2020 Integrated Project and Change Management Framework for Healthcare Projects A thesis presented in partial fulfilment of the requirements for the degree of Master of Quality Systems at Massey University, Palmerston North, New Zealand BY: FARISHA OSBORNE STUDENT ID: 1 | P a g e Copyright is owned by the Author of the thesis. Permission is given for a copy to be downloaded by an individual for the purpose of research and private study only. The thesis may not be reproduced elsewhere without the permission of the Author. 2 | P a g e Acknowledgement I would like to express my sincere thanks to my Supervisor, Nigel Grigg and Daniel Hunt; General Manager of LabPlus &APS, for their firm honest and consistent support during this research. Daniel, thank you for pointing me in the direction of transformational healthcare and empowering me to achieve my goals. Nigel, I am grateful for your expert guidance in this report's compilation, which helped raise this research to an academic standard. A huge thanks to my project team; I was fortunate to learn change management under Sandra Dodds' direction and project management from Jacob Tonner. For his practical knowledge in setting up a PMO, Paul Stevens provided the foundations of the research. James Poloai and Steven Martin for graciously provided the platform for conducting the research, allowing me to work closely with the LIS team and PGWG. Thank you for all your support and guidance. And lastly, I would like to dedicate this research to my husband and dearest friend Colin Osborne. There is no amount of thanks that I can give for everything you have done to complete this thesis. From being my pillar, someone I bounced ideas off to create the SharePoint site in record time despite the many changes. Ruth Badar Ginsberg said it quite elegantly: “If you have a caring life partner, you help the other person when that person needs it. I had a Life partner who thought my work was as important as his, and I think that made all the difference for me.” -Ruth Badar Ginsberg 3 | P a g e Table of Contents Acknowledgement ................................................................................................................................ 2 Table of Contents .................................................................................................................................. 3 List of Acronyms.................................................................................................................................... 6 List of Tables ......................................................................................................................................... 7 List of Charts ......................................................................................................................................... 8 List of Figures ........................................................................................................................................ 9 Abstract ............................................................................................................................................... 10 Chapter 1 Introduction .................................................................................................................... 11 1.1 Background ......................................................................................................................... 11 1.2 The Importance of the Research ........................................................................................ 13 1.3 Scope and Boundaries of the Research .............................................................................. 14 1.4 Research Aim, Question ...................................................................................................... 14 1.5 Research Objectives ............................................................................................................ 15 1.6 Limitations of the study ...................................................................................................... 15 1.7 Structure of the Thesis ........................................................................................................ 16 Chapter 2 Literature Review ............................................................................................................ 18 2.1 Project Management .......................................................................................................... 18 2.2 Project Management Methodologies ................................................................................. 18 2.3 Comparison of Project Management Methodologies ........................................................ 27 2.4 Change Management .......................................................................................................... 31 2.5 Change Management Methodologies ................................................................................ 33 2.6 Comparison of Change Management Methodologies ........................................................ 39 2.7 The Importance of Integrating Project and Change Management in Healthcare .............. 41 2.7.1 Research Gap .............................................................................................................. 43 2.8 Building Project and Change Management Capability ....................................................... 44 4 | P a g e 2.8.1 Research Gap .............................................................................................................. 49 Chapter 3 Research Methodology ................................................................................................... 50 3.1 Detailed descriptions of research questions/ hypotheses ................................................. 50 3.2 Consideration for Research Strategy .................................................................................. 51 3.3 Research methodologies .................................................................................................... 51 3.4 Research Design .................................................................................................................. 52 3.5 Research Management ....................................................................................................... 53 3.6 Detailed Description of the Research Approach................................................................. 55 3.7 Ethical considerations ......................................................................................................... 59 Chapter 4 Results ............................................................................................................................. 61 4.1 Survey Results ..................................................................................................................... 61 4.1.1 Quantitative analysis of the Survey Results ................................................................ 62 4.1.2 Qualitative analysis of Survey Results ........................................................................ 66 Chapter 5 Development of an Integrated Project and Change Management Framework (IPCMF) 70 Chapter 6 Building Project and Change Management Capability in LabPlus and APS .................... 78 6.1 Soft System Configuration .................................................................................................. 78 6.1.1 Overall Management System and Culture .................................................................. 78 6.2 Hard System Configuration ................................................................................................. 81 6.2.1 The Process ................................................................................................................. 81 6.2.2 Tools and Techniques ................................................................................................. 81 Chapter 7 Conclusion ....................................................................................................................... 83 7.1 Future Research .................................................................................................................. 85 Chapter 8 Reference ........................................................................................................................ 86 Chapter 9 Appendix ......................................................................................................................... 90 9.1 Appendix 1 .......................................................................................................................... 90 9.2 Appendix 2 .......................................................................................................................... 92 9.3 Appendix 3 .......................................................................................................................... 93 9.4 Appendix 4 .......................................................................................................................... 95 5 | P a g e 9.5 Appendix 5 ........................................................................................................................ 111 9.6 Appendix 6 ........................................................................................................................ 111 9.7 Appendix 7 ........................................................................................................................ 113 9.8 Appendix 8 ........................................................................................................................ 114 9.9 Appendix 9 ........................................................................................................................ 118 9.10 Appendix 10 ...................................................................................................................... 119 9.11 Appendix 11 ...................................................................................................................... 120 9.12 Appendix 12 ...................................................................................................................... 121 6 | P a g e List of Acronyms ADHB Auckland District Health Board APM Agile Project Management APS Anatomical Pathology Services CAS Complex Adaptive System CM Change Management EPMO Enterprise Portfolio Management Office ICR Investor Confidence Rating IPCMF Integrated Project and Change Management Framework LIS Laboratory Information Services NRLTIP Northern Region Long Term Investment Plan OD Organisational Development OGC Office of Government Commerce P3M3 Portfolio, Programme and Project Management PGWG Project Gateway group PM Project Management PMBok Project Management Body of Knowledge PMI Project Management Institute PMM Project Management Methodologies PMO Project Management Office PPM Project Portfolio Management PRINCE 2 Project in Controlled Environment VAPM Value Adding Path Map WHO World Health Organization 7 | P a g e List of Tables Table 2.1 Summary of the literature search findings for project management methodologies Table 2.2 PMBoK Knowledge Areas Table 2.3 Themes and Principles of PRINCE 2 Methodology Table 2.1 Agile Project Management Practices Table 2.2 Phases of Lean Project Management Table 2. 