I’m the current head of the program for health service improvement. I lead an enterprise level program management office, overseeing and supporting the organization, delivering this very large program of transformation and services.
The HSE—for U.K. listeners is similar to the NHS—however, we also provide social care services to councils. We essentially provide all of the health and social care across acute hospitals, primary care, social care, disabilities, mental health services, screening, health & well-being promotion, and environmental health services across Ireland. It’s a very large organization. Between our direct employees and people employed by services that we fund 100%, we come close to about 120,000 people for employees.
Like any transformation or reform program, it’s very broad. We have the programs and projects that would cover designing and implementing new models of integrated care. We would have projects establishing new service delivery structures like our hospital groups and community healthcare organizations.
We’ve started this improvement projects across all of the services. For example, the National Ambulance Service has some projects aimed at improving their response times and introducing a clinical hub to improve the level of service they can provide—looking to go above and beyond just responding to ambulance or response car services. We’re looking to improve our overall offerings to patients and service users.
On our enabling projects like HIT, CR, and shared business services finance, we have a number of new projects there such as a new single finance system for the entire healthcare service, activity-based funding models being introduced, and implementing our people’s strategy. Behind all of that, we’re implementing electronic healthcare records systems right across our services.
The drivers come from a number of sources. The two big sources for us would be, as an organization that’s responsible under law for delivering health care services, it’s incumbent for us to ensure that we’re doing this to the best possible standards and level of performance. Naturally, as an organization, we drive ourselves hard and have a program of work in place to do that. We also take our direction from the lawmakers. Our government has issued a number of strategies over the years and this program attempts to bring those all together into a cohesive set or project, programs, and deliverables. The most recent in which we are working out the alignment of our current portfolio to refer to the logic care report. It’s a very ambitious, ten-year plan that is cross parties. We would like to see that as our vision with going forward.
At the end of the day, the citizens elect their government and set the policy. Our job is to implement that policy. Vey often those priorities will be determined for us. To some extent, we have to say what’s doable and not doable. We interact with our colleagues in the department of health very closely. In fact, we have them involved in the governance of the projects and programs.
You have to think about health—it’s so broad you have to parse it out. You may be prioritizing slightly different ways for different parts of the service. We’ll have big drivers and priorities in our mental health area. We’ll have big drivers and priorities that are often based on coverage in the media. We have to make sure we’re prioritizing those issues, while also doing the more strategic service improvement that is more sustainable and long-term, while you’re operating projects that are there to fight the fires. It’s very demanding and requires us to be quite agile in certain ways and responsive to the needs of our patients and staff.
It’s fairly simple—leadership. If we don’t have clear, unequivocal commitment to change at the leadership level, people are so busy with doing the day to day that asking them to make change requires really strong leadership. If there’s any out, people are so busy they may take it. A programmatic approach is really important. Historically the health and public services will trust that people will make the changes envisioned. That hasn’t worked.
Too often you hear about different strategies sitting on a shelf and never implemented, and that is because there wasn’t a programmatic and pragmatic way of programming and implementing the changes needed. The programmatic approach is really important. We’re resourcing program management teams right across the country and our services, and giving them the tools and skills they need to do this.
2. Change management
I see the project and program management a little controversial here as a part of doing change. Too often the view was the project manager needed to have change management skills. In fact, we’re all change managers, and we use project and program management disciplines to deliver that. We have to look at various models for change. With the size of our organization, the best way to drive change is through social movement—to create a social movement. We have a unique program in place regarding health services called our Values and Actions. It’s about creating the right culture driven by behaviors. As program managers, it can often sound too hard or a bit wishy-washy, but it’s completely necessary. If you’re going to make the right changes, you have to have the right culture in the organization to embrace change and to push to do the best for the patient/service user.
With a program this big and complex, it’s important that we have a strong governance model to manage, oversee, drive, and support the activity right across the system.
Yes. There was a time when the project manager was the only person who knew what was going on in the project. The advent of cloud-based systems has transformed the data side of it. Just as we spoke of the importance of change management—project managers are also changing managers—we see that’s a big change.
The role of social media is emerging in PPM. To some extent that’s surprising. Using social media to communicate across projects and to build support for projects is interesting and quite useful—both internally and externally. What is internal to an organization that has 120,00 employees across 2,000 entities? Anything we say is public instantly.
It’s no secret that the health service gets beaten up on a regular basis in the press. We always have to be conscious of how we’re perceived. When you’re coming from a deficit that makes it difficult. It makes it difficult for people to take you seriously.
The most difficult part of my job is balancing the resources available to meet the many needs across the health and social care system that want to improve. We have a very limited set of resources and budget to do this. We have to make tough choices. Sometimes we can’t just resource everything though we would like to.
Those priorities can change regularly. They can change with a press story on something or unfortunately adverse incidents. Changes of minister or government can bring about a significant change of direction. What we try to do is work with our departments and the department of health and the ministers to try and have a somewhat steady approach. This report, which is a cross-party initiative, is not pinned to any one party. That may give it a better endurance across some of those governmental changes or changes in personnel over time.
It’s a privilege to be able to work here. It’s a part of life that’s so personal. Whether it’s with direct experiences or friends and family members, who have had experience with the healthcare system. It’s a privilege to be able to work in an environment where you can bring some positive change. It’s equally a privilege for someone who doesn’t come from a medical background like myself to work with clinicians and share in the successes and help where we can with the difficulties. That’s the reward. It gives you an incredible sense of pride.
At the very start, I explained the length and breadth of this program—it’s enormous. To think you could do this with people maintaining project plans on their management software, excel spreadsheet, or piece of paper wasn’t going to fly.
