For this bonus Project Management Paradise Podcast episode, which is a recording taken from an international conference on best-practice PPM, it’s our pleasure to introduce you to Michael Orchard. Michael is a programme assurance manager for Lancashire & South Cumbria NHS Foundation Trust.
He has an in-depth knowledge of the workings of the UK’s national health service after a decade spent working at the heart of the organization overseeing transformation programs. In the podcast episode, Michael discusses the challenges of managing transformation in a Healthcare PMO for Lancashire & South Cumbria NHS Foundation Trust.
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Transcript from Episode 110: “Challenges of Managing Transformation in a Healthcare PMO” with Michael Orchard
We provide services across Lancashire and South Cumbria. We specialize in securing patient mental health and community mental health provision but we also provide a large amount of community health and wellbeing services and children’s services, as well. We work across each of the five ICP areas in Lancashire and South Cumbria in patient mental health, district nursing, health-visiting, care provision as we really diverse Trust.
In my ambulance days, the focus was quite narrow on ambulances and completely shifted when I went to Lancashire care. It’s a massive broad range of services that we provide. Whatever the challenges and this type of delivery does cause challenges in management structures. I mean, how do you management structure which takes into account all those different services with different specialists involved?
How do we focus our organization, what priorities do we focus upon, quite often we get in conflict within the organization. Mental health is very high-profile at the moment and the organization is heavily focused on working with mental health. Of course, we’re only one organization and we can only do so much. So perhaps, we negate some of the other services which we offer.
At the moment, we are working on integrating South Cumbria’s mental health services. It is one of our projects in Cora. We are also implementing a new electronic patient record system. At the same time, we’re attempting to completely redesign equipment of the health pathway.
Obviously, the poor scope of projects is probably the root cause of most of the issues that we’ve got. We are really bad at understanding what the project is. It is not just Lancashire’s care, we have pockets of good practice, but we have our challenges and actually across the NHS is a real issue in actually understanding the project as a discrete piece of work.
It has a start, it has a finish and it requires a scope and we’re really struggling with that. There’s a lack of trained project managers or people with project management experience in program management experience. There’s a lot of transformational experience but no project management experience. So, the whole idea of structure and control around change is not really there where it should be really.
Unrealistic deadlines we have all had them. I have literally been given projects with deadlines before they’ve even been scoped. We know we got to do something and it is going to get done next week, that does actually happen. Risk management was hilarious. We actually could have risks on our risk register like that. It is possible but it is so huge now in our risk register.
We couldn’t possibly find them if we did. I think there’s a fundamental misunderstanding across the Trust and across NHS, the distinction between project and program risks and risks to the Trust. When we start upper project, the first thing we do is absolutely list down every risk we could possibly think of and stick it on our Trust risk register. That is what the project should be doing, mitigating risks already on the Trust risk register and the rest of the project delivery don’t need to be escalated up to that level. Recently, we had over 80 risks to mobilize the service of 140 people.
There we go. One of the first things we do when we start a project is we carve it up into workstreams based around what people do. So, we have a finance workstream, we have IT workstream, we have a state’s workstream and then we have the clinical workstream. That is literally where all the work actually happens. Again, we end up with silos leads on top of all of those workstreams and rarely do we then consider the needs to actually put someone in charge of the overall project and managing in a way that doesn’t necessarily create those gaps between people.
We are resource-poor for projects in the NHS absolutely. It is possibly the result again of poor scoping in the first place and a complete lack of understanding. But we are absolutely fantastic at the stage gate reviews and the assurance. We are brilliant at that. But, we are not too great on gaining enough people to actually do the doing.
I was only using that one as a bit of an illustration about the Gantt chart because some people are struggling to actually do them. Then I read the Gantt Chart and thought, yeah. It is not far off. The projects around in Lancashire care and across the NHS, largely, in my experience, by operational leads and by clinicians, and frankly they did not get into the NHS to run projects, they got in the NHS to help people. It is not their first love. It really is a challenge in terms of helping them understand how we need to move forward in a structured and controlled way.
