Improving the success rate of NHS IT projects

Stethoscope on a computer keyboard Delays and failures of IT projects are common in both private and public sector. With this in mind three staff members at University College London (UCLH) set out to study and review all the IT projects initiated within UCLH over three years.

Within this study they identified characteristics of projects which were risk at factors for failure, and to recommend processes which could improve project success rates. In fact 60 per cent of ICT projects at UCLH were a success, which compares favorably with private and public sector.

Typical projects included implementing EPR components, upgrading IT infrastructure or setting up departmental applications. Data collected included the type of project, the role of project sponsor, number of departments involved, the adherence to PRINCE2 methodology, the number of end users, and whether the project was a success or failure. The projects were retrospectively analysed to classify the reason the project failed in line with failure reasons identified by the National Audit Office NAO report.

NAO identified risk factors are as follows:

  • Design and definition failures - the required outputs are not described with sufficient clarity so the end goal is not achievable,
  • Decision making failures - the project fails due to lack of a single responsible owner who is able to make decisions about the project,
  • Project discipline failures - project documentation replaces project management with poor arrangements to identify and manage risks properly,
  • Supplier management failures - the project fails due to lack of understanding between the supplier and the customer,
  • People failure - occurs when the project delivers as specified, but the project does not fit the business or clinical requirement.

Out of the total of 377 projects 40 per cent failed to meet the original objectives. Factors which affect the project outcome are as follows:

  1. Classification / type of the project is the most important factor. 80 per cent of infrastructure projects were a success compared to 47 per cent for new functionality projects.
  2. Number of departments involved. 70 per cent of projects with just one department were a success compared to 37 per cent when more than three departments were involved.
  3. Adherence to Prince 2. 78 per cent of projects which adhered to Prince 2 were a success compared to 38 per cent where Prince 2 was not used.
  4. Role of the sponsor. 76 per cent of director lead projects were a success compared to 50 per cent for clinical staff.
  5. Number of end users is the least important factor. 67 per cent of projects with less than 50 end users were a success, compared to 38 per cent where then number of end users was over 500.

Out of the 40 per cent of projects which failed it was found that:

  • 42 per cent failed due to design and definitions failure;
  • 39 per cent failed due to decision making failure;
  • 7 per cent failed due to project discipline failure;
  • 7 per cent failed due to supplier management failure;
  • 4 per cent failed due to failure of the project to meet the requirement.

The most likely reasons for project failure are design and definition failures, and decision-making failures. Projects with a large number of end users or a large amount of cross boundary working are around twice as likely to fail due to design and definition failures.

This may be due to the nature of such projects being technically more complex, and such projects should therefore have a robust technical assessment of feasibility. Projects with a small number of end users, or projects which do not cross boundaries are around five times more likely to fail due to decision making failures.

These are typically clinician led, and failure may be due to clinicians not having time or skills to manage projects, or not having line management responsibility for project managers.

The findings in this study demonstrate that project success rate could be significantly improved with the implementation of a robust programme management process which manages identified risks and enables appropriate staff to shape the IT priorities to meet the organisations objectives and save resources.

Clinical staff are key to the NHS business of healthcare, it is critical that clinicians, managers and IT work together. In order to be successful, projects need appropriate levels of sponsorship (to mitigate against decision making failures) management (to mitigate against risks such as project discipline failures) and technical input (to mitigate against design and definition failures).

A programme of projects with input from clinical, managerial and technical stakeholders, with clear governance and reporting lines is key to ensuring a higher success rate of IT projects in line with strategy.

The following five steps should be included in the programme management process to help mitigate against identified risks.

  1. When notifying a project there should be clear deliverables in line with clinical and business requirements. There should be appropriate sponsorship, and a technical evaluation of proposals,
  2. Project proposals should be assessed independently by appropriate technical, managerial or clinical staff to ensure that risks are identified,
  3. A group of director level staff including clinicians should prioritise projects in line with organisation and clinical objectives. This may be an IT strategy group,
  4. Projects should follow the PRINCE2 project process, with highlight reports back to the IT strategy group,
  5. IT strategy group should review programme process and reprioritise projects on an ongoing basis, as requirements of the organisation change.

The authors

Toby Cave, senior ICT project manager. University College London Hospital,
Professor David Ingram, health informatics and director of the centre for health informatics, University College London,
Dr Rob Stein, medical oncologist, University College London Hospital.

Further reading

BMA report on the NPfiCT August 2006 
INTOSAI EDP Audit Committee - Best Practice - Why IT projects fail August 2005 
Royal College of Physicians London, Making a difference together January 2005

July 2008