Features: June 1st, 2012

Peter Osborne examines the challenges posed by business change resulting from the new health and social care legislation. He describes how common pitfalls can be avoided by performing a health check and acting early on the intelligence it provides.

Despite intense scrutiny and political opposition, the Health and Social Care Bill will now become law. Designed to create an independent NHS Board, promote patient choice and reduce administration costs, it will also reform the Department of Health’s supporting bodies.

Clinical Commissioning Groups (CCGs) working with the NHS Commissioning Board (NHS CB) will assume responsibility for the majority of the NHS budget. Tasked with bringing a focus on quality and outcomes to realise a step change in the patient services being delivered, they will have the freedom to decide how to carry out their commissioning functions and, through the build/buy/share process, the support they use.

Meanwhile, Primary Care Trusts (PCTs) and PCT Clusters providing commissioning support are looking to define and shape services in a structured and coherent way that can logically support the CCGs. They will focus primarily on the core back-office functions – such as finance, IT systems and support, legal services and HR.

Given the unprecedented scale of change, healthcare organisations are engaging specialist management consultants to help deliver the necessary business transformation. As an independent third-party, they not only provide a perspective free from internal constraints, they can also perform a regular review or ‘health check’ to ensure successful outcomes are achieved. Crucially, a health check is a relatively simple and inexpensive exercise when compared to the multi-billion pounds at stake.

Health check fundamentals

A health check provides stakeholders, sponsors and other relevant parties tasked with managing the delivery, as well as those employees impacted by a project, with peace of mind that the business benefits will be realised within the given time and resource constraints. Yet in the same way that most people only go to the doctor when they feel ill, the majority of organisations only perform a health check if they believe that something is fundamentally wrong.

Even if the warning signs are visible, there is a tendency to carry on with a project in the belief that issues can be resolved by doubling efforts or by throwing more resources at them. However, unless corrective actions that target the fundamental aspects of a delivery are implemented early, in most cases, outcomes will not be realised or a catastrophic failure will occur. Fear of failure is often an overriding issue, coupled with the reticence of involved staff to flag problems when it reflects badly on themselves or their colleagues.

A project health check examines a wide range of aspects. This includes objectives, scope, approach, plans and management, as well as quality of resource, programme governance and sponsor/stakeholder commitment. Essentially, it enables programme leaders to identify what is working well and why, what is not working well and why and the actions necessary to resolve issues.

Ultimately, there are five fundamentals that dictate whether or not a successful outcome will be achieved. These are:
• Leadership – successful programmes require key individuals with the right skills, behaviours and attitudes in critical decision-making roles. Programme director and programme manager are the obvious ones, but leadership is required at all levels, from business sponsors and stakeholders, to those within the programme teams and within suppliers.
• Clarity of purpose – encompasses the vision, the imperative and how to get there. Failing to re-assess these items regularly, agree actions and communicate revisions effectively can result in major gaps opening up.
• Effective governance – in most large organisations the programme board is the key element and should be set up to ensure that all stakeholders have the right level of membership to be credible and authoritative.
• Delivery culture – concerns how people feel, behave and are motivated, with clarity of accountability and a readiness to accept being key to establishing an honest appraisal of real status and issues, and an ability to resolve problems that actually affect outcomes.
• Smart processes that fit with business context – all programmes need clearly defined ways of planning, monitoring and decision-making with the appropriate control, direction and use of resources. These processes need to add value and support rather than constrain the delivery culture, but must be configured to fit within the business they serve and communicated effectively throughout the organisation.

Breaking down programme success into a small number of fundamentals is helpful in finding ways of assessing hugely complex programmes of organisational redesign and business change. But these fundamentals interact very strongly and are mutually dependent not exclusive.
Clarity of purpose and effective governance for example, play a vital role in ensuring a good fit with business context, especially given that there could be stakeholders and sponsors from all or some of the new organisations the health care sector will comprise. For example, a CSS transformational change project will include stakeholders from the PCT/Cluster, as well as the CSS, with liaison from the relevant CCG. With the latter, liaison would be required with key sponsors and stakeholders from the relevant CCS taking cognisance that the CCG is the new intelligent customer.

Having a smart process is much easier in a good delivery culture. The latter hinges on bringing in key individuals for key roles and is achieved both through effective leadership and by active demonstration – i.e. the project manager is first into the office and the last to complain. It’s also achieved by a focus on quality. If team members see the project manager is targeting the things they view as being important, then it is possible to drive everyone towards a delivery outcome.

You can lead a horse to water

At a strategic level, the board must engage closely with programme content. Action-orientated boards will move on the intelligence they receive and ensure a programme is successful, whereas information-orientated boards report to stakeholders on progress but tend to take a back seat in terms of delivery. Performing a health check provides a set of viable recommendations, but if sponsors and stakeholders fail to implement them, then the exercise becomes almost futile. As the saying goes, you can lead a horse to water but…

Finally, the approach to adopt is one of practicality – i.e. determining what is sufficient to make a project successful. Here, the Pareto Principle applies, because an organisation will typically be resource, time or financially constrained. The results of a health check can be summarised into several themes gravitating around the five fundamentals of project delivery and prioritised according to those that will deliver the greatest impact..

Performing health checks in an independent and structured manner – e.g. at the end of the design phase and during the build and implementation phases – and taking the right actions at the right time can be an incredibly cost-effective means of ensuring a successful outcome when compared with the cost of business change or organisational redesign and the potential price of failure.

Peter Osborne is MD at LOC Consulting the specialist management consultancy, which partners with its clients to deliver complex business change and IT projects and programmes.