1) A cross-sectional study by Alam et al. found an association between tobacco and alcohol use and head and neck cancers in India. Tobacco and alcohol exposure were not reliably measured.
2) A case-control study by Gupta et al. found associations between poor oral hygiene, diet, tobacco/alcohol and oral cancer risk in India. Exposure was accurately measured to minimize bias.
3) A cohort study by Jayalekshmi et al. found tobacco chewing and bidi smoking increased oral cancer risk in India. Exposure and outcomes were accurately measured, and confounding factors were considered.
Association between tobacco, alcohol and oral cancer in Southeast Asia
1. PUBH6005: Epidemiology
Assignment- 3
Critical Appraisal Essay
Title: To find the association between use of tobacco and
alcohol and head and
neck/ Oral Cancer in South East Asia.
Name of student: Rajwant Kaur
Student ID: 00275380T
Name of topic co-ordinator: Dr. Bhawna Gupta
Topic: PUBH6005: Epidemiology
Introduction
2. The major risk factors for head and neck cancers are tobacco
and alcohol consumption. Smoking
and alcohol are independent risk factor for head and neck
cancer. Tobacco use can be chewing
tobacco, snuff and smoking tobacco. At least 75% of head and
neck cancers are caused by
tobacco and alcohol use (NIH 2017). In developing countries
like Southeast Asia, tobacco is used
in many forms along with alcohol consumptions. Areca nuts
and betel leaf with or without
tobacco also cause cancers Other factors also increase the
vulnerability of people for cancers
such as low education, low family income, poor oral hygiene
and environment (Priebe et al.,
2008).
Awareness is virtually non-existence in the developing
countries of Southeast Asia and therefore
people with rising affluence tend to buy more of tobacco
products and thus increase their risks
for cancer. To prevent the cancers, the health organizations and
health professionals should
focus on educating the people through various means to quit
habits of tobacco use and alcohol
consumption. Regular screening is also important to detect the
3. cancer at early stage (Priebe et
al., 2008).
Methodology
Method:
Three selected papers were evaluated and explained by NHMRC
form, in which level of evidence,
bias, confounding factors and chances, clinical impacts,
applicability are defined. CASP
framework with checklist that can explain or support in
analyzing and justifying the questions
and characteristics.
Search strategy:
Before commencing critical appraisal of studies, I did
systematic review on our research question
about identifying the association between use of tobacco and
alcohol and head and neck/ Oral
Cancer in South East Asia. Systematic reviews apply strategies
for eliminating biases and random
errors. They adhere to a scientific design for offering reliable,
4. reproducible and defensible
conclusions. The evidences use more rigorous methodology
/designs that minimize bias.
Systematic reviews incorporate results of multiple studies
(Guide, 2018).
The literature search covered the studies applying alternative
terminologies, like the terms sed
for education on cancer include Recommendation, Internet-
based intervention on cancer,
teletherapy, etc.
Databases:
The databases used in the research include (1) Cochrane Library
(Cochrane Database of
Systematic Reviews), (2) CINAHL Plus with full text (3)
MEDLINE via PubMed (4) EBSCOhost, (5)
Ovid, and (6) ProQuest. I searched 105 studies, out of which
three studies are selected, which are
identifies as the most compatible with the research question.
5. Key words: -
Search terms used in the search include:
• Causes of the oral cancer, education, interventions, substance
abuse adverse impact on
health.
• telemedicine, video conferencing, tele-CBT, Internet-assisted
healthcare, telehealth
• home therapy, rehabilitation, telemedicine, Government
programs
• teenager, youngster, adolescent of south East Asia
• social issues, behavior, lifestyle,
• rural, remote
• efficacy, effectiveness
• face-to-face, in-person care
Use of Boolean Operators and Truncation
I used Boolean operators (AND, OR, NOT) to expand or limit
the search. For example: young AND
elders, young OR old people, Internet OR mobile based,
information OR discussion OR
interaction. To expand or emphasize the search I used
truncation (behav*, young*, educat*).
Inclusion criteria
Inclusion criteria are the original peer-review articles, academic
research papers, Scholarly
6. articles (perspective articles, opinions, reviews, documents),
published in English language within
last ten years.
Results:-
Table 1 Cross-sectional study:
Epidemiological profile of head and neck cancer patients in
Western Uttar Pradesh and
analysis of distributions of risk factors in relation to site of
tumor
Critical appraisal questions Underline your answer
Were the criteria for inclusion in the sample
clearly defined?
Yes
Evidence:
In this cross-sectional study, the criteria of inclusion were
clearly defined as the patients
(n=850) having head and neck cancers (HNC) between a
particular time period.
Critical appraisal questions Underline your answer
7. Were the study subjects and the setting
described in detail?
Yes
Evidence:
The study subjects and setting are clearly described as to
identify the differences in site,
pattern and incidences of head and neck cancers in a specific
geography (Western Uttar
Pradesh, India). Moreover, the patients were categorized in
accordance with the
histopathological reports into different categories.
Critical appraisal questions Underline your answer
Was the exposure measured in a valid and
reliable way?
No
Evidence:
The exposure to tobacco and alcohol was not measured in valid
and reliable manner. For
example, there was not description of age when started,
frequency and duration of
8. cigarette smoking or tobacco chewing.
Critical appraisal questions Underline your answer
Were objective, standard criteria used for
measurement of the condition?
Yes
Evidence:
The cancers have been measured using the standard and
objective criteria. For example,
HNCs were classified on the basis of the anatomical sites like
oral cavity, tongue, salivary
gland, oropharynx or paranasal sinus. Histopathological
assessment was also conducted.
Critical appraisal questions Underline your answer
Were confounding factors identified? Yes
Evidence:
In this study, the confounding factors were detected as poor
socioeconomic class and low
literacy which are known risk factors for cancers (Davis et al.,
2002, pp 134).
Critical appraisal questions Underline your answer
9. Were strategies to deal with confounding
factors stated?
No
Evidence:
No strategy to deal confounding factor is stated in the study.
Critical appraisal questions Underline your answer
Were the outcomes measured in a valid and
reliable way?
Yes
Evidence:
The outcomes were measured in detailed manner using reliable
and valid procedures.
There is no bias as study is retrospective and objective, based
on case history and
histopathological reports. In addition, all measurements tools
were appropriately used.
Critical appraisal questions Underline your answer
Was appropriate statistical analysis used? Yes
10. Evidence:
Appropriate statistical analysis methods were used. Significance
P values and correlation
values were determined by using valid Pearson Ch-square test
(Zaccai, 2004; Health
Knowledge, 2017).
Reference:
Alam, M. S., Siddiqui, S.A. & Perween, R. (2017).
Epidemiological profile of head and neck cancer
patients in Western Uttar Pradesh and analysis of distributions
of risk factors in relation to site
of tumor. Journal of Cancer Research and Therapeutics, 13:
430-35. doi: 10.1111/j.1349-
7006.2010.01785.x
Table 2 Case-control study:
Associations between oral hygiene habits, diet, tobacco and
alcohol and risk of oral cancer:
A case–control study from India
Critical appraisal questions Underline your answer
11. 1. Did the study address a clearly focused issue? Yes
Evidence:
This case control study addressed an important issue of
association of poor oral hygiene,
diet, tobacco chewing/smoking and alcohol (risk factors) with
the oral cancers (outcomes).
Critical appraisal questions Underline your answer
2. Did the authors use an appropriate method to answer their
question?
Yes
Evidence:
The method is appropriate to answer the question but there is
possibility of biases as the
patients have awareness about risk factors and diagnosis and
therefore, they are motivated
to recall more of risk factors.
Critical appraisal questions Underline your answer
3. Were the cases recruited in an acceptable way? Yes
Evidence:
The cases were recruited appropriately, and the criteria of
12. inclusion were clearly defined.
The patients selected from two big tertiary hospitals of Pune
City. All 187 patients with oral
cancers were recruited irrespective of their age, sex and stages
of disease.
Critical appraisal questions Underline your answer
4. Were the controls selected in an acceptable way? Yes
Evidence:
The controls were selected in sufficient numbers (240). The
controls are the patients
having non-neoplastic disease, recruited within same time frame
and matched in terms of
sex and age with the cases.
Critical appraisal questions Underline your answer
5. Was the exposure accurately measured to minimise bias? Yes
Evidence:
Exposure measurements were described accurately in detail that
included data from face-
to-face interview, questionnaire, life grid tool, exposure to
tobacco, oral hygiene habit,
13. anthropometry, intraoral examination and putative risk factors.
Frequency, duration and
cumulative effect of smoking and tobacco chewing recorded in
valid and reliable manner.
The cancers were measured using standard criteria (extent, type,
stages, site and
comorbidities.
Critical appraisal questions
Underline your answer
6. Aside from the experimental intervention, were the groups
treated equally?
Yes
Evidence:
Aside from the experimental intervention, both groups were
equally treated to minimize
any bias.