3 Strength and Weakness of Project Management Methodologies/ Framework Table 2.7 Summary of the literature search findings for change management models Table 2.8 The Principles of Kotter’s Eight-Step Model Table 2.9 Elements of Change for McKinsey’s 7-S Model Table 2.10 Summary of tactics used in ADKAR Table 2.11 Strength and Weakness of the Different Change Methodologies Table 2.12 Overall management system activities to consider for Soft System Configuration/People Side Table 2.13 Culture activities to consider for Soft System Configuration/People Side Table 2.14 Process activities to consider for Hard System Configuration/ Technical Side Table 2.15 Training and knowledge management activities to consider for Hard System Configuration/ Technical Side Table 2.16 Tools and techniques activities to consider for Hard System Configuration/ Technical Side Table 3.1 Make-up of the Project Team Table 3.2 Ethical Considerations Table 4.1 Survey Details Table 4.2 Participants of the Survey Table 4.3 Types of Projects included in the Survey Table 4.4 Results for the Mann Witney Test Table 4.5 Qualitative Analysis of Survey Results Table 4.6 Sample Statement for Qualitative analysis 8 | P a g e Table 5.1 Comparison of ADKAR Activities against ADHB’s P3M3 Framework Activities List of Charts Chart 4.1 Perceived Project Success Chart 4.2 Survey Results for Perceived Successful Projects Chart 4.3 Survey Results for Perceived Unsuccessful Projects 9 | P a g e List of Figures Fig 2.1 Waterfall Methodology Fig 2.2 ADHB’s P3M3 Project Management Framework Fig 2.3 Kubler – Ross Change Curve Fig 2.4 McKinsey’s 7-S Model Fig 2.5 PROSCI ADKAR Model Fig 2.6 PROSCI 3 phase process for organisational change management Fig 2.7 Enterprise Change Management ECM Fig 3.1 Framework Development Sprint Fig 3.2 SharePoint Development Sprints Fig 5.1 Project and Change Management Framework IPCMF Fig 5.2 Integrated Project and Change Management Framework IPCMF Fig 5.3 Prepare step of a project Fig 5.4 Manage step of a project Fig 5.5 Close step of a project Fig 6.1 Mind Map from the Brain Storming session with the Project Gateway Group Fig 6.2 LabPLUS Project Centre SharePoint Site 10 | P a g e Abstract The purpose of this study was to develop an integrated project and change management framework for healthcare. Transformative healthcare has become front and centre in the health industry, utilising projects as a form of delivery. Healthcare projects invariably create change, to which either staff or patients need to accommodate. Hence, having a framework that consolidated the two practices would be valuable. Set at Auckland District Health Board (ADHB) the research utilised a case study design and employing a pragmatic research methodology as it provided a flexible and more reflexive approach to research design. The research findings show that project and change management can be integrated and extremely useful in a healthcare setting. However, building capability for both domains requires a series of logical, economic and reasonable steps. Due to the time limitation of a master’s thesis, it is difficult to evaluate the new framework's implementation fully. This, however, paves the way for future research. 11 | P a g e Chapter 1 Introduction 1.1 Background Investor Confidence Rating ICR is a three-yearly assessment scheme that The Treasury uses to assess the performance of investment agencies in managing investments and assets critical to the delivery of NZ government services (Treasury, 2019). One of the eight parts of the ICR is an assessment using the Portfolio, Programme and Project Management maturity, also known as P3M3 (Treasury, 2019). Portfolios play a key role in controlling projects and programmes, and collectively, how the entire organisation invests in and manages change. A portfolio is a group of initiatives (including projects), that may or may not be related to each other, coordinated to deliver strategic objectives (EPMO, 2018). Managing a Portfolio is concerned with doing the right things through effective planning, coordination and prioritisation processes. These processes aim to achieve optimum value by aligning investment with business strategies (EPMO, 2018). An individual portfolio area, for example, may include various ‘major’ projects, ongoing work programmes (such as infrastructure remediation) and many projects. In 2016, The Treasury assessed Auckland DHB as part of the Investor Confidence Rating ICR. The outcome of the assessment indicated the need to improve the approach of project, programme and portfolio management, and the delivery of change within the organisation. In response to this assessment, Auckland DHB initiated the development of a Project Management Framework as part of the organisation's overall attempt to improve project, programme and portfolio capability, aiming to close the gaps in maturity identified in the P3M3 assessment (EPMO, 2018). The framework did not attempt to define every aspect of project management or offer a prescriptive step-by-step approach to run a project. Instead, the aim was to provide staff at ADHB with standard policies and guidelines for the critical elements of project management within the organisation. It also set the minimum standards that senior management and executives could expect from any project, regardless of size or complexity (EPMO, 2018). "Auckland District Health Board Project Management Framework; Guides, policies, and standards" was first published in 2017 and is owned by the Auckland DHB Enterprise Portfolio Management Office (EPMO). 12 | P a g e Healthcare projects can range from facility upgrades and health IT implementation to quality improvements such as implementing best practice guidelines (Richer, Marchionni, Lavoie- Tremblay, & Aubry, 2013). Project Portfolio Management (PPM) has become increasingly important within the District Health Boards (DHB), as executives carefully prioritise funding and resources to those projects that will yield the most significant alignment to the business's objectives (EPMO, 2018). In LabPLUS & Anatomical Pathology Service (APS), this task has been assigned to the Project Gateway Group (PGWG). This group ensures that before any large project commences, investment of resources is reflective of the strategic priorities of the organisation and projects' have minimum governance of Sponsor/Clinical lead, Project manager and Change owner/business owner. Healthcare resource can be limited, and the demand for constant improvement endless. Projects need gating in this manner so that limited resources such as Information Technology (IT), scientific and clinical expertise are not overburdened. Work is prioritised based on the availability of funds, skills and risk. Given the nature of healthcare projects, change management's role in achieving project success has grown substantially. Benefit realisation relies heavily on the workforce adopting the change that a project will deliver (Galli, 2018; Hornstein, 2012). While organisational change management activities are undertaken, leading change in a project's context is an area that still requires further development. Change Management support and advice is provided by the Organisational Development (OD) team at Auckland DHB. ADKAR by PROSCI is the methodology that has been adopted and encouraged by the organisation. While this methodology has a tremendous practical application, the researcher saw potential in exploring how these practices could be integrated with the project management framework. The benefit would be a more realistic approach to project and change management while running projects in a healthcare setting. An integrated approach would address the technical delivery of the project and the challenges of adoption. Both of which aid overall benefits realization. 13 | P a g e 1.2 The Importance of the Research In the World Health Organization (WHO) European Region’s Framework for Action on Integrated Health Services Delivery, WHO calls for actions across several domains, one of which is to facilitate the strategic management of health service transformations towards integrated care (Cash-Gibson, Tigova, Alonso, Binkley, & Rosenmöller, 2019). In 2018 the Northern Region Long Term Investment Plan (NRLTIP) was publicly released. Developed by the Northland, Waitemata, Auckland and Counties Manukau DHBs, with the Ministry of Health, Treasury, and other partner agencies' input, it provided important context for future investment decisions. Equity in health was the main feature in the document. The region has committed to reducing inequities in the system and working across DHB boundaries, integrating, and sharing resources, assets and services to optimise health outcomes for all communities. NRLTIP performed a deep dive into specific areas of the regional healthcare system. Phase one looked at future care models for cancer services, elective surgery, radiology, and services for the frail and elderly. Phase two focused on developing detailed plans for these areas and conducting deep dives into the community/primary care, population health, mental health, and laboratory services. The laboratory deep dive was completed in 2017 and included 13 recommendations centred around creating a single collaborative and integrated pathology network across the four District Health Boards in the Northern Region that is patient-focused. Over the past two decades, the merging of services has gained popularity as a way of reforming the healthcare sector (Gordon & Pollack, 2018). Integration has come about in response to the poor patient outcomes resulting from a fragmented service (Cash-Gibson et al., 2019). For many healthcare systems, the service is centred on functions (Gordon & Pollack, 2018). Functional units create a territorial silo, which can inadvertently ignore the needs of the patient and lead to low patient experience (Gordon & Pollack, 2018). In the last decade, Canada and the United Kingdom both mandated integrating their health services into local health networks (Beastall, 2008; Gordon & Pollack, 2018). The goal was to unify common elements of the primary disciplines to enhance service delivery to patients and overcome fiscal constraints (Gordon & Pollack, 2018). However, despite the need to continuously improve practices, implementation of changes can be very challenging. This is attributed to healthcare complexity and the persuasive influence that context has on implementation and improvement (Augustsson, Churruca, & Braithwaite, 2019). Typically, healthcare integration projects involve significant organisational 14 | P a g e change. Such projects' management needs may benefit from a combination of project and change management practices (Gordon & Pollack, 2018). 1.3 Scope and Boundaries of the Research This research was conducted at LabPlus & APS, a tertiary referral medical laboratory, part of the state-owned Auckland District Health Board (ADHB). It is the fourth-largest district health board in New Zealand and is a government-funded provider of health services for 542,000 residents living in the Auckland central district (Auckland District Health Board, 2020). The growth projections for the district are nearly 100,000 extra people by 2030 (Auckland District Health Board, 2020). Auckland DHB is responsible for the health and wellbeing of the population that live within the district. As an organisation, it provides a range of hospital and community services from multiple sites including Auckland City Hospital, Greenlane Clinical Centre and the Buchanan Rehabilitation centre. ADHB also works with community-based providers such as primary healthcare organisations (PHO) and Auckland Council to improve population outcomes (Auckland District Health Board, 2020). LabPLUS & APS provides primary and secondary pathology service, which consist of a comprehensive range of over 900 routine and specialist laboratory tests. It is a centre for referral tests from other laboratories, government bodies, private and commercial institutions and research bodies within New Zealand and overseas (LabPlus, 2020). The organisation employs over 450 staff, covering areas such as Chemical pathology, Haematology, Microbiology, Virology and Immunology, National testing centre, Forensic Pathology, Anatomical Pathology and Diagnostic Genetics. These departments are supported by highly specialised Phlebotomy, Specimen Services, Clinical Trials, Administration, and Customer Service teams (LabPlus, 2020). 