NHS Computer System - Research Paper Example

?Project Management: A Case Study of the NHS Computer System Project management has become one of the most populartools used by both public and private sector. The reason behind this is that it allows an organisation to deliver projects on time, within budget, and in the best quality (Wysocki & McGary 2003). But even as this is a positive thing, projects undergo a constant change because of its dynamic processes and the inability of the project team to predict all factors that can lead to deviation. Moreover, changes in customer requirements and poor planning as well as unexpected “surprises” are some things that also make projects complicated (White 2006). Therefore, most projects even the most sophisticated ones become hard to manage, and some go to a halt (Foti 2004). This paper seeks to explain the reasons behind the complexity of project management by analysing the case study of the UK’s NHS computer system, a ?12 billion centralised records system for over 50 million across the UK that has taken many years to develop than planned, and have exceeded an original cost of ?6.2 billion. This paper has five sections with the first being the background of project management and of the NHS computer system. Secondly is the analysis of current operational position of the NHS project the health sector. The third section will explain the available options to ensure success of the project, and the fourth section is a project plan that can be used to ensure that the project gets back on track without further costs and time. The fifth section will give conclusive remarks about the whole paper. The paper will also have a reference section. Background Project management Carly (2004) has defined project management in terms of the project activities and goals, i.e. the process of the application of various skills, techniques and tools, along with the application constitutes what can be termed as project management. It involves an interrelated group of processes that enables a team to achieve success in a project. Payne et. al. explains it as a structured process for managing project change in a careful manner. It is used by organisation to produce specific products and services with a given level of resources while keeping time, as this will enable it to achieve planned outcomes and benefits (2011). Project management is further explained in five processes including initiation, planning, execution, controlling and closure. Moreover, it involves other knowledge areas such as time, scope, expenditure, risks involved, quality, commucation, procurement and even, integration at times (Milosevic 2003). The activities managed by the project team include identifying requirements, managing the expectations of stakeholders, and competing for time, scope, risk, cost, and quality. Projects are always marred by deviations from the scope, objectives and execution, and this has pushed project managers to link and harmonise change management, project control and risk management. This is because risks usually arise from inefficiency in management and inadequate documentation of changes (Heldman & Heldman 2007). Frame (2003) explains the importance of readiness by the project team to deal with changes and that it is risky to ignore a project’s environmental impacts and adequate information in the planning stage. According to Kerzner (2006), change and risk management is important as it reduces the number and level of surprises. He further he explains that risks and changes are “hand in hand” as risks are usually created by changes. NHS computer system NHS computer system was created under the functioning of UK Department of Health, and the system was produced to deliver the NHS National Programme which falls under IT (NPfIT). NPfIT was, however, initiated by the Department of Health of England which was given the task of shifting England`s National Health Service (NHS) to an integrated, electronic care record which can be centrally managed for patients, also which has the capacity connect over 30,000 medical practitioners to 300 hospitals. This NHS was to offer a secure, along with an audited way to access these health records which were then to be authorized by qualified health professionals. Also, these patients were to have access to all their online records via specific HealthSpace service, at some point NPfIT was said to be one of the world’s biggest civil information programme by the NHS. The NPfIT was established in October 2002 and on 1st April 2005 NHS Connecting for Health (CfH) was formed to execute the programme. CfH has its offices in Leeds, West Yorkshire (Revill 2006). The computer programme is known to have a broad range of patients’ data for example, age, gender, type of illness and even the latest contact with the NHS. This was seen as a way of knowing which patients needed more attention and once recognized, the NHS care teams can help them to maintain and improve their health which eventually prevents their frequent hospital visit. This programme helps NHS deliver care to people with long-term conditions (Beynon-Davies 1994). Problems of NHS system The NHS programme has been recently come under criticism especially with Department of Health refusing to give solid information about its progress to external observers. This has even led to academics in computer related fields to write a letter to the Health Select Committee raising concern about the programme. The government has also been under fire for its apparent reluctance to evaluate and audit the programme, and in case the development of the policy getss failed, i.e. the ICT policy proposed tends to cost less and benefit more, much evidence regarding technology is lacking. (Connecting for Health fails to lead on contact nd.). In 2009, the Public Accounts Committee reported that, the risks to the deployment system are getting higher and further termed in as being “as serious as ever,” whereby they further continued to say that the base of the project is now almost “way off the pace”, at this point further indicating the the revision date which has already been