Critical appraisal questions Underline your answer
14. 7. Have the authors taken account of the potential confounding
factors in the design and/or in their analysis?
Yes
Evidence:
There was possibility of confounding factors like age, family
income, socioeconomic status,
and education which may have effect on the outcomes or
increase the cancer risks
(Jayalekshmi et al., 2011). The article used unconditional
logistic regression model to adjust
the confounding factors.
Critical appraisal questions Underline your answer
8. How large was the treatment effect? Yes
Evidence:
The results are consistent with previous research reports and are
believable. The
Confidence interval 95% CIs and P value = 0.001 showing
precise research. A linear dose
related association was found between tobacco chewing and
occurrence of oral cancer.
15. Critical appraisal questions Underline your answer
9. How precise was the estimate of the treatment effect? Yes
Evidence:
The results are reliable and trustworthy. The results cannot be
applied to Australia as the
tobacco chewing is not prevalent and oral hygiene is remarkably
better than India.
The results are consistent with previous research reports and are
believable. The
Confidence interval 95% CIs and P value = 0.001 showing
precise research.
Critical appraisal questions Underline your answer
10. Do you believe the results? Yes
Evidence:
The findings are in line and consistent with the previous
research findings. Regarding the
results, the association between oral /oropharyngeal cancers and
tobacco with alcohol is
explained as potent risk factor. The novel finding is the
evidence of increased risks of oral
cancer when patients are chewing tobacco in presence of poor
16. oral hygiene.
Critical appraisal questions Underline your answer
11. Can the results be applied to the local population? No
Evidence:
The results cannot be applied to Australia as the tobacco
chewing is not prevalent and oral
hygiene is remarkably better than India. The findings are in line
and consistent with the
previous research findings
Critical appraisal questions Underline your answer
12. Do the results of this study fit with other available
evidence? Yes
Evidence:
The findings are in line and consistent with the previous
research findings
Reference:
Gupta, B., Bray, F., Kumar, N. & Johnson, N.W. (2017).
Associations between oral hygiene habits,
diet, tobacco and alcohol and risk of oral cancer: A case–control
17. study from India, Cancer
Epidemiology, 51:7-14. doi.org/10.1016/j.canep.2017.09.003
Table 3 Cohort study:
Oral cavity cancer risk in relation to tobacco chewing and bidi
smoking among men in
Karunagappally
Critical appraisal questions Underline your answer
Did the study address a clearly focused issue? Yes
Evidence:
Yes, the study addressed a clearly focused issue. This cohort
study aims to analyze
relationship of oral cancer with tobacco use, alcohol drinking
and low socioeconomic status
in the rural population that is the Karunagapally cohort of
Kerala.
Critical appraisal questions Underline your answer
Was the cohort recruited in an acceptable
way?
18. Yes
Evidence:
Yes, the cohort recruited in an acceptable way. Virtually all
residents (n= 66277) aged 30-
84 years in the cohort were recruited in Jan 1990 using Poisson
regression analysis of
grouped data stratified on age, calendar time, education and
family income to deal with
biases and confounders. Therefore, virtually all households
were recruited in the cohort.
Critical appraisal questions Underline your answer
Was the exposure accurately measured to
minimise bias?
Yes
Evidence:
Regarding exposure, tobacco use, alcohol and socioeconomic
stats were measured
appropriately. The participants were asked for history of
tobacco chewing (not chewing,
habitually in past, habitually currently), age when they started
chewing tobacco and the
19. duration. Similar questions were put forward for BIDI and
cigarette smokers. Thus, the bias
is controlled.
Critical appraisal questions Underline your answer
Was the outcome accurately measured to
minimise bias?
Yes
Evidence:
Outcomes (development of cancers) were ascertained by the
Cancer Registry during the
long period between 1990 and 2005 under the Regional Cancer
Center (RCC). Biases are
minimized with accurate measurement and diagnosis of cancers.
By the end of 2005, 160
men developed oral cancers.
Critical appraisal questions Underline your answer
Have the authors identified all important
confounding factors?
Yes
20. Evidence:
The confounding factors were identified as family income, age,
calendar time and
education level.
Critical appraisal questions Underline your answer
Have they taken account of the confounding
factors in the design and/or analysis?
Yes
Evidence:
To deal with confounding factors, stratification strategy and
regression strategy were
adopted.
Critical appraisal questions Underline your answer
Was the follow up of subjects complete
enough?
Yes
Evidence:
The follow up was complete and long enough from 1990 to
2005. Migrants were identified
from door to door monitoring survey. Only 0.7% participants
21. were lost due to permanent
migrations.
Critical appraisal questions Underline your answer
Was the follow up of subjects long enough? Yes
Evidence:
The follow up was complete and long enough from 1990 to 2005
(15 years long). Migrants
were identified from door to door monitoring survey.
Critical appraisal questions Underline your answer
What are the results of this study? Yes
Evidence:
Results show that tobacco chewing increases risk of cancers of
gums and mouth among
people who keeps tobacco in the cheek. In addition, even pan
with or without tobacco
causes oral cancer Bidi smoking also increases risk for cancers.
Critical appraisal questions Underline your answer
How precise are the results? Yes
22. Evidence:
Results are precise with use of appropriate methodologies and
statistical analysis. Cancers
at different sites in oral cavity are examined for risk factors.
For example, risk of tongue
cancer is related with duration of bidis smoking (RR =3.4, 95%
CI and p=0.034). P value is
0.001 and CI is 95% Confidence interval shows the precision of
the study
Critical appraisal questions Underline your answer
Do you believe the results? Yes
Evidence:
Results are believable as the study sample is large and study
duration in long enough. The
methods are appropriate without bias and confounders.
Critical appraisal questions Underline your answer
Can the results be applied to the local population? Yes
Evidence:
The results can be partially applied to local Australian
population where smoking is
prevalent. However, Pan and tobacco chewable products
23. (smokeless tobacco) are not
prevalent.
Critical appraisal questions Underline your answer
Do the results of this study fit with other available
evidence?
Yes
Evidence:
The results of this study are supported by most of the articles in
literature. Alam et al.
(2017) also found the tobacco use as important risk factor for
cancer in the oral cavity.
Critical appraisal questions Underline your answer
What are the implications of this study for
practice?
Yes
Evidence:
Regarding implication, the nurses and social workers should
educate the people regarding
the harmful impact of tobacco and alcohol in causing cancers.
24. In vulnerable patients with
habits of tobacco use, a complete screening should be done at
regular interval to detect
early cancers. Smokeless tobacco (chewing) is equally harmful.
Reference:
Jayalekshmi, P.A., Gangadharan, P., Akiba, S., Koriyama, C. &
Nair, R.R.K. (2011). Oral cavity
cancer risk in relation to tobacco chewing and bidi smoking
among men in Karunagappally,
Kerala, India: Karunagappally cohort study. Cancer Sci,
102:460-467. doi: 10.1111/j.1349-
7006.2010.01785.x
Discussion:-
Article 1: Cross-sectional study authored by Alam et al. (2017,
pp. 430-435).
In this cross-sectional study, the criteria of inclusion were
clearly defined as the patients (n=850)
25. having head and neck cancers (HNC) between a particular time
period. Study subject and setting
are clearly described as to identify the differences in site,
pattern and incidences of head and
neck cancers in a specific geography (Western Uttar Pradesh,
India). The patients were
categorized according to the histopathological reports into
different categories.
Exposure to tobacco and alcohol was not measured in valid and
reliable manner. For example,
there was not description of age when started, frequency and
duration of cigarette smoking or
tobacco chewing. The cancers have been measured using the
standard and objective criteria. For
example, HNCs were classified on the basis of the anatomical
sites like oral cavity, tongue, salivary
gland, oropharynx or paranasal sinus. Histopathological
assessment was also conducted. In this
study, the confounding factors were detected as poor
socioeconomic class and low literacy which
are known risk factors for cancers (Davis et al., 2002, pp 134).
However, no strategy to deal
confounding factor is stated in the study.
Appropriate statistical analysis methods were used. Significance
26. P values and correlation values
were determined by using valid Pearson Ch-square test.
Outcomes were measured in detailed
manner using reliable and valid procedures. There is no bias as
study is retrospective and
objective, based on case history and histopathological reports.
In addition, all measurements
tools were appropriately used. Chance or sample error is
minimal as the sample size and time
span were large enough to represent the population (Zaccai,
2004; Health Knowledge, 2017).
The result of the study showed that maximum cases of HNC are
between 40-60 years of age.
Tobacco smoking and tobacco chewing are most prevalent risk
factors. Alcohol alone is an
insignificant risk factor, but it has synergistic effect with
tobacco use in causing buccal mucosa
cancers. The results are generalizable as the study is rigorous
with large sample size and research
design.