1.4 Research Aim, Question After participating in a transformational project at LabPLUS & APS, the researcher was intrigued to explore ways of managing projects of this calibre. Upon performing an initial investigation into organisational change projects, the researcher realised that the process that was missing for LabPLUS & APS projects was change Management. This set-in motion the project's overall aim; to integrate the two disciplines of project and change management and provide a case for senior 15 | P a g e leaders to consider adopting elements of both practices for future organisaional projects and service delivery. Research questions: 1. Can elements of project and change management practices be integrated into one framework? 2. Is there a need for both practices in a healthcare project? 3. What would an integrated project and change management framework look like in practice in a healthcare setting? 4. How can capability for this framework be embedded into an organisation? 1.5 Research Objectives The study was a collaborative work that explored existing project management and organisational change management frameworks within Auckland DHB; together with the management systems in LabPLUS and APS. The objectives of the project were: • Understand the requirements for project and change management in LabPlus & APS. • Increase the awareness and desire for better project and change management practices in LabPlus & APS staff. • Create a framework that integrates project and change management practices. • Create tools and training opportunities in both disciplines to increase the capability of the two practices in the organisation. • Create a SharePoint site for the Project Gate Way Group to assist with project proposal submissions and tracking. 1.6 Limitations of the study As the research was conducted at LabPlus & APS, which is part of ADHB, the researcher had to use Project Management (PM) and Change Management (CM) methodologies that ADHB endorses. Due to the time limitations of two years for a Master’s thesis (in part-time mode), this research's conceptual model could not be verified using current projects. Future work for this can be undertaken as further research. 16 | P a g e 1.7 Structure of the Thesis The structure of the thesis is as follows: Chapter Two: Literature review attempts to answer the first research question; Can elements of project and change management practices be integrated into one framework? The first part analyses the strengths and weaknesses of the most common project and change management methodologies. Followed by a summary of current literature on the topic of integrating project and change management practices. The final part of the literature review explores how the capability of both disciplines could be improved. Chapter Three: Methodology, starts by explaining the ontological and epistemological perspectives considered for the research. It describes and evaluates the research design methodology and then explains the approach taken, including the use of mixed methods and case study. Research management explains how the case study research was conducted, followed by the project's ethical considerations. Chapter Four: Results; address the second research question; Is there a need for both practices in a healthcare project? The results of the survey conducted in LabPlus & APS is analysed. Elements that contributed to a project's success are identified—providing evidence for the need for project and change management practices in a healthcare setting. Chapter Five: Development of an Integrated Project and Change Management Framework, answers the third research question; What would an integrated project and change management framework look like in practice in a healthcare setting? This chapter explains how the researcher developed the integrated framework and the logic of the layout. Chapter Six: Building Capability of Project and Change Management, explores the tools and techniques used by the researcher to build staff capability in the use of the new framework. This chapter addresses the fourth research question; How can capability for this framework be embedded into an organisation? 17 | P a g e Chapter Seven: Conclusion summarises the research's key findings and the contribution to the current body of knowledge. It also concludes whether the research questions were answered and if the objectives of the study were achieved. The previously stated limitations of the study are revisited and recommendations for future research provided. 18 | P a g e Chapter 2 Literature Review 2.1 Project Management Organisations are becoming increasingly project-oriented; adopting this approach to create and deliver new business products or implement changes (Bentley, 2015; Fernandes, Ward, & Araújo, 2015). According to Aubry, Hobbs, and Thuillier (2007), project management is a dynamic structure that is articulated in organisations to aid the delivery of corporate objectives. It provides a set of business skills that can help control cost, reduce risk and improve outcomes (Sa Couto, 2008). Project management utilises the processes of systematically planning, organising, and then executing a pre-determined set of steps to maximise resources and achieve specific objectives. The use of projects, programs, and portfolios is becoming a growing trend in the corpeorate world to achieve strategic objectives (Aubry et al., 2007). This management approach facilitates selecting the best projects and brings considerable benefits to the business through the alignment of projects with the objectives, optimal assignment of the resources, and minimising the risk of investments (Ershadi, Jefferies, Davis, & Mojtahedi, 2020). Due to the lack of funding in healthcare and an increase in demand for health and wellbeing services, more healthcare providers are rethinking the actual means of delivering care, focusing more on value and performance rather than on the volume of work that is processed (Cash-Gibson et al., 2019; Lippi, 2018). The drive to provide better patient care has led to continuous refinement of the services in an effort to improve it (Chiocchio, Rabbat, & Lebel, 2015). Transformative healthcare has become front and centre of the health industry, utilising projects as a form of delivery (Cash-Gibson et al., 2019). 2.2 Project Management Methodologies The concept of project management (PM) has been around for thousands of years, from the constructions of Giza's pyramids, the Taj Mahal, and the Great Wall of China to the modern-day placement of space shuttles into earth's orbit (Project Management Institute, 2017). As the discipline has grown, proven traditional practices have been handed down, and innovative new 19 | P a g e practices have emerged. Project Management methodologies are used to provide guidelines for managing a project. Theory and practice of project management include many practically applicable methodologies for the efficient management of a project (Jovanović & Berić, 2018). Their general aim is to standardise, structure and organise work methods. A literature search for project management methodologies in key business management databases produced an array of results. Table 2.1 summarises the findings of the literature search. Although there are many more PM methodologies; PMBoK, PRINCE 2, Waterfall, Agile and Lean Six Sigma featured prominently in the search results. The following section of the literature review attempts to explain each PMM and outline their strength and weakness. Table 2.1 Summary of the literature search findings for project management methodologies Search criteria: Number of search results in a database Scopus Discover Emerald Insight Business Source Complete Web of Science “Project Management” 184,593 179,768 16,000 38,170 104,355 “Project Management” AND “PMBok” 5,947 1,217 555 251 325 “Project Management” AND “Waterfall” 722 274 161 62 145 “Project Management” AND “Agile” 11,173 3,564 1000 735 2,031 “Project Management” AND “PRINCE 2” 886 351 177 64 80 “Project Management” AND “Lean Six Sigma” 1139 212 535 38 56 Waterfall Methodology Waterfall methodology also referred to as the traditional way of doing projects, is perhaps the earliest form of project management (Pace, 2019). It is termed as “waterfall” because the method follows a linear progression from one step to another in a downwards fashion (Kalso, 2020). The most common version has six steps that flow in strict sequential order (Kalso, 2020). Each step is completed before the next starts using the output from the previous step, and there is no 20 | P a g e overlapping of steps (Kalso, 2020). Typically used when the project has a well-defined scope and design and planning must be done upfront (EPMO, 2018). Examples of projects that would use this method include new buildings, rollover or replacing assets. While there are different versions of the approach, Figure 2.1 summarises the most common version with six steps. Stakeholder and customer requirements are gathered at the beginning of the project. The product is designed, developed, verified, deployed, and upon release any maintenance or adjustment where required. Fig 2. 1 Waterfall Methodology PMBoK Framework Project Management Body of Knowledge (PMBoK) is an international reference guide that incorporates a wide range of knowledge about project management (Parra, Saroza, Martínez, & Bello, 2016). The PMBOK provides a set of guiding principles for project management which are recognised as “good practices”, and can be applied to most projects. It is published by the Project Management Institute (PMI) who are based in the United States and is recognised globally as a guide for professionals in managing projects. The knowledge, skills, tools and techniques provided in this framework can be adapted according to the type of project and the project manager's capabilities (Project Management Institute, 2017). PMBoK Guide defines a Project Life Cycle into five process groups and ten knowledge areas. A project is accomplished by integrating the project management processes, while the project team operates in ten knowledge areas(Abyad, 2018). Requirement Design Development Verification Deployment Maintence 21 | P a g e Process Groups: 1) Initiating – to understand and agree on what the project will achieve and why. This process ensures that the project is feasible and has good governance. If done correctly, will set the project up for success. 2) Planning – The Process(es) used to refine the objectives and define the scope. Develop the relevant resources, timelines and milestones, and mapping project delivery to business priorities (i.e. risk management, communications, quality, cost/budgeting, duration, sequencing, and external dependencies). 3) Executing – Those process(es) performed to complete the work defined in the project management plan to satisfy the project requirements. Assigning the project team and distributing information to ensure the proper activities are undertaken. This process also includes ensuring quality assurance methods are in place to address change management, organisational updates, possible changes to the plan, etc. 4) Monitoring and Controlling – The process(es) required to track, review, and regulate the project's progress and performance; this assures the stakeholders that the project is on track and that the resulting product maps back to the original plan. Changes to scope/plan should be documented, and risk from uncontrolled external actions are mitigated. 5) Closing – The process(es) performed to complete or close a project formally. Includes ensuring the output/s of the project have been delivered, and the benefits are on track to be realised. The project team is disbanded, and outcomes are transitioned to BAU. Table 2.2 PMBoK Knowledge Areas Knowledge Areas 1. Integration Management • Develop the Project Charter • Scope Statement and Plan. • Direct, Manage. • Monitor and Control Project Change 2. Scope Management • Planning, Definition • Work Break-down Structure (WBS) Creation • Verification and Control. 