1. March 2006 Bromley PCT Deployment of Connecting for Health PACS A Programme Manager’s viewpoint Geoff Broome

2. March 2006 Agenda Context and roles PACS: Why bother? Lessons and challenges –What was hard work –What would we do differently –What we could have been better at Questions

3. March 2006 Projects in context – old world Your project Trust SHA Supplier RequirementsResponses and delivery Information Authority Support and standards Approval and performance management

4. March 2006 Projects in context – new world Your project Trust Cluster Legacy supplier Connecting for Health (CfH) Department of Health Strategic Health Authority Local Service Provider (LSP) LSP supplier

5. March 2006 Projects in context – new world – it gets worse! Your project Trust Cluster Legacy supplier Connecting for Health (CfH) Department of Health Strategic Health Authority Local Service Provider (LSP) LSP supplier

6. 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

7. 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

8. 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

9. 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

10. 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 least Ultimately 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)

11. 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!

12. 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

13. March 2006 What was hard work (2) Educating CCA (in particular) about the need to get user acceptance for systems to work Getting past the “contractual” in order to deliver an acceptable local solution Stopping them “presumptively closing” re acceptance and moving on to new projects –managing the move to later phases –support in a business as usual world

14. 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

15. March 2006 What would we do differently (1) Engage non-Radiology users earlier Think about partner relationships which may be impacted –especially if you are a supplier of diagnostic services Have better test plans and insist on them Engagement of operational management earlier and in more detail, especially re workflow design

16. March 2006 What would we do differently (2) Engagement of information governance specialists earlier to ensure access policies and disaster recovery issues are tackled Agree 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

17. March 2006 What we could have been better at (1) Analysing Trust side responsibilities and ensuring we had the funds and capability to deliver Communications especially outside Radiology Allocating dedicated training facilities Watching our audit trail and ensuring good configuration management on our side

18. 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

19. 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

20. 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

21. March 2006 Questions ?