The National Programme for IT in the NHS Project Scope - Case Study Example

Advanced Project Name Tutor: Course: Date: Table of Contents 1. Table of Contents 2 List of Figures 5 1.NHS PROJECT FEEDBACK REPORT 6 1.1Description Status and Progress 6 1.2 Progress/Feedback Report 6 1.2.1 Time 6 Figure 1: Status of Deployments as at 31st March 2008 8 1.2.2 Cost 8 Figure 2: Project cost report as at 31st March 2008 10 Figure 3: Delay deductions to suppliers 10 1.2.3 Benefits 11 Figure 4: Savings on costs 11 1.2.4. Technical performance 11 1.2.5 Supplier performance 12 Figure 5: Supplier Performance 12 1.3 Change Management 13 1.4 The National Programme for IT in the NHS Project Scope 16 1.4.1 Specific project goals 16 1.4.2 Cost 16 1.4.3 Duration of completion 17 1.4.4 Resources and terms of service 17 1.4.5 Organizational structure 18 1.4.6 Deliverables 18 1.4.7 Risks 19 1.4.8 Tasks 19 2. 0 PROJECT PLAN DOSSIER 19 2.1 Scope statement 19 2.1.1 Project Objectives 19 2.1.2 Deliverables 19 2.1.3 Milestones 20 2.1.4 Programme Specifications 20 2.1.5 Limits and Exclusions 21 2.1.6 Customer Review 21 2.2PROJECT PLAN 21 2.2.1 Project Overview 21 2.2.2 Project Summary 21 2.2.3 Project Management Approach 22 2.2.4 Project scope 22 2.2.5 Milestone list 22 2.2.6 Work Breakdown Structure 23 Figure 6: Lorenzo Bury regional care WBS 23 2.2.8 Schedule Baseline 23 Figure 7: Lorenzo Bury regional care Gantt chart 24 2.2.9 Communication Plan 24 2.3.0 Human resource plan 24 2.3.1 Cost Plan 25 2.3.2 Quality Plan 25 3.0Risk Management Plan 27 3.1 Analysis and Evaluation of Risks 28 3.2 Fair Mode Effects Analysis (FMEA) 29 4.0 Organizational Structure 31 Figure 8: Lorenzo Bury regional care organizational structure 31 References 32 List of Figures Figure 1: Status of Deployments as at 31st March 2008 8 Figure 2: Project cost report as at 31st March 2008 10 Figure 3: Delay deductions to suppliers 10 Figure 4: Savings on costs 11 Figure 5: Supplier Performance 12 Figure 6: Lorenzo Bury regional care WBS 23 Figure 7: Lorenzo Bury regional care Gantt chart 24 Figure 8: Lorenzo Bury regional care organizational structure 31 1. NHS PROJECT FEEDBACK REPORT ID Description Customer Name UK Department of Health, National Health Services Division (NHS) Project Name The National Programme for IT in the NHS Project Sponsor Chief Executive, NHS Connecting for Health Review Period 2006-2008 Review Manager Tim Burr, National Audit office Comptroller Review Team Laura Brackwell, Oliver Lodge, Angela hands, Baljinder Virk, Doug Neal and Scott McMillan 1.1 Description Status and Progress National Programme for IT in the NHS has a responsibility of reforming and improving services and quality of patient care with regard to use of information by the National Health Service (NHS) in England. The system is desired to bring about substantial cultural and organizational change (Archer & Ghasemzadeh, 1999). The program has included another stakeholder as partner, Chief Executives of the ten Strategic Health Authorities. The programe specifically reports on development, service availability, deployment, cost and usage of the components of the programme. First Review: June 2006 Second Review: March 2008 1.2 Progress/Feedback Report 1.2.1 Time Systems implementation to be completed and each patient to have electronic care card by 2010. Key components have not been met and the programme is behind schedule. The details are as provided in the table below; Deliverable Baseline Current Status Remarks/Changes Summary Care Records Deployment by March 2005 Public information campaigns Upload records Implementation in early stages 31st March 2008: Two adopters, Bury Primary Care Trusts and Bolton uploaded patient records to the system Three remaining adopters have not uploaded records but public information campaigns are underway National roll-out of the Summary Care Records to be informed on the remaining 147 Primary Care Trusts upon evaluation of the early adopter programme Detailed Care Records Deployment of Electronic Detailed care record systems to be completed in March 2005 Local NHS responsible for accountability for implementation Local Service Providers (LSP) now supporting the creation of Detailed care records Millennium Product providing required functions in London and the South Lorenzo system taking longer by 6 months to roll-out. In the interim, LSP is implementing and upgrading existing care records system 34% of deployments have been completed Developing and deploying systems is challenging Timescales originally agreed between LSP and NHS are unachievable Deployment in Trusts very slow. SHA and LSP to develop plans for future deployments Final releases of care records software to be deployed from 2009/10 to 2014/15 Other elements of the programme N3 network and Spine releases by March 2007 18,000 sites connected to N3 by January 2007 All Acute Trusts have communication systems for imaging and digital X-rays complete by March 2008 Deployments ahead of schedule All Acute Trusts are within schedule Electronic prescriptions now enabled though paper prescriptions still required Deployments of electronic care records systems as at 31st March 2008 Figure 1: Status of Deployments as at 31st March 2008 Conclusion: It may take four more years to complete deployment of care records systems by NHS Trusts. Lorenzo has to be available for certainty in timing in some places like East, Midlands and North. Other elements of the programme are showing good progress. Lessons: Original timescales proved unachievable. The confidence of the programme was a risk. Unrealistic expectations posted (Morgan & Henrion, 2002). 