Fuzzy front-end of design in the NHS Manchester, Salford and Trafford (MaST) LIFT primary healthcare projects.

This report sets out the findings of research into the development of MaST LIFT (Manchester Salford and Trafford) primary healthcare facilities, the aim of which was to understand the process and identify how the front-end of design was conducted, the skills and competencies used and where potential lessons could be learnt for in future developments. ¿ Data has been gathered through a series of 22 semi-structured interviews with key personnel involved in MaST, namely the public sector client, the LIFT team and the private sector partner. ¿ Particular focus was given to 4 schemes that had achieved financial close by 1st of July 2004. The interviews focused on eliciting the interviewees' personal background in terms of their educational and career history, their involvement in the front-end of the design process and their perspectives of the issues encountered in defining requirements and developing designs. ¿ The analysis in this report represents a snapshot in time, from the establishment of MaST LIFT until September 2004. ¿ The findings describe the organisational structure of MaST LIFT, a process map describing key activities on a timeline, a description of the main issues identified and possible improvements, and a description of the skills and competences used throughout the process. ¿ The main issues identified were classified as follows: (a) the healthcare delivery system redesign; ¿ There were some concerns that the service models were not sufficiently defined when design development started (b) the organisational structure; ¿ A complex organisational structure and multitude of stakeholders were put in place to deliver MaST LIFT, the expected economies of scale have not yet been achieved. There have also been constant changes of the stakeholders involved with the schemes, leading to continuous redesign. In addition, some tensions between stakeholders has occurred as a consequences of the complex MaST organisational structure. (c) the definition of processes; ¿ PCTs are considered to be novice construction clients. However, they were involved in the development of 13 schemes without appropriate technical support and without knowledge on the requirements capture and design issues. There is some indication that the schemes were being developed at their initial stages without appropriate project management structures to link the LIFT vision to its operational level. Design management is considered by the interviewees to have been generally poor. There were also some difficulties with regards to affordability and, in general, erratic management of change. All these issues are related to poor definition of processes. d) the definition of roles and responsibilities; ¿ The poor definition of processes has also led to a degree of confusion with regards to roles and responsibilities. There was lack of specific expertise that should have been available throughout the process (e.g. development), some roles and responsibilities were not clear for all involved in the process (e.g. MaST core team after the bidding process), and this has led to difficulties in terms of drilling down directives from the strategic leadership. ¿ Fourteen broad level skills, qualifications and experience were identified amongst the team. ¿ It was found that the complexity of the organisational structure coupled with the lack of common understanding of the process, roles and responsibilities exerted pressures on the 'as is' skills profile of the stakeholders involved. ¿ The report makes recommendations with regard to the use of skills audits and the skill needs for managing such initiatives.