THE FAILURE OF THE NATIONAL HEALTH SECTORS’ (NHS’) CIVILIAN IT PROJECT OF UNITED KINGDOM
The National Health Service (NHS) is the worlds’ largest and oldest publicly funded healthcare system which originated in the United Kingdom. They expanded their capacity by embarking a national programme for IT which was originally budgeted approximately 6 billion pounds. The project was aimed to use the technology productively by paving the IT systems to integrate with health care facilities, records, documentations and health care services across communities and health care providers. This was expected to reach a standard as the world’s largest civilian IT system. The projects failure is magnificent that the expertise feels the need to recognize the NHS civilian IT project as the “Biggest IT failure in the history of mankind which caused a scandalous waste of public funds”.
The programme was abandoned officially in 2011 by the Liberal Democrat Government of UK after the history of its performance deficiencies, reported delays, implementation issues, and stakeholder conflicts. The major downfalls of the project were technical problems, changed specifications, less communication / disclosures among responsible parties, inadequate preliminary research, ineffective planning and simply the visionless leadership and poor project management which ultimately doomed the existence of this project.
Success in Project Management
How to manage a project: Limit it in scope. Make it simple. Get success. Then literate.
The success of a project cannot be clearly differentiated from failure as there is no common definition used to explain the term “project success”. It is important to have a clear and agreed definition of what constitutes project success as it can be used as a guiding light to focus projects to reach desired outcomes.
Simply the classic text book definition for a project success is the ability of a project to achieve all the originally agreed project objectives decided over the scope, regardless of the budget and the schedule performance. But since there is a clear visibility on the budget and schedule people tend to believe the project success really is the ability to deliver the product of the programme on schedule within the agreed budget. The project sponsors’ perspective toward the project success may differ as it is decided on the ability of the product produced by the programme to create a significant net value after the project is completed. The differing perspectives of the society over project success are a clear sign of the fluidity of the idea and its possibility to change over time.
Figure 1. Layers in project success
Many organizations experience project failure due to a small loop hole in the system and few pitfalls which are enough to create disasters which ultimately end up by sinking the project. The definition of the project failure vary as there is no agreed explanation for the term as well. There are many causes of project failure and every case have its own personalized set of reasons. Minority of the causes will be a single trigger event that lead the project to fail. But most of the situations it is a complicated entwined set of problems which ultimately results in failure (Ducan, 1996).
Despite all the reasons the culprit behind the project failure is poor understanding of project management by all the parties involved with the project, specially the management and the leadership. According to the PMBOK (Project Management Body of Knowledge) guide, which is the most widely applied theory of project management, the central idea of the project management is a closed loop. It divides project management into components like initiation, planning, controlling, execution and closing processes. Among the components core processes are identified as planning, controlling and execution (Ducan, 1996).
Figure 2: Project management
Source; Developed by the Author
Project failures are resulted due to poor preparation of the organization toward the project which expresses a failure in the planning stage. Mainly the lack of early disclosures of expectance of the cost, time, product quality and other relevant information with responsible parties like stakeholders is the reason for the poor understanding on scope planning, resource planning, cost estimation and project plan development, which ultimately disrupts the bloomingof success in the initial stage of the project management.
The theory of execution provides the interface between plan and work. It lies between the decision which was largely taken care of under planning and delivering of the assignment to the work station. Most of the reasons for project failures are reported in this stage, sincein this section the technique or plans produced are applied and the project is at “action”. The overall control and performance reporting are considered the major sub processes. Any issue in the stage of control will create extensive problems since troubleshooting was not carried out as it is the main responsibility at this stage.
The sources like database of “catalogue and catastrophes” evident many failed projects around the globe due to various reasons which brings to our attention that most of the organizations in the world including government projects have implemented poor project management strategies and ended up delivering failed projects. This issue should be addressed significantly as it squander the resources and a waste of time.
1.3 The NHS’ Civilian IT Project Of UK
This national program for IT in the national Health Sector (NHS) was the largest publically funded health care system ever attempted in United Kingdom (UK). It was budgeted approximately 12 billion pounds with the funding of tax payers (White, 2008).
