The Project Management Challenge Facing the NHS

The NHS is facing an almost unprecedented challenge with the pandemic. On top of this, there are the inevitable demands of winter on the NHS, and the challenges that come with the reorganisation of the NHS into Integrated Care Systems (ICS).

Integrated care systems (ICSs) and Integrated Care Partnerships (ICPs) are new organisations that are designed to meet the health and care needs across an area. The ICSs will coordinate services and plan in a way that improves population health and reduces inequalities between different groups.

The ICS organisations need to be in place by April 2022. The NHS will face a significant amount of change in order to create these substantial organisational structures. In addition to this change, they will need to continue to deliver the ongoing Cost Improvement Programmes (CIPs) and digital transformations. There will be a huge amount of change programmes that need to be delivered successfully. It follows that in order for these projects and programmes to be delivered successfully, the NHS needs an excellent project management capability. If not, significant money will be wasted on poorly executed projects and planned benefits will not be realised.

The remainder of this article looks at a number of project management challenges that the NHS faces with some suggestions on how to overcome these challenges and deliver successful outcomes.

Challenge #1 Not everyone is a Project Manager

There is a general perception in many organisations that everyone can deliver projects, i.e., everyone has the skills and experience to be a project manager. This, in my opinion, is not true and devalues the project manager profession. Similar to the fact that not everyone is creative or can sell, not everyone has the skills to be a project manager without proper training. In the NHS, clinicians are sometimes asked to manage projects. Some will have the aptitude to project manage but some won’t. Without careful assessment of these ‘accidental’ project managers, the NHS may be asking people to perform a role that they are not suited to performing. This is not good for the individual or for the NHS.

Solution to Challenge #1 – Assess the capability of each potential project manager and develop training /mentoring programmes.

Challenge #2 Our Project Management Tool is a Spreadsheet

If you are not a professional project manager then a Project, Portfolio Management (PPM) tool, like PM3 (Bestoutcome’s PPM tool for the NHS) can be daunting, as can scheduling tools like Microsoft Project. The default option for the ‘accidental project manager’ is to use a spreadsheet for project planning and managing Risks, Assumptions, Issues and Decision (RAID) logs. A spreadsheet is a great tool, but it is not a project management tool. Of course, you can use it to plan a project and record risks, but spreadsheets are not designed for this and, unless your workbook is very advanced, it will not have the project planning rules that a scheduling tool, or a tool like PM3, has. It is, in effect, a blank sheet of paper.

There are a number of documented issues when using a spreadsheet for managing projects. The majority of these workbooks have errors, multiple versions are created, and they are not suited for multi-user access. If you, as a project manager, are tasked with managing a multi-million-pound project then you need to use the tools that are fit for purpose and designed for that task.

Solution to Challenge #2 – Use the Tools that are designed for managing projects and programmes.

Challenge #3 Not everyone is a Programme Manager

This is similar to Challenge 1. In this situation it is easy to think that every project manager can successfully deliver programmes. Managing a programme requires a different set of skills than a project. I speak here as someone who has managed large scale transformation programmes.

A programme, by its nature, is large, will often cross departmental boundaries and have a varied set of stakeholders. Projects tend to be smaller and are often contained within one departmental area. The programme manager needs to keep many plates spinning at once. They need to:

• Be comfortable at operating at a senior level, possibly C Level
• Be a Leader
• Be a Good Communicator
• Understand change management
• Be benefits focussed
• Resolve conflict
• Command respect

Having a project manager who is not capable of managing a project, has the potential to waste time and money as a consequence of the non-delivery of a project. However, a failing programme manager will, everything else being equal, cause a bigger waste of resources and unplanned benefits than a failing project manager. As programmes are, by definition, bigger than most projects in terms of people, budget and benefits, the failure of a programme has a bigger negative consequence than the failure of a project.

Solution to Challenge #3 – Assign programme managers who are qualified and have the experience to run programmes.

Challenge #4 There is no standard delivery approach

Most people would argue that it makes sense for a common project delivery approach to be used across an organisation. It is probably a stretch target for the whole of the NHS to use a common approach but within each Trust or an ICS, it is typical to have many different approaches to managing and delivering projects and programmes. A common approach that is fit for purpose will deliver many benefits to an NHS Trust or an ICS. Of course, the approach needs to be right for the organisation and it is perfectly acceptable for variants of a common approach to be used. A large project may require more stage gates or phases than a small, less risky project. It is a mistake to force a ‘one size fits all’ for all projects. However, there should be mandatory stages that each project must go through. The benefits of a common approach (with variants) are:

• The productivity of the project teams is increased as no one is reinventing the wheel by designing their own project method
• Key important check points are carried out for each project so that only viable projects are delivered
• Resources can switch project teams and do not have to learn a new framework or approach which again increases productivity
• Audits are more likely to be passed if all projects follow a standard approach
• It is unlikely that irrelevant tasks and activities are carried out by the project team.
• After time, stakeholders understand the project delivery approach which builds confidence in the project team and also enables them to ask more probing questions as they become more experienced in their role in a standard approach

Solution to Challenge #4 – Adopt a standard project and programme delivery approach ensuring some variants are allowed for different size projects. Also, the stakeholders including sponsors need to challenge project managers when a non-standard delivery approach is used.

Challenge #5 – There are no standard governance reports

This challenge is also related to challenge #4. Too often an organisation will have a multitude of highlight and status reports. Not only is this inefficient it can create a lack of confidence in the project team by the sponsor and stakeholders if each project they are involved in has a different set of governance reports.

There will be different governance bodies and steering groups for different types of projects and programmes. Some will require more or less detail depending on the particular governance body and the size and/ or risk of the project.  The standard reporting pack needs to be agreed for each governance body and no variants should be allowed. Too often, stakeholders request different reports or information. This should be resisted as it wastes valuable time producing non-standard reports and usually adds very little marginal value. Also, stakeholders will feel less comfortable in understanding highlight reports if they are all different.

Solution to Challenge #5 – Adopt the same reporting templates for projects and programmes.

Summary

I think it is hard to argue with these challenges and solutions. The positive point is that these solutions are not difficult to implement. They do require, however, sponsorship and change management to address each of these challenges. For example, sponsors and stakeholders can help by not signing off key project deliverables if non-standard reports or approaches are being used.

In the next few years, the scale of the project delivery challenge in the NHS is huge. These five relatively simple steps can help improve a project team’s productivity and deliver projects with a high probability of success.