LEADERSHIP & MANAGEMENT IN HEALTH

Constraints Triangle
Lecturer: Ann Downer, MS, EdD

This lecture is about the constraints triangle that I mentioned in an earlier lecture. It’s about the
things that typically go wrong or change once you have developed a nice, tight, well-considered,
well-thought out workplan for your project. Yes, it happens to everyone. It even has a name—
the constraints triangle. It looks like this.

The constraints triangle is also sometimes called the OTOBOS triangle (O-T-O-B-O-S). That
stands for the ideal—on target, on budget, on scope. That, of course, is what we always aim for.
However, as you know as well as anyone, most projects don’t unfold quite that easily. They’re
constrained by time; the deadline changes, you find out there’s less availability of the people
you need than you thought, something related to time occurs as a constraint. Maybe you’re told
that the implementation project that you’re doing needs to happen in February instead of July,
which is what you were originally told. That’s an example of a time constraint.

The scope constraint up at the top refers in this case to what your client, or your stakeholders or
your funders want you to do to create or deliver verses what you’re actually able to do in the
end given the kinds of constraints that you face. For instance, you might have been told that
rather than training new employees on four subjects, they now want you to include six more
subjects in the training, six subjects that all need to be developed from scratch. This is an
example of a scope change and in business circles in the private sector they sometimes call that
scope creep.

The third box here on the right side refers to budget and this really more accurately should be
thought of as resources because sometimes it’s financial but other times it has to do with
human resources or even the kinds of materials or tools or other resources that you need to get
the project done. For instance, maybe you’re suddenly told that the administrative assistant
that you were promised is being pulled off the job in order to assist somebody else with a
higher priority project.

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All three of these constraints potentially impact on the quality of what you can produce, right?
And they impact one another, like dominos falling. For instance, if the administrative assistant
isn’t available anymore, you could do all the work yourself, but you might need to have the
deadline changed for completing the project. Or you could accommodate a shorter timeline and
have the new training produced by February, but you’re probably going to need more money to
hire a consultant or expand your team somehow. Even expanding the scope of a project could
be handled if there were some flexibility in terms of time available to complete it or if funding
can be increased in order to do the work quickly.

I’m guessing that all this sounds familiar to you? I suspect it does. The question for us as project
managers is, What do we do about it? It’s inevitable but how do we cope?

Let’s look at some ideas for dealing with constraints.

Each project is going to be different and it will have its own mix of constraints. I think it’s
important to become familiar with the constraints triangle both because it’s very likely to
contribute to the implementation of your project, but it can also help you to anticipate changes
or even prevent them if you’re looking out for what could be unexpectedly happening. I find the
constraints triangle useful in project planning because it makes me be more realistic about the
planning that I’m doing. It makes me be cautious about overestimating or underestimating time,
cost or resources needed to accomplish the scope. So, try to anticipate the likely constraints
that you’ll face. And try to be realistic in planning so that you don’t create restraints yourself for
your own project.

And finally, be proactive in response to the emergence of constraints. There are two ideas to
think about a little bit more. One is being able to negotiate once a constraint emerges and
things need to be changed. And the other is the importance of transparency. There’s an old
adage that goes like this: Fast-Cheap-Good: you can have any two of these. It can be fast and
good or it can be cheap and good or it can be good and cheap but it excludes the third thing
when that happens. So, if it’s fast and cheap it may not be good. If it’s good and fast it’s
probably not going to be cheap. You get the idea. I think if you get this in your head, you can
help your constituents, funder or your stakeholders understand what the ramifications are
when constraints emerge that affect either your cost, your timeline or the resources that you
have.

In terms of negotiating, you need to be able to explain that you can speed up the project but
that means reducing the scope or dedicating more resources. You can increase the scope by
adding people or extending the deadline or maybe even both. You can complete a project under
budget but you’re probably going to have to cut the scope or reducing the number of workers
and extending the time it takes to finish. These are the kinds of things in your negotiation that
you need to be clear about yourself but also help other people see clearly.