1.2.2 Cost The programme according to 2004/05 prices has taken £12.7billion. These are local costs incurred and paid as central costs. They were recorded by NHS Connecting for Health. Uncertainty sorrounds the estimation of local costs (Chapman, 1997). Local expenditure collected by annual survey of NHS. Deliverable Baseline Current Status Remarks/Changes Estimates First report estimated £12.4 billion Current estimates at £12.7 billion Purchase of increased functionality No increases on individual elements procured under the original contract There has been an increase of about £678 million which represents 11% of the budget on core contracts Increases in core contracts due to sub-contractor and supplier changes Reduction in cost estimates since the costs are now certain Expenditure Original cost profile £3,428 million Spending on Core contracts £4,390 million All Trusts to take new system at some point Payments made to suppliers where LSP have not received anticipated revenue due to the Department Delay deductions for suppliers missing key milestone dates to be earned later Current spending on the programme stands at £3,550 million Spending on core contracts £1,933 million Payments made to supplier under these arrangments have totalled £36.1 million (£30.3 million-Care record systems in London, East and Midlands; £29.1 million deducted from charges if deployments proceed; £5.8 million for picture archiving and communication system for Midlands, East and North) Deductions of £26.3 million so far made, £9.5million retained by department and suppliers earned back £10.1million. Remainder to be earned back Deployment of care records systems is slow Suppliers paid after prove of delivery and system functionality Some have not been paid for over 12 months the LSP in the south Figure 2: Project cost report as at 31st March 2008 Figure 3: Delay deductions to suppliers Conclusion: Estimates on total costs remains largely unchanged. Purchase of increased functionality has so far increased the costs. Reliable estimates of local costs still difficult. To date, the expenditure is still less than profiled (Krajewski & Ritzman, 2005). Lessons: Program costs still on the path save for some milestones which have slipped away 1.2.3 Benefits First annual benefits statement published by the program was in 2008 for work done in 2006/07. This is information from 20% of the NHS organizations utilizing programme’s systems and deployments. An earned value of £1.1 billion will have been saved in the ten years. Over 90% of the estimated financial savings are attributed to N3 network. There is no baseline over upon which benefits can be assessed but expectations are that the savings will be higher than £1.1billion. Figure 4: Savings on costs Conclusions: Some of the benefits like financial savings are starting to emerge from the program. Identification and measurement of potential and actual benefits are still at a rudimentary stage. Lessons: Project vision should remain intact and feasible 1.2.4. Technical performance Deliverable Baseline Actual Status Remarks/Changes Supplier performance Supplier performance monitored against response times and service availability. This implies the response time of the system when in use and time taken to fix the problems Suppliers incur performance deductions for failure and earned back if rectified Suppliers have achieved their service availability targets of 99.9% Perfomance deductions of £14.2 million incurred (3% of total service charges) Performance deductions £14.2 million(£5.7 retained by department, £1.8 supplier earned back, £6.7 available to be earned back) Technical challenges experienced Staff showed preference to the new system than one being replaced Dissatisfied staff cited some issues were being ignored 1.2.5 Supplier performance Figure 5: Supplier Performance Conclusions: Service availability and performance deductions targets have been met by suppliers especially where there are service failures. In the period following deployment technical challenges were experienced by the Trusts in using new care records system (Kerzner, 2004). 