Article 2: Case control study authored by Gupta et al. (2017)
This case control study addressed an important issue of
association of poor oral hygiene, diet,
27. tobacco chewing/smoking and alcohol (risk factors) with the
oral cancers (outcomes). The
method is appropriate to answer the question but there is
possibility of biases as the patients
have awareness about risk factors and diagnosis and therefore,
they are motivated to recall more
of risk factors. The disadvantage is that the findings are
dependent on the memory of the
patients.
The cases were recruited appropriately, and the criteria of
inclusion were clearly defined. The
patients selected from two big tertiary hospitals of Pune City.
All 187 patients with oral cancers
were recruited irrespective of their age, sex and stages of
disease. The controls were selected in
sufficient numbers (240). The controls are the patients having
non-neoplastic disease, recruited
within same time frame and matched in terms of sex and age
with the cases. Thus, there is no
evidence of selection biases.
Exposure measurements were described accurately in detail that
included data from face-to-face
28. interview, questionnaire, life grid tool, exposure to tobacco,
oral hygiene habit, anthropometry,
intraoral examination and putative risk factors. Frequency,
duration and cumulative effect of
smoking and tobacco chewing recorded in valid and reliable
manner. The cancers were measured
using standard criteria (extent, type, stages, site and
comorbidities. Both groups were equally
treated to minimize any bias.
There was possibility of confounding factors like age, family
income, socioeconomic status, and
education which may have effect on the outcomes or increase
the cancer risks (Jayalekshmi et
al., 2011). The article used unconditional logistic regression
model to adjust the confounding
factors. Regarding the results, the association between oral
/oropharyngeal cancers and tobacco
with alcohol is explained as potent risk factor. The novel
finding is the evidence of increased risks
of oral cancer when patients are chewing tobacco in presence of
poor oral hygiene.
The results are consistent with previous research reports and are
believable. The Confidence
29. interval 95% CIs and P value = 0.001 showing precise research.
A linear dose related association
was found between tobacco chewing and occurrence of oral
cancer.
The results are reliable and trustworthy. The results cannot be
applied to Australia as the tobacco
chewing is not prevalent and oral hygiene is remarkably better
than India. The findings are in line
and consistent with the previous research findings (Alam et al
2017)
Article 3: Cohort Study Authored by Jayalekshmi et al. (2011)
This cohort study aims to analyze relationship of oral cancer
with tobacco use, alcohol drinking
and low socioeconomic status in the rural population that is the
Karunagapally cohort of Kerala.
Virtually all residents (n= 66277) aged 30-84 years in the
cohort were recruited in Jan 1990 using
Poisson regression analysis of grouped data stratified on age,
calendar time, education and family
income to deal with biases and confounders. Therefore,
virtually all households were recruited
in the cohort.
30. Regarding exposure, tobacco use, alcohol and socioeconomic
stats were measured
appropriately. The participants were asked for history of
tobacco chewing (not chewing,
habitually in past, habitually currently), age when they started
chewing tobacco and the duration.
Similar questions were put forward for BIDI and cigarette
smokers. Thus, the bias is controlled.
Outcomes (development of cancers) were ascertained by the
Cancer Registry during the long
period between 1990 and 2005 under the Regional Cancer
Center (RCC). Biases are minimized
with accurate measurement and diagnosis of cancers. By the end
of 2005, 160 men developed
oral cancers.
The confounding factors were identified as family income, age,
calendar time and education
level. To deal with confounding factors, stratification strategy
and regression strategy were
adopted. The follow up was complete and long enough from
1990 to 2005. Migrants were
identified from door to door monitoring survey. Only 0.7%
participants were lost due to
31. permanent migrations.
Results show that tobacco chewing increases risk of cancers of
gums and mouth among people
who keeps tobacco in the cheek. In addition, even pan with or
without tobacco causes oral cancer
Bidi smoking also increases risk for cancers. Results are precise
with use of appropriate
methodologies and statistical analysis. Cancers at different
sites in oral cavity are examined for
risk factors. For example, risk of tongue cancer is related with
duration of bidis smoking (RR =3.4,
95% CI and p=0.034). P value is 0.001 and CI is 95%
Confidence interval shows the precision of
the study.
Results are believable as the study sample is large and study
duration in long enough. The
methods are appropriate without bias and confounders. The
results can be partially applied to
local Australian population where smoking is prevalent.
However, Pan and tobacco chewable
products (smokeless tobacco) are not prevalent. The results of
this study are supported by most
of the articles in literature. Alam et al. (2017) also found the
tobacco use as important risk factor
32. for cancer in the oral cavity. Regarding implication, the nurses
and social workers should educate
the people regarding the harmful impact of tobacco and alcohol
in causing cancers. In vulnerable
patients with habits of tobacco use, a complete screening should
be done at regular interval to
detect early cancers. Smokeless tobacco (chewing) is equally
harmful.
Discussion on bias, confounding factors and chances
Bias is a systematic error that should be minimized by proper
selection of the cases and proper
measurement. Bias does not disqualify the study. Research
studies can have pitfall called
Confounding which arises when the risk factor and the outcome
both are associated with a third
variable which creates a confusion. To avoid confounding, the
control should be the subject who
might have been the cases but are independent of the exposure.
Confounding can be prevented
by randomization, restriction and matching. Confounding can be
adjusted during statistical
33. analysis by using stratified analysis and multivariate analysis
techniques. Stratification is the best
technique to avoid confounding as used by Jayalekshmi et al.
(2011). Regression is also effective
technique for confounding as used by Gupta et al. (2017).
Chance is a sample error that should
be dealt by recruiting a large sample (Zaccai, 2004).
Conclusion:-
The paper concluded that tobacco consumption in any form is
injurious to health as it is the major
independent risk factor for head and neck cancers. Alcohol acts
as synergy with tobacco by
facilitating carcinogen uptake to the tissues. People in the
Southeast Asia have generally low
education and poor socioeconomic status. People in remote
villages and even in urban areas
have unhealthy lifestyle that increase the risks for cancers. The
health organization should
intensify their mission of educating the people in order to
control the cancers.
34. References:-
Alam, M. S., Siddiqui, S.A. & Perween, R. (2017).
Epidemiological profile of head and neck cancer
patients in Western Uttar Pradesh and analysis of distributions
of risk factors in relation to site
of tumor. Journal of Cancer Research and Therapeutics, 13:
430-35. doi: 10.1111/j.1349-
7006.2010.01785.x
Davis, T. C., Williams, M.V., Marin, E., Parker, R.M. & Glass
J. (2002). Health literacy and cancer
communication. CA: A Cancer Journal for Clinicians,
52(3):134-49.
Guide: University of Canberra (2018). Evidence-based practice
in health: Guide. Retrieved from
https://canberra.libguides.com/c.php?g=599346&p=4149721>.
35. Gupta, B., Bray, F., Kumar, N. & Johnson, N.W. (2017).
Associations between oral hygiene habits,
diet, tobacco and alcohol and risk of oral cancer: A case–control
study from India, Cancer
Epidemiology, 51:7-14. doi.org/10.1016/j.canep.2017.09.003
Health Knowledge (2017). Errors in epidemiological
measurements. Retrieved from
<https://www.healthknowledge.org.uk/e-
learning/epidemiology/practitioners/errors-
epidemiological-measurements>.
Jayalekshmi, P.A., Gangadharan, P., Akiba, S., Koriyama, C. &
Nair, R.R.K. (2011). Oral cavity
cancer risk in relation to tobacco chewing and bidi smoking
among men in Karunagappally.
Kerala, India: Karunagappally cohort study. Cancer Science,
102:460-467. doi: 10.1111/j.1349-
7006.2010.01785.x
National Cancer Institute (NIH) (2017). Head and Neck
Cancers. Retrieved from
<https://www.cancer.gov/types/head-and-neck/head-neck-fact-
sheet>.
Priebe, S. L., Aleksejuniene, J., Dharamsi, S. & Zed, C. (2008).
Oral cancer and cultural factors in
36. Asia. The Canadian Journal of Dental Hygiene, 42(6):291-293
Zaccai, J.H. (2004). How to assess epidemiological studies:
Review. The Canadian Journal of
Dental Hygiene, 80(941):140–147. doi:
10.1136/pgmj.2003.012633.
