Priority action approach
how to apply the principles of first aid to recovering your ailing project
The Priority Action Approach (PAA) is a technique used by emergency health services all over the world. It involves a sequence of steps: primary assessment, critical interventions, secondary assessment, and treatment. The main objective of PAA is to save the life of the patient, comfort the patient, and make sure that he or she received the proper level of care needed in each situation.
As project managers, when faced with a troubled project, the most common problem we face is that we don’t know where to start when we need to focus on the health of our project. This article will provide some tools and a framework for taking care of our “patient.”
Priority Action Approach (PAA) Description
For anyone involved in emergency care, being a first respondent, advanced life support technician, or a first-aid attendant in a company, the concept of the Priority Action Approach (PAA) is the key training element.
PAA is based on two basic principles:
- Emergency-situation actions have to be taken in a structured manner
- Those actions have to be taken to preserve human life
Training for emergency personnel consists mainly of repeating the same steps over and over again until the steps are imprinted in the subconscious and the actions taken correspond to the sequence required by the approach. Even basic first-aid course students can spend over 30 hours just on scenario situations and drills.
The PAA steps are:
- Rescue Scene Evaluation
Ensure no danger. Remove Danger if possible. Gloves if necessary
Introduce self. Instruct victims to not move.
Mechanism if injury – check for potential spinal injury
Bystanders/number of patients
LOC – Assess level of consciousness
Call for Back-up/EMS
ABC: Airway is adequate, Breathing is adequate, Circulation is adequate
Rapid body survey – check for Deadly bleeding or Escaping air
Position patient appropriately (recovery, semi-sitting, etc.)
Chief complaint – “What is bothering you the most right now?”
History of chief complaint – “How did it happen? How long have you had it, etc.?”
Allergies and medications
Medical history – “Do you have any medical problems, such as cardiac problems, respiratory problems, asthma, diabetes, etc?”
PQRST – mnemonic for “Pain, Quality, Radiating, Severity, and Timing”
Personal Info – patient’s name, address, phone number, BC medical plan number, postal code, birthday, age, sex, and doctor’s name
B. Vital Signs
Time of Day
LOC – level of consciousness (Alert, Responds to Voice, Responds to Pain, Unresponsive)
P – Pulse rate and character
R – Respirations rate and character
E – Eyes (equal and reactive? size?)
S – Skin temp, color, and condition
C. Head to Toe
Head and neck
Abdomen and back
Treat ABC and life-threatening problems as you find them
No other treatments are made after the secondary survey is complete.
What is the logic behind this approach? As previously described, the intent is to preserve human life. If you attack an emergency situation without assessing the scene, you are putting yourself in danger. A dead or incapacitated attendant is not helpful; then, the most important elements of human life are treated: Air, Breathing, and Circulation (usually shortened to ABC). A problem in any of these three areas requires immediate intervention. Once these vital elements have been checked, the attendant can move on to see if there are other areas (less critical) to take care of. Finally, the attendant can focus on other areas of treatment; even if they are not vital, they are important for the patient’s comfort.
Applying PAA Principles to Projects
Upon further inspection, the principles applied to attend to a critical patient have a very strong correlation to the principles applied to troubled projects. For instance, there are critical vital components in a project that have to be attended to first. A project manager should be able to evaluate the impacts of financial situations well before a situation with a sub-contractor is discussed.
The key to this approach is the discipline: no matter what situation a project manager finds, there should be consistency in the steps taken to diagnose and attack any issues.
The vital components of a project are scope, cost, time and quality. If any of these is failing, there is a critical situation that requires immediate attention. Once they are under control, any other components can be analyzed and treatment can commence.
Purba and Zucchero (2004) propose a four-phase intervention framework that can be directly tied back to the PAA. The phases in this model are: assessment, intervention planning, intervention execution, and post-intervention review.
One additional item to consider are the Knowledge Areas discussed in A Guide to the Project Management Body of Knowledge (PMBOK® Guide) which provide an excellent tool for keeping all the important components under a watchful eye.
In this first phase, the assigned project manager should be able to gather all the information required to make any decisions. Sources of information are project documentation, interviews with stakeholders and project members, review of the project history (including status reports and dashboards), and review of existing or upcoming deliverables.
At this point, if the project manager is completely certain that an immediate action is required, then that action should be taken. For example, if the project is losing money at a rate of US$100K per day and the project can contractually be stopped under a specific clause, the decision has to be taken until a more thorough analysis can be completed and an action plan can be laid out.
One particular item requires strong executive commitment: recognizing that there is a problem! In emergency situations, you can find patients who believe they do not require help even though everyone else sees they are in trouble. In the corporate environment, it is no different: a decision to attack problems requires recognition that there is a problem and that it can be solved.
The main tool available (similar to the ABC approach in the PAA) is a project audit. A project audit can provide a facts-based diagnosis of the project situation and drive any actions and the next steps required; without an audit, actions may not be properly supported.
A key element of the assessment is the risk. As the project manager moves into the assessment phase, the risk associated with each finding has to be scored. Typically, the risks in ailing projects are not well understood. As part of any rescue plan, the risks have to be re-stated and re-analyzed. It’s very likely that those risks are affecting the project as issues without a clear understanding of their effect in the overall project status.