1.3 Change Management Factor Challenge Lessons Leadership and governance Locally driven implementation despite the centralized procurement of the programmes major components Impacts of the program have not yet been felt Difficulty in collating the programs current position on reasonable accuracy, program communications and reporting There was need to strengthen local accountability for the program to be delivered Proper reporting and communication eases volume of data and difficulties associated with piecing up the components of the program Security of Patients records From the indications of early adopters, few patients are taking up the initiative of choosing to or not to have Summary Care Records Unauthorized access of data Inappropriate use of health records Concerns over security of information and public sector data protection (Dorfman, 2007) Security of records maintains the confidence of patients Security is governed by actions of individuals, protections in place and range of controls available NHS Connecting for Health instituted a mechanism to secure processing, storage, and transmission of patient data to eliminate unauthorized access There was need to develop a guarantee on how to handle electronic cards and access to care records limited by pass-codes and Smartcards Individuals also granted access based on role and level of involvement in patient care. Possible legal proceedings, disciplinary measures and audit of access Strategic Health Authorities undertaking a broad review all areas of data security throughout the NHS Local participation Less than 30% of NHS staff could make decisions regarding the new system There is a lot to gain for contributing to the system and IT changes. Steps have been taken to increase engagement among the clinical staff. Expansion of network on advocacy and communication Greater involvement of clinicians and other staff important for project success and in ensuring products fit the purpose. There is need to improve patient safety and patient care Supplier management Complexity and scale of the programme is challenging Resource planning and deployment relies on many decisions made at a local level Confidence with LSP still low and relations still immature Need for adaptability and flexibility to meet changing NHS requirements. Resetting contracts helped to reflect on changing circumstances and realistic schedules. Proper teamwork and cohesion to handle changing and uncertainties arising. Relationship and learning important for all the parties to move on smoothly Conclusions: Challenges will help in taking new lessons and being flexible to changing circumstances. The practice of good leadership, negotiation and partnership with suppliers, teamwork between staff and LSPs and consistent reporting of progress are essential for project success (Nederpelt, 2012). Summary Progress Report To: NHS, Chief Executive From: Comptroller, National Audit office Subject: Summary Progress Report, Date: 03/31/2008 Project Name: The National Programme for IT in the NHS Report Period: 2006-2008 Project Manager: Phone, E-mail: Project Description: IT upgrade to NHS Project Priority: Project Status Notification: ____Green ____Yellow ____Red Key: Red: Behind Schedule Yellow: Within Schedule Green: Ahead of schedule Project Status Summary: ____Red 1.4 The National Programme for IT in the NHS Project Scope The scope of the NHS project is governed by the boundaries with regard to deliverables, project goals, tasks, costs and deadlines. Responsibilities of each team member are established, procedures on completion, verification and approval of work (Thieraus, et al. 2009). 1.4.1 Specific project goals The goals of the program are; Improve quality and services of patient care Increase efficiency of NHS Transmission of accurate and timely information Accurate availability of care records These goals are backed up by activities, inputs, outputs and objectives. The scope of the project will also be defined by people, materials, systems and processes (Roehrig, 2006). 1.4.2 Cost The project was estimated to cost £12.4 billion, with estimation for 2007/08 alone going at £1.4billion. The distribution of costs are as follows; total for core contracts (£6.8 million), Products added to the scope (£666 million), Other central costs (£1.6 billion). Total central costs comes to £9.07 billion) and the local costs are £3.585 billion. These costs should have been completely utilized by December 2015. Costs are allocated to specific categies as; Category Cost (£ millions) Choose and Book 144.5 N3 network 530 Spine 889 South 1104 London 1021 North East 1035 East 930 North West and West Midlands 1042 Retained by Accenture 110 1.4.3 Duration of completion The project takes 12 years (2003-2015). Adjusted from the previous ten years due to delays. The deadlines for deployment of all the Trusts in all the areas in England will be as follows; Category Deadline Choose and Book December 2009 N3 network March 2011 Spine June 2013 South December 2014 London October 2015 North East December 2015 East December 2015 North West and West Midlands December 2015 1.4.4 Resources and terms of service Requires 