Transforming a good idea into working reality - how does it happen?
Can a good idea be turned into a working reality?
It’s a simple question but one that takes on huge significance as the NHS navigates its Long-Term Plan – sometimes known as the 10-year plan. The need to deliver digital health solutions to support patients and improve outcomes is the focus of many NHS organisations across the country.
The Health Informatics Service (THIS) enables new, empowering, efficient, and secure communications and IT services for clients including health trusts, GPs, laboratories, hospices, and care charities.
Some of those solutions delivered by THIS for its host trust, the Calderdale and Huddersfield NHS Foundation Trust (CHFT), have helped to contribute to its current status as a ‘digitally aspirant’ trust, taking it from 150th in a digital trust league table to being one of the most digitally mature trusts in England.
The Long-Term Plan will increase the range of digital health tools and services.
It calls for investment in improving NHS IT systems and in developing new technology to ensure staff have the tools they need to do their jobs, and that NHS systems can talk to each other and share vital information to support the delivery of care.
The management and delivery of these projects, however, can often prove challenging, and this is where the role of a project manager is crucial.
THIS currently employs nine project managers of varying seniority plus a project support officer and typically facilitates 40-50 projects for its host trust and other clients in the healthcare sector at any one time. All project managers employed by THIS are Prince2 practitioners and base their work on the seven processes of that methodology:
- Starting up a project
- Directing a project
- Initiating a project
- Controlling a stage
- Managing product delivery
- Managing stage boundaries
- Closing the project
However, while most projects conform to Prince2, THIS can tailor projects according to size and complexity and will introduce agile methodology where necessary.
What is a project?
David Armitage, THIS’ Senior Project Manager, defines a project as a piece of work which:
- Requires multiple skills
- Is delivered to a timescale
- Has budget restraints
The question of whether a good idea can be turned into a working reality poses even more questions, such as:
- Is the project required – what is the current situation and what is the vision for the future?
- What is it trying to achieve – what are the objectives and benefits?
- Is it affordable – are there staff numbers to implement it, is there funding and time available, and are there any associated risks?
- Does it fit with the bigger picture – who is going to take ownership and establish the links and dependencies?
The role of a project manager
THIS’ Project Management Office (PMO) Manager is Julie Howson. She says:
“Project managers are front and centre from the very beginning, even at the light bulb stage. We facilitate the writing of the business cases and we're there through every stage of a project’s lifecycle – that is before, during and after. It’s like writing the song and the music, playing it, getting a record deal and releasing it!”
The lifecycle of a project
A glimpse at the job of a senior project manager with THIS reveals a complex, all-encompassing role that calls for a substantial, proven track record of NHS project management; planning and implementation of multiple complex projects - gained from working in a range of organisations in an NHS setting.
A project manager navigates its lifecycle with infinite control and clarity.
“When a project is complete you can see the calibre of the project manager who led it, particularly through the governance.
“We show we’ve got control over what we do, as well as control over the finances and the timescales. It shows that everybody's aware of exactly where they are on that project and what their expectations are. They know what the issues are, they know who's managing those issues and how they are being resolved.
“Our project managers are people capable of telling you the honest truth of where you are and being able to find a way through the maze to get the problems resolved. And it's making sure that the organisation then has confidence that things are being governed properly and that both the business and the finance is being checked, watched, and managed correctly.
“It’s also about winning the confidence of everyone concerned is it’s someone who is actually going to suggest you stop a project, or suggest you take a different course on it, which is something we do. There are times when we have to question why are we continuing with this? Is it still offering the value or accomplishing what we thought it would when we set off down this road, because particularly in the NHS, the political arena changes quite often.”
It's essential that THIS’ project managers have experience of:
- Working across a range of health or social care organisations.
- A grasp of the principles of NHS modernisation, including experience of service improvement and re-design, monitoring change, and facilitating staff to change the way they work.
- An understanding of clinical and corporate governance and risk management systems and processes.
Nurturing the next generation of talent
THIS is not just about senior project managers; it also plays it part in creating a future generation of PMs thanks to its graduate recruitment scheme.
