March 2006

Bromley PCT

Deployment of Connecting for Health PACS

A Programme Manager’s viewpoint

Geoff Broome

March 2006

Agenda

Context and rolesPACS: Why bother?Lessons and challenges– What was hard work– What would we do differently– What we could have been better at

Questions

March 2006

Projects in context – old world

Your project

Trust

SHA

Supplier

Requirements Responses and delivery

InformationAuthority

Support andstandards

Approval and performancemanagement

March 2006

Projects in context – new world

Your project

Trust

Cluster

Legacysupplier

Connectingfor

Health (CfH)

Departmentof

Health

StrategicHealth

Authority

LocalService

Provider (LSP)

LSP supplier

March 2006

Projects in context – new world – it gets worse!

Your project

Trust

Cluster

Legacysupplier

Connectingfor

Health (CfH)

Departmentof

Health

StrategicHealth

Authority

LocalService

Provider (LSP)

LSP supplier

March 2006

Context and roles (1)

PACS was an afterthought in national programme– no Trust level input to negotiations– anything in “too hard/ risky” or “can’t assess”

column given to Trusts– Trusts categorised as S/M/L

CCA role– between supplier and Trust– contractual risk and margin management– had to sign off changes without knowledge of

context

March 2006

Context and roles (2)

Cluster role– was CCAs “client”– programme management with CfH interests

driving them

Trust role– bigger than anticipated – not always clear – negotiated by others

March 2006

Context and roles (3)

Philips role– supplier with hands tied behind back– forced to work through CCA– no direct contact with the Trust allowed

March 2006

PACS: Why bother? (1)

Strategic flexibility/ position – to grow, distribute diagnostic services– better (more multi-disciplinary) practice

• ease of getting others involved

– many risks held outside Trust level

Patients want (expect) it– may influence GPs referring behaviour

Clinicians wanted it– decision support system– better (flexible) working conditions for staff

(recruitment/ retention)

– Qudos

March 2006

PACS: Why bother? (2)

It is working and is free to air (albeit with large project costs)Will differentiate Trusts that have it as “forward thinking” for a while at leastUltimately will improve departmental efficiency with knock on effect in wider hospital– investigations/ radiology department employee– cancelled appointments/ repeat tests due to

mislaid images– Average Length of Stay (ALOS)

March 2006

PACS: Why bother? (3)

If you are not doing anything else you will learn about the programme

Some of the lessons are being learnt and should make later projects easier!

March 2006

What was hard work (1)

Agreeing plan (inc. technical details) and who owns it– roles, governance, configuration management

Getting through CCA/ cluster to the supplier– many more relationships to be managed

Educating CCA about the NHS– role of doctors and the need to listen to them– clinical risks and why we try and minimise

them

March 2006

What was hard work (2)

Educating CCA (in particular) about the need to get user acceptance for systems to workGetting past the “contractual” in order to deliver an acceptable local solutionStopping them “presumptively closing” re acceptance and moving on to new projects– managing the move to later phases– support in a business as usual world

March 2006

What was hard work (3)

Identifying all users and roles

Gaining respect for role of Project Board and ensuring that suppliers and cluster do not circumvent it

March 2006

What would we do differently (1)

Engage non-Radiology users earlierThink about partner relationships which may be impacted – especially if you are a supplier of diagnostic

services

Have better test plans and insist on themEngagement of operational management earlier and in more detail, especially re workflow design

March 2006

What would we do differently (2)

Engagement of information governance specialists earlier to ensure access policies and disaster recovery issues are tackledAgree business plans with clear funding sources and contingencies before the project starts– including backfill

Think about how junior doctor rotation should be managed vis a vis training

March 2006

What we could have been better at (1)

Analysing Trust side responsibilities and ensuring we had the funds and capability to deliverCommunications especially outside RadiologyAllocating dedicated training facilitiesWatching our audit trail and ensuring good configuration management on our side

March 2006

What we could have been better at (2)

External relationship building– differentiating the must win battles from nice

to haves– being prepared to help external parties

Getting specification nailed down, changes were difficult to agree, caused delays and were expensive

March 2006

Summary – take home messages (1)

Insist on role as customer but don’t try to fight on all fronts at once– try to understand and come to terms with the

supplier/ cluster/ SHA/ CfH side– use PRINCE2 to make sure that suppliers stay

focussed on your agenda and managerial attention on issues is sustained

• keep the focus on your Project

Make sure you manage your own side well, do not give them weapons– be persistent and be prepared to repeat yourself or

change audience– do not select purely “administrative” project

managers

March 2006

Summary – take home messages (2)

Pick strong and knowledgeable “Senior User(s)” or “Business Change Managers”– expose all external parties to vociferous but

articulate users– listen to them, but be willing to challenge

appropriately in right setting

It’s our programme let’s fix it

March 2006

Questions

?