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QuestionsAbouttheStudyProject
Case 6.1 Network Diagram for a Large Construction
Project
Case6.2MelbourneConstructionCompany,A
Case6.3MelbourneConstructionCompany,B
Case6.4MelbourneConstructionCompany,C
Endnotes
7AdvancedProjectNetworkAnalysisandScheduling
7.1CPMandTime-CostTradeoff
7.2VariabilityofActivityDuration
7.3PERT
7.4 Allocating Resources and Multiple Project
Scheduling
7.5TheoryofConstraintsandCriticalChainMethod
7.6TOCMethod forAllocatingResources toMultiple
Projects
7.7DiscussionandSummary
SummaryListofSymbols
ReviewQuestionsandProblems
QuestionsAbouttheStudyProject
Case7.1BridgeconContractors
Case7.2LOGONProject
Case7.3PapuaPeteraVillageProject
Endnotes
8CostEstimatingandBudgeting
8.1CostEstimates
8.2CostEscalation
8.3 Cost Estimating and the Systems Development
57. 18ProjectSelectionandPortfolioManagement
18.1ProjectPortfolioManagement
18.2 Framework for Project Selection and Portfolio
Management
18.3MethodsforAssessingIndividualProjects
18.4MethodsforComparingandSelectingProjects
18.5 Integrating the Gating Process and Portfolio
Management
18.6SummaryandDiscussion
ReviewQuestionsandProblems
QuestionAbouttheStudyProject
Case18.1ConsolidatedEnergyCompany
Case18.2ProposedCementFactoryforPCSCompany
Endnotes
19InternationalProjectManagement
19.1InternationalProjects
19.2ProblemsManagingInternationalProjects
19.3LocalInstitutionsandCulture
19.4LocalStakeholders
19.5Geo-NationalIssues
19.6ProjectManager
19.7LocalRepresentative
19.8TopManagement,SteeringCommittee,andPMO
19.9TeamandRelationshipBuilding
19.10ProjectDefinition
19.11ProjectMonitoring
19.12Communication
19.13RisksandContingencies
19.14Summary
58. ReviewQuestions
QuestionsAbouttheStudyProject
Case 19.1 Mozal Project—International Investment in
anUndevelopedCountry
Case19.2SpiritElectronics’PuertoRicoOffice
Endnotes
APPENDIXARFPforMidwestParcelDistributionCompany
APPENDIXBProposalforLogisticalOnlineSystemProject(LOGO
N)
APPENDIXCProjectExecutionPlanforLogisticalOnlineSystem
Index
Preface
When people see or use something impressive—a bridge arching
high over a
canyon,aspaceprobetouchingdownonadistantplanet,ananimatedg
ameso
realistic you think you’re there, or a nifty
phone/camera/computer the size of
yourhand—
theysometimeswonder,“Howdidtheydothat?”Bythey,ofcourse,
theyarereferringtothecreators,designers,andbuilders,thepeoplew
hocreated
—thoughtupandmade—
thosethings.Seldomdotheywonderabouttheleaders
andmanagers, thepeoplewhoorganizedand led theefforts
thatbrought those
astounding things from concept to reality andwithout whommost
neat ideas
would never have been achieved. This book is about them—the
managers of
project managers, the mostly unsung heroes of engineering,
59. business, and
technologywho standoutside thepublic eyebutultimately are
responsible for
practicallyeverythingthatrequirescollectivehumaneffort.
The projectmanager is but one ofmany people involved in the
creation of
society’sproducts,systems,andartifacts,yetit
isheorshewhogetstheothers
involved and organizes and directs their efforts so everything
comes out right.
Occasionally, themanager and the creator happen to be the
same:BurtRutan,
WoodyAllen,andGutzonBorglumareexamples; their lifework—
inaerospace,
motion pictures, and monumental sculptures, respectively—
represent not only
creativeortechnologicalgenius,butleadershipandmanagerialtalent
aswell.
In the last several decades businesses have expanded from
domestic,
nationalistic enterprises andmarkets intomultinational, global
enterprises and
markets.Asaresult, fromabusinessperspectivethere
ismoreofeverythingto
contend with—more ideas, competitors, resources, constraints,
and, certainly,
more people doing andwanting things. Technology is advancing
and products
andprocessesevolvingatamorerapidpace;asaresult, the
lifecyclesofmost
thingsinsocietyaregettingshorter.This“moreofeverything”hashad
adirect
impact on the conduct of projects—including projects to
develop products,
60. systems,orprocessesthatcompeteinlocal,domestic,andinternation
almarkets;
projects to create and implement new ways of meeting demand
for energy,
recreation, housing, communication, transportation, and food;
and projects to
answer basic questions in science and resolve grave problems
such as disease,
pollution, global warming, and the aftermath of natural
disasters. All of this
project activity has spurred a growing interest in improved ways
to plan,
organize,andguideprojectstobettermeettheneedsofcustomers,mar
kets,and
societywithintheboundsoflimitedtimeandresources.
Associatedwiththisinterestisthegrowingneedtoeducateandtrainpr
oject
managers. In thepast—and still today—projectmanagerswere
chosen for some
demonstratedexceptionalcapability,althoughnotnecessarilymana
gerial.Ifyou
were a good engineer, systems analyst, researcher, architect, or
accountant,
eventually you would become a project manager. Somewhere
along the way,
presumably, you would pick up the “other” necessary skills. The
flaw in this
reasoning is that project management encompasses a broad
range of skills—
managerial, leadership, interpersonal—that are much different
from and
independent of skills associated with technical competency. And
61. there is no
reason to presume that the project environment alone will
provide the
opportunityforsomeoneto“pickup”theseothernecessaryskills.
Asatextandhandbook,thisbookisaboutthe“right”waytomanagepro
jects.
Itisintendedforadvancedundergraduateandgraduateuniversitystud
entsand
practicingmanagersinengineering,business,andtechnology.Asthet
itlesays,it
isabookaboutprinciplesandpractice,meaningthatthetopicsinitarep
ractical
and meant to be applied. It covers the big picture of project
management—
origins,applications,andphilosophy,aswellas thenitty-gritty,how-
tosteps. It
describes the usual project management topics of schedules,
budgets, and
controls, but also the human side of projectmanagement,
including leadership
andconflict.
Why a book on project management in engineering and business
and
technology? In our experience, technology specialists such as
engineers,
programmers, architects, chemists, and so on, involved in
“engineering/technology projects” often have little or no
management or
leadershiptraining.Thisbook,whichincludesmanyengineeringandt
echnology
examples, provides somewhat broad exposure to business
concepts and
62. management specifics to help these specialists get started as
managers and
leaders.
Whataboutthosepeopleinvolvedinproductdevelopment,marketing
,process
improvement,andrelatedprojectscommonlythoughtofas“business
projects”?
Just as technology specialists seldom receive formal
management training,
students and practitioners of business rarely get formal
exposure to practices
common in technology projects. For them, this book describes
not only how
“business”projectsareconducted,butalsothenecessarystepsinthec
onception
and execution of engineering, system development,
construction, and other
“technology” projects. Of course, every technology project is
also a business
project:itisconductedinabusinesscontextandinvolvesbusinessissu
essuchas
customersatisfaction,resourceutilization,deadlines,costs,andprof
its.
Virtuallyallprojects—engineering,technology,andbusiness—
originateandare
conducted in a similar way, in this book conceptualized using a
methodology
called the Systems Development Cycle (SDC). The SDC serves
as a general
framework for discussing the principles and practices of project
management,
andillustratingcommonalitiesanddifferencesamongawidevarietyo
fprojects.
63. This book is an outgrowth of the authors’ combined several
decades of
experience teaching project management at Loyola University
Chicago and
UniversityofPretoriatobusinessandengineeringstudents,preceded
byseveral
years’ experience in business and technology projects, including
for aircraft
design and flight test, large-scale process facility construction,
and software
applications development and process improvement. This
practical experience
gave us an appreciation not only for the business-management
side of project
management,butalsoforthehuman-
interpersonalsideaswell.Wehaveseenthe
benefitsofgoodcommunication,trust,andteamwork,aswellastheco
stsofpoor
leadership, emotional stress, and group conflict. In our
experience, the most
successful projects are those where leadership, trust,
communication, and
teamworkflourished,regardlessoftheformalplanningandcontrolme
thodsand
systemsinplace.Thisbooklargelyreflectsthesepersonalexperience
s.Ofcourse,
comprehensive coverage of project management required that
we look much
beyondourownexperienceanddrawuponthepublishedworksofman
yothers
andthewisdomandsuggestionsofcolleaguesandreviewers.
In this fifth editionwe have revised and addedmaterial to
incorporate new
64. topicsofinterest,currentexamples,andthegrowingbodyofliterature
inproject
management. Among significant new additions are a chapter on
agile project
management and lean production, extended coverage of
programmanagement,
aswell as 18newend-of-chapter case studies.The Introduction
includes tables
that relate sections of the book to the most-common project
management
knowledgeareasandmethodologies:PMIPMBOK,
IPMA,APM,andPRINCE2.
Books tend to grow in sizewith each new edition; to combat that
all chapters
havebeenrewrittentomakeeverythingmorereadableandconcise.De
spitethe
inclusionofnewmaterial,we’veheldthepagecounttoroughlywhatit
wasin
thepreviousedition.
Ourgoal inwritingthisbook is
toprovidestudentsandpracticingmanagers
themostpractical, current, and interesting
textpossible.Weappreciatehearing
yourcommentsandsuggestions.Pleasesendthemtousat[email prote
cted]and
[email protected]
Acknowledgments
Likemostprojects,writingabookreflectsthecontributionsofmanype
ople.We
65. wanttoacknowledgeandgivespecialthankstothosewhocontributedt
hemost.
