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Management CIMA Clinical

Critically analyze the NHS IT Project ‘Connecting for Health’ (CfH) Success and Failure factors for the Project to date’

Project Management is the integration of all aspects of a project, ensuring that the proper knowledge and resources are available when and where needed, and above all to ensure that the expected outcome is produced in a timely and cost effective manner.

(CIMA: Official Terminology, 2000) It is the discipline of organizing and managing resources in such a way that these resources deliver all the work required to complete a project within defined scope, time, and cost constraints. Project control is the element which is responsible for keeping the project on-track.

From numerous studies by Standish Group for traditional project management methods, only 44% of projects typically finish on time, projects usually complete at 222% of the duration originally planned, 189% of the original budgeted cost, 70% of projects fall short of their planned scope (technical content delivered), and 30% are cancelled before completion.(Web 1)

An ambitious large scale project of £6.2bn was announced by Tony Blair to improve and integrate NHS systems for the betterment of patient care. The project was supposed to be difficult and ambitious considering NHS’ history of managing projects. In the past, NHS had failed to implement successfully much smaller, national technology-based schemes. (Goldratt & Eliyahu, 2005).

The project has been criticized right from the start and it is largely believed that the project was initiated without knowing the full facts and cost implications. Also, the risks associated with the project were underestimated.

Failure factors

Factors where the CfH project falls short of expectations are analyzed below:

Lack of clinical engagement – One of the failure factors of the CfH project is the minimal involvement of clinical staff during the planning and implementation of the project. The project has led and developed solely from IT and technical perspective which does not include inputs from the clinical staff who are the ones going to be affected by the project. The project team might not have a fair understanding of the health Nursing process.

As Paul Goss, director of healthIT research firm Silicon Bridge points out "The planning phase was all about rolling out technology, but the experience of all Nursinges, including the public sector, is that you do not do technology projects without understanding the core Nursing." (cited in Clark; pg 12) Some NHS staff and executives involved in implementing the project have serious misgivings about aspects of the scheme, including its failure to engage local health employees. (Leader, 2006; pg 16).
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Not involving the end users may also lead to a lack of willingness on the part of GPs, doctors, nurses and NHS staff to use the end systems. Also this is a change initiative and doctors and nurses should be made to adapt to the change by their involvement in the change process. Thrusting the change might lead to a feeling of loss of autonomy and possibly a lack or loss of functionality.

Project Delays – The NHS Project has also been delayed because it is largely believed that the project timescale was largely underestimated and the complexity of the project wasn’t gauged properly. The project was originally to be undertaken in two years and nine months, beginning in April 2003. It has since become a 10-year programme (Computer Weekly, 2005). It is also believed that one of the main reasons of this delay is, because of the optimistic and artificially short deadline for implementation presented in front of the government to get the project financed.

Project over-budget – The initial cost of the project was forecasted to be £6.2bn but because of the project getting delayed, there is huge cost implications associated with it.

Communication issues –Minimal involvement of clinical staff has also led to a lack of communication. Listening to external project stakeholders and users is a key element of project management. Communication in the NHS Project has been reduced to a one-way traffic from NPfIT (NHS connecting for health IT Project) headquarters to trusts, and this alone is unlikely to win co-operation. (Computer Weekly, 2006; pg 16)

Supplier issues – The project has also been criticized for being excessively harsh to suppliers. There is no advance payment to suppliers unless suppliers put up a good case that delays are not entirely their fault. Suppliers were not valued and there has been speculations in the market that some suppliers might scale back work on the programme or withdraw completely if losses and their financial risks on contracts with the NHS continued to increase.

This does not help with cash flow either. As Geoff Reiss, chairman of the programme management special interest group of the Association for Project Management and the British Computer Society, said, "If you keep bashing suppliers on the head, they will fall unconscious and you will lose them. Eg. Accenture, which supplies patient record and other systems to trusts and GPs, was the first of the programme's local service providers to report losses due to delays on the NHS contracts.

