Bromley PCT

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

2. 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. Projects in context – old world Supplier Trust Your project Requirements Responses and delivery Approval and performance management Support and standards SHA Information Authority

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

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

6. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. Questions ?