“We have an entry level into project management through our junior PM roles where we train in-house to our high standards, as well as ensure they attain project management qualifications. We also actively look to promote people internally, who have demonstrated the experience or relevant skills required to do project management and watched them go on and flourish.
“We are really successful at doing this and are proud that past colleagues have gained skills and developed which have enabled them to further their careers and gone on to bigger and better things both internally and with external organisations.”
Seeing the light
David likens a project to projecting light through a prism to identify and simplify its lifecycle, consider its key elements, and illustrate the importance of ownership, delegation and communication. It calls for every single quality demanded of a project manager.
But what makes a good project manager?
“It calls for many different qualities. Obviously, you have to be organised, you must be personable, a good listener and co-ordinator. You must ask questions but really listen to what people are telling you and be flexible.
“For example, understand that what is a priority to you, might not be a priority in a clinician’s world. When I'm working within our host trust, it’s their job is to look after a patient and deliver the best possible clinical care. My job is to put a system into their service that's going to help support them to do that. I have to be aware that what's important to me, probably isn’t as important to them. They've got a day job to do in there.”
Julie Howson sees communication as the key quality of a good project manager.
“It is the communication with the stakeholders and being able to relate to all the different stakeholders to get the best out of them and keep them motivated to the end of the project. Without that leadership, if you don't keep those people together, the project will fail.
“If you have a good project manager, they keep the project flowing, they provide good updates, get issues unblocked and get everybody working together.”
“The question I'd ask any sponsor or executive after a project is complete is, ‘were you always clear where you were on that project? Whether that was good, bad, or indifferent; were you always clear on what was happening? If the answer to all that is a yes, then it's been a well-managed project in my opinion.”
Case study: information sharing on a mum-to-be’s maternity journey
The mother-centric shared maternity record enables all trusts involved within the West Yorkshire and Harrogate local maternity system to share specific documents relating to care during the maternity journey of a mum-to-be.
Currently, information needed for pregnancy care may be stored in several different trust maternity systems - and potentially in non-maternity systems too.
However, maternity patients under the care of one trust may need, or choose, to visit different healthcare settings during their pregnancy.
The Yorkshire and Humber Care Record (YHCR) is the regional Yorkshire and Humber integration system that facilitates the different West Yorkshire and Harrogate trusts involved in exchanging this vital maternity information electronically, and was Yorkshire and Humber’s answer to the ground-breaking NHS Local Health Care Record Exemplar (LHCRE) programme back in 2018.
With this new initiative, if a mum-to-be booked at CHFT goes to a neighbouring trust for care, staff there will be able to check the portal for her relevant details. Likewise, if the Trust is registering someone booked elsewhere on the system, staff will be able to search for information regarding the maternity pathway.
Clinical benefits of information sharing
Sharing data in this way is essential to provide the very best care across the maternity pathway. It also enables the healthcare services to work more efficiently.
“Improved connectivity and integration will provide clinical and care staff, directly involved in the mother’s care, access to the most up to date information.
“It means we’ll be able to view real time maternity information across care providers and between different IT systems safely and securely. Time consuming telephone calls to understand different systems and chase up information will become a thing of the past too.
“Immediate access to healthcare information all in one place will mean fewer delays in treatment and provides extra support to clinicians if a woman comes to the trust unexpectedly. This might include, for example, identifying people who may need extra support because of safeguarding or other concerns.”
As an exception to the norm, this project didn’t warrant a specific project board. Instead, project governance was done via the Divisional Digital Board.
A six-strong project team of key individuals to manage project tasks was created and communicated via weekly calls on Microsoft Teams.
The team was made up of:
- David Maidment, Synanetics (WYHCP technical partner)
- Emma Smith, Synanetics
- David Armitage, THIS
- Chris Mabey, K2ms (Maternity system supplier)
- Richard Stokes, West Yorkshire Health and Care Partnership
- Emma Burbidge, CHFT maternity service.
