Seeking the approaches that enable faster change in the complex world of health and social care
I love Gantt charts!!
I find them enjoyable and challenging to create and really easy to read. However, it seems that few people share my enjoyment.
Over the years, I’ve learned to adapt my passion and create simple alternatives, or keep my gantt chart in the background whilst presenting the plan in very different ways. As I’ve adapted my approach to presenting plans, I’ve also adapted my approach to planning. I initially adopted the rolling wave approach, a 2-3 month ahead rolling detailed plan within a longer term overview plan. As most of the detail kept changing, I ended up spending lots of time rewriting plans or not having a plan at all. I then moved to a framework plan with a rolling element of only a few couple of weeks, this worked better, cutting down on unproductive planning time, but maintaining a narrative for the work that needed to be undertaken.
During 2014 I spent some time understanding the features that accelerate change in 5 programmes. One of the common features supporting acceleration in these programmes, was the framework planning approach that I’d also adapted. It was comforting that others working in the complex environment of health and social care, had also reached a very similar solution.
This planning approach is based on a framework plan consisting of a number of key milestones to describe the structure of the overall plan. I observed that in most cases a detailed plan was developed at the beginning, seemingly to inform the timing of the key milestones. At the start of a set of activities, I noted that this detailed plan was quickly forgotten in favour of a very flexible short term plan, driven by weekly adjustment planning meetings. However, the high level milestones rarely changed and were the stable element of the planning. Thus, these plans end up being a blend of the kind of planning used by project/programme and operational management, described by some as a balance of discipline and flexibility.
Is this planning approach the perfect answer for the complexity of health and social care? I’m not sure, as I’ve found difficulties engaging some scarce resources in such a flexible manner, and the communication overhead to ensure a flexible plan is effective can be high. So, in some circumstances, I’ve used a different approach, based on agile project management. This has been largely effective, not only in improving planning but also in improving the quality of project/programme outputs. It has potential to accelerate change in this environment.
The agile project management approach to planning is based on short, time bound periods that focus on specific deliverable(s). These are often referred to as sprints. No activity planning occurs prior to the sprint, other than drawing together a suitable sprint team. However, the first activity for the sprint team is to build a plan, which they will then constantly adjust throughout the sprint. This approach is used extensively in the development of software and has been adapted for service change. I’m still learning about the best sprint approach and will outline more of the specifics and learning around this approach in future posts.
In summary, to accelerate change in health and social care, planning needs to be flexible to cope with complexity, but needs to have a fairly static milestone framework to anchor this flexibility. This seems to be a common and successful approach in health and social care, however there is potential to further enhance planning in this complex environment. In my view, agile planning, using sprints, provides an approach that could further aid planning and accelerate change in this environment. Perhaps this is something everyone could learn to love, unlike the poor old Gantt chart.
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