extended i.e. the completion due date of 2014-2015 is still in doubt especially in the aftermath of the Fujistu`s contract being terminated, which had to cover the South. Moreover, it was concluded that there is already delay in essential systems, thus even if an effort to deploy the system is made, the clinical staff has high expectations which will not be possible to comply with. Furthermore, considering the current cost of the program, along with the managerial issues going on and also with the four IT providers being sacked, there has been an increase in the criticism going on about the project. The Public Accounts Committee, has thus expressed its concerns with the scope, budgeting, planning, also the practical implications of the project once it`s deployed. (Brennan 2005). A summary of the recent developments Fujitsu, which is a local service provider, indicated via an issued statement that a few parts of NHS weren`t quite satisfied with the standard solutions put forth, and thus in this context it would be more appropriate to utilize flexible and innovative approaches in the light of the local requirements. This may be interpreted as an indication to change the cruel standards of the NPfIT. Secondly, the ministers along with the senior officials also seem to have changed the plans to convert the NHS Health system to the arm’s-length agency. Moroever, the report constituting the progress and the challenges posed to the project will also no longer be published. Thirdly, indicators so far indicate that the budgets allocated for the plan termed NPfIT Local Ownership Programme, being a further devolution of NPfIT to NHS, for which the trusts are being downsized. Lastly, Richard Granger`s loss, who was NHS IT Director means that new appointment will have to take place at the Health Department. As a consequence, there will be diffusion in the leadership concerning the (Worlwide Computer Products News nd.). NHS computer system contribution or impacts to the health sector The NHS record system has been characterized by irregularities that hospitals are bearing. Many hospitals have been struggling to keep track of people requiring operations, people needing urgent consultation for example, prospective cancer sufferers, and patients suspected to suffer from MRSA. The hitches of the Connecting for health system have further brought delays to the accident as well as emergency departments, alongside a high rate concerning complaints, and also the failure to recognize the child abuse victims. Also, the revelations on part of the Enfield Primary Care indicates that the system also lacks the vital data needed for patients awaiting operations. This caused a delay in the number of operations. i.e. of about 63 patients being operated, that of Barnet and Chase Farm Hospitals NHS trust. Furthermore, it was found out by the trust later, that the system also failed in the identification of the possible victims to be identified for child abuse, after which the receptionist was given the entire responsibility. (Doward 2008). The aforementioned trust also managed to record the last-minute cancellations of about 272 elective operations scheduled, which was termed for rather non-clinical reasons. Also, due to the failure in the tracking system to work on the new system, about 20 patients were not been able to be re-admitted for within about 28 days. Adding insult to injury, the record of the trust`s board also quote the minutes which indicates an increase of about 5,500 in 2006 to 14,000 in 2007 which has been increasing ever since. These problems also seem to have posed questions to system’s introduction to about hundreds of other hospitals and trusts. Nevertheless, these revelations are setbacks that the government can use as a way of improving NHS services (Doward 2008). Options to ensure the success of the project NHS has been dealing with the lower odds of accomplishment prompting the project team to have understood the project management initiative which tend to optimize the likelihood of success. Mentioned below are a few of the options which may be considered by the team to re-ensure that the project can be applicable and in the shape to be implemented again: The objectives along with the scope of this system need a clarification once again. Since there seems to be a major divergence in terms of quality and cost, deliverables and scope, the potential participants should be defined beforehand. If, in any case, the stakeholders do fail to concur to the basic parameters of the project, this may lead to a rapid wastage of time and effort, and in the worst case scenario, the failure of the project. NHS constitutes a steering committee that doesn`t persuade the personal accountability amongst the project participants. This calls for the use of a single executive sponsor who is in charge for the accomplishment of the overall objectives of the project implementation. The sponsor, in this case, will rather be assigned the task of constantly evaluating the progress and dealing with the resolution of issues which may stop the progress. However, the sponsor can be supported by a commission which offers the oversight and also, serve as a medium for communication also the resolution of issues. According to Javitt (2004), apart from the sponsor, a permanent project manager must be allotted to the task of overseeing the daily project operations, and consequently be in a fine position to track and then report progress further to the project sponsor. A committed group of staff resources need to be put in place and the project manager should also obtain the formal along with the written commitments via the department managers which will contribute toward the allocation of the time for staff. Such commitments ought to also be permitted by executives, thus giving the due authority to the project manager to further demand commitment. Commitment via vendors and the suppliers must also be obtained. The NHS project further needs to be divided into convenient segments to trim down the chances of complexity. This way, any such project may be simplified once divided into segments and then turning