Project management LITE

a roadmap for merging project management styles

Manager, National Programme Management Office, Health Services Executive

Abstract

The Health Service Executive (HSE) was established in 2005. This merged a number of different Health Boards and organisations. To enable this change and achieve its objectives the HSE launched The HSE Transformation Programme (2007 – 2010) consisting of 13 programmes with 119 projects. In parallel, the HSE established a National Programme Office (NPMO) with the responsibility to implement a standard Project Management Methodology and approach for the management of the 119 projects. Following the implementation of the HSE there were many different methodologies and styles to project management as each of the 11 areas were independent organisations up until then.

The paper describes how the NPMO developed a standard methodology and implemented it for the Transformation Programme. Following a review of the process in operation it identified the weakness in the adopted methodology and approach. The paper includes an outline of the challenges that faced the HSE and the NPMO to develop an alternative approach for the management of projects, one that had better buy in and effectiveness.

The process undertaken to develop a revised approach to project management resulted in the development of HSE Project Management LITE. The roadmap in developing this approach is outlined together with the key principles adopted to implement Project Management LITE.

Introduction

The content of this paper refers to work that was undertaken in the Health Services Executive (HSE), Republic of Ireland. The HSE is responsible for managing and delivering health and personal social services in Ireland. It is the largest employer in the country with just under 110,000 staff and a budget of almost €14 billion (HSE Annual Report, 2009, p. 9).

In 2005 the HSE was established following the passing of legislation to change the existing structure that had been in place from 1970 for the delivery of Health & Social Care Services to the population of Ireland. The HSE sought to create an integrated Health Service by combining the management and delivery of these services by the Eastern Regional Health Authority and 10 regional Health Boards and a number of other organisations within one authority. Each of these Health Boards had their own CEO and management structure and while they delivered services as per the policy and budget allocation as defined by the Department of Health & Children (DOH&C), they primarily worked as independent organisations. The amalgamation was primarily focused on the reorganisation of service delivery so that it would be integrated and provided in a consistent, standardised manner conforming to best standards of practice and quality. Organisational structures had to be redesigned and implemented. The HSE was to be managed through one CEO and four Regional Directors as opposed to 11 CEOs and their management teams.

To enable this change and achieve its objectives the HSE launched The HSE Transformation Programme (2007 – 2010). The programme of work described the current service delivery model that existed in 2007, the vision of the desired state to be achieved by 2010, and the priority actions needed to attain that vision. The priority actions were classified into 13 programmes with 119 projects. These were large-scale programmes and projects, e.g., Programe 3 covered the following:

Example of some projects of Programme 3 – HSE Transformation Programme (2007 – 2010

Exhibit 1 – Example of some projects of Programme 3 - HSE Transformation Programme (2007 – 2010)

(The HSE Transformation Programme 2007 – 2010)

  “Project 3.2 Services configuration implementation – NE transformation plan” covered the reconfiguration of the services delivered in five hospitals—transferring services from one hospital to another, discontinuing some services in this area and transferring some services for delivery to Community Care.

In order to maximise the prospects for successful implementation of these priority actions, the CEO mandated that these programmes and projects should to be managed using a standardised project management methodology. These projects were identified as a priority for the newly established HSE National Programme Management Office (NPMO).

When established the NPMO found that there were many different methodologies in place throughout the HSE while in some parts of the organisation methodology-based project management was not practised at all. To standardise the process it developed and implemented an Interim Project Management Methodology (IPMM).

Following use of the methodology for a year its effectiveness was reviewed. The review was very informative and allowed the NPMO to revise and redesign its project management approach and toolset. This drove the development of the HSE Project Management LITE methodology.

Transformation Programme and Projects

The HSE launched its Transformation Programme (2007 – 2010) that encompassed two broad categories of propriety activities:

Category 1 - Direct Services that had six programmes and

Category II - Enabling/Infrastructure that had seven programmes.

Each programme was allocated a senior manager from within the HSE to act as Programme Lead.

In conjunction with the programme leads, the NPMO obtained the agreement of the HSE’s Senior Management Team to proceed with a total of 93 projects and 26 sub-projects within the Transformation Programme.

