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How I Made IT Project Management In The NHS My Career

How I Made IT Project Management In The NHS My Career

Kim Wright explains what you need to know to become an IT Programme Manager in the NHS.

Written by Kim Wright

How Did I Become An IT Project Manager In The NHS?

I was always good at organising.

I’d been a nurse for 12 years, and I loved the job, but things were changing and newly trained nurses no longer had practical experience before they hit the wards.

I blended my nursing experience and project management, resulting in a skillset that was unique at the time, but now forms the job description of today’s ‘NHS Digital Project Manager’.

When I entered project management, I was still a nurse, working full-time on an acute surgical ward in a hospital. Information Technology was not available in any organised form, apart from a green-screen monitor which recorded the bed state. This was used only by the ward clerk.

However, it was the early days of clinical audit and clinical governance, which gathered pace in the mid-90s because of the Bristol babies’ crisis.

Managers demanded organised information about patients that clinicians could understand; clinical project managers were needed. Microsoft Windows, including Access and Excel, was about to become available on NHS computers, making it much easier to collect and analyse data.

As, I’d spent my entire working life in the NHS, I could speak and understand the language (the NHS has one of its own) as well as being familiar with the culture. I’ve seen non-NHS project managers struggle whilst they’re getting to know the NHS, so having experience of it in some other capacity is always an advantage.

My challenge at the time was to learn how to use the new personal computer!

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What Qualifications Does An IT Project Manager Need?

I have many qualifications, but my most valuable asset, is blending learning with my NHS experience.

When I trained as a nurse, my qualification, Registered General Nurse (RGN), was obtained by doing 3 years practical training, with 4 practical assessments and exams at the end. There was also a qualification called Enrolled Nurse (EN), which was a year shorter in training, and did not require ‘A’ levels as a prerequisite, but involved less responsibility on the wards. A nurse registered or enrolled once to become a nurse for life.

In the early nineties, partly in response to what was labelled as the ‘demographic time-bomb’, nurse education changed. It was predicted that the number of young people wanting to do a vocational job such as nursing would drop, and that there would be a huge shortage of nurses from the year 2000 onwards, thus the label ‘time-bomb’ and its saviour, ‘Project 2000’.

Nursing needed to become more attractive. RGN training became a degree with practically no on-the-job training, and EN training was phased out. Many of my colleagues and friends who were EN’s, were required to ‘convert’ to RGN.

Some embraced it, and became expert nurses. Others felt it was a step too far, so they stayed as EN’s as long as possible, then retired or moved into the private sector where EN’s were still able to work. Newly-qualified RGNs with a more hands-off approach to patients took their place.

This fundamental change had a big impact across all aspects of nursing. Nurses do the job because they want to make a difference to people’s lives, not to get a degree. This was certainly my reason for being a nurse.

The Bristol babies’ crisis put the focus on clinical professionals keeping up-to-date. With the resulting change to 3-yearly re-registration for RGNs, lifelong learning became a requirement.

A local university created an experimental post-registration degree for RGNs, so I applied and took the opportunity to update myself.

It was 4 years of one day a week to achieve a BSc (Hons) in Nursing Studies. During that time, I was offered a secondment as an ‘Audit Project Nurse’ in the Clinical Audit Department, so I shared my time between the ward, university and the office, before becoming a full-time project manager.

I like to think that I also became an expert nurse, but with the added ingredients of academic/NHS data expertise and computer skills.

The use of BSC (Hons) on my CV was a start, but the value was added by the application of my learning to my working life.

In 2002, I worked at a local hospital in the role of Nurse Informatician. I undertook PRINCE2 Project Management training (PRojects In Controlled Environments). It was a week’s residential course, with 2 exams at the end, and was essential for managing NHS projects.

Most of the group were doing the course to become project managers, but found both the course and the exams difficult. The course was expensive and the pass rate was low. However, because of my experience in doing projects, I found PRINCE2 to be a helpful framework that put labels and organisation to what I’d been doing for several years.

15 years later, I use elements of PRINCE, without even thinking about it. A PRINCE project manager qualification should be updated every 5 years, but not doing this hasn’t held me back.

Out of choice, I also did a 2-year part time MSc in Health Informatics at University College, London. The group was multi-professional and international. By the time I’d finished, I was super-knowledgeable and was able to apply the knowledge real-time at work.

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What Skills Does An IT Project Manager Need?

An obvious skill of a project manager is organising a project, ensuring it runs to plan. I started in clinical audit by managing small uni-disciplinary, single site projects, and progressed to multi-million-pound complex IT projects.