First,thankstoourresearchassistants.Researchassistantsingeneral
doalotof
work—
academicaswellasgofer,andwithouttheirtoilingeffortsmostprofess
ors
would accomplish far less. We were fortunate to have had the
assistance of
severalsuchbrightandcapablepeople,particularlyElisaDenney,Hol
lyceJames,
Diane Petrozzo, Miguel Velasco, Gaurav Monga, Cary Morgan,
Louis
Schwartzman,andBrianWhelan.
SpecialthankstocurrentandformercolleaguesatLoyolaUniversityC
hicago
andtheUniversityofPretoria.InChicago,thankstoDr.GezinusHiddi
ngforhis
enthusiasm and contributions to the field of project
management; and to Drs.
EnriqueVenta,HaroldDyck,SamuelRamenofsky,andDonaldMeyer
,andElaine
Strnad, Paul Flugel, John Edison, Sharon Tylus, and Debbie
Gillespie for their
suggestions and support for this and earlier editions. In
Pretoria, thanks toDr.
TinusPretoriusforencouragingeducationandresearchinprojectman
agementat
theGraduateSchoolofTechnologyManagementandforsupportingth
eworkon
thisbook.I(Herman)alsowanttoexpressappreciationtoDr.GielBek
ker,Philip
Viljoen,Dr.TarynBond-
Barnard,Dr.PieterPretorius,Dr.KrigeVisser,Corrovan
Waveren,Dr.MichaelCarruthersandDr.Marie-
66. LouiseBarryfortheirdirectand
indirectcontributionstothisbookandforallIhavelearnedfromthem.I
(John)
want to acknowledge the influence of three of my professors,
Dr. Charles
ThompsonandDr.GustaveRathatNorthwesternUniversity,andDr.
DickEvans
attheUniversityofIllinois,whosephilosophiesandteachingshelped
shapedthis
book.IalsowanttothankChrisPharesandBobZimmerman,dearfrien
dsand
project managers extraordinaire, for ongoing sharing of their
wisdom on the
meaningandsignificanceofprojectleadership.
SpecialthanksalsotoourwivesSharryandKaren.Sharryprovidednu
merous
suggestionstothefirsteditionandhelpedreducetheamountof“techno
-jargon”
inthebook;shemanagedthehomefrontandfreeduptimesothatI(John
)could
pursue and complete this project. Karen provided wifely support
and
encouragement;as in thecaseof somanyotherprojects I
(Herman)havebeen
involved in,mycontribution to
thisprojectwouldneverhavematerializedhad
notitbeenforhersupport.
Thanks also to Amy Laurens and the folks at Routledge and
Taylor and
Francis, and special thanks toHollyDavis for her ongoing
support throughout
67. preparationofthisfifthedition.
Other colleagues, students, and friends, some mentioned in the
endnotes
throughoutthebook,providedsupport,encouragement,andreferenc
ematerials;
tothemalsowesaythankyou.Despitetheassistanceofsomanypeople
andour
ownbestefforts,therearestilllikelytobeomissionsorerrors.Wehadfi
nalsay
andacceptresponsibilityforthem.
JohnM.Nicholas
HermanSteyn
AbouttheAuthors
JOHNNICHOLASisProfessorOperationsManagementandProject
Management
intheQuinlanSchoolofBusinessatLoyolaUniversityChicago.Heisa
nactive
teacher, writer, and researcher in project management and
production
management, and conducts executive seminars and consults on
project
managementandprocessimprovement.Johnistheauthorofnumerous
academic
and technical publications, and five books including Lean
Production for
CompetitiveAdvantage (2011)andThePortaltoLeanProduction
(2006).Hehas
heldthepositionsofteamleadandengineeronaircraftdevelopmentpr
ojectsat
68. Lockheed-Martin Corporation, team lead and business systems
analyst on
operations projects at Bank America, and researcher on energy-
environmental
research projects atArgonneNational Laboratory.He has aBS in
aeronautical
and astronautical engineering and an MBA in operations
research from the
University of Illinois, Urbana-Champaign, and a PhD in
industrial engineering
andappliedbehavioralsciencefromNorthwesternUniversity.
HERMANSTEYNisProfessorofProjectManagementintheGraduat
eSchoolof
Technology Management, University of Pretoria, South Africa.
He has been
involved inprojects in industry since1975,hasmanagedavarietyof
largeand
small engineering projects (system, product, and process
development) in the
minerals, defense and nuclear industries, and has alsomanaged
programs and
project portfolios. In 1996 he was appointed to his current
position at the
University of Pretoria where he initiated a masters’ program in
project
management. Besides supervising project management research
and teaching
graduate project management courses, Herman has conducted
more than 200
seminarsandworkshopsonprojectmanagement.Hehasabachelor’sd
egreeand
graduate diploma in metallurgical engineering, an MBA, and a
PhD in
engineeringmanagement.
69. Introduction
I.1InTheBeginning…
Sometime during the third millennium BC, workers on the Great
Pyramid of
Cheops set the last stone in place. Theymust have felt jubilant,
for this event
represented a milestone of sorts in one of humanity’s grandest
undertakings.
Although much of the ancient Egyptians’ technology is still a
mystery, the
enormityandqualityofthefinishedproductremainsamarvel.Despite
thelack
ofsophisticatedmachinery, theywereable
toraiseandfitsome2,300,000stone
blocks,weighing2to70tonsapiece,intoastructuretheheightofamod
ern40-
story building. Each facing stonewas set against thenextwith an
accuracy of
0.04 inch (1mm),and thebase,whichcovers13acres
(52,600m2),deviates less
than1inch(25mm)fromlevel(FigureI.1).1
Equally as staggering was the number of workers involved. To
quarry the
stonesandtransportthemdowntheNile,about100,000laborerswerel
evied.In
addition,40,000skilledmasonsandattendantswereemployed
inpreparingand
laying the blocks and erecting or dismantling the ramps. Public
works were
70. essential tokeep theworkingpopulationemployedand fed, and it
is estimated
thatnolessthan150,000womenandchildrenalsohadtobehousedandf
ed.2But
just as mind-boggling was the managerial ability exercised by
the Egyptians
throughout the 20-year durationof the pyramid construction.
FrancisBarber, a
nineteenth-centurypyramidscholar,concludedthat:
Itmusthavetakentheorganizationalcapacityofageniustoplanallthe
work,tolayitout,toprovide
foremergenciesandaccidents, to see that themen in
thequarries,on theboatsand sleds, and in the
mason’s and smithies shops were all continuously and usefully
employed, that the means of
transportationwasample…thatthewatersupplywasample…andthat
thesickreliefswereonhand.3
BuildingtheGreatPyramidiswhatwetodaywouldcallalarge-
scaleproject.It
stands among numerous projects from early recorded history
that required
massive human works and managerial competency. Worthy of
note are the
managerialandleadershipaccomplishmentsofMoses.TheBiblicala
ccountofthe
exodusoftheHebrewsfromthebondageoftheEgyptiansgivessomepe
rspective
onthepreparation,organization,andexecutionofthistremendousun
dertaking.
Supposedly Moses did a magnificent job of personnel selection,
71. training,
organization,anddelegationofauthority.4ThefamedrulerSolomona
lsowasthe
“manager”ofgreatprojects.Hetransformedthebatteredruinsofmany
ancient
cities and crude shantytowns into powerful fortifications.With
hiswealth and
the help of Phoenician artisans, Solomon built the Temple in
Jerusalem. Seven
years went into the construction of the Temple, after which
Solomon took 13
years more to build a palace for himself. He employed a
workforce of 30,000
IsraelitestofelltreesandimporttimberfromtheforestsofLebanon.5T
hatwas
almost3,000yearsago.
FigureI.1TheGreatPyramidofCheops,anearly(circa2500BC)large
-scaleproject.
PhotocourtesyofiStock.
With later civilizations, notably the Greeks and Romans,
projects requiring
extensive planning and organizing escalated. To facilitate their
military
campaigns and commercial interests, the Romans constructed
networks of
highways and roads throughout Europe, Asia Minor, Palestine,
and northern
Africa so that all roadswould “lead toRome.”The civilizations
ofRenaissance
EuropeandtheMiddleandFarEastundertookriverengineering,const
72. ructionof
aqueducts,canals,dams,locks,andportandharborfacilities.Withthe
spreadof
modern religions, construction of temples, monasteries,
mosques, and massive
urbancathedralswasaddedtothelistofprojects.
With the advent of industrialization and electricity, projects for
the
construction of railroads, electrical and hydro-electrical power
facilities and
infrastructures, subways, and factories became commonplace. In
recent times,
development of large systems for communications, defense,
transportation,
research,andinformationtechnologyhavespurreddifferent,moreco
mplexkinds
ofprojectactivity.
Aslongaspeopledothings,therewillbeprojects.Manyprojectsofthef
uture
will be similar to those in the past.Otherswill be different either
in terms of
increased scale of effort or more advanced technology.
