12 Billion Pounds NHS Computer Scheme Project - Essay Example

? ?12BILLION NHS COMPUTER SCHEME PROJECT Introduction Hospitals are organizations having their own mechanisms for working. National Health Service has been giving independent service, offered by each hospital. Automated system for billing was used, which harmonized the working practice. The IT system was integrated and new medical systems was enabled at individual hospitals. The NHS started as one of the largest public healthcare system implementation, which was needed for improving the overall service of the health care industry. Mintzberg et al (2005, p.8) comment ‘Strategy is a pattern, that is, consistency in behaviour over time. A company that perpetually markets the most expensive products in its industry pursues what is commonly called a high-end strategy, just as a person who always accepts the most challenging of jobs may be described as pursuing a high-risk strategy.’ The Project Management Process and Planning If the organization moves from simple system to complex, its environment and a number of other aspects needed to be modified. Employee and staff relationship is also important in this regard where the new relationships, departments and new skills are defined (Appleton, 1999). Change leads to resistance and confusion (Glover et al., 1999). The “Connecting for health” was the brand name given for automating and integrating the heath care service in UK. The plan was to automate a range of functions, including mundane services such as enabling members to use online system to making book appointments having their GPs (general practitioners). Clinically sensitive functions such as maintaining patient records and managing scans were part of the project. The whole system already posed a range of software system, which achieved few functions but these systems were not integrated fully. The common model for implementation involved questions such as What are we trying to accomplish? How we consider change is an improvement What changes can be achieved for improvement The project implementation processes involves - Study, Plan, Act and Do. The project lifecycle of NHS was determined through gateways such as the following- Strategic assessment (The earliest stage was to set up the business strategies and to make the initial feasibility study) Business justification (After the development of program brief and business case, the business justification was identified, which requires detailed analysis of the project, capital investments, cash flow, operating expenditure such as salaries, maintenance materials, lease and revenue) Delivery strategy The investment decision Readiness for service (The project manager opts for implementation method for minimizing changes and improving coordination with interfaces from different stakeholders and suppliers is determined) Assessment of project, operational review and benefit realisation (The project should be able to provide benefits for decades) The security system of the project was developed with the help of Spine, which is the provider of security, and security measures were also compiled in the early stage of development. Wells (1996, p. 80) states ‘Sub organizations should create lower-level measurement plans that link with the corporate strategic measurement plan. If the sub-organization has a separate strategic plan, then it will also need a separate strategic measurement plan. If the sub organization’s strategic plan starts at the strategy or objective level, it needs to have measures that link directly to the corporate strategic measurements. In the event that only a few measures can be linked, the sub organization should create additional strategic measurements that better describe its outcomes.’ The portfolio approach has been adopted by the project management teams for managing software development risk (McFarlan, 1981). Prior to this, risk was only considered from the technological perspective (Anderson and Narasumhan, 1979) and from the software development view (Barki, et al. 1993). For IT implementation the project should be started with a business perspective and the managers should gain clear knowledge of the strategies and structure involved in the business, for example - how to deliver the value, how the business works? What are the processes? The technique used for evaluation and assessment of risks is primary as follows: Barnstorming Interviews SWOT analyses Questionnaires ad surveys Using technology Scenario analysis The principle output of the project was expected to render the following: Maintain a single repository for storing and retrieving information, projects plans, data, system usage and other related information. Automated reports for improving the accuracy of programme and for improving the efficiency. Reports for improving completeness and accuracy of program data, which is in the repository. Geographical information which showed the location and milestones The portal to support the distribution of reports How Managing a Large Scale Project Differs From Smaller Scale Projects Large scale projects are difficult to manage as compared to small scale projects because large IT projects have colossal complexity. Powerful workstations are needed for every desk and the computers are connected through network, which is linked to the teams, who should be able to handle the systems effectively. The lack of alignment between organization structure, strategy and processes as well as the chosen IT implementation mechanisms, can be a bigger risk and it has been repeatedly identified by researchers as the cause of failure (Davenport, 1998; 2000). Small