The Portal That Keeps Growing
A 900-bed hospital is building a patient portal. The approved scope covers appointment booking, results viewing and prescription renewal requests. Six weeks in, the chief cardiologist, who chairs the clinical governance committee, asks for e-prescribing to be added 'or clinicians won't use it'. The security team has found that the audit log specification in the requirements is too weak to meet the national data protection standard and must be redesigned, adding roughly 12 days of work. The patient advocacy group, which has no budget authority, has collected 400 signatures asking for the portal in three languages. The project board approved a scope baseline and a change budget of 5% of the £800,000 total. The current schedule has 9 days of float and a signed contract with a fixed delivery date. The acceptance criterion for the booking module reads: 'the portal must be intuitive for patients'.
1. Classify the cardiologist, the security team and the patient advocacy group on a power/interest grid, and state the engagement approach for each.
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| Stakeholder | Power | Interest | Approach |
|---|---|---|---|
| Chief cardiologist | High (chairs clinical governance, can block adoption) | High | Manage closely: bring into the governance route, give a named decision point, ask them to sponsor a documented change request rather than a corridor request |
| Security team | High (can veto on compliance grounds) | Moderate on features, high on controls | Keep satisfied and consult early: treat as an authority, agree the audit log design and its acceptance evidence jointly |
| Patient advocacy group | Low formal power, high interest | High | Keep informed: acknowledge the petition, publish the roadmap and the criteria for prioritising languages, offer a route into user testing |
Two refinements matter. First, the security item is not a stakeholder preference but a compliance obligation; it should be handled as a mandatory change, not negotiated against features. Second, low power does not mean low influence: the advocacy group can damage adoption and reputation, so the approach is to convert interest into a productive channel (usability testing, translation review) rather than to ignore it.
2. The cardiologist's request arrives after the scope baseline. Describe how the project manager should handle it and what evidence should go to the project board.
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Handle it through change control, neither accepting it informally nor refusing it flatly.
- Log the request in the change register with the requester, date and business justification.
- Perform an impact analysis: effort and cost, effect on the fixed delivery date (e-prescribing will not fit the 9 days of float), effect on the 5% change budget, regulatory and clinical-safety implications, and dependencies on the audit log redesign.
- Identify options with the requester: include now (with a date or budget consequence), defer to release two, descope something of equal size, or run as a separate project.
- Assess priority transparently against agreed criteria; clinical safety and statutory compliance outrank convenience features.
- Escalate to the board, since it approved the baseline and owns the change budget.
The board pack should contain the change request form, the quantified impact, the options, the recommendation, the effect on benefits and on the fixed contract date, and the risks of both accepting and rejecting. The decision and its rationale must be recorded so the new baseline is unambiguous.
3. Rewrite the booking module acceptance criterion so it can be tested.
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The current wording contains no measurable attribute, so two reviewers could disagree forever and the module could never formally be accepted. A testable criterion needs a condition, a metric, a population and a threshold:
'In usability testing with 20 first-time patients drawn from the registered patient panel, including at least 4 participants who use assistive technology, at least 16 of 20 complete an appointment booking unaided within 3 minutes. No severity 1 or 2 accessibility defects remain open against WCAG 2.2 AA. A booking confirmation is issued within 2 minutes in at least 99 of 100 scripted test cases, including the double-booking and no-availability scenarios.'
This keeps the intent (the portal must be usable) but converts it into evidence the project can collect and the board can judge. It also names the population and the exception paths, which is where usability usually fails. The same treatment should be applied to the results viewing and renewal criteria before those modules reach acceptance.