The project was a network infrastructure designed to maintain services like an electronic patient record (EPR) systems, computerized referrals, service selection and booking system and prescription systems(Borrielloet al 2007). The EPR carries information important to individual patient including patient’s medical history. Health professionals were granted secure access to EPR records by which they believed that the project will improve emergency care and will keep health professionals updated with the upcoming & effective treatments(Campion-Awwadet al. 2014). The diagnostic imaging system in the project facilitated storing and exchanging of electronic prescriptions and X-ray images and software was used for selecting and scheduling consultation (White, 2008).
It is often considered as the would have been the world’s largest civilian computer system as it turned out to be the worst and most expensive project failures of the history of UK’s public sector. The project was launched in 2002 and was dismantled in 2011 due to its failure (Campion-Awwadet al. 2014).
Objectives of the project
- Develop personalized health system
- Improve emergency care through online information services and telemedicine
- Analyze performance of health care services including hospitals
- Update treatments for patient and health care professionals
- Improve the accumulation and circulation of information on public health
- Mapping of diseases based on prevalence and epidemiology
- Mapping of treatments
Failure of the NHS’ Civilian IT Project
According to the perspective of the PMBOK guide, this project has failed on its all the three stages of planning, execution and control.
Table 1: Issues of NHS Civilians IT project according to the PMBOK guide
|Planning stage||Execution stage||Control stage|
|Poorly defined project scope||Inadequate risk management||Lack of detailed documentation|
|Poorly defined roles and responsibilities||Project managers who lack experience and training||Failure to track progress|
|Failure to identify key assumptions||Less effectiveness of formal methods and strategies||Disregarding project warning signs|
|Lack of detailed documentation||Lack of effective communication at all levels||Inadequate testing processes|
|Lack of detail in the project plans||Ineffective leadership||No change control process|
|Inaccurate time and effort estimates||Lack of detailed documentation||Failure to understand or address system performance requirements|
|Poor Preparation||Failure to track requirements|
|Failure to define parameters and enforce Them||Cultural differences in global projects|
|Inaccurate cost estimations||Inadequate documentation and tracking|
|Lack of organizational support||Lack of prioritization and project portfolio management|
|Insufficient resources (funding and personnel)||Stakeholder conflict|
|Unrealistic timeframes and tasks||Overruns of schedule and cost|
|Undefined objectives and goals|
Originally an ambitious programme turned in to a system wide failure,was based on many reasons including its so much haste and less speed.The base and the preliminary work needed to properly establish the programme was not adequate enough. The system was not tested often and there was no way to check the progress with the expected objectives.The unrealistic time table of the project allowed little or no time to engage with campaigners which lead to lack of the necessary amount of consultation with the key stakeholders leading to failure in managing confidentiality issues of the project. The issue was addressed at that time by the British Medical association on the EPR for publicizing the patient information and for putting the privacy at risk (Borrielloet al 2007). This was resulted due to stakeholder oppositions and due to the less time allocated for consultation which was caused by excessive speed or urgency of actions prioritized for policy making, implementation processes and procurement by certain parties to benefit from the programme (Campion-Awwadet al. 2014).
Also the weak leadership of NHS is responsible for the poor accountability of the projects’ performance. Some of the issues could have been solved in their initial stage if the project leadership and management reached for the consultancy of health professionals. The skills are considered poor in the project team as it lacked a clear direction (due to poor leadership), strategies and management. Furthermore, at that time the culture within the department of health in UK itself was not properly trained to conduct swift identification, strategic correction and lacked the technical knowledge to identify errors. The training given for the users to properly handle the system was not adequate enough (Campion-Awwadet al. 2014).
The projects’ original intents was not delivered by the management as expected since the targets were reported to not achieve on time which showed that there was a clear issue in the functionality of the project management. In the NHS civilians IT project, separate managements were not maintained for component parts to have an accountability structure with in the programme design, which lead to drain the project from the its initial stage of the designing (Schaffhauser, 2007).
Also, the perspective of the management was not effective and lacked the transparency for stakeholders and other responsible parties as it did not reveal minor details to complicated matters like how the actions contribute to achieve the goals set to the project (Cooper, 1993).
