Sign in

Building NHS Capability in Portfolio, Programme and Project Management

Case Study

Building NHS Capability in Portfolio, Programme and Project Management

Case Study

  • Case Study
  • Portfolio management
  • Project management
  • Programme management
  • P3M3

February 10, 2014 |

 12 min read

  • Case Study
  • Portfolio management
  • Project management
  • Programme management
  • P3M3

All of our White Papers and Case Studies are subject to the following Terms of Use.

This case study reports on a pilot study carried out on the largest publicly funded healthcare provider, the NHS, to assess its portfolio, programme and project management at a crucial time of organizational change. P3M3® was used to evaluate three NHS organizations to assess their levels of organizational ability, highlight areas for development and strategize for an improved approach.

To read the rest of this white paper and to get access to all of Axelos' white papers, please log in or create a user profile.

1. Introduction


As the largest publicly funded health service in the world, the National Health Service (NHS) provides for the healthcare needs of everyone in the UK, free at the point of delivery. In England it caters for a population of 56 million, employs more than 1.3 million workers and deals with a million patients every 36 hours.

NHS organizations are going through a period of change and reform, facing the challenging task of delivering transformation while protecting quality, the effective use of resources and continuing productivity. The NHS needed a framework to manage and control the delivery of change across portfolio, programme and project management, with the aim of building its capabilities to manage the implementation of transformation objectives both effectively and efficiently.

Axelos’ Portfolio, Programme and Project Management Maturity Model (P3M3®) is designed to explore process and capability maturity in organizations as a basis for improvement. It recognizes the value of corporate portfolio management, and includes guidance from AXELOS publications such as Managing Successful Programmes (MSP®), to offer a thorough assessment of portfolio, programme and project management (P3M).

2. The aim

The aim

Research has shown that high-performing project organizations tend to have a systematic and consistently applied approach to projects. By assessing their portfolio, programme and project management maturity against the five maturity levels of P3M3 (see 4.1), organizations can understand how well their programme and project management processes are embedded into their corporate approach. This, in turn, provides an indication of their future performance. The NHS elected to evaluate P3M3 as a potential way forward: to measure its current levels of organizational ability, establish where improvement was needed and track the journey to achieving a higher level of ability.

A pilot study of P3M3 was set up across three NHS organizations that were facing change with different and significant challenges. The overall aim was to gain a deeper understanding of how the P3M3 maturity model could support portfolio, programme and project management improvement within healthcare organizations.

The initiative would assess how P3M3 could:

  • Provide a baseline of the organization’s current project management capability from which to measure improvement
  • Identify the organization’s strengths and weaknesses across existing skill sets
  • Help to prioritize project management improvement initiatives
  • Support the goal of project management maturity improvement.

The following three organizations were chosen for the pilot:

  • East Midlands Ambulance Service (EMAS) which had recently established a Programme Management Office (PMO) and was keen to assess its project management maturity to set a baseline for the measurement of further improvements.
  • Yorkshire Ambulance Service (YAS) which was investing in organizational development to support its transition through to being authorized as a foundation trust. YAS looked to P3M3 for an independent assessment of the project management maturity level of its approach, and to highlight those areas where investment and performance improvement could give the most value. This helped set a benchmark from which YAS could establish the maturity level it aspired to reach, providing a gap analysis between current and target levels and the project management skills required to deliver projects to the desired standard.
  • Sheffield Teaching Hospitals (STH) which wanted to understand more about its current project management capability, in order to prioritize investment in specific areas of development and improvement.

3. The approach

The approach

The P3M3 assessment was carried out using a moderated self-assessment approach with three key steps:

1. An initial assessment was carried out by each organization’s project staff using the online self-assessment questionnaire.

2. A workshop was held at all three organizations for staff to discuss the individual assessments and to derive the organization’s overall maturity level. These workshops were facilitated by members of the P3M development team in the Department of Health Informatics Directorate (DHID). The facilitators ’ independence enabled the workshop discussions and analysis to be moderated effectively.

3. Focus groups were held to look at each organization’s reflections and the lessons learned from the pilot, in order to draw out the applicability of P3M3 as a tool that could contribute to NHS service improvement.

Throughout the sessions, project professionals from all the organizations worked with P3M3 to assess current performance against the perspectives and attributes within the model.

4. Challenges


  • For YAS, not all projects were controlled through the programme and project management team, so there was a need to bring other project managers on board.
  • Setting appropriate target levels of maturity to aspire to (see 4.1), having established the levels of maturity for current project and programme management operations.
  • Achieving buy-in from the organization as a whole for the various elements and governance for delivering projects to the P3M3 guidance.
Level 1 – Awareness process The organization can recognize projects but has little structured
approach for dealing with them.
Level 2 – Repeatable process Some areas are beginning to use standard processes, but there is no
consistency across the organization.
Level 3 – Defined process A consistent set of standards is used, with clear process ownership.
Level 4 – Managed process Process efficiency is monitored and measured with active interventions
for improvement.
Level 5 – Optimized process Quantitatively managed processes are optimized according to changing business needs and external factors.

