronic case of “addition sickness.” Project management may not be the most exciting aspect of work, but addressing it helped the department turn to more important matters: supporting clinician-faculty, needs assessments to better serve the learners and designing effective learning experiences and materials. The project team found the DMAIC framework and tools to be therapeutic, as templates once bloated with up to 175 tasks were trimmed to just 38.
The hundreds of hours saved completing administrative tasks can be reallocated toward the department's core work: Designing, developing and delivering high-quality education that meets healthcare professionals' learning needs. As the department aims to meet increasingly complex learner needs and professionwide goals, let this project inspire opportunities to reward simplification. After all, complexity is not a virtue, efficiency is contagious, and sometimes the best cure is a well-timed bulk delete.
References
de Barros, L. B., Bassi, L. C., Caldas, L. P., Sarantopoulos, A., Zeferino, E. B. B., Minatogawa, V., & Gasparino, R. C. (2021). Lean Healthcare Tools for Processes Evaluation: An Integrative Review. International journal of environmental research and public health, 18(14), 7389. https://doi.org/10.3390/ijerph18147389
Institute for Healthcare Improvement. (2025). 5 Whys: Finding the Root Cause. Retrieved from 5 Whys: Finding the Root Cause | Institute for Healthcare Improvement
Monday L. M. (2022). Define, Measure, Analyze, Improve, Control (DMAIC) Methodology as a Roadmap in Quality Improvement. Global journal on quality and safety in healthcare, 5(2), 44–46. https://doi.org/10.36401/JQSH-22-X2
Sutton, R. I., & Rao, H. (2024). The friction project: How smart leaders make the right things easier and the wrong things harder. NY: St. Martin’s Press.
Acknowledgements
The authors would like to thank Garrett Schramm, PharmD, for his sponsorship of this QI project and review of the final document. In addition, the authors would like to thank their larger QI project team for their contributions: Julie Reed, Christopher Stewart, Denise Klarich, Dorinda Johnson, Barbara LeSuer, Marilyn Marolt, Kristen Jones, Kari Koenigs, Nicole Oertli, MA, Cassandra Skomer, Iwona Bukato, M.M. Melissa Hernandez and Catherine Schilling.
Adria Hoffman, PhD, is a senior education specialist and instructor of medical education at the Mayo Clinic School of Continuous Professional Development.
Jessica Carter, MAOL, CMP, is a CME specialist and instructor of medical education at the Mayo Clinic School of Continuous Professional Development.
Mallory Hedquist, BA, is a CME specialist and instructor of medical education at the Mayo Clinic School of Continuous Professional Development.
Sam Keefe, MBA, is a program manager and instructor of medical education at the Mayo Clinic School of Continuous Professional Development.
Karen Steele is an education administrator coordinator and instructor of medical education at the Mayo Clinic School of Continuous Professional Development.
Lisa Winter, MA, PMP, is a CME specialist at the Mayo Clinic School of Continuous Professional Development.
Laura Wilson, MHHSA, is a communications specialist and instructor of medical education at Mayo Clinic.