Certain facilities of the programme were delivered successfully when some other important elements were delivered with greater difficulties. The EPR system which is the major feature of the programme encountered delays in developing and was not effective enough (Schaffhauser, 2007). Most important and the major goal in a proper project management system is to get the intended product produced which was not successful in this project as the EPR system itself showed major complications and issues in delivering the service to the registered users (Cooper, 1993).
The model of the project was considered overambitious, narrow and centralized since it has not given much importance for user satisfaction and confidentiality as the design was more focused toward cost cutting and prompt adaptation to the local level (Campion-Awwadet al. 2014).
Internal goals like cost minimization and level of utilization was applied in the wrong departments of the programme as the cost cutting lead to less user satisfaction and confidentially issues. The quality of the organizations work was treasury emphasized over price (Campion-Awwadet al. 2014). As the project did not give much importance to customer expectancy for quality and flexibility it failed to achieve even the external goals allocated for the project (Cooper, 1993).
There was also an uncertainty around estimation of cost as it was informed at the launch of the programme that the project budget will be a 6.2 billion pounds which was then later changed to 12.7 billion pounds. The uncertainty of the cost of the national programme was again displayed with the resent statement that the total forecast of the project is 9.8 billion pounds. A proper estimate is not given by the parliament on what has been exactly delivered by the substantial amount of money invested on the project (Daniel Martin 2011).
The triple constraints (scope, schedule and cost), are considered the most significant restrictions of a project. These facts along with the time, quality and risk management were very poor in this project as it clearly lacked the department of management.
Table 2: Project management perspective over the failure on NHS Civilian IT project
|Layers of Management||Root causes of the NHS Civilians IT projects’failure|
|Scope||The scope of an organization is its relevant extent of subject matters. The NHS’ IT projects’ management lacked the knowledge and the extent of the area the project is capable to cover. The continuous change of the aim of the organization is a visible prove for its lack of scope management. The unavailability of an exit plan for the project and having no alternative also support its deficiencies. There was a problem over the implementation of the programme parallel to the culture and skills at that time. There was a clear less understanding of the managementas they were unaware of the issue and did not take actions as providing necessary training to the users of the programme. Inadequate preliminary work and unrealistic nature of the time frames also supports the above argument (Campion-Awwadet al. 2014).|
|Schedule||The time table of the project was not properly managed. The time frames of the project was not effective enough as their nature appeared unrealistic and not up to a standard good enough to cope up with the work load|
|Cost||The estimated cost of the budget was increased from its original estimations over the years as it was originally approximated to be 6 billion pounds which was then later topped up to an even 12 billion pounds. A cost cutting was carried out in the most important features of the project which lead to an emphasis on price over quality.|
|Time||Less time was allocated to maintain disclosures among important stakeholders as the project gave priority to policy making which ultimately lead the project to drain as important issues were not addressed to improve the projects’ performance.|
|Quality||The quality of the project was not good as they failed to check progress against organizations’ expectations. The main features of the programme was debilitated due to cost cuttings and poor management which lead to customer dissatisfaction over the quality of the service provided by the project. The confidentiality issue and lack of privacy were considered the most prominent issues of the quality of this programme. Often the users complained the system was very slow and time taken to address a patient took more time than the normal procedures. The management was unaware of the issue and therefore, the issue was never taken care of. They failed to recognize the fact that if the projects quality is not up to a standard, there is a possibility of taking it over by a new technology (Campion-Awwadet al. 2014).|
|Risk||The project failed in risk management as it did not perform risk assessments to identify the possible risks.|
EVALUATION OF THE EMPLOYEE PERFORMANCE IN AN ORGANIZATION WITH A GOOD PROCESS USING THE NORMAL DISTRIBUTION CURVE OF TALENT (THE BELL CURVE)
Many organizations in the todays’ world make use of the bell curve for their employee evaluation process. They choose to reward the top performers which is mostly a small percentage, motivates the larger majority of mediocre achievers and guide or lay off the lower performers.