1,100 staff (clinicians and other staff) and contractors (three local service providers). The qualification of the staff and contractors are specified. The staff should be qualified in clinical medicine with at least two years experience in diagnosis, investigation, treatment, and prescription of different ailments. They should also be knoledgeable on the various types of records.The contractors who include IT designers and administrators should have more than five years experience with work successfully completed in reputable firms (Palmer, 2009). Compensation will be based on agreed terms for the staff as well as the contractors. Labor measurements will be on hourly basis (£/hr). The budget is inclusive of operational and labor costs. The three contractors are; BT, Fujitsu and CSC. The other contractor is iPM working on North, Midlands and East to be soon replaced by a strategic solution, Lorenzo. The contractors are paid upon delivery of service or functional systems, short of which there will be delayed deductions or cancelled payments for poor work delivery. 1.4.5 Organizational structure Chief Executive of the NHS (Senior responsible owner of the programme), NHS programme project manager, Local NHS, Chief executives of 10 Strategic Health Authorities, independent regulators, 152 Primary care trusts, 88 Foundation Trusts, 8,444 GP practices and 152 NHS Trusts. The organization structure is a matrix style commonly used in project management. The project manager is tasked with the role of coordinating and leading the project team (Mulcahy, 2003). He/she also also to link the various units described above. 1.4.6 Deliverables Deliverable Description Summary Care Record Consists of key medical and demographic information. They will be available to all NHS staff treating patients across England. If patients register with HealthSpace Service, they will have their Summary Care Record access online. They will also be able to choose or not to have the Summary Care Record created or attach limits Detailed Care Record Contains complete information on patients treatment and medical history. There will be access to patients GP in Detailed Care Records in both hospital and community settings. For instance, referral for hospital treatment. NHS will have details of all patients treated in the Detailed Care Record. This reflects the fact that doctors have to become legally obliged to maintain the records of the treatment provided. Systems and Services (N3, electronic booking and prescription) N3 network provides connectivity, IT infrastructure, networking services and broadband capacity for present and future needs. Electronic booking service which is Choose and Book alongside electronic prescription service Spine for Patient data storage, interfaces with other systems and security Picture archiving and communication systems for imaging, digital X-rays and NHS e-mail system Note: Deployment of GP systems is out of scope for this programme 1.4.7 Risks Data loss, delay and unauthorized access to medical records. These risks are analyzed on the basis of impact, likelihood and hideability based on Fair Mode Effects Analysis (FMEA) 1.4.8 Tasks Contracting, deployment plans, hiring of project staff and contractors, prototype, documentation, testing, deployment and installation, and feedback. These tasks will be planned and implemented in sequence. For instance, brainstorming meetings will be followed by listing of user requirements and hiring of contractors. The staff and contractors will then embark on designing the prototype, documenting the various outcomes and testing for functionality (Mooz & Cotterman, 2007). The tasks will be assigned to resources such as costs, time, quality and human labor. This will be based on the work breakdown structure to corrrectly assigned resources to activities after a thorough work study. The tasks will be undertaken using a Gantt chart and regular reports will be provided on costs, activities, earned value and technical performance or functionality of the system. 2. 0 PROJECT PLAN DOSSIER 2.1 Scope statement 2.1.1 Project Objectives i) To resolve issues and improve the operational stability of the NHS IT system by 50% within the next two years ii) To implement new functionality with 99.9% performance rate in daily hospital operations iii) To support users by ensuring that the NHS IT system meets 99.9% of the hospital business requirements in daily hospital operations 2.1.2 Deliverables Service management and live issues Disaster Recovery test, infrastructure hardware upgrades, and a data migration purge activity Build, service packs and hot fixes Support for services Transition to Business as Usual (BAU) Deployment verification (DV) Future project priorities 2.1.3 Milestones 1. A number of system upgrades implemented to fix known issues-3rd November 2009 2. Embedding and developing the existing service management processes completed-November 2009 3. Plans in support of a transition to a Business as Usual (BAU) organization completed as of 1st July 20104. 