Project management as a tool of policy implementation
Project management has developed in an evolutionary manner from a technical endeavour, with objectives expressed in terms of physical artefacts, to a socio-technical process that can deliver artefacts, organisational change, and/or knowledge. Internationally, there is a growing concern that governments have lost policy capacity, particularly around implementation and delivery. Healthcare policy in all countries is seen as one of the most complex policy areas of government, with systemic problems of underfunding, workload, and difficulty in recruiting and retaining healthcare staff. The proposed research will explore the potential for project management in government policy processes, with specific reference to national healthcare policy, to investigate whether project management can contribute to building government policy capability.
Keywords: policy implementation; organizational change; healthcare sector
Project management has developed in an evolutionary manner from a technical endeavour to a socio-technical process. This frames project management as a complex, socially situated activity that involves organizational, behavioural, and technical changes. The primary focus of project management is on the delivery of project objectives that are usually expressed as physical artefacts and the interrelationship of those artefacts with their organizational and human contexts. But today's projects simultaneously facilitate organisational change and this dual agenda has allowed project management to extend from the traditional industry sectors of construction and engineering to other non-traditional sectors, such as banking and legal processes (Cardon & Egan, 2008). The extension of project management practices into all areas of government and business represents the key challenges to the theory, practise, and application of project management.
Government policy processes represent a particular challenge for project management. Policy processes are not conducted within strict organisational boundaries but involve an extensive range of organisations in the government sector, industry and commercial organisations, and civil society; these include not-for-profit organisations, community groups, academia, trade unions, professional associations, and even individual citizens. Delivery of healthcare in countries range on a continuum from fully privatised, through mixed private public, to fully nationalised systems.
Complexity, uncertainty, and ambiguity characterize policy development because the issues are difficult to define, with many interdependencies, no clear solutions; they often involve changing the behavior of individuals and there may be a lack of knowledge, skills, or expertise about the given situation (Rittel & Webber, 1973). This makes policy implementation difficult, because the risks are hard to define and measure, the stakeholders broad and varied, and the implementation processes and structures are complex. To successfully manage these complex processes involves working across department boundaries and engaging with stakeholders and community groups. Involving such a diverse range of stakeholders adds to the complexity, as each has a different agenda and viewpoint (Head, 2010).
If policy development and implementation is considered a project, classical project management assumes that everything in these policy processes can be controlled (Morris, 2002). This approach does not adequately deal with the complex nature of government policy processes, because project management processes do not adequately acknowledge or incorporate the human, contextual, and emergent elements of such projects and therefore do not equip practitioners to deal adequately with the socio-technical complexities and change (Owen 2010, Young, Owen & Connor 2011). Thus, project management needs to be conceptualised more broadly in order to incorporate a range of outputs with inherent complexity, and rethink the assumptions that underpin project management practices to include emergence, self-organization, and adaptation.
Healthcare in all countries is seen as one of the most complex policy areas of government. In Australia, under our federal system, responsibility for healthcare is split between the federal and state governments, with the federal government responsible for funding and the states for delivery of healthcare. Healthcare policy needs to address systemic problems of underfunding, workload issues, and difficulty in recruiting and retaining healthcare staff (Tiernan, 2006; Forster, 2005), as well as broader issues of governance, resource allocation, and rationalization, integration between primary and acute care and allied health, and the technological infrastructure to support healthcare delivery, such as electronic health records.
Repeated, consistent, and systematic failures in policy implementation have led governments to focus on ways to strengthen their ability to effectively implement policy (Shergold, 2006). We propose to conceptualise policy development and implementation as a project and to extend project management practices to manage such complex projects. We introduce the concept of knowledge-based practices (KBPs) as a way of understanding project practices that are deployed to deal with complexity, and intrinsic and emergent issue KBPs are deployed in conjunction with traditional project practices within the project but play a significant role outside the project boundary as well as integrating these spheres of activities (Owen, 2010; Owen & Linger 2011).
Research Question and Significance
This study explores the potential for project management in government policy processes with specific reference to national healthcare policy. The specific question addressed by this project is: Can project management contribute to building government policy development and implementation capability?
The objective of this project is to broaden the applicability of project management practices to address complex activities that are primarily concerned with social and behavioural changes. The specific aims of this research are to:
- characterize the government policy process as a project;
- formulate project management principles that integrate the social action outcomes of government policy with the tangible outcomes that represent that action; and
- identify project management practices that accommodate the policy process.
The project will be conducted in two phases:
- A bibliometric study covering policy implementation, healthcare policy, and its implementation, and project management as a tool for policy implementation;
- An exploratory case study of a healthcare policy implementation using secondary data sources.
Phase one will establish a conceptual structure to define policy processes and identify how the project management toolset needs to be extended to support that structure (Arnott & Pervan, 2006).
Phase two will use a case study methodology based on publicly available secondary sources. The analysis of the case will be informed by the bibliometric review and the research team's expertise in project management methodology and approaches. This approach will ensure a theoretically and empirically robust case analysis and allow for the construction of further research (Benbasat et al., 1987).
The case study will allow us:
- to compare policy practice with the conceptualisation of that practice derived from the literature;
- provide a rich analysis of the phenomena in a natural setting (Stake, 2005);
- provide insight into how policy processes can be constructed as a project; and,
- identify what tools and techniques are required to manage the policy process.
The rich detailed analysis of this exploratory case study will be the basis for an in-depth study (Benbasat et al., 1987; Eisenhardt, 1989) of heathcare policy as a project.
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