Published here July 2002


Musings Index

When is a project not a project?

Recently we have had rather longer than we would have liked to contemplate the question "When is a project not a project?" The occasion has been a performance improvement project known to the health service as a quadruple by-pass heart operation. Certainly, to the chief stakeholder (us), the project has long been identified as a priority need requiring notification of other stakeholders (business associates, family and friends) careful planning and consistent processing and even expediting. Risk assessment has also received attention, with what-if scenarios developed and mitigation and contingency plans invoked. It's one of those projects, like building a home, that is pretty standard stuff to the builders, but is a very personal and unique expedition for the intended owner.

We will not dwell here on the marvels of the technology involved. Anyone who is interested in that aspect can find plenty of explanation by surfing the Internet. However, the project did not proceed entirely without incident. It started with an attempt at "angioplasty", a process of ballooning open blocked arteries and holding them open with "stents" (a sort of perforated cylinder that enables blood flow to be maintained). Such a solution would be very time and cost effective with least demands on the existing systems. Unfortunately, not only did the "alternative solution" fail but, in the event, made the true solution more difficult to implement due to limiting the remaining access space.

Scheduling the project was difficult; it depended on a myriad of professional stakeholders, their availability and the availability of support services suffering under resource constraints and competing priority demands. Notwithstanding the condition of our project, amongst competing projects, the priority, based on urgency, was ranked relatively low. In the event, a cancellation enabled us to be "slotted in" some three to four months earlier, but at only about four hours notice.

The procedure itself, though classed as "major', is now standard, common, and conceptually simple. It is a matter of taking some redundant pipework from the leg and using the material recovered to update the plumbing in the heart area. Having experienced the frustrations and bad language necessary to accomplish even the most elementary of household plumbing repair tasks, we were very intrigued to know how solid, non-leaking joints were guaranteed within the heart area. The surgeon patiently explained that it was simply a matter of cutting small slots in one line, inserting the end of the new piece of pipe, repeating the same with the other end and sewing both rather carefully in place. After that it appears that the body does its own equivalent of "soldering the joints".

The internal organs and even the chest area are relatively insensitive to pain. Unfortunately, the surface of the leg is not. In our case, we now have the results of a pipeline excavation that extends from about the middle of the inside of the thigh to just above the ankle. Its route feels about as long and tortuous as the proposed Mackenzie Valley Pipeline - and every bit as environmentally unfriendly.

The procedure itself was a snap. We were simply absent from the proceedings and, in fact, it was some 24 hours before we were once more "compus mentis", and returned to the general recovery ward. Here followed an intensive period of testing and poking followed by enough pills to fill a pharmacy, to say nothing of injections and suture and staple removal, all for the purpose of bringing the project "under control", and keeping it, "on track". The record keeping was prolific. We asked one nurse "Does anyone really read all of that stuff?" She rather indignantly responded that she certainly did! That was a source of great comfort, considering how many projects that we have been involved in where voluminous reports are produced but no one takes the time to look at them.

We were also intrigued to know who was really managing the project team. We ambled (shuffled would be a better word) up to the nursing station. There on the wall was a long list of the day's people responsible for everything from cardiology, to anaesthesia, to nutrition, to counseling and religious support. Pointing to the list, we asked the attendant staff "Who is in charge?" To our amusement, the quick response was "Oh, that's all the BigWigs!" There then followed a very pregnant non-verbal pause in which it was evident that the real work was done by all the LittleWigs.

This five day recovery period also progressed through an interesting transformation. At the outset, nothing was too much trouble and the nursing support was superb. But the object of the exercise is to get you out as soon as possible, which means getting you self-sufficient. In practice that means that when the hospital beds become so impossibly intolerable, you can either get up and remake them your self - or leave.

Still, the intervening period leaves you lots of time to reflect and ponder life's finer points. Like waking up on Canada Day (July 1st) to brilliant sunshine and a wondrously deep blue sky. Or to contemplate the warm care-giving of the succession of staff that cycled through their series of shifts, even over the holiday period. Or, again, the ultimate satisfaction of a thunderous bowel movement after several days of inactivity in that area. And so the time came to depart, with a three-ring binder full of instructions for conducting the next six to eight weeks of rehabilitation to full recovery. And so the project is progressing, with the main stakeholder awaiting full satisfaction of the final deliverables.

But what of the members of the hospital team? Each specialist group follows highly detailed operational and post-operational procedures to reach predefined positive outcomes and deliverables to the patient's benefit. So, for them, as soon as the bed is empty, the area is cleaned up, the linen changed, and all preparations made for the next occupant. And so the whole activity sequence is repeated again, and again, and again. The only difference in each case is the patient personality involved and their particular peccadillos.

So, what we have here is a case of selected projects applied to established processes, rather than selected processes applied to established projects. Which leaves us wondering - just how many projects are there out there that, for the team members, are not projects at all, but just regular operational routine?

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