Management were acutely aware that the HSE was undertaking one of the most significant change programmes in the history of the State. International evidence points to a high failure rate in implementing transformational change. Organisations have realised, often following painful failures, that managing change differs significantly from managing the business. To minimise the risk of failure the NPMO was requested to develop an appropriate Project Implementation approach and methodology that would ensure standardisation, transparency, good monitoring, and effective progress reporting.

The HSE National Programme Management Office (NPMO)

The HSE established a National Programme Management Office (NPMO). In the previous Health Board structures, each Board decided its own approach and methodology for project management and to what extent it wished to use project management methodologies. Just prior to the implementation of the HSE a Project Methodology Guide for use with projects within the Health Board Structure was published by The Health Board Executive (HeBE). This was a first step to being some standardisation to the management of projects throughout the Health Boards.

The NPMO was to implement a standardised methodology, providing a toolset, training and field support to project teams. The vision was that this approach would build a project management competency within the HSE that would support the organisation in its goal to implement change in a structured project environment using a standardised approach. While the focus for the NPMO was on supporting the Transformation Programme the output and learning was to be applied to other large-scale projects in the HSE.

In providing project management support to the Transformation Programme the NPMO was specifically asked to:

–   Develop appropriate management processes, including portfolio, programme, and project management to support the HSE Transformation Programme 2007-2010.

–   Support the CEO and Management Team through formal programme assurance.

–   Manage the monthly, quarterly and annual monitoring and review process for the Transformation Programme.

–   Provide direct support to programme and project managers including intensive field level activities.

–   Support the development of programme and project management capability within the organisation through the development and delivery of specific methodologies, standards and training.

Managing the Transformation Programme using a Project Management Approach

The Environment and Culture

The NPMO had to deliver a structured and standardised approach where the current environment had different approaches to project management, different documentation in use, and different levels of experience in managing projects. In addition the NPMO was just established and had not yet built a relationship with existing managers throughout the HSE. The Unit had to establish itself, identify its way of working, develop a project management standard within the HSE and in parallel implement, and support a robust project management methodology for the implementation of the largest change management project in the history of the state. The level of change that had taken place with the implementation of the new HSE structure was significant, which had many managers and staff adjusting to their new roles and environment.

Senior management was of the view that there was a good knowledge and experience in the application of project management discipline throughout the regions.

Developing a Standard Project Management Approach for the Transformation Programme

The NPMO decided to develop an Interim Project Management Methodology (IPMM) for use by the HSE project teams pending the development and adoption of a national standard HSE Project Management Methodology (PMM). This approach was taken as there was an immediate need for standardisation to be adopted and implemented. There was not time for the agreement and adoption of a final methodology.

The NPMO reviewed existing documentation that was in place from the former Health Board structure. This included the PRINCE Methodology, which was adopted for ICT Projects together with The Health Boards Executive Project Methodology Guide based on the Project Management Body of Knowledge - PMBOK produced by the former Health Board Executive organisation (HeBE) in partnership with The Centre for Project Management, University of Limerick (HeBE Project Methodology Guide). An IPMM was published that aimed to provide a structured, accessible and user-friendly approach for all HSE personnel who were involved in projects. Where an existing and robust PMM was already in place and was being followed rigorously, there was no requirement to adopt the interim methodology.

The objective of the IPMM was to ensure that projects were conducted in a disciplined, coherent, and consistent manner. The ultimate goal of the methodology was to promote the delivery of quality services projects that would be completed on time and within budget. All projects undertaken within the HSE were to be conducted within a formal project management methodology.

Implementing the Interim Project Management Methodology (IPMM)

Work started to apply the principles of the IPMM to the Transformation Programme projects. The programme had a good governance structure with the management team taking on the role of the steering group. The setup of the programme with the breakdown of the priorities into 13 different programmes broken down into projects and sub-projects was a good starting point and very much in line with the IPMM. Programme leads were identified to manage each of the programmes.