By the end of this fiscal year Accenture expected to have on its balance sheets services and other assets attributable to the NHS worth up to £244m for which it has not issued invoices. (Robin, 2005; pg 8)

Structural Concerns - Collins (2005; pg 4) points out that the lack of clarity from the NPfIT about future developments coupled with poor communication between NPfIT headquarters, the local service provider and trust managers, is a major concern for the effective completion of the project. The scheme has also been hit by interfacing and other technical difficulties which have led to delays in implementation.

Unrealistic Expectations - It has been repeatedly eluded in the text that the CfH project has suffered because of unrealistic calculations and expectation from the project in terms of cost, schedule, timescale and usability. (Wysocki and McGary, 2005) highlights that there was no category for calculating one of the greatest risks to the project, that doctors and nurses would not accept the new system. Also, the specific risks and complexities of the IT programme were evaluated on a points system which bore little relation to the magnitude of the scheme.

Other factors – Resource constraints have limited the scale of the project and early engagement efforts a few times. The project at times has shown lack of clarity and direction in terms of delivery and deliverables.

Success factors

In spite of all the failures, the CfH project has been successful in some areas. Report produced by National Audit Office looking into the programme's origins, the support it has in Westminster and Whitehall, its procurement processes and preparations being made to roll out the core Connecting for Health systems across the NHS has come out with positive findings about the project. The success factors include

Tight control exhibited over NHS Contractors – Efficient management of contracts has resulted in successfully placing contracts very quickly, after securing large reductions in prices from bidders and contract terms.

Robust infrastructure – The management systems and structures adequately match the scale and complexity of the challenge

Strong leadership and sufficient backing – Even though the project has been in the eye of storm right from inception, it has enjoyed strong ministerial and senior management support and been ably by strong leadership.

Integration – The project has been successful in integrating and delivering the new hospital systems which has allowed GPs to make online bookings.

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Security – The project has maintained high security standards for access to patient information and there hasn’t been any significant security breach.

Conclusions

The main reason for the failure of the CfH project has been the approach towards the project. The project, rather than being treated as a change management initiative has been treated as a core IT project. There has been more focus on the technical side of things rather than the human aspect of the project. The project has to overcome the inherent weaknesses and engage wherever possible with the frontline staff that will be using the new systems to deliver better patient care.

Rather than imposing the system on central and regional organizations, NHS has to involve the users in the project and listen to their needs. It has to ensure that the changing needs of the suppliers and the project are met. In spite of its failure on several fronts, the project cannot definitively be classed as a failure, especially, considering its complexity and magnanimity.

More than 90% of the major projects fail on one parameter or the other but still end up giving desirable deliverables. If NHS improves the way it has been approaching the project and learns its lessons from the project so far, the project might end up being a success. Some of the problems affecting the success are not within the power and scope of NHS and Project designers to solve, anyway.

References

Collins, T (2005), NHS staff reveal serious concerns over IT plan., Computer Weekly, , p4-4

Collins, T (2005), Did Blair approve NHS scheme without knowing the full risks?, Computer Weekly, p1-4

Collins, T (2006), NHS IT.,Computer Weekly, p10-10,

Computer Weekly (2005), Dose of realism for NHS IT plan. Computer Weekly, p16-16

Goldratt, Eliyahu M. (2005) : Critical Chain, North River Press, Great Barrington, MA.

Lindsay , C (2005), Successes, delays and cost fears for NHS plan.,. Computer Weekly, p12-12

Lindsay., C (2006), How will IT be paid for? ask doctors., p16-16, 3/4p

Lindsay, C (2006), Connecting for Health maintains hard line on suppliers by only paying on successful delivery: Payment delays highlight major slippage in NHS IT programme. Computer Weekly, p31-31

Maylor, H. (2003) Project Management Harlow: Financial Times/Prentice Hall

Rae, D, (2006), Diagnosis: Healthy It For NHS. Financial Director, Jul/Aug2006, p49-49

Robin, G (2005), What the doctor ordered.,Computer Weekly, p28-28

Wysocki, R. and McGary, R. (2005) Effective Project Management: Traditional, Adaptive, Extreme Indianapolis, John Wiley & Sons

Websites

(Web 1) The Standish Group Report (online) (cited 9 December) Available from <URL://http://www.ise.canberra.edu.au/un6348/iso-2-06/lecture%20notes/chaos_report.pdf>

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