4. 18 clinical documents developed by an NME wide project group completed-December 2010 5. Care Plans allowing individualized care plans finalized- December 2010 6. Deployment verification completed- December 15th, 2009 7. Lorenzo Regional Care Release 1.9 (LRC1.9) transitions to Business as Usual (BAU) - 1st July 2010 2.1.4 Programme Specifications 1. Should employ Health Resource Groups (HRGs) to underpin payments by results 2. System upgrades should be complete before Disaster recovery tests, infrastructure hardware upgrades and data migration purge activity 3. Upgrades should use ‘pseudo zero down time’ technology in readiness for the future use of full ‘zero down time’ technology 4. Management should be through workarounds and detection and/or resolution scripts 5. Support to be delivered to users via the Support for Services initiative 6. Functionality to support Sealing and Sealing & Locking of sensitive patient information in support of the Care Records Guarantee 7. Build to be in the range 622-627, Service Pack 1-3 and Hot fixes 1-20 8. Must meet clinical classification coding and possess Consent to Treat (CTT) functionality 9. Clinical documents to meet specific business needs 2.1.5 Limits and Exclusions 1. The program will be built to the design and specifications of the initial blueprints provided by the NHS 2. Contractors will be responsible for their staff compensation and motivation 3. Workers will not be compensated during system down times 5. Contractor reserves the right to contract out services. 7. Site work arrangements are limited to 10 hours from Monday through Friday, 7.30 A.M. to 5:30 P.M. 2.1.6 Customer Review Mats Lund 2.2 PROJECT PLAN 2.2.1 Project Overview 2.2.2 Project Summary Lorenzo Regional Care Release 1.9 (LRC1.9) implemented in NHS Bury has been live for the last six months. The systems support and embed benefits to Bury users. The programme will specifically help patients in the North, Midlands and East. The cost of the programme is £1,072 billion and is anticipated to end in December 2015 when all the Trusts will have completed deployments to the Patients care records system. The implementation of the programme is complete pending installation and ‘go live’ (PMBOK® Guide, 2005). 2.2.3 Project Management Approach The project manager for NHS Bury Lorenzo, Mats Lund, is in-charge of overall responsibility and authority in implementation and management of the project. The project team consists of quality control, coding, technical writing and testing (ISO/DIS 31000, 2009). The manager utilizes all the resources in project planning. Project and subsidiary plans to be reviewed and approved by the Chief Executive Connecting for Health who makes funding decisions. Delegation of approval authority is done in writing and signed off by the sponsor and project manager. The project team will be a matrix type from clinical department and contractors reporting throughout the project life. Project manager communicates performance and progress of each resource. 2.2.4 Project scope The scope of Lorenzo Regional Care Release 1.9 (LRC1.9) entails planning, design, development, testing and transition of electronic care records system. The budget is £1,972 billion and is expected to end in December 2015. It involves 200 clinical staff and three Trusts. The software has to exceed or meet NHS requirements (Charvat, 2005). The scope includes completion of manuals, documentation and training aids. Go live will be possible through transition of the program to Business as Usual. The scope excludes anu changes of the standard OS for running the software, revisions or updates. 2.2.5 Milestone list A number of system upgrades implemented to fix known issues-3rd November 2009 2. Embedding and developing the existing service management processes completed-November 2009 3. Plans in support of a transition to a Business as Usual (BAU) organization completed as of 1st July 20104. 4. 18 clinical documents developed by an NME wide project group completed-December 2010 5. Care Plans allowing individualized care plans finalized- December 2010 6. Deployment verification completed- December 15th, 2009 7. Lorenzo Regional Care Release 1.9 (LRC1.9) transitions to Business as Usual (BAU) - 1st July 2010 2.2.6 Work Breakdown Structure The Work Breakdown Structure comprises of work packages not exceeding 50 hours of work but at least 5 hours of work (Mathis, 2009). Team members and NHS stakeholders collaborate to develop the work packages. All the work packages listed in the WBS structure below assist in planning, task completion and enabling the deliverables to meet the requirements (Carly, 2004). It will involve 200 clinical staff and three Trusts. Change request will be required for the project if exceeding the project boundary conditions. The conditions are; Cost Performance Index ≤0.8 or ≥1.2 Schedule Performance Index ≤0.8 or ≤1.2 Figure 6: Lorenzo Bury regional care WBS 2.2.8 Schedule Baseline The schedule was derived from the WBS, completed and reviewed by NHS Connecting for Health. The schedule is a Gantt chart as shown below; Figure 7: Lorenzo Bury regional care Gantt chart The schedule isactually set to be complete by December 2015 when all the deliverables and milestones will have been completed. Change management on schedule will be required if the specific activities are delayed. 