Seeking the approaches that enable faster change in the complex world of health and social care
I was recently asked about ‘critical path’, and my heart sank.
Why, in a change environment dominated by people, would we think that a technical, linear, engineering technique would help accelerate change in health and social care? Is it because this is a concept that is easily taught on management courses and is associated with project management? My belief is, other than in pure engineering projects, this is a flawed technique and would wish anyone looking for a critical path, good luck. I suspect it would take longer to find than the project itself!
Critical path is focused on time and seeks to compress a plan to it’s shortest and most efficient use of resources, but it assumes a high level of predictability. In Health and Social Care change, even without planners using ‘critical path’, my experience is that plans also seek to reduce the length of a project and use resource efficiently. Effectively, these plans prioritise those activities that might be close to a critical path. Perhaps, this is more of a critical thoroughfare than a path, but seems a sensible adaption of the key concept of the critical path tool, for a more uncertain environment. This approach could be described as having a ‘gravitational pull’ towards timescales.
Is acceleration of change all about timescales? I would argue that the purpose of projects and programmes is to produce benefits and so these must be an important part of any definition of acceleration. Clearly, there is a time aspect to these benefits, however blind focus on timescales might hit timescales and miss benefits.
Imagine, if you would, a decision to deliver a business case to a very tight timescale. Completing a business case template to a timescale can be a very straightforward exercise, however would this approach compromise the engagement, design and planning needed to ensure the later delivery of the benefits?
How many projects have we all seen where the project RAG rating is based on timescales, rather than benefits? In my case, most, if not all. Is this accelerating change?
I’ve begun to understand that a primary focus on time is a significant flaw, and often leads to poor decision making, particularly when things don’t go to plan. My experience, and my own practice, has been to complete activities in the shortest time assuming that this leads to the benefits. However, this drives decision making that ensures timescales are met, through approaches such as, reducing scope, accepting poorer quality outputs or accepting greater risk. This isn’t always the fastest route to the benefits. In making these decisions, I’m not sure I fully took into account the impact on the benefits as I felt the gravitational pull towards timescales that was central to my project and programme management education.
What if the gravitational pull was towards the benefits, would decisions be different? I think so, I also think the impact of these decisions would be much greater. For example, taking a decision to take a new service live would focus on the elements giving the greatest benefits and if further resources or time was required to achieve this. I also think this gravitational pull is important in accelerating change in health and social care. Indeed, I have seen this kind of pull at work in successful operational delivery groups (outlined in a previous post).
For me, it’s time to let go of the project and programme doctrine of time based pull and feel the gravitational pull towards achieving benefits. I know that a critical path or thoroughfare to achieving benefits will be much more effective in accelerating change, but it will be challenging to persuade those expecting a time based critical path, that this is really what they are asking for.
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