I hesitate to call it scope creep to be honest with you because you need to have a scope to have scope creep. We do have undefined projects and initiatives but we don’t really have an end and really have a point where we say we have done that and we are moving on to something else now.
Starting our journey. We have worked with Cora for a bit now. Probably about a year. We’ve got a new boss and a PMO, there she is – Laura. She didn’t take us all skiing on the first day, it’s alright, it was just a snowy day in Lancashire that day. But, she was great. Laura had an accounting background, she came into our team without preconceptions at all and she actually listened to what we were saying were the issues. Rather than forcefully implement something and forcefully, you know, this is the direction you are going to take, it’s actually better to build a strategy based upon their engagement with us. It is good leadership.
We knew we needed a process, we needed the methodology at the same time. People said it before we needed the tool within which to implement that process and methodology as well. There was confusion over the role of a PMO in the Trust. NHS Trust generally told they have to have a PMO but they not quite enough overly sure what to do with it and that certainly is the case within many Trusts I’m aware of.
So, we knew we needed to clear a remit of what we were about what we could offer the Trust. We knew we needed to help better coordinated change and provide a government structure and the tool, of course, to help people do the job. So, we settled on the five areas really of operation. This is before we decided upon Cora and actually by articulating what it is we actually wanted to offer the Trust in the first instance. That helped us back up the system around which eventually turned out to be Cora.
We wanted to ensure that we established our way of doing things. I remember back to London and PwC we’re talking. They talked about the PwC way and that quite resonated with me actually. We needed a Lancashire care way of doing things so that’s kind of how we have been trying to move forward within the Trust as well. When we needed to sell that way to the Trust departments and get buy-in from people around us.
We wanted to define a single assurance structure. We were in a situation where we got multiple projects and programs going on across the Trust all going at multiple lines of assurance, going to different meetings, a lot of duplication and a lot of issues around that. We knew we needed to achieve that level of assurance that we had to have a kind of basic level of planning and project planning across the Trust. So we implemented a very simple GDPM. I don’t know if anyone heard of it, Goal-Directed Project Management.
It is a very simple way of output milestones, tasks and to try to educate people to do that think about what you were trying to achieve and what are the steps in getting there to achieve it and what else do you need to do to meet those steps. That was actually quite successful in terms of engaging people who are not project managers. It is pragmatic, it is simple and we can build on it moving forward in the future. We had to get people away from single-action plans, literally task lists, to-do lists to be like hundreds of lines long with no consideration for dependencies, no consideration around resource and requirements and generally as well arbitrary dates and just dates.
We wanted to be a place where lessons learned could be applied, we wanted to be that repository of lessons across the Trust. We knew as well we needed to establish the application of lessons learned, that the injection of lessons learned and the extraction of lessons learned within that compliance process as well for each of our projects. That was something that we were really keen to do, pre-mortem, post-mortem events and things like that.
Advice and support.
Of course, that was what we have to do because we don’t work with project managers very much. We work with clinicians so we have to do a lot of helping people a lot of skilling people up who don’t want to be necessarily skilled up in what we are trying to offer. That’s around basic concepts as well just absolute basic concepts and basic tools Gantt Charts, risk issues and stuff like that. We had to try and do that without alienating other people across the Trust who were already working on change transformation quality improvement. I felt they were doing a very good job.
Alignment of ducks.
We wanted to try and start getting far more control around the projects that existed at the Trust but we also want to then stop pulling them into more emerging programs and try to establish an organization alignment.
I know it’s the wrong way round but that was the way we wanted to try and get it up on people’s radar that we need to take them on a more programmatic approach to change the link through to our organizational strategy aims. We have been challenged in this. We are making progress but we have been challenged because we have now received an entirely new executive team in the last couple of months as well. So, naturally, our organizational strategy is someone up in the air at the moment. But we are going to be settling the new one in the next couple of months.
We knew we needed support from our system when trying to achieve those five areas. At this stage, we were using SharePoint sites, a colleague of mine built one but it was nowhere near what we needed in terms of trying to achieve what we were achieving. Essentially, we were using a lot of SharePoint just to store documentation. We were using Excel obviously as everyone does. Massive Excel spreadsheets which were hundreds of lines long trying to attract tasks and milestones across the Trust.