And then transparency. What I mean by this is that I think it’s very important to be able to
convey the ramifications or these changes from constraints to the stakeholders that you’re
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working with and to your team. So rather than trying to hide them or make up for it or
somehow magically succeed despite the constraints. I think having the vocabulary that we’re
talking about here to discuss those constraints and their impacts on your project is really
important.

Again, we manage in highly complex environments, most of us. Many things can go wrong and
usually something does. And that is exactly why we need skilled project managers and team
leads working on our projects.

Here you see some illustrations of just a few of the challenges that I imagine some of us have
had to face at some point.

• The first one illustrates unrealistic expectations that were not countered at the
beginning or were not communicated clearly. For instance, the client or your funder
wants a nice stuffed armchair but they give us the budget for a three-legged stool.

• The second picture is poor project design. And this occurs in my experience when we
forget that the project we’re working on is dependent upon and it affects and influences
the systems around it. This we call systems thinking, the ability to analyze one element
and all of the other factors that are influencing it.

I want to give you an example here of a project we were doing. We designed a beautiful
training program for nurses in Southern Africa and one of the nurses said to us, “We
continue to go to nice trainings, to get new forms to use that are designed to improve
patient quality of care, but everything is impossible to implement. My clinic is
understaffed, there are no machines to copy forms, and it is unclear who the forms are
supposed to go to.”

Another nurse at that same meeting took us outside to see her mobile unit. She drives
around her entire district, seeing 25-50 patients a day, in a tiny truck with a small
camper on the back that is basically her clinic. The wheels all needed to be replaced

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 largely because the majority of her time is spent on dirt roads that often flood. In fact,
flooding had killed 3 people two weeks just before the meeting we were in.

So, use this as an example of poor program design of forgetting to think about the
realities of the environment in which we are trying to implement a project. The project
can be perfectly designed a perfectly justified in terms of need and yet not be very
realistic given the larger issues.

• The third picture here talks about project delays. You can see this one was delayed right
into the winter. In my work experience, this usually occurs when the money hasn’t
arrived on time. And there’s only a certain amount of risk that we’re willing to take in
terms of starting activities before money arrives. So that’s a potential, in some ways,
inevitable constraint that we have to deal with.

• Another picture here shows the result of inadequate resources. There are lots of
situations that I’ve worked in where within a country where the currency of that country
is devalued and suddenly the budget is no longer sufficient to cover the costs of
implementing the project. I’ve also worked on projects where fraud resulted in a huge
deficit in terms of the amount of money available for the project.

Obviously when any of these things happen you have to go back to your workplan and
back to your constituents with transparency to negotiate a way forward.

• The fifth picture here is the unrealistic budget. This is a situation where you’ve often bid
too low because you were thinking this was the only way you could win the project or
win the bid. I think this is the classic example of where we are shooting ourselves in the
foot – where we really want to do a certain type of work or work in a place with a
certain group of stakeholders and so we underbid or underestimate what it would take
to implement the project.

• And then finally, the sixth illustration here shows inadequate capacity. Again, without
proper analysis ahead of time in the early stages of project planning we fail to notice
that in the systems with which we’re working, the larger systems around the project that
we’re doing there is simply not enough capacity to sustain the program or sometimes
even to implement it.

For instance, I’ve worked on ad campaigns to generate new clients in countries where
there just simply were not enough delivery sites to absorb the clients that we generated.
Or I’ve worked in many situations where we’ve urged people to go for testing for a
particular health issue and there were not sufficient staff or drugs or sites to provide the
services to people who show up.

I think many of these are possible to anticipate if you really spend time in the early
stages of project design and project justification to understand exactly what you’re
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 doing, where you’re doing it, who you’re doing it with, what it would take to do it right
and what could go wrong.

To succeed, a project manager really needs to be proactive and decisive in terms of anticipating
and managing challenges.

I think really often we blame our failures in projects on circumstances “out of our control.”
While this is sometimes true, there are natural disasters and other things that interrupt our
plans. Too often it is used as an excuse because we are trying to cover up even to ourselves the
fact that the risks might have been better anticipated, analyzed, and actively managed. To retain
control of their projects – and thereby promote project success – we as project managers need
to develop the skills required to proactively identify the challenges that are ahead and to
effectively manage their projects even when these challenges occur.

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