Project managers had to be identified and assigned to each of the projects. The majority of the projects were service delivery. The appropriate people to manage these projects needed to come from the services, e.g., clinicians, nurses, physiotherapists, etc. Project management cannot succeed unless a good project manager is at the controls. “It is far more likely that project managers will succeed if it is obvious to the subordinates that the general manager has appointed them” (Gautam). Due to the budget and manpower recruitment restrictions it was necessary to appoint the project managers from existing resources with their existing workload shared by their colleagues. In many cases project managers could only be freed up to mange the project on a part time basis while maintaining their existing workload. “Leadership of a project team requires many skills beyond technical knowledge. A team leader must be able to communicate effectively and work well with all stakeholders” (Brown, 2009).

The NPMO devised a set of templates for use. Guidance documentation was produced and a training programme developed. The resources from the NPMO provided field support. Working with the project managers and sponsors to develop their Project Initiation Documents and Scope Statements proved challenging. This part of the project took longer and placed a greater demand on the NPMO than was envisaged. While it was clear that the project managers coming from the front line service were a key asset to the project the need for support and training in the IPMM was proving challenging. These managers knew their area of business, were capable of getting the buy in for the change, could bring their colleagues with them in the project but struggled with the disciple and the use of the tool set that was defined for use to manage the project. Due to the double demands on the project managers to maintain their existing workload or at least 50% of it and to find time to manage the project it proved virtually impossible to extract them for training in the IPMM toolset. They were eager to make the project work and welcomed the training opportunity but for many the demands on their time were so great that attendance at training courses often had to be forfeited.

As the Transformation Programme progressed the tool set was used. Scope statements and project plans were developed with ongoing progress reporting put in place.

A key part of managing the project was the completion of a monthly status report for submission to the CEO and steering group. The programme leads compiled the reports from their project managers and submitted a summarised report to the NPMO. These reports used the red, amber, and green (RAG) concept for reporting from the project manager up to CEO level (RAG Status definition – Imperial College London). The NPMO collated the information and produced the overall management report for the CEO and steering group. The NPMO also had to provide an independent assessment on how the projects were progressing and how accurately the state of the project was being reflected in the reports. Each quarter a more detailed report was prepared.

Review of the Operation of the Interim Project Management Methodology in Operation

After the first year of the Transformation Programme and the use of the IPMM, the NPMO reviewed the application of the methodology and its effectiveness. The review included feedback from the users and the management team. The findings showed that while the IPMM was in place with the tool set being used it was not being as effective as required. The users found it to be an additional overhead and struggled to see a real benefit from its use. The findings showed that in some instances templates were being completed to fulfil the need of the methodology as opposed to assisting the project. It also showed that while scope statements and plans were in use they were not accurately reflecting the real objectives and status of the project. While monitoring and progress reports were in place and being completed they were not giving the information on the projects that was needed. The NPMO could gain more knowledge from onsite visits and one-to-one interaction with the project managers. In summary the IPMM appeared more to be an end in itself—perhaps just to meet the discipline and requirement to manage the project according to the prescribed methodology. “However having a framework in place is no guarantee of success and we delved a little deeper into the issue by asking about how the methodology is used by staff’ (Clarion, 2008).

Building on the Feedback and Getting a More Effective Project Management Approach

With this information the NPMO had to pause, reflect, and identify how the situation could be improved. It had developing a standardised approach, agreed a tool set but while in many cases these were being used they were not achieving the desired result. At this point the HSE drew on the expertise of the Project Management Institute of Ireland through its Training Partners OLASIT/Turlon & Associates to provide guidance on what needed to be done. On presenting the findings of the review of the current project management approach OLASIT/Turlon & Associates asked the HSE to focus on the “Level of Maturity” of the HSE as an organisation for the management of projects. This was a new concept for the NPMO. The NPMO had to familiarise itself with this concept and identify how it would help to address the issues identified in project managing the Transformation Programme projects.