Representative of the
latter are two recent projects, the English Channel tunnel
(Chunnel) and the
International Space Station. The Chunnel required tremendous
resources and
tookadecadetocomplete.TheInternationalSpaceStation(Figure
I.2) required
developmentofnew technologiesand theeffortsof
theUS,Russian,European,
Canadian,andJapanesespaceagencies.
73. FigureI.2TheInternationalSpaceStation,amodernlarge-
scaleproject.
PhotocourtesyofNASA.
I.2WhatIsaProject?
From these examples it is clear that humankind has been
involved in project
activities for a long time. Butwhy are these considered
“projects”while other
humanactivities,suchasplantingandharvestingacrop,stockingawar
ehouse,
issuingpayrollchecks,ormanufacturingaproduct,arenot?
Whatisaproject?Thisisaquestionwewillcoverinmuchdetaillater.A
san
introduction though, below are listed some characteristics that
warrant
classifyinganactivityasaproject.6
1. A project has a defined goal—a purpose with well-defined
end-items,
deliverables,results,orproductstoachievespecificbenefits.
2. It is unique; it requires doing something different than was
done
previously.Itisaone-timeactivity,nevertobeexactlyrepeatedagain.
3.Itisatemporaryorganizationthatseekstoaccomplishthegoalwithi
na
scheduledtimeframe.
74. 4. It utilizes people and other resources from different
organizations and
functions.
5.Giventhateachprojectisunique,itcarriesunfamiliarityandrisk.
The examples described earlier are for familiar kinds of projects
such as
construction(pyramids)andtechnologydevelopment(spacestation)
.Ingeneral,
the list of activities that qualify as projects is long and
includesmany that are
commonplace.Weddings,remodelingahome,andmovingtoanother
houseare
projects; so are company audits, major litigations, corporate
relocations, and
projects;andsoareeffortstodevelopnewproductsandimplementnew
systems.
Military campaigns also qualify as projects; they are temporary,
unique efforts
directedtowardaspecificgoal.TheNormandyInvasioninWorldWarI
IonJune
6,1944isanexample:
The technical ingenuity and organizational skill thatmade the
landings possiblewas staggering. The
invasionarmadaincludednearly5,000shipsofalldescriptionsprotec
tedbyanother900warships.The
plancalledforlanding150,000troopsand1500tanksontheNormandy
coastinthefirst48hours.7
Mostartisticendeavorsareprojects,too.Composingasongorsympho
ny,writing
75. anovel,ormakingasculptureareone-
personprojects.Someartisticprojectsalso
require the skills of engineers and builders, for exampleMount
Rushmore, the
StatueofLiberty,andtheEiffelTower.
Manyeffortsatsavinghumanlifeandrecoveringfromman-
madeornatural
disastersbecomeprojects.Examplesarethemassivecleanupfollowin
gtheSoviet
nuclear accident at Chernobyl, and rescue and recovery
operations following
disastrous earthquakes in Chile, Haiti, China, Pakistan, Mexico,
Turkey, and
elsewhere,theIndianOceantsunamiof2004,andtheEbolaoutbreakin
western
Africain2014.
Figure I.3 shows diverse project endeavors and examples of
well-known
projects,andwheretheprojectsfallwithrespecttocomplexityandunc
ertainty.
Complexity ismeasuredby themagnitudeof the effort—
thenumberof groups
and organizations involved and the diversity of skills or
expertise needed to
accomplish the work. Time and resource commitments tend to
increase with
complexity.
Uncertainty is measured roughly by the difficulty in predicting
the final
outcomeintermsofthedimensionsoftime,cost,and
technicalperformance. In
mostprojectsthereissomeuncertaintyinoneortwodimensions(e.g.w
eddings);
76. in complex projects there is uncertainty in all three dimensions
(e.g. the space
station).
Generally, themoreoften something is done, the lessuncertainty
there is in
doing it. This is simply because people learn by doing and so
improve their
efforts—the “learning curve” concept. Projects that are very
similar to previous
ones and about which there is abundant knowledge have lower
uncertainty.
These are found in the lower portion of Figure I.3 (e.g.
weddings, highways,
dams, system implementation). Projectswithhighuncertainty are
in theupper
portionofthefigure.
Whentheuncertaintyofaprojectdropstonearlyzero,andwhentheproj
ect
effort is repeated a large number of times, then thework is
usually no longer
considered a project. For example, building a skyscraper is
definitely a project,
but mass construction of prefabricated homes more closely
resembles a
scheduled,repetitiveoperationthanaproject.ThefirstflighttotheSo
uthPoleby
AdmiralByrdwasaproject,butmoderndailysupply flights tobases
thereare
not.WheninthefuturetouristsbegintakingcharteredexcursionstoM
ars,trips
therewillnotbeconsideredprojectseither.Theywilljustbeordinarys
77. cheduled
operations.
ThecostcurveinFigureI.3indicatesthataproject’sexpensetendstoin
crease
roughly in proportion to its complexity and uncertainty. Cost,
represented in
termsoftimeoreconomicvalue,isattheleveloftensorhundredsoflabo
rhours
forprojectswith lowcomplexityanduncertainty,but increases
tomillionsand
billionsofhoursforprojectswiththegreatestcomplexityanduncertai
nty.
In all cases, projects are conducted by organizations that after
the project is
completedgoontodosomethingelse(constructioncompanies)orared
isbanded
(AdmiralByrd’s crew, theMars exploration team). In contrast,
repetitive, high-
certainty activities (prefabricated housing, supply flights, and
tourist trips to
AntarcticaorMars)areperformedbypermanentorganizationsthatdo
thesame
thingrepeatedly,withlittlechangesinoperationsotherthanschedulin
g.Because
projectsarenotrepetitiveisthereasontheymustbemanageddifferentl
y.
I.3AllProjectsareNottheSame8
BesidesFigure I.3,anotherwayto illustrate thediversity inprojects
iswith the
so-calledNTCPmodel,whichclassifiesprojectsandtheirend-
78. resultsorproducts
intofourdimensions,eachwiththreeorfourpossiblelevels.Thedime
nsionsand
levelsare:
•Novelty: This represents how new the project end-item or
product is to
customersandpotentialusersandhowwelldefinedareitsinitialprodu
ct
requirements.Itincludesthreelevels:
FigureI.3Atypologyofprojects.
• Derivative—the project end-item or product is an extension or
improvementofanexistingproductorsystem;e.g.newfeaturesto
anexistingcarmodel;
• Platform—the end-item or product is a new generation of an
existingproduct line inawell-establishedmarket;e.g.anewcar
model;
•Breakthrough—theend-itemorproductisnewtotheworld;e.g.the
firstmobiletelephone,thefirst3MPost-itnotes.
• Technology: This represents the project’s technological
uncertainty and
whetheritisnewormature.Itaddressesthequestionofhowmuchnew
technologyisrequiredtocreate,build,manufactureandenabletheuse
of
theproductandhowmuchtechnicalcompetencyisneededbytheproje
ct
managerandtheteam.Ithasfourlevels:
•Low-tech—involvesonlywell-establishedtechnologies;
79. •Medium-tech—usesmainly existing technologies, but also
limited
useofsomenewtechnologyornewfeatures;e.g.automotiveand
appliancesindustries;
•High-tech—uses technologies that aremostlynew to the firmbut
already exist and are available at project initiation; typical of
manydefenseandcomputerprojects; issynonymouswith“high-
risk”;
• Super-high-tech—relies on new technologies that do not exist
at
projectinitiation.Theprojectgoaliswelldefined,butthesolution
isnot;e.g.landingamanonthemoon;isoftensynonymouswith
“veryhigh-risk.”
•Complexity:Thismeasuresthecomplexityoftheproductandtheproj
ect
organization.Therearethreelevels:
•Assembly—theprojectinvolvescombiningacollectionofelements,
components, and modules into a single unit or entity that
performsasinglefunction;e.g.developinganewcoffeemachine
or creating a department to manage a single function (such as
payroll);
•System—involvesacomplexcollectionof interactiveelementsand
subsystems that jointly perform multiple functions to meet
specificoperationalneeds;e.g.anewcar,newcomputer,entirely
newbusiness;
•Array—theprojectinvolvesalargevarietyofdispersedsystems(a
80. system of systems, or “super system”) that function together to
achieve a common purpose; e.g. national communications
network, mass transit infrastructure, regional power generation
anddistributionnetwork,anentirecorporation.
•Pace:Thisreferstotimeavailablefortheproject—
theurgencyorcriticality
ofmeetingtheproject’stimegoals.Therearefourlevels:
•Regular—nourgency;timeisnotcriticaltoimmediatesuccess;
• Fast/competitive—complete project in adequate time to
address
marketopportunities,createastrategicpositioning,orformanew
business unit; e.g. launching a new drug, introducing a new
productline;
•Time-critical—completeprojectbyaspecificdeadline;missingthe
deadlinemeansproject failure; e.g.Y2Kprojects; constructionof
facilities for the Olympic Games; launch of space probe to a
comet;
•Blitz—acrisisproject;thecriterionforsuccessissolvingaproblem
asfastaspossible;e.g.savepeoplefromasinkingship.
