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Project Management Guide

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This six-stage service improvement guide provides a framework for service improvement within the NHS. We suggest you read through the whole project guide before you undertake any actions relating to the stages. This will help you get an overall picture of what all the stages involve.It is important to realise that this guide is a suggested framework. Each project is different and you may find that you do things slightly different for different projects.

Section A provides an outline of the stages and section B covers them in more detail.

Section A. Outline of the six stages:

  1. Start out
  2. Define and scope
  3. Measure and understand
  4. Design and plan
  5. Pilot and implement
  6. Sustain and share

One important fact to consider is that there are certain critical elements for success which should be continually considered throughout the life of the project. These are:

  1. Stakeholder engagament and involvement
  2. Sustainability
  3. Measurement
  4. Risk and issues management
  5. Project documentation and gateway criteria

Section B. Detail of the six stages

STAGE 1: START OUT

Aim of this stage: To establish a rationale for any improvement work and obtain support for this work from an appropriate sponsor

KEY steps Relevant tools
1.1 Establish the service that is to be improved or the particular area that is to be addressed. This may be identified by an individual, a team member, manager or from organisational strategy that has been informed by patient requirements.
1.2 Identify a small number of key individuals, bothatasenior and operational level, whom it would be worthwhile sounding out regarding this area offocus. If you are unsure who these individuals are,you can use stakeholder analysis to help youidentify them. This will help begin to establish the merits of focusing on this area and identify any important considerations there may be. These individuals may form part of your project structure in future stages such as the project team and project board.
1.3 Gather ideas from staff and patients on how this particular service may be improved. Establish which ideas to take forward. A number of creativity tools are available both to generate ideas and also to help narrow down the ones to take forward. These techniques are excellent for all stages of a project. They can help develop solutions to issues that may arise or to generate new ideas to achieve a desired aim.
1.4 It may be worth testing whether the current idea could be improved or stretched further, to make aneven bigger difference
1.5 To help get support for your improvement project itis beneficial to make clear how the aims of the improvement work are aligned to the overall organisational aims. The potential short-term and long-term benefits should be articulated.
1.6 To give focus for the improvement you should set measurable targets for the aims that you want to achieve.
1.7 The next step is to capture the information from the previous steps into a simple document. This can help gain support from an appropriate sponsorand initiate the project to start to use resources.

Depending on the complexity of the project, this document can take different forms. For example, you may use a project charter. More technical andcomplex projects may use a project initiation document.

For this guide we will use the project charter as the example that we follow. It is recommended that the project charter holds all of the key information on a single A3/A4 sheet.

At this stage you may only be able to complete certain elements of the project charter, such as overall aims. You may decide to have a go at completing some other sections, but these will need to be refined in future stages as it becomes clearer what the project will actually entail.
1.8 Obtain agreement from the project sponsor that the project can move to the next stage.

In future stages a more formal gateway process will be implemented.

STAGE 2: DEFINE AND SCOPE

Aim of this stage: To ensure the project starts in the right areas and to develop a project structure to provide a solid foundation

KEY steps Relevant tools
2.1 Undertake root cause analysis to help identify the underlying issues that are creating the current situation that is to be improved.

To achieve this, map the current situation and use appropriate diagnostic tools to determine what the root causes of the situation are. You will need to involve the stakeholders who provide and use the services that are being improved.
2.2 Gathering patient experiences via feedback, complaints, PALS issues, serious incidents and patient and staff satisfaction surveys are all excellent sources to help identify underlying causes.
2.3 Once the true underlying issues have been defined, you can establish more detailed objectives that need to be achieved. This can help determine what is in scope and ensure that the project focuses on what have been deemed the most important things to tackle. All other issues are out of scope.

In the work area you may display visually on boards the aims and objectives of the project that have now been determined. This can help engage everyone with what the improvement project is trying to achieve.
2.4 Identify key individuals who are critical to achievingthe aims and objectives defined. This can help obtain the required buy-in for project success. Again stakeholder analysis can again help determine who these key individuals are.

Obtain agreement from a small number of these key individuals to act as a project board for the progress of the work. This board should include the project sponsor and the project manager.

Stakeholder analysis has the added benefit of displaying those individuals who will need to have a level of communication regarding the proposed change and at what detail. If there are many people to communicate with, you need to develop a simple plan of how and when you will update them.
2.5 At this stage you may want to consider the stakeholders who may challenge the change you propose.

It is important to remember that often a challenge to change can be positive. You should be considerate of potential reactions to the change that the improvement work may lead to. Use tools and techniques to help reduce the risk of thisimpacting negatively on the project.
2.6 For small and simple projects you may simply pulltogether individuals with the skills you require and decide among yourselves progression through the stages.

For larger projects, you may need a more extensive project structure. This would include an identified project team who are going to do the work. The structure would also include a separate project board who would sign off progression from stage to stage. Membership of this board should be small in number and include the project sponsor.
2.7 Establish a way of identifying all the issues and potential stumbling blocks (risks) that may occur. Develop risk and issue logs to record these. Brainstorming is excellent for identifying potential risks.

A lessons learned log should also be created. The logs should be updated throughout the life of the project.

The NHS Institute Sustainability Model and Guide is excellent for establishing the areas that need to be strengthened and how in order for a project to be successfully sustained.
2.8 Update the project charter throughout the stage with the new and updated information.