The sheer size of the program and we needed the visibility of it. We’re a system of organizations, so we grew out of the health boards. Not only do we have health boards in Ireland that were all separate at one point in their life, but also we have voluntary hospitals. These are hospitals that are set up under different statues, and we fund them almost completely. They’re apart of our service delivery system, but they have separate corporate structures, and therefore they have their own security across their networks. There could hundreds of them involved in this between the hospitals and the other voluntary bodies we deal with—to manage the numerous interdependencies across that.
Those are the three big challenges that we had and needed to meet. Just managing that in the traditional way of having project plans sitting on a person’s PC or shared drive, that’s too passive. We need a much more tailored response to the data handling and processing needs and are reported across the system, the accountability for public money and safety. We needed a much more readily available and interactive support and data system. That drives on into how you structure your teams and have them work together.
First and foremost we’re a statutory organization, so we have to follow public procurement processes and comply with the EU directives. It was a fully open public procurement process. There were some bidders. We laid out our requirements and the requests for tender and exactly what we wanted to achieve. We also left it open during bidding and added how we could add value to that. This required them to understand our business—they did very well.
Cora scored highest overall across the boards regarding the availability of the system and is cloud-based. We didn’t want to host it, so that was apart of our criteria. It had to have high levels of security regarding access. We operate to tight standards. We deal with health data at the end of the day, so it’s important that it’s very secure. It has very good interpretability. It was able to accept a lot of the plans that had already been developed. The big decider for us was the flexibility and the functionality around reporting and managing interdependencies. Cora took a lot of time to understand the health service and its needs.
It’s not just about the system; it’s about the business process. We have a clear methodology that we follow for our projects and programs that’s reflected in the system. The system configured to reflect not only our project/program portfolio methodology. In there is also the specific risk management used by the Irish Health Service. When that’s all taken into account, we have to make sure we train people. With hundreds of people to train, we’ve had to establish a specific unit for resourcing. That takes everything from people through their recruitment, induction, and training not only in the methodologies but in project vision itself. Between sources we’ve developed internally supported by Cora training division, we’ve developed a tailored course that allows us to train people and support people in the use of the system. We don’t just throw them in and say here’s a tool use it. There’s quite a lot of investment in training.
We constantly review methodologies and procedures. We’ve got lots of complex projects that are facing demands on our methodologies and the system. Regarding, does that work for us? Why? There may be a particular way that works well for most, but then you find a big program that has complexity associated that says well actually we need to develop something else.
We try to stay true to keeping it simple. The last thing you want to do is overwhelm very busy clinical people with filling out 15 templates. That never plays well. Using project vision has allowed us to bring that down to a single template before people can get a project off the ground. It’s throughout the system, and everyone has a role in maintaining it. It gives us a consistency across the system.
We manage change management and control very carefully around the system. We can’t have chaos Every time we change it we have to train everyone that’s using it, so we have to do that in a considerate way. It facilitates us. Not only regarding our project methodology but our benefits and realization methodologies as well. This is crucial to us regarding actually measuring as to whether or not that was the right project to do at all. It doesn’t reap benefits just to question why you do it, so it’s ingrained in the system. We keep it simple, but at a high standard.
Historically, we haven’t been very programmatic in the way that we’ve implemented or not implemented things Project vision allows us to allow that programmatic approach to permeate throughout the system. It’s guiding you in certain ways to how you manage those tasks providing you with a consistency in how you report progress on those tasks. To a certain degree, it gives you control and consistency. It also gives you the ability to see inside projects. As I said earlier you're not just relying on someone to tell you. You're going to the portfolio yourself. In regards to the reporting, it keeps our governance involved. We’re such a big organization that if you try to over command and control that, you’ll fail because it’s too big. In fact, our whole transformation program that we’re engaged in right now is on the basis that we’re pushing control closer to where we deliver services to our client. Accountability and responsibility for that are being pushed back out for the over-centralization that was done when the HSE was established. That doesn’t mean we give away control in an irresponsible way; we will always have oversight and the ability to assess what’s going on.
With a very large program, you’ve got to have the confidence in your system to take on that responsibility and accountability. Project Vision gives us a safe base to do that.
When you’re establishing a hospital group, that’s a huge program. IT’s got 14 different projects that need to be delivered to establish a hospital group. There are massive interdependencies regarding finance systems, electronic health records, manpower planning processes that are happening in another part of the program. Some are under our finance program; some are under our ICT or HR program. And managing our interdependencies. The ability for us to go in and see how are those interdependencies being met. Are the projects delivering those interdependencies running well? What’s the risk profile or issues looking like? We can see all of that. The ability of an issue by issue basis to go in and interrogate the source of how we solve these things through interdependencies is unmatched regarding capabilities. It’s a fantastic opportunity and capability for us to have.
An informed governance is crucial. We’ve got a complex governance—local groups that feed into national groups and three program boards.
Our three program boards
1. Service Design—designing the delivery of services in a more integrated and patient-centered way.
2. Service Delivery—establish the new service delivery organizations and how we restructure the new center of the HSE.
3. Enablers—ICT, HR, finance services.
Having them informed is crucial to their decision-making. You cant just ask that group of 10 or 12 people to take on every decision, so how the teams and systems allow them to prioritize is critical.
To be honest, you couldn’t consider taking a program on of this size and complexity without it. I was part of the first transformation program. It didn’t do well because it wasn’t able to bring teams together. A system on its own doesn’t bring teams together, but it’s a crucial part in achieving that. I don’t think we could ever succeed without a system like this. It’s not the only element, but it is a crucial one.
1. Insight—the ability to see inside your projects and understand what’s happening.
2. Communications—getting that information and knowledge around all of our projects and the risks associated.
3. Properly Govern—isn’t there when you don’t have load accessible data.
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