Allprojectscanbecharacterizedaccordingtothefourdimensions.InF
igure I.4,
eachofthedimensionsisrepresentedbyaquadrantonthegraph.Thedi
amond-
shaped profiles show the four dimensions for two examples, the
Apollo lunar
programandthespaceshuttleprogram.
FigureI.4ShenharandDvir’sNTCPDiamondmodelcontrastingtheA
82. whycathedralstookdecadesorcenturiestocomplete).Ifakingranout
ofmoney
whilebuildingapalace,hesimplyraisedtaxes.Incaseswhereaddition
almoney
orworkerscouldnotbefoundortheprojectdelayed,thenthescaleofeff
ortor
qualityofworkmanshipwasreducedtoaccommodatetheconstraints.
In the Pathfinder project, many of the requirements were
inflexible: the
missionteamwaschallengedwithdevelopingandlandingavehicleon
Marsin
lessthan3years’timeandona$150millionbudget,whichwaslessthan
halfthe
timeand1/20ththecostofthelastprobeNASAhadlandedonMars.The
project
involvedadvancedresearchanddevelopmentandexplorednewareas
ofscience
andengineering.Technicalperformancerequirementscouldnotbeco
mpromised;
todosowouldincreasetherisktoundertakingsthatwerealreadyveryri
sky.
Constraints and uncertainty in projectwork are not restricted to
large-scale
governmental science programs. They are common in everyday
business and
technologywhereorganizationscontinuallystrivetodevelopandimp
lementnew
products, processes, and systems, and to adapt to changing
requirements in a
changing world. Consider Dalian Company’s development of
“Product J,” a
productdevelopmentprojectthatexemplifieswhatcompaniesevery
wheremust
dotobecompetitiveandsurvive.ProductJisapromisingbutradically
83. newidea.
Tomovetheideafromaconcepttoarealproductwillrequiretheinvolv
ementof
engineersandtechniciansfromseveralDaliandivisionsandsuppliers
.ProductJ
will require meeting tough technical challenges, launching the
product well
aheadofthecompetition,anddoingitforacostthecompanycanafford.
Another example is Shah Alam Hospital’s installation of a new
employee
benefitsplan.Theprojectwould involvedevelopingnewpolicies,
training staff
workers, familiarizing 10,000 employees with the plan, and
installing a new
computernetworkanddatabase,andrequireactiveparticipationfrom
personnel
inhumanresources,financialservice,andinformationsystems,aswel
lasexperts
from two consulting firms. It typifies “change” projects
everywhere—projects
initiated in response to changing needs andwith the goal of
transforming the
organization’swayofdoingthings.
Finally, consider that virtually every company has or will have
a website.
Behindeachsitearemultipleprojectstodeveloporenhancethewebsit
eandto
integrate electronic business technology into the company’s
mainstream
marketing and supply-chain operations. Such projects are also
examples of
84. organizations’ need to change, in this case to keep pace with
advances in
informationtechnologyandbusinessprocesses.
Activitiessuchastheseexamplesdefytraditionalmanagementappro
achesfor
planning, organization, and control. They are representative of
activities that
requiremodernmethodsofprojectmanagementtomeetdifficulttechn
ologicalor
market-
relatedperformancegoalsinspiteoflimitedtimeandresources.
I.5ProjectGoal:Time,Cost,andPerformance
FigureI.5Three-dimensionalprojectgoal.
Source:AdaptedfromRosenauM.,SuccessfulProjectManagement.
Belmont,CA:LifetimeLearning
Publications;1981,p,16.
The goal of virtually every project can be conceptualized in
terms of hitting a
target that floats in three-dimensional space—the dimensions
being cost, time,
andperformance(FigureI.5).Costisthespecifiedorbudgetedcostfor
theproject.
Timeisthescheduledperiodoverwhichtheworkistobedone.Perform
anceis
what the project end-item, deliverables, or final result must do;
it includes
whatever the project customer, end-user, and other stakeholders
consider
85. necessary or important. The target represents a goal to deliver a
certain
somethingtosomebodybyacertaindateandforacertaincost.Thepurp
oseof
projectmanagementistohitthetarget—
i.e.,toachievethegoaloftheproject.9
But technological complexity, changing markets, and an
uncontrollable
environment make it difficult to hit the target. Time, cost, and
technical
performance are interrelated, and exclusive emphasis on any
one will likely
underminetheothers.Intryingtomeetschedulesandperformancereq
uirements,
costs increase; conversely, in trying to contain costs,work
performance erodes
andschedules slip. Inearlier times,oneor twoaspectsof
thegoalweresimply
allowed to slide so that the “most fixed” could be met. Most
projects, as the
Pathfinder, Dalian Company, and Shah Alam Hospital examples
show, do not
havethisluxury.Projectmanagementoffersawaytomaintainfocuson
allthree
dimensionsandtocontrolthetradeoffsamongthem.
I.6ProjectManagement:ThePerson,TheTeam,The
Methodology
Three key features distinguish project management from
86. traditional forms of
management:theperson,theteam,andthemethodology.
The most prominent feature about project management is the
role of the
project manager—the individual who has overall responsibility
to plan, direct,
and integrate the efforts of everyone involved in the project
(stakeholders) to
achieve the project goal. In the role of project manager, one
person is held
accountable for the project and is totally dedicated to achieving
its goals. The
projectmanagercoordinatestheeffortsofeveryfunctionalareaandor
ganization
intheprojectandoverseestheplanningandcontrolofcosts,schedules,
andwork
tasks.Aswewilldiscusslater,numerousotherparties(stakeholders)a
reinvolved
inandcrucialtoprojectmanagement;nonetheless,theroleofprojectm
anageris
akeyfeaturethatdistinguishesproject-fromnon-
projectmanagement.
Doing a project is a team effort, and project management means
bringing
individualsandgroupstogethertoformtheteamanddirectingthemto
wardthe
commongoal.The teamwill often consist of people andgroups
fromdifferent
functional areas and organizations. Depending on the project,
the size and
composition of the team may fluctuate; usually the team
disbands after the
projectiscompleted.
87. The project manager and project team typically perform work in
phases
according to a “projectmanagementmethodology.”
Thismethodology provides
for integrative planning and control of projects,which according
toArchibald
refersto
thepullingtogetherofallimportantelementsofinformationrelatedto
(1)theproductsorresultsofthe
project,(2)thetime,and(3)thecost,infunds,manpower,orotherkeyr
esources…forall(orasmanyas
practical) phases of the project. [It] requires continual revision
of future plans, comparison of actual
resultswithplans,andprojectionoftotaltimeandcostatcompletionth
roughinterrelatedevaluationof
allelementsofinformation.10
Asaprojectproceedsfromonephasetothenext,theprojectmanagerrel
ieson
the methodology to (1) identify the project tasks, (2) identify
the required
resourcesandthecosts,(3)establishpriorities,(4)planandupdatesch
edules,(5)
monitorandcontrolend-
itemqualityandperformance,and(6)measureproject
performance.11
I.7ProjectManagementStandardsofKnowledgeand
Competencies
88. Project management has become a recognized vocation
supported by several
professionalorganizationsaroundtheworld.Theseorganizationsha
veadvanced
project management by establishing standards, guidelines, and
certifications.
Among the more well-known of these organizations are IPMA
(International
Project Management Association), APM Group (Association for
Project
Management),andPMI(ProjectManagementInstitute).ThePMIisba
sedinthe
USandisthelargestoftheseorganizations;theIPMA,basedintheNeth
erlands,
isaninternationalgroupofnationalprojectmanagementassociations
inEurope,
Africa,AsiaandNorthandSouthAmerica;theAPMisbasedintheUK.
Theseprofessionalorganizationshavegathered
theacceptedbestpracticesof
projectmanagementandpublishedthemasstandardsor“bodiesofkno
wledge”
(BOKs)andcompetenciesfortheprofession.12Althoughnoneofthes
tandardsor
BOKs covers everything about project management, they have
become
recognized norms about what minimally a project management
professional
shouldknow.Theorganizationsalsoofferlevelsofqualificationandc
ertification
that include, for example, PMI’s PMP (Project Management
Professional)
certification; APM’s APMP (APM professional), and IPMA’s
CPMA (Certified
Project Management Associate). PMI’s and APM’s
certifications are “body of
89. knowledge-based”; IPMA’s certifications are “competency-
based.” Another
certificationpopularinEuropeandparticularlytheUKisbaseduponP
RINCE2
(PRojectsINControlledEnvironments,Version2),amethodologyfo
rmanaging
projectsoriginatedbytheUKOfficeofGovernmentCommerce.13
Forreadersinterestedinprofessionalcertification,TablesI.1through
TableI.4
intheAppendixtothechaptershowthecorrespondencebetweenthekn
owledge
areas,competenciesexpected,andmethodsfromPMI,IPMA,APM,a
ndPRINCE,
andchaptersinthisbookmostrelevanttothem.