2.2.9 Communication Plan Communication Type Description Frequency Format Participants Deliverable Owner Weekly Status Report summary of project status via Email Once a week E-mail Program Sponsor, Stakeholders and Team Status Report Program Manager Weekly Project Team Meeting Meeting to review status and action register Once a week In Person Program Team Updated Action Register Program Manager Project Monthly Review (PMR) Present metrics and status to sponsor and team Once a month In Person Project Sponsor, Stakeholders, and Team Metric and Status Presentation Program Manager Project Gate Reviews Kickoff next phase and Present closeout of project phases When required In Person Program Sponsor, Stakeholders and Team Phase kickoff and Phase completion report and Program Manager Technical Design Review Review of any technical designs or work associated with the project When required In Person Project Team Technical Design Package Program Manager 2.3.0 Human resource plan Role Qualification Description Program Manager (1 position) Degree in project management Managing and leading the Lorenzo Regional Care Release 1.9 (LRC1.9) Programmers (10 positions) Advanced Degree in computer science and programming Coding and programming tasks. Ensuring compliance with standards. Create work packages, schedules and reports Quality specialists Degree in quality management Develop quality control and assurance standards. Maintain quality control logs. Compile quality reports and metrics. Provide feedback on functionality and performance Technical writers (15 positions) Degree in computer science Documentation and reporting into NHS formats. Configuration management and revision control Testing specialist (8 positions) Advanced degree in systems management and troubleshooting Establish testing specifications. Coordinate testing resources, and provide feedback on performance evaluations 2.3.1 Cost Plan Cost Amount(£millions) Deployment 572m Service Management 220m System upgrades 250 Total 1,042 2.3.2 Quality Plan Item Acceptable Level Comments Patient care records ≥0.98 accuracy level with ≤0.02 errors in text Using standard TSI English language databases Compatibility No errors linked to running software with compatible applications Using the __XP_____ suite of applications Supporting Documentation ≤0.01 failure rate in beta testing new users to execute software functionality and run setup   Document Project Plan Information Program Manager Tim Burr Date 2nd March 2014 Approve Yes Comments The Plan is fit for implementation 3.0 Risk Management Plan Risk score is established by computing probability, the impact and hide-ability. The product of the three gives the risk score and allows the prioritization process to be undertaken. The values determined range from 50 (very high exposure) to 1(very low exposure). However, the risk exposure ranking may not be able to show specific break points though the risk exposure of less than 20 is commonly seen as a low risk event (Hillson & Webster, 2004). The values in the range of 20 and 39 denotes a moderate risk while exposure values in the range of 40 and 50 are considered as high risk events (Crockford, 2006). The explanations of Low (L), Moderate (M), and High (H) are; High Risk: The risk event is likely to cause huge reputational and financial loses to the NHS programme. This may demand a high priority management and further action to control the risk to acceptable level. NHS will need to conduct in-depth response plans to reduce the risk. Moderate Risk: The risk causes moderate reputational and financial losses. Special action and management attention is needed to control the risk to acceptable level (Gorrod, 2004). The Lorenzo Regional Care Release 1.9 (LRC1.9) will also need to undertake response planning. Low Risk: Little or no potential financial and reputational losses is experienced. Actions within the scope of NHS operations and normal business continuity management need to control the risk to acceptable level (Abrams, 2001). No response plans will be needed but NHS will manage and monitor as they come. The risk score table is as shown below; Impact Probability Negligible (1) Minor (3) Moderate (5) Serious (8) Critical (10) Very likely (5) 5 15 25 40 50 Likely (4) 4 12 20 32 40 50% chance (3) 3 9 15 24 30 Unlikely (2) 2 6 10 16 20 Very unlikely (1) 1 3 5 8 10 The risk falling in the YELLOW and Zone RED zone needs urgent risk response planning such as a risk mitigation strategy and risk contingency plan (Roehrig, 2006). 