3. Schedule Management • Definition, Sequencing • Resource and Duration Estimating, • Schedule Development and Schedule Control. 22 | P a g e Knowledge Areas 4. Cost Management • Resource Planning, • Cost Estimating, • Budgeting and Control. 5. Quality Management • Quality Planning, • Quality Assurance and Quality Control. 6. Resource Management • HR Planning, • Hiring, Developing and • Managing Project Team. 7. Communication Management • Communications Planning, • Information Distribution, • Performance Reporting, 8. Risk Management • Risk Planning and Identification • Risk Analysis (Qualitative and Quantitative), • Risk Response (Action) Planning and • Risk Monitoring and Control. 9. Procurement Management • Acquisition and Contracting Plan, • Sellers Responses and Selection, • Contract Administration and Contract Closure. 10. Stakeholder Management • Identify Stakeholders • Engagement plans Note: Contents adapted from Project Management Institute (2017) PRINCE 2 Methodology Project in a Controlled Environment (PRINCE 2), this methodology helps determine what, how, when and by whom the activities will be implemented using a common language and dividing the project into manageable and controlled stages (Parra et al., 2016). It was developed in the United Kingdom to manage Informatics/ computer projects (Jovanović & Berić, 2018) and is owned by the company AXELOS; which is a joint venture set up by the Office of Government Commerce (OGC) and the Capita (Ng, 2018). PRINCE 2 has seven processes that provide a controlled start, controlled progress and a controlled close to a project (Bentley, 2015). Seven themes explain the philosophy of the various aspects of the project; why they are needed and how they can be used. These philosophies are implemented through the processes (Bentley, 2015). There are seven key principles interwoven into the processes and themes to form a strong structure (Bentley, 2015). 23 | P a g e Processes 1. Starting Up a Project – in the pre-project process, the project sponsor and project manager are appointed, and a project brief is produced. 2. Initiating a Project – this process scopes the project, prepares a business case and a project plan. The documents will provide sufficient justification to proceed, also a baseline against which progress and success will be measured. 3. Directing A Project – dictates how the project board will oversee the project. The project board are the key decision-makers. Made up of the management team representing the sponsor, the users of the final product and the suppliers of the product 4. Controlling Stage – dictates how to control each stage of the project. 5. Managing Product Delivery - This process provides a control mechanism so that the Project Manager and specialist teams can agree with the details of the work required. Create formal requirements on accepting, executing and delivering project work. 6. Managing Staged Boundaries – this process dictates how to transition from one stage to the next. 7. Closing – Covers the formal decommissioning of the project, follow-up actions and evaluation of benefit achievement. Table 2.3 Themes and Principles of PRINCE 2 Methodology Theme Related to Principles Explanation 1. Business case Continued Business Justification Establish mechanisms to judge whether the project is desirable, viable and achievable 2. Organisation Defined Roles and Responsibilities Define and establish the project’s structure of accountability and responsibility 3. Quality Defined Roles and Responsibilities Focus on Products Learn from Experience Define and implement how the project will verify that products are fit for purpose 4. Plan Continued Business Justification Manage by Stages Manage by Expectations Defined Roles and Responsibilities Learn from Experience Facilitate communication and control by defining the means of delivering the product 24 | P a g e Theme Related to Principles Explanation 5. Risk Continued Business Justification Defined Roles and Responsibilities Learn from Experience Identify, assess and control the uncertainty and improve the ability of the project to succeed 6. Change Continued Business Justification Defined Roles and Responsibilities Learn from Experience Identify, assess and compare achievements against those planned 7. Progress Continued Business Justification Manage by Stages Manage by Expectations Learn from Experience To monitor and compare actual achievements against those planned Note: Contents adapted from Bentley (2015) Agile Project Management (APM) Methodology Agile project management is based on the "Agile manifesto" which was created in 2001 (Cesarotti, Gubinelli, & Introna, 2019). It evolved from software developers who out of frustration at traditional business practices sought to foster productivity and innovation by improving the quality of collaboration (Codington-Lacerte, 2020). Software development relies heavily on capturing user requirements accurately. The difficulties lie in the clients knowing what they want and being able to articulate it, developers completely understanding those wants and needs, errors that are part and parcel of software development and a future that is unpredictable (Twidale & Hansen, 2019). The agile manifesto is a set of principles and practices that aim to enhance a team’s ability to respond to the changing environment and product requirements (Krehbiel et al., 2017). A project that employs agile methodologies is complex adaptive systems (CAS). The CAS based Agile Project Management (APM) framework prescribes the six practices for managing agile development projects: Table 2.4 Agile Project Management Practices Practice Explanation 1. Guiding Vision Recognizing and nurturing a shared project vision as an internal model translates it into a powerful influence on team behaviour. 2. Agile Vigilance In a context of continually changing, the agile manager must adapt the project on the edge. Without a rigid project structure, 25 | P a g e Practice Explanation supervision takes on a central role to balance, chaos, risk and project boundaries. 3. Organic Self Organised Team Small and dynamic team composition that supports adaptability to changing external conditions. Scrum formally recognizes three key roles: Product owner, Development team and Scrum Master. The product owner represents the stakeholders and ensures that the team offers value to the business. The Development team is responsible for the practical advancement of the project. The Scrum Master acts to support the team in applying the Scrum methodology and prevents external influences from reducing the effectiveness of the team. 4. Simple Rules Generative and straightforward rules, if some practices are not being followed, the team analyses and remove the causes. In this way, the rules become easily implementable and do no restrict the autonomy and creativity of team members 5. Open Information The group's knowledge enriches the single element of the team— open and free-flowing information between team members. 6. Adaptive Leadership Adaptive leadership promotes the creation of an adaptable and evolving team process able to adapt to different contexts. Collaboration and communication are central aspects and allow teams to move faster by solving things face to face. Note: Contents adapted from Cesarotti et al. (2019) APM embodies the majority of today's methodologies, like Extreme Programming, Crystal Methodologies, Scrum, Adaptive Software Development, Feature-Driven Development, Dynamic Systems Development Methodology and others (Cesarotti et al., 2019). These methods differ in specific techniques but have in common: short iterative lifecycles known as sprints, frequent relations with customers, and constant learning (Codington-Lacerte, 2020). Instead of in-depth planning at the beginning, the project is broken down in to into smaller manageable subsets which the project teams pursue using a process called design sprints. The goal of each sprint is to produce a working component which is then improved upon if required. Versions of the components of the overall output, are produced, tested, and reviewed. More versions are produced until the final version, is delivered. A design sprint can be broken down into five stages 26 | P a g e (Twidale & Hansen, 2019). These stages do not have to follow sequentially; they represent a systematic way the short iterative cycles can be tackled (Twidale & Hansen, 2019). Design sprints can occur in several iterative cycles and more importantly, can run in parallel (Twidale & Hansen, 2019). The stages of design sprints are as follows: • Understand - An exploration of the problem(s) trying to gain an empathetic understanding of it. This information gathered and synthesised will feed into defining or redefining of the problem. • Sketch - Conceptualise the problem through ideation and exploring alternative solutions. • Decide – Choose an idea or theory and visualise it. • Prototype - Materialise (build) ideas sketched earlier. • Validate – test the idea or prototype, learn and reflect The agile manager understands the effects of the mutual interactions among a project’s various parts and steers them in the direction of continuous learning and adaption (Cesarotti et al., 2019). Adaptive APM-based framework includes several practices, like adaptability; fluid organizations, recognition of external control limits in task prioritisation and the focus on problem-solving techniques in which the individual plays a central role. All members are skilled and valuable stakeholders in team management. The primary troubleshooting mechanism is the team's self- regulating ability that minimises up-front planning and focuses on adaptability to changing conditions. Lean Six Sigma Methodology A lean project is structured to provide a product that improves the maximum value and minimise waste. The lean management approach originated from the automotive industry, and over the decades has become well established in the service industry. John Krafcik, American research coined the term in the 1980s when his research team noted that the Japanese firm Toyota produced vehicles with fewer defects and greater variety than their competitors, using less of everything; time, money and resources (Ballard & Tommelein, 2012). Over the decades, lean production has made its way into project management as a method of improving delivery in a production environment. The main results consist of significant improvements in schedule and waste (time and resources) reduction (Cesarotti et al., 2019). Six Sigma is a data-driven methodology focused on eliminating defects, usually implemented to fix an existing product or process that does not meet customer specification or the performance 27 | P a g e required by the company. The method can also be applied to design new products or services; in this case, it is called; Design for six sigma (Cesarotti et al., 2019). Six sigma is implemented using sequential phases known as DMAIC: Define, Measure, Analyse, Improve, Control (Cesarotti et al., 2019). Table 2.5 describes the activities carried out in each phase of DMAIC. Table 2.5 Phases of Lean Project Management Phase Activities Define • Understand the opportunity • Build the team • Know what the customer wants • Build the case for change Measure • Map the process • Gather data • Show size of the problem • Confirm true cause Analyse • Identify potential causes • Analyse the process • Analyse the data • Confirm the causes Improve • Organise the workplace • Generate potential solutions • Select the best solution • Implement Control • Implement process control • Ensure all new processes are documented • Make the improved process the standard way • Capture team learning Note: Contents adapted from Cesarotti et al. (2019) 2.3 Comparison of Project Management Methodologies Project management methodologies (PMM) are the different approaches and techniques that teams may use to deliver a project. No one methodology is better than the others; some structured for speed while others for comprehensiveness. Each approach has its pros and cons for specific scenarios. Table 2.6 Compares the strength and weakness of the five methodologies discussed earlier in the literature review. The researcher has summarised the findings into a table format. 