The Emergency Department Upgrade
A regional health authority is replacing its patient records system. The board has mandated a fixed go-live of 1 November because the current vendor contract ends on 31 October and cannot be extended. The appointed project manager is new to PRINCE2 and has been told by a senior clinician that 'we cannot plan clinical work in detail, so we will just start and adapt as we go.' The project manager produces a single end-stage plan covering all 14 months, no product descriptions, and a business case that states only 'improved patient safety.' Three months in, the authority's finance director asks how benefits will be measured and who owns them. No one can answer. The project manager proposes to skip the initiation stage and move straight to delivery to save time.
1. Using the PRINCE2 principles, evaluate the project manager's proposal to skip initiation. Which principles are being breached and how?
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Which principles are at stake
- Manage by stages: the proposal collapses the project into one undifferentiated block. PRINCE2 requires a minimum of two management stages (initiation plus at least one delivery stage) so the project board has a control point. Skipping initiation removes the very stage that produces the PID and the plans the board would use to direct.
- Continued business justification: the business case is a single slogan with no measurable benefits, no benefit owner, no baseline. The finance director's question exposes this. Without a defined justification there is nothing to re-confirm at stage boundaries.
- Defined roles and responsibilities: the clinician's 'adapt as we go' and the absent benefit owner mean accountability is unassigned.
- Tailor to suit the environment: note carefully - the clinician is right that clinical activity is hard to plan in detail, but the correct response is tailoring (e.g. rolling-wave planning, product-based planning at a higher level, tolerances) not abandonment of planning. Tailoring is a principle; skipping control is not.
Judgement
Refuse the proposal. Initiation is not bureaucracy - it is where the PID, business case, benefit measures and stage plan are created. The fixed go-live is a constraint that should be captured in the business case and stage plan, not a reason to remove the control that lets the board detect slippage early enough to act.
2. The clinician argues that 'defined roles' conflict with clinical autonomy. How should the project manager respond using PRINCE2 roles?
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Separate authority from clinical expertise
PRINCE2 does not put clinicians and managers in competition. It separates accountability for the project from accountability for the product:
- Project board (Executive, Senior User, Senior Supplier) is accountable for the project's success, tolerance decisions and continued justification. The Senior User is the natural home for the clinician's voice on requirements and benefits.
- Senior Supplier owns the supplier's commitment to deliver.
- Project Manager runs the project on a day-to-day basis within tolerances.
- Team Manager(s) and Project Assurance provide delivery and independent checking.
Response to the clinician
Autonomy over clinical content is preserved: clinicians should be Senior Users, team members writing product descriptions for clinical products, and reviewers/approvers of those products. What PRINCE2 adds is a named person who approves each product and a named person who owns each benefit. That is what is currently missing - the finance director found no benefit owner.
So the answer is not 'roles override clinicians' but 'roles make sure someone is accountable for the clinical products and the benefits, and that person can be a clinician.'
3. The project has 14 months to run with a hard end date. How should the project manager structure management stages and still keep the board in control?
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Design stages around decision points, not calendar symmetry
The hard end date is a constraint, not a stage boundary. Stages should be cut where the board genuinely needs to make a decision or where risk is highest:
- Initiation stage - produce PID, business case, benefit measures, project plan, first stage plan. Ends with the board's 'authorise the project' decision.
- Delivery stages - e.g. design/configuration, pilot in one department, roll-out, handover. Each ends with an End Stage Report and an 'authorise next stage' decision.
- Final stage - handover, benefits realisation plan, project closure.
Practical tailoring for a fixed date
- Use tolerances (time, cost, scope, risk, benefit) so the project manager can act without escalation, and set them tightly near go-live.
- Use rolling-wave planning: the project plan is high-level; each stage plan is detailed only when the stage is authorised.
- Put the vendor contract end date and clinical readiness on the risk register as top risks, with owners.
- At each stage boundary, re-confirm the business case - including whether the fixed date still justifies the scope being delivered.
Trap to avoid: creating stages purely to match months (e.g. 'Stage 1 = months 1–7') with no decision at the boundary. That gives the board meetings without control.