Assignment Cover Sheet

Centre name School of Higher Education (SHEL)

Learner name Jessica Forbes

Membership number 2116482

Word count 2400 words

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Date: 29.7 .22

Executive Summary

The National Program for IT (NPfIT) in the National Health Service (NHS) was the largest public sector IT
program ever attempted in the UK.The originally budget for the program was approximately £6 billion from
major contracts. These contracts were awarded to some of the prominent contractors in the IT industry
(Accenture, CSC, Atos Origin, Fujitsu and BT). The project had numerous delays, stakeholder opposition and
implementation issues and was mostly a success. This caused the project to be dismantled by the Conservative-
Liberal Democrat government in 2011. This is approximately 10 years after Prime Minister Tony Blair
initiated it at a seminar in Downing Street in 2002. The core aim of the NPfIT was to ensure that the NHS was
equipped with information technology for 21st century environment.

The expectation of this introduction was for an integrated electronic patient records systems, online ‘choose
and book’ services, computerized referral and prescription systems and underpinning network infrastructure.
Once implemented this would have made an efficient system and a faster and efficient way for citizens to
access health care. Despite the failure of many of these services for taxpayers, the project incurred significant
costs for the program including contract transition and exit costs which cost a total amount of more than £10
billion.
Table of Contents:

Introduction page 2

Project Management Failure page 4-5

Operation Management Failure page 6

Risk Impact Matrix page 7

Risk Assessment page 8

Total Quality Management page 9

Reference page 10-11

Introduction

Technology is the application of scientific knowledge for practical purposes (Hersh,2009). Technology can
be used as a driver for development in an industry but once not managed, technology can also be the detriment
of a company.

The main reasons for the failure of this project were issues with data management, patient confidentiality, and
missing deadlines (Poole, 2011). The UK government decided to cease the project when the expenditure had
soared above the £11 billion budgeted allocation. Primarily the main problem was due to the fact that some
suppliers did not have the capabilities that were needed to do what was actually required (Smith, 2011). These
incompetent suppliers were not capable to be a part of the project and caused missed milestones and deadlines.

Project management is the process of leading the work of a team to achieve project goals within the given
constraints. This information is usually described in project documentation, created at the beginning of the
development process (Schwalbe, 2009)

PM Failing 1: Unclear Objectives

There are a number of reasons why NPfIT failed and it is primarily due to poor planning and unclear
objectives. The project had numerous risks during the tenure of the contractor and after the changing on the
various contractors. The NPfIT lacked clear direction, project management and an exit strategy, meaning that
the setbacks of pursuing such a program quickly turned into a system-wide risk with numerous failures. Failure
to learn from past mistakes due to inadequate project planning is a major concept to prevent industries from
failure from new processes (Hall ,2009). Arguably, one of the mistakes made by both NPfIT and their
suppliers, was the failure to learn the lesson from previous system failure from IT transitions.

Secondly the governance of the project was designed by politicians with the delivery decentralized to
external firms and hospital staff. This section of roles and responsibilities that was listed was the first risk as
it was very confusing and had no clear role and responsibility (Guah ,2007). The risk of not governing the
iniation of the project is the cause of the downfall of NPfIT. This is because it was designed and led with
challenges for staff, suppliers, service providers and administrators. This risk in not governing the project
from start or for the duration of the project resulted in unrealistic expectations which caused the collapse.

If more small and medium enterprises were involved in the programme, the results may have been more
positive. It would have been effective if the stakeholders would have communicated effectively the objectives
for each component of the project , rather than the bureaucrats who were not concerned with the services. The
government should have made it mandatory for hospitals to develop their own record systems that were
compatible with the set guidelines to prevent the failure of the project.

PM Failing 2: Cost Management Failure

Planning is the most essential process when it comes to implementing a project. NPfIT project had great ideas
on the revitalisation of the health system but did not plan how the systems would be implemented. This could
have been effectively mitigated if adequate planning before launching the new system was conducted. The
incorrect forecasting for the project was the main failure as the budget was over £1 Billion. There was no
proper leadership and guidance for the executing body and no clear guideline of how money allocated was
being spent. The constant rise in price (commodities and services) was not considered as it was after £11
Billion the government was aware of the risk and immediately ceased the project (Hendy et al. 2005).

NPfIT could have used two KPI’s that would ensure the efficiency of the project.

Planned value (PV): This is the estimated cost for the project activities scheduled as of the reporting date.

Return on investment (ROI): This highlights a project’s profitability and the benefits.

PM Failing 3: Communication

Clear communication was another failure of NPfIT as after 10 years of delays, the NPfIT Board had
numerous technical issues. The lack of clarity from the NPfIT about future developments was caused by
poor communication between NPfIT headquarters, the local service provider and trust managers. This was
reported to be a major concern in all four trusts. Managers felt that local needs and advice were being
ignored and disempowered. There was a divide between the central NPfIT office and trusts, with the latter
considering the former as failing to understand local issues. This lack of communication was filtered down
as managers reluctance to communicate the benefits of the NPfIT and areas for opportunity to front line
staff.

NPfIT did not inquire as to why development of the system was not progressing. This is a downfall of the
project as some workstreams were years behind schedule. Instead of investigating the issue behind the
delays, NPfIT went along with the updated timeline. As a result, the final platform was unstable and
incomplete. Clear communication and strategic planning are integral at every stage of an enterprise software
project. This ensures that nothing is left assumed or obscured. To mitigate this project failure frequent
meetings are expected to clarify concerns in the project so that the common objective is met.
Operational management is an area of management concerned with designing and controlling the process of
production and altering business operations of goods or services (Colman, 2005). Operational failures that
occurred in NPfIT are primarily through management failure that in turn had catastrophic effects on NPfIT.