28 | P a g e Table 2.6 Strengths and Weaknesses of Project Management Methodologies/ Framework. Source: Author Methodology/ Framework Strengths Weakness Waterfall • It allows for departmentalization and managerial control. • Simple and easy to understand and use.1 • Easy to manage due to the rigidity of the Model – each phase has specific deliverables and a review process.1 • Sequential phases are processed and completed one at a time.1 • Works well for smaller projects where requirements are very well understood.1 • It does not allow for much reflection or revision.1 • Difficult to make changes or correction once past each phase. Not suitable for the projects where requirements are at a moderate to high risk of changing.1 • Not a good model for complex and object-oriented projects.1 High amount of risk and uncertainty PMBoK • It is a globally recognized standard.2 • It builds on experience. • It contains the accumulation of years and years of good practices from thousands of project managers.2 • It is process-oriented every process is totally defined with inputs, tools, techniques and outputs. • Can be applied to projects from any industry.2 • Can be too complicated for small projects • Highly document-oriented • Difficult to keep the team connected. PRINCE 2 • The method is repeatable and therefore, teachable. • Can be applied to Projects from any industry. • It builds on experience. • Everyone knows what to expect. • If a project is handed over in the middle, it is useful to know what • Can be document heavy • Does not cover soft skills • Not enough emphasis on project plan and execution.3 29 | P a g e Methodology/ Framework Strengths Weakness documents to look for and where to find them.3 • There is early warning of problems.3 Agile • The customer gets results faster • Flexibility and adaptability to user changes. • It allows the opportunity to reflect and gather requirements after each deliverable • User feedback continues through the entire project • It can generate scope creep because users add more requirements according to the deliverables received. • Works better in small teams. • It is harder to implement quality controls because of constant Change. Lean Six Sigma • Customer-focused • Shorter customer fulfilment lead times • Improved quality • Lower costs to apply the methodology • Improved capacity utilisation • Maximise invested capital • Customer loyalty and retention • Data driven • One size does not fit all • Too rigid Note: Reference 1 Kalso (2020) and 2 Project Management Institute (2017) and 3 Bentley (2015) When managing a project at ADHB the organisation endorses the use of ADHB’s P3M3 framework, which incorporates both PRINCE 2 and PMBOK methodologies for project management. PMBoK and PRINCE 2 both complement each other in practice and provides a useful groundwork for project management. Prince 2 describes itself as a project management methodology. Whereas PMBok provides best practice in terms of norms, process and methods that successful project managers should know. ADHB’s project management framework was designed to provide standard policies and guidance for project management's critical elements and set the minimum standards that senior management and the executive can expect from any project, regardless of size, or complexity. Fig 2.2 summarises ADHB’s P3M3 framework, which divides the project lifecycle into five phases; Pre- project, Initiate, Plan, Execute, and Close. The lifecycle phases are intentionally broad to make the 30 | P a g e framework applicable across the entire organisation at a macro level, ensuring a consistent but scalable approach to project delivery. Fig 2.2 ADHB’s P3M3 Project Management Framework The focus of the framework is project management, rather than technical elements of developing outputs. As a result, this framework is high level and intended to accommodate different development approaches, tools, the ADHB project lifecycle, and the minimum standards' parameters (EPMO, 2018). It does not provide technical guidance on product/service/output development, or elements such as requirements analysis, design & development, testing, and release management (EPMO, 2018). As part of project initiate and plan phase, projects will define the approach for developing and delivering the project’s outputs. Many projects, particularly information technology or construction projects, will need to incorporate a specialist development methodology and processes to support their approach. Three development approach commonly used at ADHB is waterfall, Agile or Lean Six Sigma. The differences between these approaches relate to how outputs or components of outputs are developed and delivered to the customer/business (EPMO, 2018). 31 | P a g e A useful framework should be tailored to the specific environment and adaptable to projects' dynamic nature and stakeholder demands (EPMO, 2018). It needs to be flexible while still providing guidelines that leverage both best practices and past experiences to ensure the project goals are achieved. Based on this argument coupled with the research being conducted at Labplus & APS which is part of ADHB, the new integrated framework incorporated ADHB’s P3M3 Project Management framework. Agile methodology was used for project delivery given nature of the research was exploratory, requiring an iterative process with outputs that had to be established, designed and developed. 2.4 Change Management Coping with change can be challenging for both individuals and organisations. Harvey (1990) stated: “It is crucial to remember that for every change proposed or achieved, someone loses something” (Elrod & Tippett Donald, 2002). This element of loss if unaddressed can manifest as emotions like those accompanying the stages of grief. The Change Curve seen in Fig 2.3, is perhaps one of the best known and most applied models for businesses and organisations when looking at changes in the workplace (Critchley, 2012). It is an adaptation of the Kubler - Ross grief curve that documented the five stages of grief an individual passes through when coping with trauma and terminal illness (Elrod & Tippett Donald, 2002); (1) Denial, (2) Anger, (3) Bargaining, (4) Depression and (5) Acceptance. Kubler Ross laid the foundation for understating the process of Change. 32 | P a g e Fig 2.3 Kubler - Ross Change Curve Note: Adapted from Elizabeth Kubler Ross Foundation (2020) The change curve is a theory which tracks the different stages of an individual's psychological journey through change. In the face of change, people experience a vast range of emotions. However, the speed at which a person may go through these emotions varies based on the individual’s circumstance (Wiggins, 2009). For example, people are more open to change if they have had a positive experience in the past or can identify with the benefits that may come from the “new environment”. It is important to note that change is not a linear process, people may cycle through the emotions, and at times go backwards. There will be a dip in productivity or a low point; the idea is to be able to get past this and move into a place of acceptance (Critchley, 2012; Elrod & Tippett Donald, 2002) The success of organisational change interventions relies heavily on people's abilities and commitment to implement these interventions and see them through to completion (Jowett & Ma. Regina, 2017). An organisation’s capability/readiness to change is about how well it can manage and implement Change (Vaishnavi, Ma, & Pankaj, 2019). Ultimately, generating engagement for change and ensuring that people can implement these interventions rests on an organisation’s leaders' shoulders. Therefore, a key variable in organisational change is the effectiveness of its leaders – in particular, their effectiveness in leading change (Jowett & Ma. Regina, 2017). Ideal 33 | P a g e leaders of today can be described as transformational (Creasey, 2017; Singh, 2013). These leaders are distinguished by their capacity to inspire and provide inspirational motivation, individualized consideration, intellectual stimulation and idealized influence in the followers (Singh, 2013). 2.5 Change Management Methodologies Change management is the conception of planning and implementing change in an organisation (Talmaciu, 2014). It is specific activities required to foster the adoption of the proposed change (Creasey & Taylor, 2014; Talmaciu, 2014). When changes impact how employees do their jobs, the speed and level of adoption and usage directly impact the benefits realization and value creation of the change (Creasey & Taylor, 2014). Variations in personnel and organizational cultures have led to various perspectives. Change Management comprises of the three layers; organisation, people and projects (Galli, 2018). Change management methodologies synthesize the research and practice in the field as a basis to understand the processes and mechanisms of change at both organizational and individual levels. The literature is full of methods meant to achieve organizational change. Known as change theories or models of change, their adaptation to the existing situations in an organisation's life can provide viable solutions to streamline and improve change management. Although there are many change models, the researcher's literature search in key business databases produced four prominent models. Table 2.7 summarises the literature search results for the four prominent change models: Kurt Lewin’s Change Model, Kotter’s 8 Step Change Model, ADKAR Change Management Model, and Mckinsey’s 7-S Model. The following section attempts the review the different models and provides their strengths and weaknesses. 34 | P a g e Table 2.7 Summary of the literature search finding for change management models Search Criteria Scopus Discover Emerald Insight Business Source Complete Web of Science “Change Management” 57,890 61,911 15,000 10,112 5,966 “Change Management” AND “Kurt Lewin” 606 49 268 28 20 “Change Management” AND “Kotter’s 8 Step” 29 17 10 5 8 “Change Management” AND “ADKAR” 146 44 28 16 16 “Change Management” AND “McKinsey 7-S Model” 19 1 13 0 0 Kurt Lewin’s Change Management model Lewin’s theory (Lewin, 1951) distils the process of change down to three steps: the behavioural thaw (unfreezing), the change (transition) and the recrystallization of behaviours (freezing) (Galli, 2018). This three-step model has become best-known and, arguably, the most influential organisational change approach (Burnes, 2020). In the initial phase known as “unfreezing” the change is defined and respectively explored, analysed and understood. This stage highlights the difference between the organisation's real behaviour and the desirable behaviours (Talmaciu, 2014). The second phase “transition” consists of applying the change according to the chosen strategy, implementing a system of behaviour for the Change, specific new values and attitudes (Talmaciu, 2014). The final phase, known as “freezing” consolidates the new system of rules, norms, structures, and policies into the organisation's permanent elements (Talmaciu, 2014). Lewin’s change theory has been criticised as too linear and prescriptive, failing to address the complex iterative process of change (Wojciechowski, Pearsall, Murphy, & French, 2016). There is a lack of detail on how to deal with the human side of change (Galli, 2018). This is a common limitation of most methods not taking in to account an individual’s reactions to the change, leading to resistance. An organization or project team will struggle with adopting the change if people resistance is not handled correctly (Galli, 2018). Despite the limitations mentioned, Lewin’s Model of Change has become a staple in healthcare management (Wojciechowski et al., 2016). 