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)

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…..

Time-Quality-Money Triangle

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

Planning (Time) Tool – Critical Path Analysis

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

Planning (Quality) Tool – Specification of Project Outcomes

E.g. from MLAProject 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

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)

Planning (Money) Tool – The Budget Proposal

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)

Conducting (Time) Tool – the Gantt Chart

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!)

Conducting (Quality) Tool – Performance Indicators

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

Conducting (Money) Tool – the Budget Spreadsheet

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

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

Discussion

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

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

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

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

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.

Why Projects Fail - 1

1.  Lack of commitment/understanding from commissioners

2. Misalignment with organisational objectives

3. Seduction by new technology4. Failure to secure appropriate

quantity/ level of staff resource5. Incomplete project scope lacking

clear definition of the project's benefits and outcomes

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”)

TQM Exemplified

i.e. Money

i.e. Time

i.e. Expectation of Quality

i.e. Mismatch of Quality vs Time and Money

i.e. Mismatch of Expectation vs Delivery of Quality

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.