Support came from the following THIS teams covering the whole spectrum of the project:
- Server infrastructure - worked on the Installation and configuration of the server to store maternity summary documents.
- Healthcare network support – provided firewall configuration to allow secure access to and from external systems.
- Software development and integration - this involved the configuration of the Trust Integration Engine (TIE) to allow message transfers to and from the YHCR system.
- Information governance (IG) - ensured data sharing complied to the various national requirements and standards.
- Cyber IT and security - ensured the correct protocols were followed and safe connectivity obtained to external systems, thus guaranteeing patient data was submitted securely.
- Service desk - involved in the development of support processes and delivery of post project service desk support.
Overcoming the obstacles of a ‘first of type’ project
As we were creating new interoperability, there were several challenges that had to be overcome to provide governance along with the key deliverables and activities.
Breaking new ground is never easy. Several major obstacles required consideration and resolution to make the project a success including:
- Synchronisation with the NHS spine
- Third party supplier software assurance process and timeline
- Certificate sharing
- PEN testing (cyber security)
- Document handling within portal
Adding value to a project
As we’ve already detailed, the role of a senior project manager is complex and all-encompassing to achieve infinite control and clarity.
As project manager, Dave had to understand the outside pressures of the various stakeholder groups, and that called for a flexible approach to the delivery of the project requirements.
Communication was at the core of his role. Communication with various teams and arranging subject matter specific meetings as and when they were required. There was communication with the wider audience within the trust, keeping all parties aware of progress; while ensuring the Trust’s requirements were communicated and changes made to system functionality and processes as appropriate.
As a central point of contact for any project-related queries, he had to be able to relate requirements to different teams without resorting to jargon, maintain a positive environment especially during any difficult periods, and accurately record and manage any issues and risks.
And as the project drew to its conclusion, he had to ensure that testing was completed to the required standard, again communicating with the wider audience to keep everyone aware of progress.
“Project management has a very clear definition, but I particularly like to understand the service I'm working in, so I'll take the time to speak to people and ask questions to understand the bigger concept of what it is I'm trying to achieve.
“It's what’s needed to do the job properly. If you've not bought into what you’re trying to achieve, you won't do a great job. You can't point people in the right direction if you don't know what that direction is.
“You need to bring the experts into play too. You get a lot better buy-in, particularly with clinicians, if you understand how they're working and take the time to actually understand what they're trying to achieve.”
“Having a project manager for the maternity data sharing project has been invaluable. Dave has co-ordinated and liaised at every stage of the project to ensure all ran smoothly and knew process to follow when issues arose. He is professional and approachable, and I hope to work with him again very soon,”
- Emma Burbidge, CHFT Maternity EPR Lead.
As we’ve already said, the key to good project management is governance. Here is the list of documentation that was required:
- Data sharing agreements
- Data Protection Impact assessment (DPIA)
- Data protection agreement
- YHCR technical readiness assessment
- Clinical safety assessment
- YHCR onboarding assessment
- YHCR go-live approval
- Cyber security assessment/sign-off
Our key deliverables and activities
- FHIR Proxy and Document Adapter Hosting/configuration
- Firewall configuration
- Document summaries for the development of booking in a mother, the care plan, pregnancy outcome, discharging a mother, discharging a baby and pregnancy conditions
- K2 Athena development – Document triggers and embedded portal development
- Service desk process - Go-live/BAU support
- Testing – Provision (providing documents) and consumption (receiving documents from other organisations)
- Technical sign-off
- Clinical sign-off
- Go-live communications – both internal and external
Our project managers can work across the entire healthcare sector such as GP practices, laboratories, hospices, care charities and NHS trusts. Our clients include London’s Great Ormond Street Hospital, and hospital trusts in Southampton, Oxford, Cambridge, Nottingham, Derby, Birmingham, Liverpool, Manchester, Middlesbrough, North Tees & Hartlepool, Newcastle Upon Tyne, Edinburgh, Lanarkshire and Glasgow.
If you’d like to collaborate and innovate with THIS on a project in your healthcare organisation, get in touch.