3.1 Analysis and Evaluation of Risks The table above enables the assessment and evaluation of the level of risk which is further tabulated below. Risk Likelihood(H,M,L) Level of risk (H,M,L) Score Mitigation Responsibility Unauthorized access of data H (5) H (10) 50 Critical Use pass-codes and passwords to protect the identity and records of patients Systems administrator Deployment in Trusts very slow M(3) M(8) 24 Moderate SHA and LSP to develop plans for future deployments Programme Manager Power outages H(4) H(10) 40 Critical Use Backup generators and solar panels Technical officer Concerns over security of information and public sector data protection H(3) M(8) 24 Moderate Individuals also granted access based on role and level of involvement in patient care Clinical administrator Low intranet connectivity H(2) L(3) 6 Minor Operate with superior gadgets on LAN and Ethernet Systems administrator 3.2 Fair Mode Effects Analysis (FMEA) Score Severity Likelihood Hide ability 8 Likely to cause either financial loss to the entire programme, and/or drastic overruns, and/or probably lose future patient attendance (Crockford, 2006) Almost guaranteed to occur 0.80 + probability There is no way this could be picked up 5 Likely to fundamental reduction in earned value on the programme, and./or significant overruns, and/or impact supplier relationships Potential chance of happening 0.55 + probability A considerable chance that this cause or event will be discovered 2 No significant loss of financial loss or lasting dent on supplier relationships, or loss of time The chance of occurrence is minimal +/- 0.10 Probability Almost definite that perhaps this cause or effect will be detected Failure Mode Effects Analysis (FMEA) Risk area Potential Failure Mode Potential Cause Potential Failure Effects SEV Score Likelihood Score Current Controls Hide-ability Risk Priority No. Actions Recommended Delays in uploading care records Extended duration of completion and increased direct costs Late listing of User requirements. Late payment of Local Service Providers It will delay the uploading rate of other Trusts or Miss time on critical path 9 6 Review schedule 5 270 Mats Lund to check Slow deployment Complexity and scale of the programme is challenging Suppliers paid after prove of delivery and system functionality Miss time on critical path 8 7 Review schedule 2 112 Sort issues with dissatisfied staff as some cited some issues were being ignored in the program Delay deductions for suppliers missing key milestone dates to be earned later Difficulty in collating the programs current position on reasonable accuracy, program communications and reporting Design Brief not approved in time Technical problems with the programme plans Miss time on critical path 8 7 Check 8 448 Proper reporting and communication eases volume of data and difficulties associated with piecing up the components of the program 4.0 Organizational Structure The organizational structure of Lorenzo Regional Care Release 1.9 (LRC1.9) is based on the project management structures, matrix structures. High on the hierarchy is the Chief Executive for NHS Connecting for Health who is in charge of the program. The Program manager for Lorenzo Bury program is tasked with delivering and leading the program just like the other adopters like Fujitsu and CSC (Alexander & Sheedy, 2005). The manager offers leadership, direction and motivation to all the project team members by properly allocating time and resources to all the activities. Effective compensation and remuneration of work packages will find employees up to the task. The system administrators are responsible for coding, documentation and securing the system with the help of designers and clinical staff. They are also in-charge of deployment of care records by collaborating with all the Trusts in North, West Midlands and East to upload all the patient records to the system. Deployment verifiers compliment the roles of analysts to ensure that the functionality and speed of the system is effective and convenient to the users and administrators (Galbraith, 2001). Quality analysts also ensure that the program is within the specification and that necessary steps have been taken to correct errors or omissions. The organizational structure is as shown in the figure below; Figure 8: Lorenzo Bury regional care organizational structure The manager coordinates and strengthens local accountability for the program to be delivered. Proper reporting and communication eases volume of data and difficulties associated with piecing up the components of the program (Borodzicz, 2005). Resetting contracts helped to reflect on changing circumstances and realistic schedules. Proper teamwork and cohesion to handle changing and uncertainties arising are needed. He or she will foster relationship and learning which is important for all the parties to move on smoothly. 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