Learning and Building on Organisation Project Management Maturity (OPM3)

The message we delivered to HSE managers is that project management maturity refers to the level of consistency in which projects are managed. It was important to develop an understanding that it does not mean that projects in an immature project management environment are less successful. It means that projects have different levels of consistency in how they are approached, managed, and delivered. Organisations that have a high level of maturity are found to have a higher rate of success with the projects they undertake. OPM3 helps organizations understand their project management processes, ensures that their projects are tied to the organization’s larger strategy, and measures and guides their capabilities for improvement. The standard OPM3 maturity model has five levels.

Using this concept of five levels of maturity the NPMO examined the operation of the IPMM to identify what level the organisation was at for its management of the Transformation Programme using a project management approach. It was easier to get engagement from managers using this concept for review of the current project management approach.

Maturity Levels as defined for HSE

Exhibit 2 – Maturity Levels as defined for HSE

Developed based on OPM3 in Association with OLASIT/Turlon & Associates in developing HSE Project Management “LITE”

Recognising the HSE Project Management Level of Maturity

Following an analysis of the project management approach in use in the HSE for the Transformation Programme the NPMO identified that while there were some pockets of advanced project management approaches and skills in the organisation. Overall, the organisation had a low level of project management “maturity” particularly in the service area. The highest level of maturity was in the ICT areas. Also, the analysis showed that there was a significant difference in the management of projects for product implementation as opposed to service delivery change management projects. The NPMO learned that the HSE had judged the level of competency in project management higher than it was in practice. The IPMM that had been introduced needed to take this into consideration.

Key Areas to be Addressed

An outcome from looking at the Organisational Level of maturity was the acceptance that changing the culture to one of project management disciple would be a slow process. It would take time to get buy in, to demonstrate the benefits and to develop appropriate skills. Producing guidance packs and templates with training would not make this happen. The NPMO needed to start building a project management culture and create a mindset for project managers.

Change the Culture/Environment

Another key learning related to the process being undertaken when managing the project. While the NPMO had succeeded in getting consistency and standardisation in the use of the IPMM tools there were significant differences in the processes being undertaken to identify the information to populate the toolset, e.g., while there were project initiation documents, scope statements, work breakdown structures, project plans, etc., the content was not accurately reflecting the project. The process of identifying the project details needed to be improved.

Change the Approach to Planning

In addition to the above when the NPMO examined the lifecycle for managing projects it found that the greatest strength in the organisation was in the “Execution” Phase—there was a great eagerness and traction to get to the doing phase—little time was spent on the Initiation and Planning Phases. Some projects never were closed out and completely passed over to the business.

Exhibit 3 shows the effort that was recommended as part of the IPMM.

image

Exhibit 3 – Recommended Project Life Cycle Time Input

Developed based on Training Course and Materials for Diploma in Applied Project Management 2007 – 2008

The project managers struggled in creating the implementation plans. While plans were completed they were not accurately reflecting the work that needed to be done and also as milestones were being achieved greater insight into the project objectives was being gathered resulting in significant updates to the plans.

Creating the Mindset of the Project Manager

Together with starting to build a culture of project management the need for developing a mindset for project managers was absolutely key. Plans, status reports and action lists will not on their own make a successful project. Project managers needed to understand the importance of managing and involving stakeholders and have effective communications in place. Use of a power grid as outlined by Peter Taylor (2009, p. 38) was encouraged.

Creating Project Management LITE

Armed with this information the NPMO with the guidance from the Project management Institute of Ireland through its Training Partners OLASIT/Turlon & Associates set about to revise its approach to Project Management. It had to take a lighter approach and focus more on culture, mindset, and process.

The underlying message was that using a project management approach did not have to be a burden in itself. To get the message across we build on the branding name of “LITE”. The use of LITE as a banding name got the message through that the process was changed and much more useable.

The roadmap adopted to build Project Management LITE was:

  • Identification of why projects fail and communicate this message
  • Accept the Organisation Project Management level of maturity and explain it and communicate it. Identify a roadmap for improving the level of maturity
  • Develop a culture with greater focus on stakeholder engagement, communications, and change management
  • Develop a mindset for project managers
  • Train and develop project managers
  • Never stop reviewing and improving.
HSE Project Management LITE Environment

Exhibit 4 – HSE Project Management LITE Environment

Creating a Project Management Culture

In creating Project Management LITE the HSE kept to the forefront the reasons why projects fail and kept communicating this message. Only with an ongoing consistent message can one start to change the culture. There are many reasons why projects fail but using the 80/20 rule the most common reasons can be grouped as follows:

img

(Based on studies by the Standish Group International consisting of 8,380 development programs/projects at 365 U.S. companies.)