5. Successes


5.1 East Midlands Ambulance Service

At EMAS, the P3M3 initiative provided an objective and independent assessment that the trust could use to understand where it currently stood in terms of delivering transformational change programmes using project and programme management as strategic skills. The outputs from the workshops and focus groups were repositioned as core processes within the trust and presented to the EMAS Transformation Board who agreed an action plan that resulted from the pilot. It made five recommendations:

  • Embed a standardized project management process throughout the organization. EMAS’s current processes had been based on visits to other trusts to understand best practice, and that was mixed with internal processes based on elements of PRINCE2®.
  • Use a standardized set of documents.
  • Put in place a continuing professional development programme for regular training events on project management.
  • Integrate training (which should be primarily face-to-face and based on an individual’s level of project management experience) with PRINCE2 training.
  • Improve the integration of project management within the wider business planning cycle.

In addition, a P3M3 reassessment was scheduled to measure progress and provide feedback into further development plans.

5.2 Yorkshire Ambulance Service 

The P3M3 assessment provided the YAS project management team with an authoritative and impartial assessment that could be used for discussions with executive management on the actions, commitment and resources that would be needed to achieve the target project delivery level. YAS is using the findings to transform practices which will help the foundation trust achieve its four strategic aims:

  • Continuously improving patient care By improving its delivery of projects, YAS can improve levels of patient care and experience.
  • High performing Improved project management maturity will help YAS to raise performance levels.
  • Always learning The detailed analysis of all constituent elements of the maturity assessment identified the gaps between current performance and targets. It also helped the foundation trust to gain an understanding of all the requirements for the effective delivery of project management. This could then be fed into professional development plans for individual project managers.
  • Delivering value for money Applying P3M3 consistently will provide efficiencies across all delivery processes.

5.3 Sheffield Teaching Hospitals

For Sheffield Teaching Hospitals, the P3M3 assessment provided a thorough audit of the component processes within portfolio, programme and project management. STH also found that this process was useful in helping it focus on specific areas; in particular, enhancing risk management. As a result the organization has:

  • Assessed how well it performed within each process perspective and has taken steps to embed the processes as part of the development plan
  • Identified those areas where investment in improvement will offer the most benefit
  • Prioritized investment, focusing on areas where new or enhanced skills development is most needed and will prove most effective
  • Introduced an organization-wide professional development programme that is linked to the annual appraisal process.

6. Conclusion


Sarah Briggs of the Department of Health, Informatics and Policy and Planning Directorate explains the results from the pilot: ‘These three organizations had a good level of project management maturity and were advanced in the sense that they wanted to make further improvements to their organizational project management capability. The P3M3 model and process were really useful to help them identify where improvements could be made.’

Briggs is confident that P3M3 has a lot to offer NHS organizations: ‘It encourages a really systematic approach, which helps to select, prioritize and manage the total workload involved in delivering transformational change.’

The pilot study across these three very different organizations demonstrated how the P3M3 assessment could provide an objective evaluation of a health organization’s project management maturity and so feed information into the development of an improvement action plan. With the P3M3 maturity model these organizations achieved a comprehensive assessment of their existing capabilities and organizational processes. Using this as baseline for improvement, they have been able to prioritize according to the impact of development in any given area. For an industry facing significant transformational change, this provides the critical information needed to implement and sustain effective improvements.

By using a maturity assessment model, the NHS can be confident that every aspect of current best practice has been incorporated. P3M3 includes expert guidance from the official Best Management Practice publications from the Cabinet Office, covering all aspects of portfolio, programme and project management.

7. The future

The future

The Department of Health continues to implement project and programme management standards to support the successful delivery of large-scale change in the NHS. P3M capability is being developed throughout the NHS to ensure consistency and visibility across financial and quality goals. The P3M programme is designed to build capability for the delivery of successful programmes and projects through a collaborative community that shares best practices.

An NHS P3M Resource Centre has been developed to provide information on P3M3, together with other materials, tools and guidance that are essential to the successful delivery of transformational change.

'P3M3 has provided the baseline from which we can develop and consistently strengthen our capability across all areas of portfolio, programme and project management,' Briggs confirms.

Steps are being taken to use P3M3 more widely across the NHS for current, merging and emerging organizations.

A national study is currently being undertaken, using elements of P3M3 to provide an indicative assessment of project management maturity in the NHS. Work is also being undertaken to support the accessibility of P3M3 to the NHS, through the development of simple and more detailed self-assessment spreadsheets.

There is a large amount of change activity currently taking place and organizations are gearing up to deliver this change. Many NHS organizations are looking to the P3M programme for practices and structures to assist with the delivery of their change agenda. P3M is being used to help organizations to baseline their current practices and put in place improvement plans to create the right environment to deliver change.

Note: this case study was first published in April 2012.

8. Download

Building NHS Capability in Portfolio, Programme and Project Management