Once the assessment has been completed, a rescue plan needs to be created to rescue the project. In the PAA, once the primary assessment and the critical interventions have been completed, a more thorough examination is required. This examination leads to a decision on the specific actions to take.
In the project world, the secondary analysis is the initial step toward the formulation of a new plan. Understanding objectives, business decisions, rules of engagement, risks, and specific resources is required before any intervention is performed.
Typically, scope, budget, resources, quality, and timelines will be affected by any decision. At this stage, the classical knowledge and approach of a project manager takes precedence. A project manager has to be able to create a plan. What are typical in troubled projects (as in emergency situations) are the high numbers of assumptions and constraints.
If scope is the major problem, the best tool available is to negotiate a reduced or modified scope. The classical rules of engagement for a change control do not apply, because the project manager is clearly facing a threatening situation. Negotiation and the ability to communicate are the best supplies in the first-aid kit.
If the cost is the main problem, a detailed cost analysis has to be performed. The project manager should focus on what work is remaining and how to get to the proper milestones: do not focus on the money that has been over spent on the project, because this is the symptom, not the actual disease.
The more difficult element to contain is time. Time cannot be stopped and cannot be negotiated. If the project is way behind schedule, the immediate effort needs to be aimed toward re-base-lining the project and understanding the time constraints. Is it a situation where hard dates are missing or the project is missing milestones? No effort will bring those dates back. Again, as with scope, negotiation, communication, and validation need to be in the forefront of the rescue plan.
Once a rescue plan has been created, the plan needs to be validated, updated, and tracked like any other project plan.
In emergency situations, a first respondent or first-aid attendant assumes help is on the way and that person will not have to deal with all the PAA steps by him- or herself.
The same situation exists in the project world. Once the initial steps have been taken and a plan has been approved, the project team takes over the execution; however, management is still a key element. As opposed to a typical project plan, a project rescue plan is geared toward solving specific situations and providing relief to situations previously experienced in the project. These situations can (and should) be isolated and monitored.
One specific skill that project managers (and other project resources) must have when rescuing troubled projects is the ability to deal with insidious problems. Specific skills like persuasion, negotiation, decision making, prioritizing and organizational skills are required to avoid relapses in the project problems. As a result, it is typical that “rescue” resources are brought into the project. These resources are not meant to replace project execution resources, but to support the efforts to bring specific issues under control.
Another consideration, similar to the PAA approach, is that actions have to be taken incrementally. It is almost impossible to attack all problems and provide all solutions at the same time. It is far more effective to provide solutions to situations as they are found and not to try to resolve everything at the same time.
Finally, the “secondary examination” will enable you to find other problem areas in the project. Are there contracts with third parties that have to be renegotiated? Are there resources that are creating a bad working environment? Is the project creating low-quality deliverables? In the head-to-toe examination, no area should be overlooked. In the project, no stone should be left unturned.
Even though these issues may not be as critical as scope, time, and cost, they can produce long-term effects that will reflect badly on the project and the project manager. Luckily, these are the components that tend to be easier to treat.
Once the project has been deemed “under control,” it is important to understand what went right and what went wrong. In the medical emergency world, debriefings are always performed after emergency situations in order to understand why some decisions were made and how the responses can be improved in the future.
The four key categories that require some review in projects are:
- Project management
- Executive support
- SME involvement
- Project team skill level
Each one of these categories typically has some impact on the success or failure of projects.
Finally, if some resources have been brought on board to help with the recovery, it is good practice to make them leave and transition their activities to project team members. The reason for this is twofold: it shows appreciation and responsibility for the project team and it also builds confidence in project resources.
The First Aid Approach
The framework and treatment described in the previous topics work very well when you have a very sick patient; however, not all situations require a full PAA approach.
Some projects will fare better if there is a compassionate and tender hand to treat the minor ailments. If the project manager discovers that the project is falling behind schedule or the expected cost is actually getting higher every week, very small and minor corrections can make a big difference.
One of the biggest tools available is the change request; erroneously, may project managers consider a change request only when the situation is getting very bad. Experience has shown that a change request in the right moment, with the right scope, can bring problems under control very quickly.
Another option is to make use of the communication tools. A steering committee or a project review will cost very little but will engage sponsors and stakeholders, forcing them to make decisions. No critical or dramatic interventions are required!
Recovering a troubled project is not a science; however, there are specific steps that can be taken to reach an end result consistent with organizational expectations. These steps are shockingly similar to the steps taken in the management of medical emergencies via the Priority Action Approach (PAA). Project managers can learn from these techniques about how to better approach situations in which the life of a project is in desperate need of emergency care.
Smith, J. (2001). Troubled IT projects: Prevention and turnaround. London, UK: The Institution of Electrical Engineers.
Purba, S., & Zucchero, J. (2004). Project rescue: Avoiding a project management disaster. Emeryville, CA: McGraw-Hill/Osborne.
WorkSafeBC. (2010). Occupational first aid: A reference and training manual. Victoria, BC: Workers Compensation Board of British Columbia.
© 2011, Ivan Rincon, MBA, PMP
Originally published as a part of 2011 PMI Global Congress Proceedings – Dallas, TX