The measure statistics are often criticized and remain a controversy among expertise on the matter. Even though the so called “myth” had substantially helped some organizations who are equipped with a good process system. The theory behind this situation is basically the good compatibility between the process system and the positive attributes of the bell curve.
The normal distribution curve, also called as the “Bell curve” is basically a performance categorization in a form of a trigonometric plotappears in a bell shape which is used vastly by certain organizations that believe in the concept of paying for motivation and performance exhilaration. It is considered as the best scale to understand and implement evaluations on employee performance. Since it literally divide employees in to categories, it is also considered as the “forced ranking system for appraisal”.
The bell shaped graph accounts more than 50% on mediocre performance in the middle when the exceptions show an equal or non-equal distribution on the sides of the slope. The right skewed bell curve represent lenient rating which shows the high rating employees. The mediocre performers’ also tent to lean toward the lenient scale. The left skewed bell curve represent strict ratings which shows the cluster of underperforming employees.
Figure 3: The Bell Curve
2.2 Advantages of the Bell Curve
The plot was designed based on the outcomes observed and data collected by the human resources (HR) department of the particular organization over a long period of time. This strategic distribution of employee talent helps to reward the best performers with a higher pay and other benefits. They believe that the better performer get the better pay and that encourage the employee to work with a focus to help reach the company goals by boosting the confidence over his/her talent.
The high payment and the added benefits given to the top performers was used as a bait on rest of the employees where it encourage and motivate the average / mediocre workers to increase their performance, identify poor performers in order to guide them and to lay off the non-performers.
This performance appraisal system was a highly questioned matter and yet have proven to show good results over some organizations which adapt the system as it has helped the organization to face evolution in the business world. It is a practical approach toward improvement as it enforce accountability on the employees to be the best and which in substantial return help the organization with success.
2.3. Disadvantages of the Bell Curve
The bell curve is accompanied with contrivances as some experts’ define it as a myth. Also there are speculations over the serious disadvantages of the bell curve as it has proven to damage the growth of certain organizations. The major issue discussed under that matter is the rigid approach of the bell curve when it categorize the employees in to a scale of performance. Often it is recognized not practical when the number of employees in the organization is too small and results are considered erroneous.
The humanitarian effect is criticized due to many reasons including its effect on the confidence of the employees who were categorize as average, poor and non-performers as it is believed that sometimes the employee feels discouraged due to the discrimination. Also the unnecessary competition build upon the performance category is often described to develop stress among employees and destroys the harmony which effects when working as a team. Since the morels are disrupted, employees tent to doubt their job security with the tough job market conditions which may further deteriorate the performance of the employee.
2.4. Organization with a Good Process
The above mentioned negative aspects of the bell curve are mostly influential only if the organization carried defects like having a weak process. These defects of the organization do not create a supportive environment to take in the results of the bell curve as points to improve, instead it is apprehended and applied as features of defeatists.
Process is simply the tasks needed to reach the objectives of an organization. The process is effective (a good process) only if the tasks are given a value and if the objective is strongly aligned with values and the strategy. 5. There are many theories which explains a good project processes and they provide a powerful lens when used as a cluster to understand the organizations and its managements. According to the theories, a good process is developed with the foundation of a good process model. 5. The key principles of a good process model of an organization are,
- An effective structure of the process
- Management of the employee performance
- Continuous Improvement
- Continuous monitoring
- Business strategies aligning with the tasks to achieve the objective
- Values attributed to tasks used to achieve the objective
- Documentation of fact and data
- Implementation and amending the management
- Use of technology- IT Alignment
These process models help to provide an appropriate and intermediate level of analysis, showing insights to behavior of management. Process measures come in various forms including process efficiency, customer effectiveness, service quality, and product quality and employee performance. Tools are required to find this measures and to put a value for the tasks to reach the objectives of an organization equipped with a good process. One such measure is the bell curve used to analyze employee performance and talent.
If the bell curve is applied on such kind of a so called “organization with a good process”, there is a high possibility of that organization benefiting from it as there is a need to value the tasks when reaching the objective of the improvement in employee performance.