• Project Management Skills

a. Communication – ability to be calm, informative, get on with people, challenge people and retain a sense of humour!

b. Leadership

c. Negotiation

d. Scheduling/planning

e. Cost Control

f. Cost management

g. Risk Management

h. Contract Management (including procurement knowledge)

i. Supplier Management

j. Critical thinking

k. Written communication, including:

i. Intranet

ii. Newsletters

iii. Emails

iv. Collaboration and social media tools

v. Team meetings/face-to-face

vi. Web and online conferencing.

l. Project Recovery – just in case!

m. Coaching

n. Task Management

o. Quality Management

p. Meetings Management

q. Business Case Writing

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Working In The NHS

The title of IT Project Manager is quite generic. In the NHS, there are several variations in role from IT technical projects, installing kit and wiring, to clinically-led projects, where focus is on the benefits of software to patients and staff.

NHS IT budgets are subject to the same intense focus as the rest of the NHS, and so, projects are always faced with scarce resources. NHS staff with skills such as testing management, system training and configuration are still quite rare. It can be relatively expensive to hire in contractors, and pressure to perform to financial targets is ever-present.

Add to this the difference between a software company’s development timelines, and clinicians’ expectations of how ‘ready’ software must be before go-live, it is easy to see that the project manager role is often very challenging! However, making life better for both staff and patients, is a powerful driver.

In 2005, I moved on to manage the first general hospital implementation of an NPfIT EPR outside London. It was a small hospital, but was a complex and difficult project. It required the use of all my skills and experience for a sustained period. It was exhausting, but also exciting and all-consuming.

In 2007, I took on the role of NHS programme manager in the same hospital. This allowed me to manage a linked series of projects, with more control over the finances and strategy. However, because resources were tight, I also kept the project manager role.

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Time for a Change?

In 2012, the programme I’d been managing had come to an end. NPfIT was starting to wind down to its 2015 conclusion. I had some choices:

• Accept the new role offered to me, which involved continuing to create records strategy and manage projects, whilst at the same time running the Medical Records/Coding department in the hospital. This was appealing, except for the fact that it involved a sizeable pay cut!

• Find a job somewhere else in the NHS. All local NHS Trusts were re-structuring, which made finding another job challenging

• Apply for the MARs scheme; a type of voluntary redundancy being offered at the time, availability of which was determined by whether the savings to be made for the NHS Trust outweighed the redundancy payment

With 10 to 15 years left before retirement, I could either carry on, or I could take a leap of faith and do something else. I took a few days to think about it, then asked my boss to put me in for MARs. The application was accepted!

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Working In The Private Sector

I set up my own company, Two Hats Ltd, and took my skills to NHS Trusts.

The changes this made to my working life were quite challenging:

• I took on all the requirements of self-employment, including invoicing, financial management and sales. After 30 years in public service, it was difficult getting used to working this way.

• I had the help of an accountant, but I did not use an umbrella agency to help with the rest. I was lucky to get a job as a sole contractor. The NHS now exclusively uses frameworks to employ IM&T contractors, so being on the books of an agency listed on the agreed frameworks is a must.

• I found it hard to sell myself. I was not used to telling people how good I was. However, I’d taken the time to put a lot of work into my CV, which worked in my favour.

• I’d worked locally to my home for 30 years. From the moment I started work as a contractor, I had to travel long distances and stay in hotels. The hours were determined by my employers, and the NHS did not then like the concept of ‘working at home’.

My first role in the private sector was with an NHS Trust in Kent, a long way from my home in Somerset. However, the advantages were clear; I was getting substantially paid compared to my NHS salary, whilst still working for the NHS.

It took me a while to get used to being treated as a ‘contractor’ as the role demands a different relationship with NHS colleagues.

Over the next 4 years, I worked all over the country, but especially in London. I even had a year-long project in an NHS Trust not far from home, where I’d worked 10 years before. I worked with great people in the company, many of them ex-NHS employees, and much of the time, I was fulfilled in my working life by feeling that we were making a difference.

However, the company was, and is, at the mercy of NHS requirements in terms of providing the service. Things change. The NHS has less money and is becoming more tech-savvy so less in need of outside help, which makes it more difficult to get contracts.

One thing about working away from home is that it can affect your personal life. I was lucky to be able to maintain my personal relationships whilst being away from home, but I met many people who were not as fortunate.

Also, being comfortable in your own company is a must. I spent lots of time alone in hotel rooms, particularly in London. I enjoyed it, and made the most of the city, but if you are a person who likes company, this way of life might be difficult.

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What Kind Of Person Is An NHS IT Project Manager?

To work as a contractor in the NHS, you must be as committed and determined as the NHS staff that you work with. NHS IT project teams will often be made up of people who want to make a difference, who have experience of clinical and operational parts of the service and so have taken on the challenge of improving them.

If you are a contractor, the NHS team around you will be earning quite a lot less than you. The expectation will be to be professional in your demeanour, providing leadership and high quality project management.

If you are open and outgoing, with a friendly approach, you will be welcomed. The ability to challenge existing practices and project assumptions will also be welcome, as long as the challenge is evidence-based, and you can suggest alternatives.