scale project can be integrated and controlled easily, and its applications can be handled more effectively. However, large scale IT project implementation faces the risk of loss of control. There are mostly two way to lose control over project implementation - lack of control over the employee once the system is implemented or lack of control over the project team. Project complexity has been a biggest risk, which requires accurate analysis of hardware, implementation cost, software, consulting fees and training (Davenport, 2000; Mckie, 1998). The software management of large scale project become difficult as the application becomes heavy and is difficult to manage. It also becomes invisibly covered by the large range of applications which are linked to the project. Customers, sometimes, is not aware of the underlying codes -- which consists of thousands of code for single execution and the function can be difficult to deliver on customer’s demand. Over-optimism can be a major drawback in such software implementation project. The inexperienced managers and the upper management, sometimes, under the pressure of customers or management, make unrealistic assessment and unrealistic schedules of project capabilities to meet targets. Uncertainties in software implementation stages results in creating flaws. Customers are sometimes unaware of the capabilities of software and they may not be able to explain what is needed and sometimes, they may just tell what they do not want in the software. The changing requirements can be the biggest drawback of any implementation project. The stage of software application development is based on idea, implementation and the interaction (Soyers, D., 1941). Evaluation of How the Project Was Planned and Initially Expected To Be Carried Out NHS was going through the phase of change facing challenges and delivering information while it had to protect the quality of service and makes effective use of the resources. The NHS framework was designed to manage the delivery of change, which promoted reforms in the health service. NHS project plan was to design change to manage and control the delivery of the change across the portfolio, programme and project management. The purpose was to build capabilities which can manage the transformation effectively and efficiently. The project’s role was to deliver better and safe care to the patients through the installation of new computer systems which are linked to the GPs and the community services. The system constitutes largest IT investments of UK and the expenses are expected to be more than “?12.7 billion over the years till 2013 – 2014”. It was part of the projects NHS connecting for health. The process involves the integration of more than 300 hospitals to benefit more than 40 million patients across the country. The main process deliverables in the system were - efficient system having electronic hospital booking system and he electronic service which can transmit and offer prescriptions online. Initially, the project was part of UK Department of Health and was responsible for delivering single, centrally managed electronic care record for patients which were connected by 30,000 practitioners and 300 hospitals. It was believed to provide secure data records of patients. In 2004, the data collection in the first stage of implemented resulting in the generation of a number of recommendations, which were needed for acute and sub-acute public health services. The early recommendations provided a range of lessons to the project managers. Some of them are listed as follows: Agreed measure treatment can be used for medical treatment Feedback of staff result was easy to generate Integrated program was developed Support was given for multi disciplinary committee Staff resources can be identified Analysis of Actual Execution The aim of project and benefit to staff was determined and multi-factorial approach was formed. The programme involved a range of services such as effective electronic system for apportionment and booking and electronic service for dispensing prescription and transmitting the information on line. It promoted the use of best practices for clinical methods and the other deliverables of the project were as follows: It improved focus to high risk areas Patient information and education was provided The proactive change for facilitate environmental change and offering appropriate equipment Support from executive / management It was supported by education program Integrated case records service Electronic prescription Electronic appointment booking Medical imagining System of management central email and directory services By 2002 - 98% of the GP practices were interlinked. Till 2005 half of the appointments were made through systems, which required additional time and training. 70% of the GP was released initially by 2007 and 40% of the prescription system were timed. The department expected to spend ?4.3 billion on the release of care records systems till 2015-16. The department is trying to reduce the cost in North, East and Midlands by ?500 million. NHS is trying to reduce costs by reducing the systems, which were initially mentioned in the contract. Mintzberg et al (2005, p. 189) quote ‘Deliberate strategy focuses on control—making sure that managerial intentions are realized in action—while emergent strategy emphasizes learning—coming to understand through the taking of actions what those intentions should be in the first place. Only deliberate strategy has been recognized in the three prescriptive schools of strategic management, which, as noted, emphasize control almost to the exclusion of learning.’ The key holders of any projects should be fully engaged and should have communication. The key stakeholders of the health services involve 9 “Cs” Commissioners ( who pay the organization), Customers ( who acquire and use the products ), Collaborators ( with whom the organization works to develop products),Contributors ( the external employees that he organisation acquire), Channels ( the organisation provides route to market or the customer ), Commentators ( opinion of organization which is heard by the customers) , consumer ( who promote the project) and competitor ( organisation working in same area ). The key factors involved in change were Changing the clinical intervention Changing the process and care system Creating work teams Changing the technical and behaviours The questions which are important to understand the stakeholders are 1. What is their opinion on your work? 2. Their readiness to change? 3. What motivates the stakeholders? 4. What is the information required by the stakeholders? The project required - Changing clinical interventions and Changing the processes and care system. The stakeholder groups affected by the project are Public, patients and carer - People were waiting for great choice, fast access and betters services. The impact of delay resulted in objections to plans and demonstration. Informal meetings were held to enhance involvement of clinical sub groups and issues raised by the stakeholder were - access to services, availability of services, new services etc. It was also claimed that the project was expected to be helpful to the patients as NHS staff but it became expensive and did not deliver the expected. The project was rejected and fresh advice was induced under the new management. Local People, voluntary organisation and social care groups - There were confusion over the changes and the concerns over future accessibility to services. Public consultation and project website provided updated information. MOD(Ministry of Defence - The contract was lost and shifted to MDHU(Ministry of Defence Hospital Unit). Foundation Trusts - The trusts provided support for development and participated in assessments. Staff - Staff and employee raised objections. The workforce was redefined and clinical conferences were held to resolve the matter. The project aimed to create computerised patient records system across NHS , which was scrapped. The NHS chief Executive decided to discontinue the program and the sources informed that the decision was made because of the coalition ongoing problems. National Government - The policy on NHS was modified and the national level project was changed to local level. The new change involved change in funding. One of the key aspect of the project was that the programme required procuring system but later local systems were used which have different in functionalities. The locally tailored systems were maintaining interoperability and it was delivered through the program. The development helped in promoting efficiency. Underpinning IT infrastructure and performance management in case of primary care was examined. The project was initially divided into areas which were called clusters - London, Southern North West & West Midlands, East & East Midlands and North East. The clusters had local service provider which were responsible for delivering the features at the local level. The structure mainly helped in reducing the risk of committing one supplier which may not be delivered. NHS staff and patient felt it was top-heavy, hideously expensive programme and it did not deliver the needed. It was considered to be too ambitious and money which should have been spent on patient care was spent on the technological changes which were considered wasted. No confidence was generated from the programme and the original intent as targets on dates, functionality, usage and levels of benefit were delayed and reduced. The work was refocused and hospitals were allowed to use their own IT systems and integrated to their environment. Role of Risk Management, Time Frames, Staffing, Costing and Evaluation of the Project The plan was established in October 2002 and it was supported by Department of Heath reports. IT strategies were later integrated to the NHS Connecting for Health which was responsible for delivering the project. The project was expected to cost ? 2.3 billion but the cost went above ?12.4 billion over the 10 years. By March 2011, NHS had spent ?2.7 billion on implementing the system. The original aims were to deliver NHS By 2007 and to deliver the electronic care records by 2010. The program was risky inherently because when contract for delivery of record system was formed in 2003- 2004, there was no products available with the supplier to deliver. The risks identified in the project were as follows: Lack of clear links with the strategies priorities Lack of clarity at the management level / lack of effective leadership Lack of project teams integration / Integration of project Lack of engagement from the stakeholders Evaluation based on cost Wells (1996, p. 22) states ‘The senior leadership team should outline who is going to be responsible for implementation efforts, i.e., who is the point of contact for the plan, who manages the implementation actions, who manages the resources.’ The analysis of risk in IT implementation has been a subject of research (Jiang et al., 1996; Zmud, 1980). It has been observed the cost of IT project was significantly higher as compared to traditional projects. It has been observed that implementation projects that failed in such system can be extremely damaging to the organization (Scott, 1999). The NHS - CFH now connects 1.3 million employees. The risks management systems are associated to the case when: Cost increases Estimated benefit decrease Implementation delays Change in environment internal or external Critical Evaluation of the Project The cost of the whole project exceeded its level and there were numerous ongoing problems in the project where two of the four IT provider companies which were involved in the project withdrew from the project. This led to controversial and serious concerns, which were expressed by the Common Public Account Committee. Many issues were found in scope, planning, budgeting and practical outcome. In January 2009, a part of project was deployed across NHS; however, certain key components of the system were not developed. In September some aspects of the project were cancelled and the spending was shifted to seek local system instead of having a centralised national system for managing NHS records (John Oates, 2011). The security system integrated to the NHS project was not effective and the patient’s data was not handled carefully. Conclusion Large scale software implementation project are based on the small software, which have already proved its worth. Small amount of coding and integration helps to renew the whole system. However, in software development the process should be done through evolution and the methods of implementation should not be based on creating a revolution. NHS project was an ambitious multi-billion pound program started by the UK government to create a computerised system for maintaining the patient records across the countries. In 2007, the project achieved automation in maintaining patient records, daily prescription, automation of appointments and training. Approximately ?12.7 billion were sanctioned for the IT program and only a part of project was implemented. The project suffered delays, contractual disputes, technical difficulties and the increasing costs. It was believed the whole system was based on top-down IT system which resulted in project delay. The combination of government and software has had a poor record and increased pressure on system deployment before time can result in deployment of erratic systems, which can hinder the growth of whole integrated systems and perform badly as compared to old systems. The government should try to learn the realities of software deployment and development to ensure productive mechanisms for system deployment. Recommendations The UK NHS aimed to create system which could be one of the leading global care systems. The system was designed to be best in service informatics. 1. The delivery of the system was risky and was considered unworkable at a point. It was found that the record system would have been easier to maintain if the clinical staff had clearly mentioned the specifications before the start of implementation for the IT system. The significance of understanding of user needs was examined by researchers to ensure high customer satisfaction and to prevent user resistance, project implementation of project, enhancing project scope and for top management sponsorship (Reel, 1999). To increase the success rate the probability of risks should be reduced (Barki, et al. 1993; Jiang and Klein, 1999). 2. When the government allocates the project to any private organisation, a fixed profit margin is determined for the projects which ranges from 5 to 15 % and the approach appear sensible but it may result in inefficiencies in the system. 3. The project management team admitted that the project was developed in the manner a small scale project is handled but the whole system was huge and complex. Decentralisation of decision making has been a major drawback and hence, team of managers should be allowed to make decisions (Davenport, 2000; Whitten and Bentley, 1998). 4. The employees should be aware of the reasons why the change is necessary for the organisation. They should be part of the change and feel the importance of issue which are dealt by the project. If the employee does not agree with the change or feel there are other better ways to achieve the outcome the project can be disastrous. Disagreement about the change should be handled. 5. The project realities should be clear to the project managers before starting the project. 6. Communication problem was one of the major drawbacks and improved communication with the customer and staff would have improved the development. The staff associated with the system development and implementation process did not have confidence in the overall method used for deployment of the system. The basic implementation procedure should have involved training and should have emphasised on communicating with the users to ensure the staff is motivated enough to achieve positive results. References Anderson, J.; Narasumhan, R. (1979): “Assessing Implementation Risk: A Technological Approach”, Management Science, vol.25, n.6: 512-521. Appleton, E. (1999): “How to Survive ERP”, Datamation, March. Barki, H.; Rivard, S.; Talbot, J. (Fall 1993): “Toward an Assessment of Software Development Risk”, Journal of Management Information Systems, vol.10, n.2: 203-225. Davenport, T.H. (July/August 1998): “Putting the Enterprise into the Enterprise System”, Harvard Business Review, vol.76, n.4: 121-133. Davenport, T.H. (July/August 1998): “Putting the Enterprise into the Enterprise System”, Harvard Business Review, vol.76, n.4: 121-133. Davenport, T.H. (2000): Mission Critical: Realizing The Promise Of Enterprise Systems. Harvard Business School Press. 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