How to get results from programme management

The development of a Responsibility Chart is one of the most important activities during the development of a Programme Plan, advises Conor Hannaway.

Programme management has become an important management process in the Irish health services. It is increasingly being relied on to achieve specific outcomes both nationally and within local environments.  For instance, the success of many of our national health strategies is based on programmatic delivery.  Equally, the methodology has been used at local level such as responding to a HIQA report. Programme management is very similar to, but is distinct from, project management.

Very often, a programme will consist of a number of phases or initiatives which may, or may not, be identical.  A smoking cessation programme may include educational, therapeutic and support projects which are coordinated and aligned within the programme.

Because of the multiple stakeholders involved, it can sometimes be difficult to understand the part which each one plays. For that reason, the development of a Responsibility Chart is one of the most important activities during the development of a Programme Plan.  The responsibility chart clarifies the different roles of everyone concerned with the programme. It helps to streamline programmes so that different stakeholders are involved to just the right degree.

Take, for example, a senior management team which is concerned about DNAs (Did Not Attends) in the Outpatient Department of their hospital. They set up a multi-disciplinary group to review and implement a range of initiatives in a programme designed to achieve a 33 per cent reduction in DNAs in six months.  A responsibility chart lets everyone know who is involved and to what extent.

The best known version of the chart takes the form of a matrix with the participants on one axis and the activities within the programme on the other.  The degree of involvement is expressed as letters with RACI being used in the classic version of the chart.

The letters stand for:

  • Responsibility: Usually team members with specific duties in relation to the activity.
  • Accountability: Denotes the person who is ultimately accountable for performance outcomes.
  • Consultation: People whose opinion should be sought before decisions are made. They may include experts, resource handlers or people with regulatory responsibility.
  • Inform: People who should be kept up to date on what is happening.

A simple presentation of an accountability chart above might look like the following:

Patient Communications

Reminders

Medical Compliance

Tracking

Lead Clinician R I A I
ADoN OPD R C R I
Business Manager A R I I
Medical Secretaries A R I C
Nursing I R R R
Services Manager I I I I
IT Manager I A I A

The chart demonstrates a streamlining of activities ensuring that accountability is clear, responsibilities are distributed, but that people are consulted and informed as appropriate without having to be fully involved.

Other versions of the chart use different letters such as S indicating that they are required to support an activity and NI where they should not be involved.

Conor Hannaway
Managing Director
shrc limited