OM Failure 1: Measuring and Tracking System Performance

Operational risk events stem from varied causes including transaction and execution errors, improper
business practices and technology failures (Cruz,2014). To mitigate these failures management should
source external entities that would mitigate internal corporate weaknesses and accurate definitions of the
project commencement and final dates. The system was not efficient to implement a digitised health care
system in the UK. The numerous trusts for the project were not efficient with communication and the system
was not implemented efficiently and caused a major operational failure. Tools such as Key Performing
Indicators (KPI) are integral to measure and set targets for the project. This was not done at NPfIT at work
was not measured to highlight progress or downfall.

The trusts of the project were not interlinked in communication and thus objectives were not communicated
and progress was not able to be tracked (Thorpe ,2002).

OM Failure 2: Managing Cashflow

Managing cashflow had an integral part to play in the operational failures of NPfIT. Operational risk was
lost from internal scams that were derived from asset misappropriation, forgery or theft (Adeniyi 2016).
Numerous managers complained of missing funds and not knowing how money was spent. Fraud was
committed by both internal/external parties including theft, hacking and money laundering.

The risk of inefficient cash monitoring was due to the migration of data and constant changing of suppliers.
The security gaps were created by increased digitization and costed England more than the budget allocation
and numerous lives (Becker ,2017). These loops could have been mitigated if security systems were put in
place to manage the issues of fraud and managing of the project capital.

Lastly, the constant change in contract and lack of completion of the system was another good evidence of
how money was mismanaged in the project.

OM Failing 3: Managing Reviews and Brand Reputation

During the calamity, the failure of time-sensitive payment, customer data and the disruption in the
prescription systems contributed to severe shortfalls. A framework was not effective to provide a systemic
upload and this operational risk cost many lives (Approximately 1200). This will have catastrophic impact
on brand reputation because person may deem the heath care as ineffective.

This project system was not prioritised and identifying and focusing on top priority tasks were not
scheduled. This can be challenging because it requires a certain level of dedication for the project to be
efficient. Getting a late start in instances of the constant changing of contractors made all previous efforts to
complete tasks difficult because the new contractor had to then re-evaluate the progress and reschedule their
timeline.

This could have been mitigated through the management of a greater operational system when this
migration of customer data was being implemented. Due to this, the entire operation of the health care was
compromised and distressed the millions of patients and in the UK.
Risk Assessment

Risk management is the macro-level process of analysing, prioritizing, and making a strategy to mitigate
threats to an organization's assets and earnings. (March, 2018). Risk involves uncertainty about the
effects/implications of an activity with respect to something that humans value, often focusing on negative,
undesirable consequences (Øgaard, 2019)

Systematic Risk

Systematic risk is associated with the hospital’s assets as their values are changed by systematic factors. This
risk was related to the inefficiency of the transformation of the IT system. A contingency plan for NPfIT
systematic risk is to identify a support system for stability in the IT sector towards achieving deficiencies in
the health sector. This can be done by providing assistance for patients at the institution (Sclip, 2018).

Communication Risks

Communication risk is primarily to ensure the data communicated is effectively communicated the was the
sender expected to send it. One common element in any project is effective risk communication strategies.
This is to ensure to meet the specific interests, concerns, and habits of the target audiences. This means that
employees would require different types of messaging, as well as various distribution channels to highlight
failures, opportunities and developments.

Reputation Risks

Reputational damage is the loss to financial capital, social capital and market share resulting from damage to
a firm's reputation. The risks associated with NPfIT’s reputation is high as the project has not been concluded
and has cause many fatalities. This inefficiency is primarily due to low communication between employees
and contractors. The inability to transfer the health system to an electronic based system caused the UK health
care brand to depreciate and many citizens were being administered the wrong prescription and thus person
began outsourcing treatment.
Total Quality Management (TQM) entails an organization-wide effort to develop and make a permanent
environment where employees continuously improve their ability to provide on demand products and services
that customers value. This strategy is considered a main tool that leads to the development of the organisation
and achieve profitability through improved services and quality products. (Sohal,2001)

At NPfIT the implementation of TQM will be integral to enhance the projects iniation, planning, execution
and delivery of the migration project. In Taiwan a deep study was conducted by collecting data from 76
hospitals to test a multilevel model addressing the issue of TQM adoption as one type of organizational
adoption (Huarng, 2001).

They focused on the extent of TQM adoption by the individual hospitals as dependent variable. As for t he
independent variables, they selected five multilevel constructs: the scope of the network cooperation, the
nature of the network relationship, organizational identity, adoption strategy and organizational citizenship
behaviour. The research provides multiple accounts demonstrating its impact on delivering quality products,
services, improving job attitudes, commitment among workers and employee performance (Khan 2019). The
challenges that modern healthcare is facing in the context of increased competitiveness among hospitals is
high. However, this approach’s implementation requires addressing challenges that the health care sector is
posing and implementing.

Kaizen model NPfIT would be an efficient tool for the project as this concept is focused on continued
development s and would be the best method to use for a migration project. This method would ensure that
each concept is focused on the objectives and measure the progress of the project.
Appendix

Credit Risks Market Risks Operational Risks System Risks Reputation

Risk
5 High Extreme Extreme Extreme Extreme
Almost
certain

4 Moderate High Extreme Extreme Extreme

Likely

3 Moderate Moderate High Extreme Extreme

Moderate

2 Low Moderate Moderate High

Unlikely Extreme

1 Low Low Moderate Moderate High

Rare

1 2 3 4 5
Insignificant Minor Moderate Major Catastrophic

Graph 1.

Risk Impact Matrix

Reference

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