Hubert Studer, Büro für Qualitätsentwicklung (Quality development office)
Those who use traditional project management methods and tools for health promotion and prevention projects rarely go far wrong in the planning stage. However, they can run the risk of trying to stick too rigidly to the plan during implementation. Instead, the focus should be on developing measures collaboratively, periodically reviewing them and making any adjustments as necessary.
Health promotion means supporting development
Health promotion and prevention naturally involves raising awareness of the issue, providing information on how behaviour and circumstances affect health, and advocating understanding of the need for a healthier lifestyle in the framework of a living and working environment that promotes health. Experience has shown that this is good but not good enough, as a healthy understanding rarely translates to healthy living.
Effective and sustainable health promotion and prevention is tailored to the setting and requires action to be taken at various levels: with individuals, with groups, within the setting as an organization, in the organization's environment and its position in regional networks, as well as at a societal and political level.
In line with the principles of health promotion, such as equal opportunities, participation and empowerment, intervention in settings involves working with people in their everyday environments to find, use and expand the scope for action. The settings' stakeholders are encouraged to develop their settings in a way that promotes health and are supported in this development process.
The challenge of complexity
Health promotion and prevention interventions in the form of time-restricted programmes and projects pose a major challenge due to the complexity of socio-spatial systems (see Kolip et al. 2012, Ackermann 2011). To overcome this challenge, management tailored to specific requirements is needed in addition to careful planning.
Intervention dynamics
Health promotion projects have a different dynamic to those for which traditional project management was developed. Rather than a planned sequence of interdependent activities being performed according to schedule, over a set period and using the available resources, the key to health promotion projects is providing resources and removing barriers as the situation requires in order to help bring about specific developments.
Traditional project management assumes that before a project is implemented not only are the objectives known, but also the precise manner, order and timing of the measures to achieve these objectives. The role of project management is to prevent or rectify any deviations from the plan.
The objectives of health promotion and prevention projects should also be clear from the outset, but the route to achieving these objectives should be hypothetical in nature – with the hypothesis proved correct or incorrect along the way. Measures and interim targets are established, reviewed and considered with the settings' stakeholders. Interventions in settings often require situation-led actions and decisions to be taken on a day-to-day basis, though without losing sight of the main project objectives.
Systematic management
On this basis, some health promotion and prevention project managers are drawn to the conclusion that project management is primarily reliant on (longstanding) experience and that acting methodically or systematically – which is frequently confused with a standardized process – could even be detrimental to a project's success.
However, clients and funders are increasingly demanding evidence of systematic project management from professional project managers.
If project managers wish to meet this requirement and use the concepts and methods of traditional project management to do so, a paradoxical situation arises: the measures and interim goals need to be planned and described in detail in the project concept or funding application, when the project manager would actually rather do this collaboratively with the setting stakeholders during the implementation phase.
Interim goals are connected to milestones. As in traditional project management, milestones are usually also defined for health promotion and prevention projects. Milestones are considered "reached" when significant interim goals are achieved in the course of the project. If not, they are deferred. Consequently, milestones always represent points during the project when the desire to celebrate is at its greatest and willingness to critically review the project is at its lowest.
Milestones as points for critical reflection
Traditional project management applies to projects where the timings of the different steps are largely interdependent. A project step can only be performed once all the preceding project steps have been completed. Any delay to a step will jeopardize adherence to the schedule. A key project management function is therefore ensuring that this timing is met. In health promotion and prevention interventions, the individual project steps (measures) are much less dependent on each other (in terms of timing). Work can generally be carried out in the various areas of action at the same time. Delays or difficulties in implementing specific measures do not necessarily affect other measures at different levels.
The key project management function in health promotion and prevention projects is to periodically subject the effectiveness and efficiency of the various measures to a critical review and to make any necessary adjustments.
Milestones are nothing more than points during the project for this reflection. They are regularly distributed during the project implementation phase, dividing the project into stages. This brings the term "milestones" closer to its original meaning: way markers at regular intervals.
Initially, the milestones have no content. The content to be reviewed arises from the relevant measures at the given time and the interim goals set for the milestone in question.
Development cycles
In this way, project management in intervention projects takes a cyclical form. Detailed planning of the next steps is carried out based on a systematic review of previous steps. In certain circumstances, measures are changed or abandoned in favour of other measures that offer a higher level of effectiveness or efficiency. These decisions are again critically reviewed at the next milestone, starting a new development cycle.
Successful project management in health promotion and prevention projects is not, therefore, defined by a detailed project plan established in advance, which is then followed as precisely and close to the schedule as possible, but through a periodic, systematic and critical review of the project progress and the well-founded, situation-led continuation of the project.
Summary
Health promotion and prevention projects differ considerably from other, for example technical, projects. Many of the concepts, methods and tools of traditional project management are unsuitable for intervention projects. To meet the specific needs and dynamics of health promotion and prevention projects, the project management must establish a system that permits collaborative developments, fosters innovation and creativity and ensures flexibility in the implementation of measures.
The quint-essenz quality system aims to meet these demands. It puts periodic, systematic and (self-) critical reflection on interventions at the forefront. This involves both a criteria-based systematic reflection on the project in the design and valorisation phase, as well as establishing development cycles in the implementation phase.
Good health promotion and prevention projects are not characterized by the fact that they are implemented exactly as originally planned, but by fact that the chosen route is periodically reviewed and changed as necessary. This means that project managers must be prepared to repeatedly review their own projects and project practice (self-)critically. Clients and funders can support this process by asking for development cycles to be established during the design phase rather than detailed measures and interim goals.
References
Ackermann, G. (2011). Complexity in health promotion and prevention. Newsletter quint-essenz | June 2011.
Kolip, P.; Ackermann, G.; Ruckstuhl, B.; Studer, H. (2012). Gesundheitsförderung mit System. Qualitätsentwicklung mit quint-essenz. Bern: Huber.