Only key issues and risks should be reflected in the single A3/A4 sheet that you are using for the project charter. The information in the logs is mainly for members of the project team who require greater detail.
2.9 It is important at the end of this stage that gateway criteria are established for the remaining stages. The gateway criteria will help to ensure that project only moves to each stage if certain criteria are met. This avoids projects carrying on unnecessarily and wasting resources. Ensure the criteria for this stage are actually met as well.

STAGE 3: MEASURE AND UNDERSTAND

Aim of this stage: To measure the current situation and understand the level of change required in these measures to achieve the defined aims and objectives

KEY steps Relevant tools
3.1 Having established the aims and objectives of the project and the underlying issues that need to be addressed, it is important that baseline measures are established for these. Using these measures as indicators is the only way of tracking whether the project is making progress. With an indication of where you are currently and where you need to get to, you can understand anddetermine how far the baseline measures need tomove to achieve the desired aims and objectives.
3.2 If the project is large and complex and there are many measures to consider, you may focus on those that will have the biggest impact. Using the Pareto principle is an effective way of prioritising your areas for improvement.
3.3 Use tools and techniques such as Statistical Process Control to analyse the data that you have collected for the indicators defined.

It is important that measurements for these indicators are recorded and analysed throughout the project and beyond to ensure that changes being implemented are having a positive effect.
3.4 Update risk log, issues log, lessons learned log, project charter etc. throughout the stage with the new and updated information.

Only the key measures should be reflected in the single A3/A4 sheet that you are using for the project charter. The other measures are recorded for the project team to use in their analysis.
3.5 With the help of the project board, confirm that the gateway criteria for this stage have been met toallow project to move forward to next stage.

STAGE 4: DESIGN AND PLAN

Aim of this stage: To design and plan the activities required to achieve the objectives that have been established

KEY steps Relevant tools
4.1 Having established start and end points of the project, it is a good idea to break this down into tasks that are clearly identifiable.

The use of creative thinking at this stage may help to discover innovative ways of delivering these tasks and making the design or redesign improvements that are required.

For each task, produce a list of all the activities required to deliver it. This is often called an action list.
4.2 It may be helpful to convert this into a format that all participants can easily see. This should clearly state key milestones for the project. This may bedone in a Word document. Or if you require, theplan can be captured in an electronic format - for example, in project management software. Using software like this may make the plan appear complicated so make sure you have a simple visual version for those who do not need to seethe detail. You may be able to fit a copy of this simple version in the single sheet project charter.

Share this scheduled plan with the individuals involved in the project on a regular basis to ensurethe project stays on track.
4.3 Update risk log, issues log, lessons learned log, project charter etc. throughout the stage with the new and updated information.
4.4 With the help of your project board, confirm that the gateway criteria for this stage have been met to allow project to move forward to next stage.

STAGE 5: PILOT AND IMPLEMENT

Aim of this stage: To test out proposed changes via pilots before the changes are fully implemented

KEY steps Relevant tools
5.1 You may want to test the robustness of the changes you propose by opening them to challenge by relevant stakeholders before they are implemented. This can help to decrease the likelihood of issues occurring when you move into implementation.

It is useful to build a rapport and trust with those affected by the change to help the implementation go smoothly.
5.2 Once you implement the early steps, make sure you test them to ensure they are doing what they should do. This process can be done in continuous cycles (PDSA – plan, do, study, act) until the whole change is implemented. Doing the implementation in the form of pilots can help this approach.
5.3 When moving into the stage of full implementation,ensure all testing has been successfully carried out. Record any observed issues in the issues log. If results are positive, the project can continue in the same way. If results are not positive, however, consult the project boardor sponsor about potential corrective action. This is an iterative process that should continue until full implementation has been achieved.

An example of some popular areas that are tackledby improvement projects are:

  • Flow
  • Demand and capacity
  • Managing bottlenecks
  • Reducing variation
  • Lean
  • Care pathways
  • Day surgery
  • Reducing cancelled operations
  • Did not attends - DNAs
  • Waiting list validation
  • Discharge planning
  • Length of stay
5.4 Review the gateway criteria for this stage and ensure all aspects are complete before moving to the next stage. Remember to update the project plans, logs and project charter during the stage.

STAGE 6: SUSTAIN AND SHARE

Aim of this stage: To ensure that changes which have been implemented are sustained and are shared to aid learning

KEY steps Relevant tools
6.1 Once the change is fully implemented, monitor it to ensure the original aims and benefits are continuing to be realised - with new ways of working continuing rather than the old ways being reverted back to.
6.2 Produce a brief highlight report for those involved. If you have a project team, you may do this on anagreed regular interval. This is really useful inkeeping the project team updated on progress.
6.3 To help the sustainability of the project, redo the Sustainability Model and Guide exercise.
6.4 Once the project is complete, share the learning - both good and bad - with colleagues and other departments. This helps the organisation make the most out of learning from the experience of completed projects.
6.5 A key element of this step is to carry out a post project review to ascertain what went well and to celebrate achievements. At the same time, objectively analyse the things that did not go well without highlighting individual blame. All of this learning should be reflected in the lessons learnedlog to aid future projects.
    • Lessons learned log template
6.6 Review the gateway criteria established for this stage and ensure all aspects are complete before closing the project. Remember to update the project logs, project plans and project charter during the stage.