over an individual or a group of people to complete the task within the set time frame. Moreover, it must be ensured that a clear performance measure is established and thus, a regular progress report is maintained. Reason being, that the NPfIT did not furnish feedback on the system’s advancement even after being ordered by Public Accountant Committee. This helps to access the project performance along with the measures which must be monitored on a reular basis. Performance ought to be tracked by the group members at commission level, and the reports generated must be combined also summarized to be presented to the immediate supervisor, who then has to submit it to the project manager. Later, the project manager prepares a performance’s overview to the project sponsor. He should then assess and further report it honestly to the sponsor. Divergence from the genuine performance must be discussed with the sponsor and also the team, which will ensure individual and team responsibility and consequently help in developing a possibility plan to accurate the deviations. NHS needs to also take decisive and corrective action as soon as possible rather than later. Deviations should be rapidly recognized and then eliminated, and in case they may be insurmountable, there should be immediate negotiations on modifications to the project’s finances and schedules. Since changes are inevitable, NHS should come up with a formal alteration and control mechanisms. These alterations must be acknowledged and then integrated into the development plan to ensure transparency on when and why the change was made. Documentation of changes allows the organization to avoid confusion and working at cross purpose by the project team. The changes that are beyond predetermined thresholds for example the raising of the original ?6.2 billion cost to the current ?12 billion and the delay of the project completion should seek approval from the committee and then formalized via writing. IT projects engage many significant risks along with contentious issues with the intention that the team may move forward, and should be proactively managed. The NHS has not been an exception especially with the involvement of the government making the risks political in nature and the MPs are resistant to change and reluctance to adhere to those facts of the project. In this case, the project manager ought to handle the problems which arise in a formal yet a rackable way including the advancement processes. in addition, every team members must be sensitized on the risks involved with monitoring and evaluation. NHS lacked a good communication program that avails information of the system and its progress, and therefore a communication program that promotes system’s acceptance is to be developed. An ongoing communication among project stakeholders and end-users should be promoted using multiple channels for example emails, departmental meetings, newsletters, memos, and focus groups. Communications with stakeholders on their hopes are supposed to be made before time with precision and steadiness and all the communications should be audience-appropriate. There was too much dependence on IT consultants and suppliers who seem to have modest familiarity with UK’s healthcare as well as the NHS. There should be a shift to use of IT firms that comprehend these issues well since not only will the government cut on cost, but the time of completion will also be shorter. Finally, the project should have elevated visibility throughout its life cycle and each milestone be celebrated. Acknowledging success and must be indicative of project progress overtly is an effectual way to endorse team steadiness and the standards that are vital to high quality performance. Project plan Haughey (2012) explains that creating a project plan is the first step when undertaking any kind of since it is the key to the success of the project. This is usually ignored and people just keep on working and thus, fall short in realizing that scheduling helps in saving a lot of time, funds and many other unexpected problems. In addition, people complicate the processes that need to be followed and yet the team needs to clearly understand what is expected of them. The following is a simple and sound project plan that can be used to ensure the success of NHS computer system. Figure 1: Project planning map Step 1 – Set out project goals The success of a project lies in meeting the stakeholders’ needs. Stakeholders are people who are directly or indirectly affected by the project. Identifying the stakeholders in the project is crucial although it is not easy doing it especially those indirectly affected. These stakeholders also may include the project manager, the project sponsor, also the entire project team, and more importantly the end-users of this project. Once the stakeholders are identified, the next step is acknowledging their needs, and this is done by taking the stakeholders through interviews. These interviews allow the project manager to recognize the true needs that maximize on the benefits. After the interviews, the extensive inventory of requirements is prioritized and from this list, a set of objectives may be measured. Through this procedure, it is simple for the administrator to identify when a goal is accomplished. The recognized set of goals is subsequently recorded in the plan whilst keeping in mind the requirements and the expectations of the stakeholders. This step is usually the most difficult and that is why most people skip it. Step – Project deliverables This very step deals with generating an inventory of equipment the project needs to carry, by means of the goals positioned out in step one. This step also involves identification of how and when every item must be delivered, plus totaling the deliverables to the plan with an expected delivery date. Step 3 – Project schedule This step is for creating a list of errands with the intention of the need to be carried out for every deliverable recognized in step 2. The quantity of time necessary to complete the task and then the team is recognized in each task. Input all the