If you work within the NHS and want to be an IT project manager, you will probably already know the culture. NHS colleagues I talk to often say that the move from a clinical role, to a role within an IT project team is often quite a challenge. The culture is the same, but the working practices and hours are different.

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What Keeps Me Excited About IT Project Management?

I’m approaching the end of my career, but I’m back working within the NHS as a Digital Project Lead, and love the job I do. It doesn’t earn as much as working as a contractor, but for me, some things are more important:

• I am part of a committed team of great people at the cutting edge of IT-enabled clinical and improvement projects

• The focus is more on what people who use the NHS want, with this year’s Wachter review finding that digital technology can transform how patients engage with services, drive improvements in efficiency and care co-ordination, and help people manage their health and wellbeing.

And above all, I feel like I’m making a difference.

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What Does The Future Hold Regarding Technology?

People Power

Some of the exciting developments in health technology are those which have come about without the intervention of large-scale NHS programmes or re-engineering in healthcare settings.

According to the Nuffield Trust:

Source: www.nuffieldtrust.org.uk

• In 2015, 71% of all UK citizens had a smartphone; 88% of adults used the internet,

• 50% of the UK population use the internet for self-diagnosis, while 75% search the web for health information,

• 43,000 medical apps are now available from the Apple Store; 500 million people around the world will use a healthcare app this year.

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Existing NHS healthcare technology has not been keeping up with the change in consumer habits:

Source: www.gov.uk

• For example, in 2014, only 2% of the population reported any digitally-enabled transaction with the NHS,

• By the same token, over 96% of GP practices had installed digital clinical record systems by 2014. However, fewer than 4% of practices offered patients online access to their records.

Personally, I can now request an appointment or prescription online from my local surgery via my PC, but the system is clunky and over-burdened by security messages, unlike my banking apps which are on my smartphone, secure, real-time and easy to use.

It feels like people power is the future. Bad reviews on the internet can bankrupt a business. In the same way that restaurants and holiday resorts must use online consumer data to survive, the NHS must make itself responsive to patients by improving online interaction and responsiveness.

Consumers are monitoring their own health, with wearable technology such as the Fitbit becoming part of daily life. In 2015, Tim Kelsey, then the national director for patients and information at NHS England, announced that members of the public would be able to add data from wearable devices to their electronic patient record by 2018.

This is already happening in the USA, with suppliers such as Cerner and Epic building in the capability to their patient records systems. Surely it won’t take long to reach those systems here in the UK?

Involving people in the fundamental parts of technological change is a vital part of the NHS future to ensure that the tech is usable and that uptake is good.

People need to be involved in how their data is captured and used, what devices are acceptable at the bedside and what resources are spent on making technology work for users of the NHS.

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What Challenges Have/Do You Face, And How Have You Overcome These?

The constant and enduring challenge for the NHS is the financial constraints within which it exists. The NHS must transform and reduce costs to survive. It cannot transform and improve services without the integral development and implementation of technology.

Technology is expensive. One solution to this is to implement slower. The Wachter review published almost a year ago, recommended giving the NHS more time to digitise than was set out in the government plans in 2015.

As a project manager, I’ve struggled with implementing systems to demanding timescales. Anyone managing projects will be familiar with the relationship between time, cost and quality:

• You can have something QUICK & LOW COST but it won’t be high quality,

• You can have something LOW COST & HIGH QUALITY, but it won’t be quick or on time,

• You can have something ON TIME and HIGH QUALITY but it won’t be LOW COST.

Delivery of something that hospital staff can use to care for patients that is of high quality, without high cost, takes time. Project timelines often slip. The challenge is to be creative in managing a problem to ensure minimum impact on the timeline.

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What Job Opportunities Are There?

The current opportunities within the NHS are predicated mainly upon the Global Digital Exemplar (GDE) Programme.

Hospital and mental health trusts have gained government funding to digitise. Each organisation has named ‘fast followers’; partner organisations that will adopt, and, ensure the spread of the GDE good practice.

Within the programme there are likely to be opportunities for:

• Programme managers,

• Project managers,

• Project support,

• Digital clinicians to work within projects,

• Technical support staff.

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How Much Further Training Is Available?

Training on practical project management skills for the NHS is generally via the PRINCE2 programme at www.prince2training.net. NHS trusts will often fund the training if you are working in an NHS role.

For clinicians, the NHS Digital Academy is the NHS’s first ever nationally funded programme of world-class health informatics training. Set to launch later this year in partnership with Imperial College London, the University of Edinburgh and Harvard Medical School, the NHS Digital Academy will provide specialist IT training and development support to 300 senior clinicians and health managers over a 12 month period.

The aim is to help shape a new generation of Chief Information Officers (CIO) and Chief Clinical Information Officers (CCIO) who can help drive through the digital transformation the NHS requires.

A virtual organisation, the academy, has been set up in response to the Wachter review, after finding that there is in the NHS “a lack of professionals, namely CCIOs and CIOs, that can drive forward the transformation agenda enabled by informatics and technology.”

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