35 | P a g e Kotter’s Eight Step Change Model John P.Kotter’s Eight-Step change model (Kotter, 1996) expanded Lewin’s original change theory (Appelbaum, Habashy, Malo, & Shafiq, 2012). Kotter believed that “Leadership must create and sustain the kind of changes needed for successful organizations to compete in the current competitive world” (Galli, 2018). His process emphasises a top-led model for change, where it is necessary to engage at many levels of the organisation to implement the organisational Change (Pollack & Pollack, 2015). The process is typically depicted as a linear sequence of eight steps summarised in Table 2.8. Table 2.8 The Principles of Kotter’s Eight-Step Model Principle Explanation 1. Create a sense of urgency Generate an awareness of the need for the organisation to change. It is crucial to gaining needed cooperation. 2. Create a core coalition Involves forming a group who have enough power to lead the change 3. Develop and form a strategic vision Developing a strategic vision requires formulating an overall roadmap for the change process. The transformation vision is required to align objectives and to progress as a group. 4. Communication and share vision plans Regular, consistent communication of the change to develop an understanding of the future state 5. Empowering employees to act on the vision Involves removing obstacles to change, changing structures or systems that undermine the vision, and encouraging innovative ideas 6. Generate short term wins Short-term wins help to demonstrate the viability of change and to build momentum 7. Consolidate gains and produce more change Not allowing complacency and having continuous progress is a goal. Change efforts often fail because participants revert back to their prior habits, usually failing to implement change. 36 | P a g e 8. Initiate and set new changes In this stage, the goal is to institutionalize the change and to anchor it in the organizational culture Note: Data adapted from Pollack and Pollack (2015) and Galli (2018) Despite the popularity of the process, Kotter’s model of change management lacks rigorous fundamentals. The change management model appears to derive its popularity more from its direct and usable format than scientific consensus (Appelbaum et al., 2012). Both Kotter’s (1995) article and 1996 book were based on his personal business and research experience and did not reference outside sources (Appelbaum et al., 2012). The division between how change management is described and how it is practised is not new; the explanation may lie in the target audience. The process of creating change is meant for end-users, such as stakeholders involved in managing the change (Appelbaum et al., 2012; Pollack & Pollack, 2015). Kotter’s model views change as a linear process; however, organisations are comprised of multiple instances of the process, each with overlapping stages, and each moving at their own speed (Appelbaum et al., 2012). McKinsey 7-S Model McKinsey’s 7-S Model was developed by Tom Peters, Richard Pascale, and Robert Waterman Jr., while employed by McKinsey & Company (Galli, 2018). The Model is simple yet complex, identifying seven interrelated areas to empower organisations to inventory their effectiveness (Dewey, 2020). Evaluation of an organisation's effectiveness begins by establishing the critical elements to the operations, followed by understanding how they work in cooperation with each other. This holistic approach to organisation management prepares executives to make a significant change to the business effectively and efficiently (Dewey, 2020). McKinsey’s 7-S Model identifies seven key elements that make organizations successful; strategy, structure, systems, shared values, style, staff and skills. Table 2.9 describes the seven elements of Mckinsey’s 7-S Model. Fig 2.4 depicts the interrelated relationship between the seven areas. 37 | P a g e Table 2.9 Elements of Change for McKinsey’s 7-S Model Elements of Change Strategy Involves transforming the organisation from the current position to the new position, as identified by the objectives. Structure Identifies and defines the roles, responsibilities, and accountability relationships. Systems The systems influence behaviour because they are the mechanisms that affect the resources available for a given entity and the processes by which individuals are rewarded and groups measured. They include management control systems, performance measurement/reward systems, planning, budgeting, resource allocation systems, and information systems. Shared values The central organisational beliefs and attitudes help employees understand the organisational purpose and how it will affect the internal and external environments. Staff Includes staffing levels and motivation Style This element looks at the leadership of the project and the team. It also includes how the company hires and retains staff into the organization or project team. Skills This refers to employees and team members' ability to do the organisation’s or project team’s work. Note: Contents adapted from Dewey (2020) Fig 2.4 McKinsey’s 7-S Model (Dewey, 2020) 38 | P a g e ADKAR Change Model Jeff Haitt is the founder of PROSCI and the creator of the ADKAR change model (Hiatt, 2006). The model focuses on people’s adaption to change instead of the change itself (Galli, 2018). ADKAR represents the five building blocks of by how an individual experiences change; Awareness, Desire, Knowledge, Ability and Reinforcement (Galli, 2018; Hiatt, 2006). Fig 2.5 PROSCI ADKAR Model, Hiatt (2006) Application of ADKAR methodology can be used to help individuals make sense of the change that is in progress. It can provide organisations with a common language for change. It also enables managers to lead change and diagnose gaps, which can then be remedied with corrective actions. Change is fully realised when every person impacted by the change has achieved each step of the ADKAR model. Having said that it is not feasible for an organisation to take one person at a time through the steps. Hence PROSCI 3 phase process for organisational change management provides a strategy and plan that play a role in influencing individual change. Awareness of the need to change Desire to support and participate in the change Knowledge of how to change Ability to implement required skills and behaviour Reinforcement to sustain the change 39 | P a g e Fig 2.6 PROSCI 3 phase process for organisational change management, PROSCI (2020) Each element in this model creates an environment that is more receptive to the change being implemented. Table 2.10 is a quick summary of the tactics that may be used at different stages of the process. Table 2.10 Summary of tactics used in ADKAR, Hiatt (2006) 2.6 Comparison of Change Management Methodologies There is no right or wrong change management methodology. The different methodologies do share some commonalities. When selecting a change methodology for use, it is recommended to compare the different methodologies and decide based on what the organisation needs. Table 2.11 Compares the strength and weakness of the four methodologies discussed earlier in the literature review. The researcher has summarised the findings into a table format. Change Management Activities A D K A R Communication Sponsorship Coaching Resistance Management Training 40 | P a g e Table 2.11 Strengths and Weaknesses of the Different Change Methodologies. Source: Author Methodology Strengths Weaknesses Lewin’s change model • Simple and effective three-step process, which makes it attractive for large organizations and project teams to use.1 • Analysing aspect changes is easy to do. 1 • The three major steps are transparent enough for change management novices to understand how to do the change from start to finish.1 • The Model does not detail how to deal with the human part of the change.1 • The unfreezing phase can be time- consuming and costly if planned poorly or with minimal top management support.1 • Linear and prescriptive Kotter’s Eight-Step Model • Greater direction, steps presented in action points arranged in a practical sequence • Incorporates people side of change • Advice on which point in the process to communicate with employees.1 • Advice on including employees is effective for organisations with a traditional managerial hierarchy.1 • The process describes what has to be done but little detail in how it should be achieved • Can only be applied to specific types of change • The process should be used as a simple set of linear steps.2 • It comes across as a top-down approach. The employees do not have input or the option to share ideas before strategic vision creation.2 • Prescriptive, delay or regress if steps are skipped or executed incorrectly, as each step is reliant on the last. McKinsey 7-S Model • Shows the weaknesses and strengths in seven core dimensions of the organisation or project team.1 • Can be time-consuming and tedious to go through all of the levels.1 41 | P a g e Methodology Strengths Weaknesses • This characteristic provides managers with an opportunity to identify where the need for change lies more clearly.1 • Since it is a complex model, it would be challenging to implement in a large organization.1 • Instead of focusing the entire model on the people side of change, it only focuses on the skills and staff resource.1 ADKAR • It has relatively increased focus of employee and project team member acceptance of change. The process starts and ends with them as the forefront of change.1 • Not practical for an organisation to take one person at a time through the steps. • Lack of academic research on the application of the Model. Note: Reference 1 from Galli (2018), 2 from Pollack and Pollack (2015) ADHB endorses the use of ADKAR methodology by PROSCI for change management. Hence the new integrated framework for project and change management developed by the researcher incorporated this model. Despite the lack of academic research on the application of ADKAR, its practicality makes it easy to translate into change activities. During a change project, ADHB’s approach is to create awareness and desire for the change initiative through communication at every level. Applying a standardised and consistent approach to knowledge transfer and building capability within the staff to manage and lead the change. This provides staff with the ability to handle the change and manage the challenges that may come with it. Because there is already an appetite for the ADKAR change model in the organisation, staff would be able to relate to the new integrated framework if it incorporates this model. Using the change model that the organisation endorses provides a reliable platform from which to build a framework that is more likely to succeed. 