resources that are essential for completion of a task. A major issue at this phase is when the project is in the position of determining delivery time limit from the sponsor which is not even realistic with the team’s estimate therefore the sponsor has to be contacted immediately. Options that are used in this situation include renegotiating the deadline, employing additional resources, and reducing the project’s scope for example, introducing the NHS to a few hospitals as a test before using it in other hospitals. Step 4 – Supporting plans This step deals with plans that are created alongside the planning process. These plans include; human resource plans which involves identifying the individuals and organisation by name with a leading role in the project. The roles and responsibilities of these groups are described together with the number and type of people needed. Lastly, start dates and estimated time frame should be availed to each individual. Communication plan is another supportive plan that involves creating a document showing how information is passed to the various stakeholders. The popular mechanism is a progress report, generated on a monthly or a weekly basis, which may describe the performance of the overall project, achievements currently and the work planned for the next period. The last is the risk management plan which is crucial although always overlooked. It is important that the project team identifies many risks as much as possible as this allows them prepare for the unexpected. Some of the risks that are common to projects include optimism in terms of estimates regarding the cost and the time, which may also be too slow client review and response cycle, unexpected finances cuts, and unclear roles and in some cases even the responsibilites. Others include poor understanding of stakeholders’ needs, change or additional requirements by stakeholders after the project has commenced, poor communication channels which result to misunderstandings, quality problems and repeat of work, and lack of stakeholders commitment. Each risk is written down to be referred to when such a problem recur next time. The risks are also reviewed to make sure they do not happen again, as risks do not go away easily. The above project plan has to be followed to the latter and be reviewed as the project progresses. Project management lifecycle Phase 1 – Conceptual phase Phase 2 – Planning Phase Phase 3 – Testing and implementation Closure Figure 2: Project lifecycle The conceptual phase which is also called a start-up phase involves evaluation of an idea. It is also a stage where project needs and requirements are defined including risk analysis and its impact on cost, time, requirements, and other resources. The planning stage is characterised by development of the proposed ideas in the previous phase. An organisation identifies resources and establishes realistic time and cost, description of activities, and performance parameters. The third phase involves the testing of the system to check its workability and whether it is reliable then it is documented. Thereafter, there is execution of the project. End of phase 3, which is closure, involves reallocation of resources and formal acceptance by the client. This is also a phase where new products must be established or the existing ones are improved (Nof-digitise Technical Advisory Service n.d.) Conclusion Project management in the IT industry is a rather complex system that evolves over time with the changing technology. Most of large IT systems for example the worldwide VISA payment system has been achieved through a complete control of its complexity, reduction of dependence level placed on them, and through the use of high-levels of reliable hardware and software (Kerzner 2006). The NHS is with no doubt has many good working systems that benefits the health sector, but its cost and unreliability has raised a lot of high brows from the UK residents and members of the Public Accountant Committee. There are many researches that show that the project may be leading to obscurity. There are high risks that can cost the citizens and government a lot of money. This has pushed stakeholders to come up with other options that can bring the project to a success rather than just abandon it. The steering committee has to carry out a technical review in a professional way as they have been shady all along. If this project is not done differently and using different pathway therefore the UK is in for what can be called a world’s largest computer system downfall. References Beynon-Davies, P 1994, Information management in the British National Health Service, Int. J. Information Management, vol.14, pp. 84-94 Brennan, S 2005, The NHS IT Project, Radcliffe Publishing Ltd. 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Javitt, J, C 2004, How to succeed in health information technology, Health Affairs, pp. 321-324 Kerzner, H 2006, Project management best practices: achieving global excellence, John Wiley & Sons, Hoboken. Nof-digitise Technical Advisory Service n.d., Programme Manual: Section 1, Project Management, New Opportunities Fund Partner, viewed 7th January 2013, http://www.ukoln.ac.uk/nof/support/manual/project-management/ Payne et al. 2011, BMC Public Health, vol.1, no. 424 http://www.biomedcentral.com/1471-2458/11/424 Revill, Jo 2006, Health service IT boss failed computer studies, The Observer, viewed 5th January, 2013, http://www.guardian.co.uk/society/2006/nov/12/epublic.technology. White, A, S 2006, External disturbance control for soft ware project management, International Journal of Project Management, vol. 24, no. 2, pp.127-135. Wysocki, R, K, & McGary, R 2003, Effective project management: traditional, adaptive, and extreme, 3rd edn, Wiley Publishing, Indianapolis. Milosevic, D, Z 2003, Project management toolbox: tools and techniques for the practicing project manager, John Wiley & Sons, Hoboken. Worldwide Computer Products News n.d., New computer system for NHS to improve patient care Normans Media Ltd, Coventry, United Kingdom, http://search.proquest.com/docview/224510415?accountid=45049 Read More