Seeking the approaches that enable faster change in the complex world of health and social care
How confident are you when you see a ‘sea of green’ on a project or programme progress report? The answer is probably more confident than you should be, the project may be absolutely fine, but if the focus of the green ratings is milestones, it could be masking huge problems. But why?
It’s because achieving milestones doesn’t mean that change is or will happen and it definitely doesn’t mean that the project benefits are going to arrive either. With the explosion of PMO functions in health and social care in the past few years (of which I have been a part), I’ve seen an increased and unhealthy focus on milestones and timescales to assure Boards.
So what’s going on? Simple, it’s student syndrome! Remember when you had assignments from College or University. Despite the early optimism and good intentions, when did you do them? For me and most people, the answer is the last few days before the deadline, and in these last few days/hours the quality and scope of what you initially set out to produce declines rapidly. So, you met the milestone and the world is green, but you’ve probably taken a risk on scope and quality. Usually this is fine for an assignment, but compromising quality and scope impacts on the achievement of real changes and the benefits that the project or programmes set out to achieve. So, a green milestone may hide that real change and benefits have been compromised and this won’t be evident until much later.
To illustrate this issue, I will describe a real situation from a few years ago, which although it seems extreme, isn’t that unusual in my experience. Our story starts with a high level of optimism around the integration of some disparate services to; create a much better experience for service users, reduce hospital activity and create efficiencies. A range of workshops and meetings produced a conceptual service model and a programme to deliver was initiated. In the development of the programme a service live date was set and communicated. A plan was created, savings and KPIs modelled, and the monthly multi page highlight reports showed a ‘sea of green’. A few months later the service went ‘live’ on time, everyone was happy, however over the following weeks it was clear that some stakeholders were beginning to doubt the service was all it was meant to be and the promised benefits clearly weren’t appearing. To cut a very complex and long story short, the work had been compromised right from the very start, and ended up using a meeting between groups of people as the justification for service ‘go live’, there was no truly integrated service. The temptation when under pressure, to compromise, was too great and reducing scope and quality became the way the work managed to keep on time and avoid senior level scrutiny. Unsurprisingly, the work achieved little and the programme re-initiated in a different form.
So what can you do? You can shift the reporting and decision making focus to to being primarily on benefits. Reporting in this way will look very different and will be challenging to achieve, but it will create conversations that focus on the right things. Decision making will also change, as decisions to meet a timescale versus those to achieve benefits may well be very different. Additionally, and I almost dare not suggest that a PRINCE2 management product would help, but it would! Product descriptions have helped me when they are focused on key milestones, outlining the scope and quality required to ensure the milestone is designed to meet the resulting benefits trajectory. These product descriptions create really helpful conversations when a milestone starts to look difficult to achieve.
Hopefully this article highlights the need for Boards, in particular, to be wary of green reports and PMOs to ensure reporting and assurance has breadth, which includes scope and quality of milestones, and a focus on benefits, otherwise boards could be entering the world of deluded optimism that comes from too strong a focus on milestones.