2.7 The Importance of Integrating Project and Change Management in Healthcare Project management and change management use different terminologies and different methodologies. Their respective proponents arise out of different parts of an organization and have different functional and educational backgrounds. However, they are intimately linked to a 42 | P a g e successful outcome (Fibuch & Ahmed, 2018; Hornstein, 2015). There are two distinct bodies of knowledge that underpin the two disciplines' practice (Crawford & Nahmias, 2010; Pádár, Pataki, & Sebestyén, 2017). Project management focuses on planning and control; its origins are from engineering and construction. While Change management places emphasis on behavioural aspects of adopting change and has grown from the Organisational Development field (Crawford & Nahmias, 2010). Today the vast majority of innovation and business-development opportunities require integration of processes. Healthcare integration projects typically involve significant organisational change, intending to provide improved patient services and outcomes through the integration of healthcare services. Some of the management needs of healthcare integration arguably go past the traditional domain of project management, leading practitioners in these projects to use change management combined with project management (Gordon & Pollack, 2018). Healthcare integration is an attempt to unify and simplify fragmented and uncoordinated services. There are two broad categories of healthcare integration: vertical integration and horizontal integration (Pollack & Algeo, 2014). Vertical integration focuses on acquiring primary care physicians, establishing physician alliances between hospitals and the organisations where services are managed, and establishing an organizational culture of patient healthcare maintenance (Pollack & Algeo, 2014). Horizontal integration exists when mergers and strategic alliances lead to the development of a multi-hospital system (Pollack & Algeo, 2014). The health care industry has had difficulty with the systematic use of process management techniques because of its historically fragmented organisational structure and silo mentality (Fibuch & Ahmed, 2018). Gordon and Pollack 2018 paper explores how the Canadian health sector adapted project management to organisational change needs (Gordon & Pollack, 2018). The article retrospectively analyses Ontario (Canada's) efforts to integrate its healthcare provinces in local Health Networks (LHINs), in an attempt to enhance service delivery to patients and overcome fiscal constraints. Five key themes emerged from this study; 1) Project management only partly aligns to the needs of healthcare integration projects 2) Benefits were found in combining project management with change management 3) Change management was particularly beneficial if used early in the project life cycle 4) The life cycle of these two disciplines did not align, causing complications in practice 5) Practitioners used an intuitive and improvisational approach to combine the discipline 43 | P a g e Findings of these studies underpin the need for the current research. Ministry of Health’s Northern Region Long Term Investment Plan (NRLTIP) endorses healthcare services integration across Northland, Waitemata, Auckland and Counties Manukau DHBs. The region has committed to reducing inequities that currently exist in the system and work across DHB boundaries, integrating sharing resources, assets and services to optimise health gain for all communities. Such an endeavour will require significant organisational change management and project management to deliver these outcomes. 2.7.1 Research Gap Crawford’s 2010 paper on Competencies for Managing Change highlights the organisational change as a project type (Crawford & Nahmias, 2010). Impact of organisational change management on project success has been explicitly identified in literature only recently (Fibuch & Ahmed, 2018; Gordon & Pollack, 2018; Hornstein, 2015; Pádár et al., 2017). Key components of change management, such as communication and stakeholder management, is covered in PM standards. However, the knowledge and skills required to manage organisational and behavioural change are not specifically addressed. The management of organisational change has continued to have a relatively small representation in the project management literature (Hornstein, 2015), despite multiple studies associating poor management of human factors with the failure of organisational change projects (Crawford & Nahmias, 2010). Parda et al. 2017 paper explore the interdisciplinary knowledge transfer between the two disciplines to establish common ground between the two. Both project and change management draw on very similar methodologies. The underlying concepts are the same. Nevertheless, the two disciplines continue to run in parallel. Over the past decade, there has been a growing demand for integrating the two disciplines (Crawford & Nahmias, 2010; Hornstein, 2012). Hornstein 2015 (Hornstein, 2015) paper acknowledges that each discipline requires different skill sets, as stated by Crawford and Hassner 2010 (Crawford & Nahmias, 2010). None the less the disciplines are complementary and mutually supportive areas that should be integrated rather than running in parallel. This research will attempt to create an integrated project and change management framework using ADHB’s P3M3 Project Management Framework and PROSCI’s ADKAR change model. 44 | P a g e 2.8 Building Project and Change Management Capability The connection between project management methodologies (PMM) and project success has been the topic of many research pieces. It can be generalised that effective PMM implementation does not always guarantee positive or enhanced project outcome (Wells, 2012). PMM can be useful by compensating for the absence of tacit knowledge in a project (Wells, 2012), helping managers with less experience and knowledge of project management. The same can be said for change management methodologies. Advantage of using adequate project or change management methodology is that it provides support and guidance for managing the transition and executing the project. Some of the elements that would be seen are: • Effective plans and controls • Efficient use of resources • Better communication • Effective governance • Benefit realization However, these advantages can only be achieved if the proper implementation of the methodology is deemed adequate for the type of project under consideration. An incorrect implementation or implementation of an inadequate methodology may lead to confusion and disorientation and, consequently, to poor project execution outcomes (Chin, Spowage, & Yap, 2012). Fibuch and Ahmed 2018 comments that the primary factor behind successful project management is systematic, consistent, and aligned development and deployment across the entire organisation. Legendary companies such as General Electric and Boeing are known for managing their projects and processes well (Fibuch & Ahmed, 2018). On the same token, viewing change from a systemic perspective means acknowledging and embracing people's interconnectedness affected by the change. A literature review by Shi 2011 has shown many indicators regarding the implementation of project management at both a strategic and tactical level (Shi, 2011). In an attempt to develop the best approach to implement PM practices into an organisation Shi, Qain (2011) propose a term called "Value Adding Path Map" (VAPM). His research explored project management's value in different kinds of organisations; and notes that the magnitude varies from one another. This can be attributed to two things a) the approach taken to implement PM is right, b) the environment in which PM is implemented is suitable. If you were to compare PM to an instrument, knowing the 45 | P a g e right way to operate it and the correct context to use it in are both very important. These two dimensions of PM are referred to as "Hard", and "Soft" systems. The coordination of these two systems creates the largest value to an organisation with the least amount of investment (Shi, 2011). Soft System configuration consists of the general environment in which the PM practices are being implemented. This includes the management system and the PM culture. The maturity of an organisation highly influences value return from project management. A more mature organisation will have more capability, which is the ability to direct the right resource, expertise and time to achieve successful outcomes from a project. Hard System configuration consists of the PM process, PM training and knowledge management as well as the tools and techniques used in the management of projects (Shi, 2011). Creasey and Hiatt also suggest a similar approach for building Enterprise Change Management (ECM), referred to as the ECM strategy map (Creasey, 2019). As seen in Figure 2.7, capability building is treated as a change project; transition happens from current state to future state addressing both technical and people side of the transformation (PROSCI, 2019) • People side – addresses components that build buy-in, support and commitment for change management. A fully implemented technical solution that no one supports will not deliver results and outcomes. • Technical side – implementation of solutions and mechanisms that embed change management process, tools, techniques, training and knowledge management Fig 2.7 Enterprise Change Management ECM, PROSCI (2019) 46 | P a g e Soft System Configuration / People Side This system's focus is to create an environment that endorses the use of project and change management in the core functions of the business. Table 2.12 and 2.13 lists potential activities that will help configure the system: Table 2.12 Overall management system activities to consider for Soft System Configuration/People Side. Source: Author Overall Management System Change Management Project Management • Make a leading change a core competency in leadership roles • Create a change network with business analysts, project managers, directors and executives with high accountability • Building a strong network of sponsors for enterprise change management and making sure they are visible • Budget appropriately for the resource of change management on all projects • The project management system is aligned with the business strategy • The structure of the overall management system is highly project-oriented • The project management system is very well coordinated with the overall management system including the involvement of the support functions in the organisation • The strategic planning of the organisation and project identification are tightly coupled • Project Management Office (PMO) has been set up • The project manager has a clear goal and authority when managing a project Note: Data adapted from Creasey (2019) and Shi (2011) Table 2.13 Culture activities to consider for Soft System Configuration/People Side. Source: Author Culture Change Management Project Management • Understand the organisational culture to develop the best strategy to build change capability across the organisation • The organisation recognises that project management contributes to the success of the organisation 47 | P a g e • Use change management efforts to cultivate the desired organisational culture • Change management is a highly visible initiative and inclusive of our most difficult audiences within the organisation • Maintaining a focus on how individuals benefit from the organisation adopting enterprise change management • Promote the use of change management by sharing success stories of change practices being used in the business • The organisation has a shared language for change management • The project management professionals have a clear career path in the organisation • The PMO is regarded as an essential department of the organisation • The resources allocation systems are highly project-oriented Note: Data adapted from Creasey (2019) and Shi (2011) Hard System Configuration / Technical Side This system focuses on implementing solutions and mechanisms that enable staff to practice both disciplines with a universal language and standardised approach. Table 2.14, 2.15 and 2.16 breaks the system into three areas and suggest potential activities that would promote it: Table 2. 