It was a real challenge and actually, I was using it to extract information from reports and that was taking me a week, a month to produce the report required for our governments. A quarter of my time was spent on literally producing these static reports which have just been saying, we are out of date as soon as they went up and actually, they were quite often submitted a week before the meeting as well. So, you know the time the meeting there were truly outdated.
We began our search and spoke to other PMOs. That is one of the things we did. We spoke to other Trusts. PPM software didn’t seem to be in wide use across all the Trusts. We were lucky we met a lady from Derbyshire who was well in with Cora. She was fantastic. She came to see us and she showed us what the original project vision could do for them and put us in touch with Cora.
From there we haven’t look back. So, what did we learn when we were looking? We learned we need the system, how to balance between configurability and visuals as well. Quite often on the market, you see systems which are very, very highly configurable but they don’t maintain their usability and they don’t maintain those good-looking visuals that actually we really need. It has to be a pretty picture if they’re going to pay attention to it.
On the other hand, you can get some very good looking pieces of software as well. But, they don’t have the level of configurability that certainly we needed and I would imagine other people would need to make sure that it was delivering the way you wanted to deliver things. We needed help as well we don’t want to come in as nodding dogs and go all “Yes, it’s a good idea” and Cora did come in and listen to us but they challenged us as well. With their experience in working with people from all over the country and all over the world now I suppose, that was really useful.
So, Cora engaged with us from the beginning. They offered and delivered a very Swift deployment of a system for our maturity level was absolutely bob on. The Bells and Whistles weren’t all there but we didn’t need them there at that moment in time, we just needed a basic system. Actually, since then, we’ve got on to configure it quite significantly. I am not showing off my project register skills here I should have thought about that.
Cora is the company that is listening to the people who use the software. They want to build with you and they certainly listen to and engage with us as well. You know, Katrina and Chris were absolutely fantastic particularly in helping us moving forward. Cora does offer that balance. Cora is highly configurable in the back-end and actually, we don’t need Cora to do a lot of the configuration either. We do it. Once Cora can build smartphones for you and can do things for you and absolutely will do. But I and members of my team build smartphones now. It’s not hard to learn and actually having that ownership in the house is really quite valuable and important. Cora gives you the ability to have that if you want it.
We have been deploying Cora across three areas in the Trust. We have an arms-length organization that runs our capital schemes. It was quite interesting in some of our capital developments perhaps we got coming up and we currently deploying with them. We have deployed it across our IMT Health Informatics. They have taken to it greatly.
Because they know what a project is and they know how to run one They have been fantastic. We have also been deploying across our transformation and operational delivery as well. That’s been harder but we are making headway and we are making progress. We are now getting regularly inquiries from across the Trust.
7,000 people in our Trust, not quite as big but we are getting inquiries from across to Trust now because they know about Cora, they know that we’re trying to do something and they know we are trying to make things better and give them something that will make their life easier. So, they’re coming to us and ask us what can Cora do, can Cora help us with this? So, we are making some progress there. And we know that there are opportunities to develop Cora as well as benefit tracking for example. But they are relying on us getting our maturity level up and ensure that we put our processes in place before we can properly implement.
This is what we’ve been trying to do. This is what we’ve been trying to implement. The challenge for us is the recognition of a programme approach to changes is one that can bring some successful changes. It is not given in the NHS that we accept that that’s the case, not in the local area around me.
Imports, of course, are required at each of these stages. Resources are required at each of these stages to convert that into an output so we are moving forward into the next stage. Cora can support that at each and every one of those stages and we have now managed to configure the system so the vast majority of the elements that we need are already in place.
Some are in use and some more than others. We do have all the ingredients there now to move it forward. Realistically, we were only really had the life Cora sights since February in a low mature organization with very small amounts of resources in the PMO. There are only six of us and we have come a long way. We’ve gone from no templates and multiple templates to one template. We have forms in Cora now that people can fill out.
To find out more about how Cora PPM helps management transformation in a Healthcare PMO setting click here