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Research review

Change management tools part 2: managing clinical improvement projects

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The principles of project management used in clinical improvement initiatives are similar to those used in the business arena


This paper, the second of a three-part series looking at change management tools, provides a practical guide on how to use common project management principles in practice. Much of the literature on project management focuses on the business arena, with little reference to clinical settings. Identifying this literature and understanding its relevance to managing projects in healthcare can be difficult. This article provides a practical guide to identifying the key principles of good project management and applying these in health settings.

Citation: Phillips J, Simmonds L (2013) Change management tools part 2: managing clinical improvement projects. Nursing Times; 109: 16: 20-22.

Authors: Joanna Phillips is service improvement manager; Lorraine Simmonds is head of service improvement; both at University Hospitals Birmingham Foundation Trust.

  • This article has been double-blind peer reviewed
  • Scroll down to read the article or download a print-friendly PDF including any tables and figures
  • In this series, read part 1 here and part 3 here


Project management is the process of planning, organising, leading and controlling resources to achieve specific goals. Managing a project can seem overwhelming and, without proper structure, it can easily be diverted from its intended pathway. This can result in a failure to achieve the project to time and within the budget. For this reason, more than 70% of projects fail to meet their full objectives (NHS Institute for Innovation and Improvement, 2007).

Projects are not undertaken only by those in management, administration or construction; many clinicians and nurses are excellent project managers because of their skills in managing patient care. However, the terminology used can often make project management daunting for those not in a business arena, as it is often confusing. Jargon is commonly used and, although it is useful to understand this terminology, it is not always necessary to use it (NHS Institute, 2007).

Project structure

The key to a successful project is having a clearly defined structure identifying roles and responsibilities. Although the size of the project will influence the number of people involved and therefore the structure, any project should have the following key roles:

  • Project lead: responsible for the overall delivery of the project plan, and often the person who updates the project board (if appropriate). This person is the main point of contact, particularly for issues requiring escalation;
  • Project manager: responsible for producing, updating and maintaining the project plan, and may also need to deputise for the project lead if they are unavailable.

In small-scale projects, the project manager and project lead roles may be combined, but the responsibilities and roles remain the same.

Project plan

A project plan is vital to deliver a successful project. It lists all activities that need to be completed to achieve the project’s goal, with each task given a start and end date to ensure they are completed within the project timescale. Tasks are assigned to particular people or teams to take lead responsibility.

The plan can be set out using the template below.

Project set up and structure

This section should list all the tasks associated with setting up the project and deciding on its structure. These may include the following:

  • Arranging monthly project meetings;
  • Agreeing project structure;
  • Identifying key leads within specialties;
  • Producing high-level, detailed project plans;
  • Defining project priorities;
  • Creating and maintaining a risk log;
  • Defining the project scope (what the project’s remit is);
  • Producing clear written objectives and measures.


This section should detail all the tasks that help to identify any issues that may arise. These may include:

  • Identifying and agreeing priority areas for review;
  • Processing map services, patient pathways or business processes;
  • Reviewing current patient pathways;
  • Reviewing current workforce structure;
  • Understanding current ways of working.

Consultation and redesign

This concerns actions around redesigning a process or patient pathway, or activities associated with making the change. These may include:

  • Organising workshops to feed back process mapping findings;
  • Proposing new ways of working, patient pathways or business processes for pilot testing;
  • Meeting departments and support services that may be required to give an input into the redesign;
  • Drafting new operational procedures or amending existing documentation for sign-off.

Implementation and evaluation

The final section details actions associated with implementing the new process, pathway or way of working, and evaluating its success. These may include the following:

  • Developing training manuals;
  • Drafting a training programme;
  • Developing an implementation programme;
  • Developing an evaluation tool;
  • Agreeing feedback method.

Using this template in practice

The fictional case study in Table 1 examines how “at-the-bedside” patient handover was implemented on an acute surgical ward. This example illustrates a project plan for a ward with a two-month implementation plan. The ward matron is the project lead and the ward manager has been designated as project manager.

Understanding the risks

Most projects will have some associated risk. It is important to assess and understand each risk and indicate how to limit its effect. Table 2 shows an example risk log with mitigation plan for the case study.


Good communication is essential to help make everyone involved in the project feel included and valued. This can be achieved through various methods including meetings or briefings, with the project manager regularly updating the project plan and distributing this to key project members.


Project management can seem daunting because the process is not always clearly described and much of the literature on the subject is discussed within business and construction arenas, rather than health settings. However, the key principles described in this article set out the processes of managing projects’ structure and definition, which are key features of successful projects. By applying these, progress can be easily monitored and issues highlighted at an early stage, giving time to develop a resolution.

Key points

  • Project management is the process of planning and implementing change to achieve specific goals
  • To keep on time, a plan of responsibilities and roles is needed
  • Risks should be assessed and understood, so steps can be taken to minimise them
  • Roles and responsibilities should be defined, particularly those of project lead and project manager
  • Good communication is essential to make everyone feel valued and in touch with what is being done
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