Why Impact Assessments are Critical tools for Managing NHS Schemes

Blog 09-04-2021
Impact assessment have become a part of business life in the modern world and are a key feature of governance and oversight for projects and programmes. Here, our Principal Consultant David Bowen-Cassie outlines how Impact Assessments can be used to improve engagement in both project delivery and governance design.

Following the failures in healthcare delivery at Mid Staffs, Quality Impact Assessments (QIA) became a definitive feature in the public sector, driven by the need to identify and mitigate the potential negative impacts of cost reduction programmes.

More recently the profile and complexity of Data Protection Impact Assessments (DPIA) have increased as the implementation of the General Data Protection Regulation (GDPR) has rapidly progressed. The organisational trigger for these and other similar assessments is a need to implement change, and change is often delivered through projects and programmes.

In PPM work with our clients, the variability in the quality of assessments and mitigation of risks against their criteria has become a notable feature of the challenges facing PMOs. This variability is compounded in some cases by low levels of assessment process compliance and data completeness. The resulting impact on Risk Management and Corporate Governance should not be underestimated.

Implementing a cloud-based PPM system, with the in-built capability to standardise and track Impact Assessments, creates significant governance and change implementation improvements for organisations.

Improving governance

The implementation of a Portfolio, Programme, and Project Management (PPM) system like Bestoutcome’s PM3 presents Senior Managers and PMOs with a significant opportunity to address Impact Assessment issues, Governance, and Compliance across the organisation.

The decision to procure a system or engage external PMO process experts is a clear indication to the business that leaders are focusing on a step-change in how change projects are managed, delivered, and governed.

Another governance challenge for leadership teams is recording and tracking the required documentation that relates to assessments. This can be a particular issue for high volume programmes such as annual cost reduction activities, where having more than forty schemes in a year in a large public sector organisation is common.

Each of these schemes requires the relevant suite of impact assessments to be completed, assessed by the accountable leaders, and the residual risks accepted.

The assessments then need to be filed where they can be found and reviewed as the project progresses through the required gateway stages.

Longer-term programmes that move across several annual business cycles have an additional governance risk factor – time. Using paper-based or stand-alone electronic assessment documents creates archiving and tracking challenges for the PMO, especially where staff turnover or the use of short-term interims fracture the corporate memory of what was done and when.

Shared servers or web-based collaborative document storage systems such as SharePoint go a long way in addressing this, however, there is still a reliance on someone remembering wherein the electronic file structure the original assessment documents were archived to.

Moving to an integrated PPM system, e.g. PM3, with inbuilt re-designed assessment processes and the ability to attach electronic copies of older paper assessments creates a solid foundation for tracking both current corporate governance programme activities and the relevant corporate history.

PM3 screen showing impact assessments
PM3 screen showing impact assessments


Impact Assessments create opportunities for staff engagement

When we talk to our client’s operational and project managers during a PM3 implementation a common theme is the perceived complexity of the existing assessment process and documentation. For an operational manager bureaucracy and complexity equal time, and time is not a luxury that they often have.

This time challenge translates into delays in the completion of assessments. Delayed assessments mean that risks and unintended consequences of the planned change might not be identified early. As result they are not mitigated or managed in the right timeframe for the project to deliver positively the sustainable benefits required.

Designing new impact assessments or reviewing the current corporate approach are key early steps in defining the governance aspects and processes of a PPM system. The design and review process presents the PMO with unique opportunities to engage with stakeholders, project teams, and other potential PPM system users.

The review process can also be a trigger for the leadership team to challenge how governance has (or hasn’t) been working across previous change programmes. The implementation of improved streamlined impact assessments, defined and tracked in a PPM system, can create a foundation from which the whole organisation can be engaged a change governance culture.

Developing and testing new (and old) approaches to the delivery of change

At the start of my management career, I first came across the concept of a Change Impact Assessment. It was used as the starting point for developing change plans. Broad in scope, it tried to encompass the impact on the whole change system as opposed to the different elements of the business.

Originally it was done so that we could actively manage the overall implications of our change projects, however as time and thinking progressed it became more valuable in assessing the potential triggers for change fatigue in the organisation.

Although the Change Impact Assessment has largely been replaced by the more focused elements that we have today, having all of the relevant project assessments accessible in one system does facilitate the capability to review the overall impact of a project or programme.

The concept of a project “pre-mortem” is a form of Change Impact Assessment but is more focused on how the project team will (or should not) deliver the change. The pre-mortem is not a concept that is often used outside the client project planning operations of large consultancies and is extremely rare as a planning and risk identification step in public sector organisations.

PPM systems give PMOs the ability to build, test, and evaluate such approaches to the identification of implementation and change process risks.

The ability to build, test and evaluate new assessments quickly also enables the PMO to fulfill its management innovation role in programmes and projects, improving the efficiency and effectiveness of the project delivery process and teams.

It’s not all about the projects

In his previous blog on Impact Assessments David Walton asked the question “It’s all about projects, isn’t it?”. The proven principle is that “Decisions on change start long before projects are initiated and change often happens outside projects and programmes.”

Appropriate Impact Assessments inform these decisions. If they are co-designed and implemented with the PPM system user, Risk Management, and Governance requirements fully considered, they will add value to business changes and the way that they are delivered. Co-design is the gateway to engagement and positive project manager compliance.

PPM systems and processes that fully integrate Impact Assessments with project plans and gateways make it easier to do this, and expert external guidance can facilitate the development and design process.


Impact assessments are becoming more and more important in terms of good governance. Have all these assessments in one central integrated system drives standardisation and ensures that all the appropriate assessments have been developed and reviewed by the appropriate bodies/individuals.

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