Depending on the scale and scope of the improvement(s) you are planning, it may be useful to follow a more structured, project management approach to implement changes.
Project management is relevant to quality improvement because quality improvement is all about change. Without change there can be no improvement, although it is important to remember that not all change leads to improvement. Experience suggests quality improvement (QI) projects in the NHS often lack robust project management.
Using a project management approach provides a structure within which to deliver a change and a framework to help ensure that the change is successful. Project management complements the delivery of quality improvement but in itself cannot guarantee the success of the improvement project.
A project is usually defined as a set of activities, with definite starting and finishing points, undertaken and coordinated by an individual or team to achieve specified objectives.
Project management is a discipline following a defined way of managing this change. It involves planning, organising, securing, and managing resources sometimes as part of a larger programme, and using specific tools and methods.
Projects are usually characterised by the following:
- Specific objectives or goals
- Deliver a beneficial change and improve quality
- Temporary, with a defined beginning and end
- Have a number of constraints (scope, quality, timescale and budget)
- Include interdependent activities which need to be managed and coordinated
- Involve multidisciplinary teams comprised of people who may not normally work together.
There are a number of common project management methodologies used in organisations such as PRINCE2 (PRojects IN Controlled Environments) and Lean. This website does not go into detail on each but instead provides basic information and tools that will help you to manage your project
Projects usually go through a lifecycle of: Initiation, Planning, Delivery, Evaluation, Closure. Certain tools can be used at each stage.
The first phase is where the necessary analysis is undertaken to allow the project to be planned. Key activities undertaken during the project initiation phase include:
- Agree project objectives, scope and deliverables.
Create project initiation document (including deliverables, resources, risks, governance and so on). Download a project charter here.
Identify the project team and sponsor. You’ll find more on leadership here.
NB: The sponsor is the person who is responsible for the project to be delivered successfully and therefore has a critical role in the planning and delivery of the project.
- Gain approval to move to the next phase.
- If possible, create a project management space/ room as hub for sharing and displaying information as well as team meetings.
Planning is a critical phase and adequate time and resource should be spent to ensure this phase is completed. This phase involves creating ‘live’ plans to guide the project team through the phases of the project, manage time, resources, risk and issues.
A project plan sets out the activities that need to be undertaken, the expected timescales and the individual responsible for completing each activity. If the project is very large in scale, additional action plans breaking down smaller tasks might be helpful. The plan should be viewed as a live document and reviewed on a regular basis to ensure that delivery of the improvement is on track. A project workbook template is available here for you to download.
- Minchinhampton: recall of patients needing 6-monthly review
- Inefficient utilisation of specialist clinical capacity
Driver diagrams or logic models are useful to provide a visual overview of the project inputs through to outputs.
Risk and issues will need to be identified and logged. You can do this in the project workbook.
In this phase, the change defined in the Project Charter will be undertaken. Delivery involves coordinating people and resources, as well as integrating and performing the activities of the project in accordance with the project plan.
Any project planning documents developed during the initiation and planning phases, such as the project charter, project plan, A3, risks and issues register, and benefits realisation plan, driver diagram should be continually updated and monitored against throughout the delivery phase. Regular reporting through the planned governance channels is important to provide assurance that the project is on track.
Project evaluation is a process of collecting, recording and organising information about project results and lessons learned for future projects which are captured during the closure phase. Independent evaluation may also be conducted.
- What progress has been made?
- Were outcomes achieved?
- Do the results justify the project inputs?
On project completion it is necessary to close the project. This is important on a practical level to ensure that all loose ends are tied up and that stakeholders are satisfied with the outcomes of the project.
For sustainability beyond the project, it is important to ensure stakeholders have accepted all outcomes, operational procedures, documentation and materials are in place and handed over to operational staff, and that actions and results are documented and disseminated to relevant people.
In addition to the practical considerations it is necessary to ensure that any learning from the project is captured so that it can be used to inform other projects in the future. Find out more about evaluation here.
- Mind Tools
- Project management workbook
- Benefits realisation planning – a succinct overview with template
- IHI Open school – course QI 104: The Life Cycle of a Quality Improvement Project
- IHI Open school – course PS 103: Teamwork and Communication