In addition, the HSE was very cognisant that “Many business change programmes do not provide the expected benefits: (Source: IMA, Inc; all rights reserved 1997)

(Wallace Simon 1999 - 2007)

70% of companies are unsuccessful in implementing change programmes
70% to 80% of companies do not obtain the expected return on quality improvement investments
75% of cultural change initiatives do not achieve the required change in the organisations culture
50% to 60% of customer service programmes do not result in benefit to the customer
60% to 70% of companies do not realise expected benefits from implementing technology initiatives

The Principles of HSE Project Management LITE

The principles and basic elements were agreed and communicated under the LITE brand name.

  1. Implementing a “liter” process to support the management of projects, with the end goal of building a structured, consistent, and useful process.
  2. The aim is to support Projects and not the process. A “just as much as needed” approach should be applied.
  3. Ensure consistency in the use of project management principles, tools and techniques, terms, etc.
  4. Educating service staff in how to use the process rather than follow the process.

Project LITE: basic elements

  • Agreeing the idea

    – someone needs to give the “go ahead” for an idea

  • Agreeing what the end will look like and what needs to be done

    – the work required needs to be defined so that everyone involved knows what is to be delivered

  • Timeframes

    – the schedule and milestones need to be agreed

  • Governance

    – someone needs to be responsible for approving the plan as well as delivering and managing the project

  • Implementation

    – someone needs to do the work

  • Status

    – there needs to be clarity on how the project’s progress will be tracked

  • Issues and risks

    – the issues and risks emerging during implementation need to be managed

  • Connections

    – where the project is dependent on other work being done, this needs to be identified and managed

Updated Life Cycle

The project life cycle process was refined to incorporate a series of checkpoints (gate reviews) and approvals. At the end of each phase, a Gate Review was to be undertaken. The check lists had to be meaningful and realistic to the project, not just a one-fits-all approach. The NPMO was to work with the project managers to develop and agree the check lists at the start of each phase. At the end of the phase there were to be no surprises on what needed to be achieved for approval to proceed to the next phase. Everyone was to be clear on the milestones and objectives for each phase. This helped greatly with the planning of the project.

HSE Project Management LITE Chart

Exhibit 5 – HSE Project Management LITE Chart

Revised Detailed Planning Process

Following a number of workshops on some of the projects it became apparent that the approach to detailed planning needed to be revised. The projects were service related projects with significant change management elements where the vision was clear but the objectives and deliverables was challenging to define for long periods of time. There were many dependencies from milestones achieved that were impacting the next phase of the project resulting in the plan being revised. An alternative approach as recommended in the PMBOK® Guide had to be considered—“Decomposition may not be possible for a deliverable or subproject that will be accomplished far into the future. The project management team usually waits until the deliverables or subproject is clarified so the details of the WBS can be developed. This technique is sometimes referred to as rolling wave planning” (PMBOK® Guide, 4th Edition, 2008, Chapter 5, p. 120).

In revising the methodology for the Detailed Planning Phase the introduction of Rolling Wave Planning was a welcomed change. The Rolling Wave Planning approach implemented was to have key milestones for every 90 –100 days and to have detail plans developed for these 90 –100 day periods. “Instead map your journey in a series of 100-Day Wins, aligning your deliverables by end date. So every 100 days you’ve finished a number of major milestones” (Deloitte Consulting, 2002, p. 22).

The planning of very large projects is critical for efficient management and control but is challenging. “There are two extremes in the management, organisation, planning and control of such projects with many variations between them—Complete centralisation or Complete decentralisation (Harrison, 1985, p. 236). An appropriate balance to be identified depending on the programme.

Revised Monitoring/Status Reports

The Status Reporting process was reviewed. While there was a strong favour for exception reporting a balance in reporting was recognised as sometimes the focus on exceptions/slippages does not give the full picture.

