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A TQM (Time-Quality-Money) Approach to Managing Projects in Health Care

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  1. A TQM (Time-Quality-Money) Approach to Managing Projects in Health Care Andrew Booth, Reader in Evidence Based Information Practice, Director of Information Resources & Programme Director - FOLIO Programme (A.Booth@sheffield.ac.uk)

  2. For most people TQM = Total Quality Management But when I learnt about Time Quality and Money everything I had experienced around project management fell into place…..

  3. Time-Quality-Money Triangle

  4. Planning the Project - Time • Allow for lead-in/start up time (e.g. recruitment/training) • Allow for contingencies • Plan for an earlier deadline and work back • Identify critical dependencies (minimum time for project is length of longest path) • Allow for evaluation

  5. Planning (Time) Tool – Critical Path Analysis

  6. Planning the Project - Quality • Clearly define quality within scope • Resist “scope creep” • Be explicit about constraints • Keep cross-checking expectations of team versus expectations of commissioners • Include both Process and Outcome Measures • Be SMART – Specific Measurable (objectively) Appropriate Realistic and Time-Bound

  7. Planning (Quality) Tool – Specification of Project Outcomes E.g. from MLA Project outcome meeting compulsory programme outcome • A group of three representatives of elderly people and their carers have been invited to sit on the management committee for the local library and are involved in the planning and strategic management of the service and its delivery. The group will meet quarterly for three years. Project Milestones • Recruit project Manager by Mar 09 • Start on site October 08

  8. Planning the Project - Money • Fixed Costs (Infrastructure/Employed Staff etc) • Variable Costs (Consultancy/Activity-related etc) • Heat/Light/Space and Other Indirect Costs • Inflation/Pay Increases • VAT/Overheads • Consider not just resource but timing (e.g. Staff Training mainly Year One; Dissemination mainly Year Two)

  9. Planning (Money) Tool – The Budget Proposal

  10. Carrying out the Project - Time • Build in both Internal and External Milestones • Put in a regular programme of meetings (you can always drop some if there is nothing to action/report) • Look for opportunities to “telescope” timescales • Be alive to opportunities to substitute action for unanticipated inaction (e.g. a postal strike, non-delivery of equipment etcetera)

  11. Conducting (Time) Tool – the Gantt Chart

  12. Carrying out the Project - Quality • Build in lots of “checkpoints” • Share “work in progress” with commissioners • Be clear about your expectations from the commissioners (If we are to do……we need you to do…..) • Be honest and open about external constraints (but otherwise be like a Swan!)

  13. Conducting (Quality) Tool – Performance Indicators

  14. Carrying out the Project - Money • Build in monthly review of expenditure – include committed and actual • Look out for opportunities for Casual Labour, Secondments, Work Experience • Ensure that any underspends are redirected within the project • Be honest and open about any unanticipable changes to budget assumptions

  15. Conducting (Money) Tool – the Budget Spreadsheet

  16. Monitoring the Project – Time, Quality and Money • Try to make review meetings synoptic (i.e. to consider Time, Quality and Money together) • Plan the Evaluation right from the beginning – data requirements and key informants • Make Progress Reports useful, not simply an added Task – what do I want to achieve, what support do I need • Use the Management Tools above to Identify Problems/Potential Problems • Use the Team as a Resource for Problem-Solving

  17. Contingency planning – What do you do if you hit Time, Quality or Money Problems? Discussion

  18. Contingency Planning Time • Delegation • Overtime payments • Alternative methods to obtain outcome (e.g. telephone interviews instead of questionnaires) • Redeployment (from elsewhere) • Redistribution of roles/responsibilities (internal) • Rollover to a subsequent phase • Renegotiation with commissioner/stakeholders

  19. Contingency Planning Quality • Redeploy more experienced/qualified staff • Prototyping, modelling and piloting – same quality but proof of concept • Revise customer expectations • Sound documentation of deviation from project plan and likely implications

  20. Contingency Planning Money • Substitution – same job be done by someone who is paid less? • Subsidy – utilise hidden resources from elsewhere • Economy of scale – combine with a related project • Designate as a loss leader

  21. Case Study A – REALISE Projects Box 1 Summary of dimensions covered by REALISE checklist. • Involvement • Information needs analysis • Specification and purchase • Installation • Marketing and publicity • Project support and (personal) networking • Monitoring • Impact • Staff development • Consolidation • Evaluation methods

  22. Case Study B – Trent Evaluation Learning Needs (Handled through Action Learning Set) • Roles and Expectations • Information needs – (Questionnaires/Interviews) • Web design, • Obtaining funding • Evaluation, • Stakeholders and Marketing.

  23. Why Projects Fail - 1 1.  Lack of commitment/understanding from commissioners 2. Misalignment with organisational objectives 3. Seduction by new technology 4. Failure to secure appropriate quantity/ level of staff resource 5. Incomplete project scope lacking clear definition of the project's benefits and outcomes

  24. Why Projects Fail - 2 6. Lack of attention to project planning. 7. Mismatch (or dislocation) between costs and benefits (“bangs for your buck”) 8. Insufficient funding and incorrect budgeting to meet expectations. 9. Absence of appropriate project management techniques. 10. Lack of knowledge transfer of lessons learnt (“passing the baton”)

  25. TQM Exemplified i.e. Expectation of Quality i.e. Money i.e. Time i.e. Mismatch of Quality vs Time and Money i.e. Mismatch of Expectation vs Delivery ofQuality

  26. References • Booth, A (2000). Making a case. In: Booth, A & Walton G (Eds). Managing knowledge in health services. (pp. 112-121). London: Library Association. • Booth A. (2002) On a cautious adoption of innovative projects. Health Information & Libraries Journal 19(4):239-42. • Booth, A., Sutton, A. & Falzon, L. (2003) Working together: supporting projects through action learning. Health Information & Libraries Journal 20 (4 ) : 225-231. • Booth, A (2004) Managing projects. In Walton, G. & Booth, A. (Eds) Exploiting Knowledge in Health Services (pp. 115-124) London: Facet Publishing. • Falzon, L. & Booth, A. (2001) REALISE-ing their potential?: Implementing local library projects to support evidence-based health care. Health Information & Libraries Journal 18 (2): 65-74.