NHS QIA Impact Assessments; project pre-flight checklist

NHS QIA tools designed to facilitate Impact Assessments such as QIA, EQIA, DPIA, HRIA, SIA and ISIA. Here, our PMO expert David Walton, outlines how they avoid undesired outcomes and manage risk effectively.
Regardless of the quality of the plane or the experience of the pilot, all flights conduct a standard checklist review before take-off to spot risks or faults as unintended consequences of change.

Projects also need to ensure that they are “safe” to take-off and the standard mechanism is the Impact Assessment.

Projects have impact, if not they’re not doing it right! To avoid undesired outcomes, it’s critical to check that any change doesn’t break what’s already working and also that known risks are considered.

Standard checklists or Impact Assessments are widely used in the NHS and other organisations to ensure that the change fully considers known risks and doesn’t have undesired outcomes.

Inverting the normal project approach whereby projects take a project-centric view of how they affect the organisation, Impact Assessments oblige the project (and other change mechanisms) to consider change against the organisation standards.

This helps in 2 ways. First, it obliges the project team to consider all risk areas from an organisation perspective. Secondly, it helps the reviewers and approvers as risks are presented in the format and style that they best understand.

This takes the form of a standard set of questions around defined risk areas with scored responses. The completed Impact Assessment then goes through relevant approval to ensure that the level and type of risk are appropriate.

By using a standard set of questions, projects know the standard they will be measured against and the organisation has a consistent way of evaluating the risk associated with the change.

Why are Impact Assessments important in the NHS?

In the NHS, a focus on cost and efficiency without due regard for the impact on service provision was seen as one of the key causes of poor patient care in some high visibility Trust cases. Failure to consider all outcomes can put people’s health and life at risk.

Considering things from a project perspective; it’s not surprising that projects will tend towards a positive view of outcomes and hope for the best. For the project, this is a logical approach as it increases likelihood of achieving objectives but it makes change riskier for the organisation.

When to conduct an Impact Assessment

All projects are unique and information about impact will be collected at different rates. However, it is important to conduct the impact assessment earlier rather than later, even if they are incomplete pending further information (which should be prioritised).

To be pragmatic, it makes sense to conduct an initial Impact Assessment at the start of the project and review it at the end of each stage and at the end of the project.

A Gateway should be designated as the right time for the full Impact Assessment. This should be at the point where enough information is available to make good decisions without waiting so long that key project decisions (with time and cost implications) are already made.

Where a high level of risk is identified, reviews may be needed more often. The frequency of review will be dependent on the level of risk identified and documented in the Impact Assessment.

It’s all about projects, isn’t it?

No! Decisions on change start long before projects are initiated and change often happens outside projects and programmes.

Applying Impact Assessments at the strategic level can help to assess the viability of work before projects are commissioned.

Using (appropriately sized) Impact Assessments on small changes is essential as a small change can have big impact (if you don’t believe this, have a look at the small changes and the big impact associated with the sinking of the Titanic).

It’s not about the money

One key risk to avoid is aligning the rigour of Impact Assessment with the budget of the change.

Major change usually has greater impact (and greater risk) but even small changes can have unintended consequences.

Imagine the potential consequences of digging a hole in the ground outside the A&E ambulance entrance!

Types of Impact Assessment

Impact Assessments come in many forms, below are some of the most common:

• Quality Impact Assessment (QIA)
• Data Protection Impact Assessment (DPIA)
• Equality Impact Assessment (EQIA)
• Human Rights Impact Assessment (HRIA)
• Safety Impact Assessment (SIA)
• Information Security Impact Assessment (ISIA)