2.5 Employee Performance due to Pressure
When an organization use bell curve for performance evaluation, it is recommended to maintain the balance with pressure which is considered difficult to strike. Organizations armed with good processes achieve that successfully by maintaining the layoff issue of non-performers separate from the performance evaluation (Repenning & Sterman, 2001).
Figure 5: Effect of the pressure on performance.
The situation will be maintained as appears, since underperformers feel the need to perform well due to the pressure and reward and reputation to keep up the performance of the top performers.The good process will allow the underperformer to reach his/her maximum potential and yet will not reach the tipping point of becoming unbearable. When and organization is not guided well, it tries to operate beyond this point, making the underperformers to build up stress and drop the effort to perform well (Repenning & Sterman, 2001).
2.6 Balance Pressure and Morale Using a Good Process
Under the good process theory, other than using measures like bell curve figures as tasks with an value to improve the employee performance, it maintain other tasks along with it to successfully reach other objectives of the organization. These other objectives include developing effective tasks to create the balance between the pressure created among the employees and to maintain a good moral system within the organization to make the performing employees feel more welcome and secure. The good morale helps even the most demoralized employer to feel motivated as higher the morale better the performance (Repenning & Sterman, 2001).
Such kind of an organization provide the backbone to get the maximum benefit from the bell curve and to overcome its pitfalls. The forced ranking helps the management to evaluate the performance of the employees and to reward the top performers in these organizations as supposed. Since the organization underpinned with a righteous support system other employees do not misunderstand the concept as discrimination. They tend to see the positive aspects and understand it as a challenge and get motivated. Since the performing employees were granted with the job security, they try to achieve the challenge rather than taking stress or negativity. Since initiatives were managed to retain the employees within the company, the organization can develop their growth and career plans accordingly. That helps to retain the best within the organization while climbing the ladder of success (Repenning & Sterman, 2001).
These organizations will see laying off as an option and will work on digging the best out from the under performer. Since the perspective of the organization is different, it will guide the underperforming employees and will allocate them with a suitable position desired to the level of capabilities. Also this is used to correctly allocate the employee with the types of trainings required. HR interventions along with the rank evaluations can be used to find proper positions for such employees. This approach helps HR to deal with employee development effectively as career plans of the employees can be mapped and matched with their capabilities, which ultimately illuminate the strength of the organization.
As a summary, when the bell curve is used to analyze the talent of the employees, it anyways affects the overall performance of the organization. When the pressure build by the evaluation is maintained properly below a certain level, it can increase the performance of the employees. The decoupling of the performance evaluation with the layoff issues can be maintained by keeping the pressure in an optimal level with a high morale. If the organization is armed with good processes it keep the balance between the pressure and morale in check.
Borriello, G, Stanford, V, Narayanaswami, C. & Menning, W 2007, “Pervasive Computing in Healthcare”, IEEE Pervasive Computing, Vol: 6, no. 1, pp 17-19.
Campion-Awwad, O, Hayton, A., Smith, L. & Vearan M. 2014) The National Programme for IT in the NHS, A Case History”, MPhil Public Policy 2014 –University of Cambridge, pp 1-47.
Cooper, K 1993, “The Rework Cycle: Why Projects Are Mismanaged”. pmnetwork, 5 – 7.
Duncan, W 1996 A Guide to the Project Management Body of Knowledge”, PMI Publications’, Sylva, 176.
Martin, D 2011, ‘£12bn NHS computer system is scrapped… and it’s all YOUR money that Labour poured down the drain’, Mail online. Available from: <http://www.dailymail.co.uk/news/article-2040259/NHS-IT-project-failure-Labours-12bn-scheme-scrapped.html#ixzz4ZZLfmi4a>. [22 September 2011].
Repenning, NP & Sterman, JD 2001 “Nobody ever gets the credit for fixing problems that never happened: Creating and sustaining process improvement.” California Management Review, Vol: 43, no. 4, 64
Schaffhauser, D 2007, The VA’s Computer Systems Meltdown: What Happened and Why”. ComputerWorld, pp 3- 12
White, RE 2008, “Health Information Technology Will Shift the Medical Care Paradigm”. Journal of General Internal Medicine’, Vol: 23, no. 4, pp 495–499.