14 Process activities to consider for Hard System Configuration/ Technical Side. Source: Author The Process Change Management Project Management • The organisation has a clear definition of change management process including integration management, scope management, cost management, time management, quality management, procurement management, communication management as well as risk management across the initialising, planning, executing, and closing stages of a project • The organisation has a clear definition of the project process including integration management, scope management, cost management, time management, quality management, procurement management, communication management as well as risk management across the initialising, planning, executing, and closing stages of a project 48 | P a g e • Embed change management practices into improvement initiatives and projects • Maintaining a focus on how individuals benefit from the organisation adopting enterprise Project and Change management practices • The organisation has a clear definition of portfolio and program management processes Note: Data adapted from Creasey (2019) and Shi (2011) Table 2.15 Training and knowledge management activities to consider for Hard System Configuration/ Technical Side. Source: Author Training and knowledge management • The organisation has a training budget for project and change management which is aligned with the personal development plans of project management professionals in the organisation • The organisation has a regular project management and change leadership training system for top managers • The organisation has regular training system for project team members • The organisation has sound knowledge management systems for project and change management including the learning system to improve the effectiveness of the project management professionals which goes beyond training Note: Data adapted from Creasey (2019) and Shi (2011) Table 2.16 Tools and techniques activities to consider for Hard System Configuration/ Technical Side. Source: Author Tools and techniques • The organisation has systematic project management methodologies and techniques in the implementation of project management • The organisation has software to assist with schedule, cost, quality, and risk management • The organisation can track projects to assist in resource allocation • Create a community of practice Note: Data adapted from Creasey (2019) and Shi (2011) 49 | P a g e 2.8.1 Research Gap Companies may face the challenge of establishing a series of logical, economical and reasonable steps of increasing capability in both project and change management (Crawford, Aitken, & Cooke- Davies, 2009). There is a lack of clarity about how capability growth in project and change management can be developed and facilitated by an organisation in the current research literature. This could be due to the nature of knowledge embedding processes is not being well understood at either the organisational or individual level (Fernandes et al., 2015). Organisations need more guidance on how to embed PM and CM practices into the core of their business so that they can reap maximum benefits from it. This research report is an attempt to provide such guidance using Shi, Qain “Value Adding Path Map” and PROCI ECM strategy map 50 | P a g e Chapter 3 Research Methodology 3.1 Detailed descriptions of research questions/ hypotheses Due to the size and nature of the ADHB project management can be challenging. As a public entity, the organisation relies on public funds, compliance requirements from the government or Ministry of Health, adherence to national policies and regional direction while providing service that cannot stop. With all these challenges, change management has taken a prominent role in the organisation. Service development often requires behavioural changes and usually creates extensive change to the way people perform their jobs. For an organisational change project to be successful adoption is the key. There is not always enough money or resources (staff) for a project to have a project manager and a change manager in the public health sector. Healthcare projects are usually done by technical and clinical staff who may not have project or change management training or experience. Often these staff are expected to manage both domains while continuing with BAU. Hence the first three research question explored the efficacy and practicality of combining project and change management practices. The first hypothesis is that project and change management practices can be integrated. Secondly, it would be valuable to have an integrated framework that could provide staff with guidance when fulfilling both project and change manager's role. Finally, this research's basic assumption is that an organisation can improve project outcomes performance by improving PM and CM practices. However, standardised practices for both disciplines is not always sufficient at creating value return. How well it is embedded into the company will determine the value that is gained from them. Building the capability of staff to be able to use both practices most effectively and efficiently is the aim of the second research question. If an organisation is aware of these factors and addresses them during the stages of the embedding process, then the embeddedness is more likely to be achieved. 51 | P a g e 3.2 Consideration for Research Strategy A research paradigm is based on ontological and epistemological assumptions (Berryman, 2019; Scotland, 2012). Ontology is a philosophical concept that dates to Aristotle times (West, 2011). It is part of the metaphysics study of what exists: the theory of “being” and the rules governing it (Scotland, 2012; West, 2011). Epistemology is concerned with how knowledge can be created, acquired, and communicated (Scotland, 2012). Berryman (2019) describe epistemology as “ways” of knowing; how we know what we know, and who can be a knower. “In other words, what it means to know” (Scotland, 2012). Ontology and epistemology provide an insight into the researcher's view of what constitutes the nature of truth. Different paradigms inherently contain different ontology and epistemology views based on conjecture and philosophical underpinnings (Scotland, 2012). A researcher’s ontology will generate the research question's foundation, and their epistemological position will help shape the research. Both perspectives influence the choice of methodology, that is the theory of how the inquiry will proceed (Berryman, 2019). In this research, ontology is knowing that Project and Change management are two processes that exist in the business world and healthcare. The epistemology is to understand why these processes are essential and how to use them effectively. 3.3 Research methodologies Research methodology has a crucial role in generating knowledge from studies and their design (Smyth & Morris, 2007). Providing instructions on the type of data that will be collected, how it will be gathered and subsequently analysed to generate the research question's findings (Berryman, 2019). Hence the methodology is driven by the nature of the research question. The data collected can be either quantitative or qualitative, which is influenced by the researcher's own ontology and epistemology, as discussed earlier. Epistemology and ontological position can be traced back through the methodology (Scotland, 2012). Epistemology is divided into positivism and interpretivism (Berryman, 2019). A Positivist researcher will look for quantifiable evidence; they believe in a cause and effect relationships through repeat observations (Berryman, 2019). The research will seek to establish links between constructs, generally by comparing groups or responses, utilising quantitative methodologies such as experiments and surveys with the researcher remaining separate from their investigations to 52 | P a g e maintain objectivity (Berryman, 2019). Quantitative methodology generally seeks to test a theory, hypothesis, or explanation. Variables are identified, numeric data is collected, statistical analysis is often employed, and set validity and reliability standards are used (Berryman, 2019). An interpretivist researcher seeks to understand a phenomenon, in context, through the understanding of the participants (Berryman, 2019). The world for an interpretivist holds multiple truths, which is revealed through social constructions, language, shared consciousness, and other social interactions (Berryman, 2019). Using qualitative methodologies such as case study, ethnography, phenomenology, grounded theory and narrative the researcher seeks to understand the “how” and the “why” from an individual’s perspective, investigating interaction among individuals as well as the historical and cultural contexts which people inhabit (Berryman, 2019; Scotland, 2012). Data is collected via field notes, participant observation, analytic memos, artefact collection, document analysis, interviews and focus groups (Berryman, 2019). Pragmatic research methodology rejects the qualitative/quantitative divide and adopts strategies that draw upon a mixed-method approach (Gunasekare, 2013). Positivism and interpretivism are two very mutually exclusive paradigms about nature and knowledge sources (Feilzer, 2010). Feilzer (2010) argues that pragmatism can be an alternative paradigm that “sidesteps the contentious issue of truth and reality”. Pragmatics recognises that to solve a problem in the “real world”, a singular point of view may not give an entire picture, and there may be multiple realities (Feilzer, 2010). Clarke and Visser (2019) support this argument by exploring possibilities and pitfalls of this research style; concluding that for a “novice researcher” it provides a flexible and more reflexive approach to research design. 3.4 Research Design There are two components to this research; the first part was to develop an integrated project and change management framework that could be used for healthcare projects. The second part was to build capability for project and change management in the organisation through the development of soft and hard systems. Pragmatic research was the approach selected, as it provided the freedom to use multiple methods. The study's basis was more qualitative, attempting to answer a “how” question through brainstorming sessions, group work, and feedback loops. However, in a scientific setting such as a laboratory; theories and concepts are far more likely to be adopted if backed up with empirical data. Hence, the researcher employed a survey to provide insight around 53 | P a g e the understanding of project and change management capabilities at LabPlus & APS. The questionnaire was designed to explore the use of either or both project and change management processes in the laboratory to manage and deliver projects. The survey results were used to identify gaps in the process and help create a new integrated framework. Case study research design is suited when “what” or “how” questions’ are being investigated. It allows the exploration of existing issues and develops theories within the research's real-life context (Yin, 2014). Thus, allowing the research to be tailored to the inherent complexity of the research problem. Boblin et al. (2013) suggest that a case study design is suitable to conduct in- depth studies in various organisational settings (Boblin, Ireland, Kirkpatrick, & Robertson, 2013). This research was set in the healthcare sector in a single location. LabPLUS & APS is part of the clinical support directorate within Auckland City Hospital. Limiting the study to one arm of the directorate within the hospital allowed the researcher to create an integrated framework for PM and CM in a single management structure. At the same time, LabPLUS & APS is made up of seven departments, each having their own operating model. Therefore, providing a sample population that reflects a la