“Unfortunately experience has shown that reporting by exception must be treated with caution, as often it is the unexpected that causes trouble” (Harrison, 1985, p. 317). Getting an effective status reporting process in place takes time and revision (O‘Connell Fergus, 2001).

Changing the Mindset of Project Managers

Having addressed key areas like the Project Life Cycle process, changing to Rolling Wave Planning and the Status Reporting process the next area to be addressed was the way of working in a project management environment. The most significant change to be achieved was ensuring that the process was being undertaken in an effective way to ensure that the information on the project that was gathered was reliable and robust. To achieve this, the HSE in partnership with their training partners OLASIT/Turlon & Associates built a specific training course that was focused on building what was believed to be the correct mindset of the project manager. This mindset to be one to concentrate on the process of the project as a whole, with high concentration on communication, change management, and stakeholder management. Workshops and facilitated sessions with stakeholders were to become the norm for identifying scope, milestones, and deliverables. This course is accredited by the Project Management Institute of Ireland.

Project managers welcome the training. From a series of training courses the key concerns that project managers identified were:

images  Doing the right thing

images  Lack of knowledge and skills

images  Keeping project invigorated

images  To end project

images  Conflict resolution

images  Knowing what’s expected

images  Risk and patient safety

images  Ability to deliver

images  Maintain credibility

images  Timeframes/timelines.

(Built from workshop feedback on Reconfiguration of Acute Hospital Services, Cork and Kerry, 2010.)

The NPMO took feedback from project managers on what they wanted to achieve from the training, summarised as:

images  Where and how to start

images  Understanding of role

images  Structured approach

images  Time organisation

images  Delegate appropriately

images  Stages in a project

images  Managing people

images  Framework and tools

images  Push and pull

images  Tasks

images  Gaining trust – team /stakeholders.

By taking the approach of listening to the project managers the NPMO found that the Training Programme was of interest to project managers and helped to build their skills. However, it is only with use of the methodologies, building on the recommendations and skills developed as part of the training that the HSE will develop a competent pool of project managers. No training or methodologies can replace the skill sets built from the experience of managing projects.

Conclusion

While progress has been made in identifying the ways of improving project management in the HSE particularly for large-scale service delivery projects its implementation is at an early stage. Significant learning came from the management of the projects in the HSE Transformation Programme.

We can conclude that creating a project management culture in the organisation is fundamental. In conjunction with that an appropriate project manager mindset needs to be developed—one that is focused on stakeholders, change management, and communication as opposed to well presented and completed templates. The process is essential to define and manage the project but it should be based on the concept of “just as much as is needed.” Sometimes, we as project managers, become too focused on the project management aspect itself—turning project management processes into an end in themselves as opposed to supporting the process.

The learning and training identified is being applied in the HSE. A large-scale project for the Reconfiguration of Acute Hospital Services, Cork and Kerry is being used as a primary pilot project. Learning on the implementation and use of Project Management LITE continues with a view to continuous improvement. A Project Management Guide for Acute Hospital & Pre Hospital Emergency Care Services Reconfiguration was agreed on in June 2010 and endorsed by the Department of Health & Children.

The NPMO continues to develop the project management skillsets and mindset within the HSE. The following roadmap is the route for the improvement of project management over time within the HSE.

Roadmap to develop Organisational Project Management Maturity in HSE

Exhibit 6 – Roadmap to develop Organisational Project Management Maturity in HSE

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Standish Group International. (2005) Why IT Projects Fail. Available at http://www.projectperfect.com.au/info_it_projects_fail.php

Taylor, P. (2009). The Lazy Project Manager .Oxford, UK: Infinite Ideas

Wallace, S. (1999 – 2007). The ePM Book. Available at http://www.epmbook.com/buschangeprog.htm

This material has been reproduced with the permission of the copyright owner. Unauthorized reproduction of this material is strictly prohibited. For permission to reproduce this material, please contact PMI or any listed author.

© 2010, Sarah McCormack
Originally published as a part of 2011 PMI Global Congress Proceedings – Dublin, Ireland

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