I.8AboutThisBook
PhilosophyandObjectives
As a philosophy and an approach, project management is
broader and more
sophisticatedthantraditionalmanagementofrepetitiveactivities.Ith
asrootsin
many disciplines, including management science, systems
theory, accounting,
operations management, organizational design, law, and applied
behavioral
science. What has evolved, and will continue to evolve, are a
philosophy,
approach, and set of practices, the sum total of which comprise
project
management.Somemanagersfailtounderstandthis,believingthatap
plicationof
90. techniques alone, such as “Gantt charts,” “PERT,” or
“matrixmanagement” (all
explainedlater)makeforsuccessfulprojectmanagement.Projectma
nagementis
muchmorethanthese.
C.P.Snowwroteanessayentitled“TwoCultures”abouttheculturalga
pthat
separatesscientistsfromtherestofsociety.14Managersandmanage
mentscholars
also tend to separate the world into either of two perspectives:
(1) the
“quantitativists” tend to view projects in terms of costs, dates,
and economic
variables;(2)the“behaviorists”viewprojectsintermsofpeoples’beh
avior,skills,
andattitudes,andsystemsoforganization.
The intent of this book is to give a balanced view that
emphasizes both the
behaviorist and quantitativist sides of project management. The
philosophy of
this book is that for managers to “do” project management, they
must gain
familiarity with four topical areas: system methodology;
systems development
process; managementmethods, procedures, and systems; and
organization and
human behavior; correspondingly, the objectives of this book
are to cover in
depth:
1.Theprinciplesandphilosophythatguideprojectmanagementpracti
ce.
2.Thelogicalsequenceofstagesinthelifeofaproject.
3.Themethods,procedures,andsystemsfordefining,planning,sched
91. uling,
controlling,andorganizingprojectactivities.
4. The organizational,managerial, and human behavioral issues
in project
management.
Inrecentyearsthescopeofprojectmanagementhasgrowntoencompa
ssmore
than the management of individual projects, recognizing that
project success
involvesmorethantheskillsandtalentofagoodprojectmanager;henc
e,afinal
objectiveofthebookistocover:
5. Responsibilities of the organization for assuring effective
project
managementandsuccessfulprojects.
OrganizationofThisBook
Beyondthisintroductorychapter,thebookisdividedintofivemainsec
tions.The
firstsectionisdevotedtothebasicconceptsofprojectmanagement.Th
issection
describes project management principles, systems
methodologies, and the
systems approach—the philosophy that underlies project
management. Also
coveredaretheoriginsandconceptsofprojectmanagement,situation
swhereit
isneeded,andexamplesofapplications.Thesecondsectiondescribes
thelogical
92. process in the creation and life of a system. Called the Systems
Development
Cycle,itisthesequenceofphasesthroughwhichallhuman-
madesystemsmove
frombirthtodeath.Thecycleisdescribedintermsofitsrelationtoproje
ctsand
projectmanagement.Thethirdsectionisdevotedtomethodsandproce
duresfor
planning,scheduling,costestimating,budgeting,resourceallocatio
n,controlling,
and terminatingaproject.The topicsof resourceplanning,
computerandweb-
basedprojectmanagement, andproject evaluationare also
covered.The fourth
section isdevoted toprojectorganizations, teams,and thepeople
inprojects. It
covers forms of project organization, roles and responsibilities
of project
managers and teammembers, styles of leadership, andmethods
formanaging
teamwork, conflict, and emotional stress.The last section covers
topics that lie
beyondtheprojectmanagerbutarecrucialforprojectsuccessand,mor
ebroadly,
the success of the organizations and communities that sponsor
and undertake
projects. It also covers a topic that spans most other topics in
this book but
requiresspecialattention,managingprojectsindifferentcountries.
Thefivestatedobjectivesofthisbookareroughlydividedamongchapt
ersin
thebook’sfivesections:
93. 1.Basicconceptsandsystemsphilosophy:Chapters1and2.
2.Systemsdevelopmentandprojectlifecycle:Chapters3and4.
3.Methods, procedures, and systems for planning and
control:Chapters 5
through13.
4.Organization,management,andhumanbehavior:Chapters14throu
gh16.
5.Thecorporatecontextandinternationalprojectmanagement:Chapt
ers17
through19.
Three Appendices provide examples of topicsmentioned
throughout the book:
request for proposal (AppendixA), project proposal (Appendix
B), and project
executionplan(AppendixC).
I.9StudyProject
Thebestwaytolearnaboutprojectmanagementistoactuallyparticipa
teinitor,
failingthat,towitnessit.Attheendofeverychapterinthisbookaretwo
kinds
ofquestions:thefirstkindaretheusualchapterreviewquestions,these
condare
called“QuestionsAbouttheStudyProject.”Thelatterareintendedtob
eapplied
to a particular project of the reader’s choosing. This will be
called the “study
project.”Thepurposeofthesequestionsandthestudyprojectistohelpt
hereader
94. relateconceptsfromeachchaptertoreal-lifesituations.
Thestudyprojectquestionscanbeusedintwoways:
1.Forreaderswhoarecurrentlyworkinginprojectsasmanagersorproj
ect
teammembers, the questions can be related to their currentwork.
The
questions serve to increase the reader’s awareness of key issues
surroundingtheprojectandtoguidemanagersintheconductofproject
management.
2. For readerswho are currently full- or part-time students, the
questions
can be applied to “real-life” projects they are permitted to
observe and
research. Many business firms and government agencies are
happy to
allowstudentgroupstointerviewmanagersandcollectinformationab
out
theirprojects.Thoughsecondhand,thisisnonethelessanexcellentwa
yto
learnaboutprojectmanagementpractice(andmismanagement).
Assignment
Selectaprojecttoinvestigate.Itshouldbea“real”project;thatis,aproj
ectthat
hasarealpurposeandisnotcontrivedjustsoyoucaninvestigateit.Itca
nbea
current project or one already completed; whichever, it must be
a project for
whichyoucanreadilygetinformation.
Ifyouarenotcurrentlyinvolvedinaprojectasateammember,thenyou
must
95. find one for which you have permission to study (collect data
and interview
people)asan“outsider.”Theprojectshouldincludeaprojectteam(mi
nimumof
five people)with a project leader andbe at least 2 or 3months
induration. It
should alsohave a specific goal in termsof a target
completiondate, a budget
limit,andaspecifiedend-
itemresultorproduct.Ingenerallargerprojectsafford
betteropportunity toobserve theconceptsofprojectmanagement
than smaller
ones.
Ifyouarestudyingaprojectasanoutsideritisalsoagoodideatodoitina
teamwith three to six people and an appointed team leader (i.e.,
perform the
study using a team). This, in essence, becomes your project
team—a team
organizedforthepurposeofstudyingaproject.Youcanthenreadilyap
plymany
of the planning, organizing, team building, and other procedures
discussed
throughout the book as practice and to see how they work. This
“hands-on”
experiencewithyourownteamcombinedwithwhatyoulearnfromthe
project
you are studying, will give you a fairly accurate picture about
problems
encounteredandmanagementtechniquesusedinreal-
lifeprojectmanagement.
104. Closingaproject 12
ReviewQuestions
1. Lookatwebsites,newspapers,magazines,or television
forexamplesof
projects. Surprisingly, a great number of newsworthy topics
relate to
currentandfutureprojects,ortotheoutcomeofpastprojects.Preparea
listofthesetopics.
2.
Preparealistofactivitiesthatarenotprojects.Whatdistinguishesthe
m
from project activities? Which activities are difficult to classify
as
projectsornon-projects?
3. Because this is an introductory chapter, not verymuch has
been said
about why projects must be managed differently from ordinary
“operations,” andwhat constitutes projectmanagement—the
subject of
this book. Now is a good time to speculate about these:Why do
you
thinkprojects andnon-projectsneed
tobemanageddifferently?What
doyouthinkaresomeadditionalorspecialconsiderationsnecessaryfo
r
managingprojects?
CaseI.1TheDenverAirport15
105. WhentheDenverAirportprojectwasinitiatedin1989,theplanned4-
year
timeframe seemed adequate. However, despite abundant
political backing
and adequate funding, the project suffered a 16-month delay and
a $1.5
billioncostoverrun.TheNTCPmodelcanbeusedinretrospecttoexpla
in
therootcauseofmuchoftheproject’sunsatisfactoryperformance.Wi
th20-
20hindsight onemayargue that a relatively simpleNTCPanalysis
of the
projectanditssub-
projectsatanearlystage(andadjustingthemanagement
styleaccordingly)mighthavesignificantlyimprovedperformance.
Toenableaircraftturnaroundaroundinlessthan30minutesasrequest
ed
by United Airlines, one of the airport’s largest tenants, an
automated
baggage sorting andhandling systemwasnecessary to improve
efficiency
over the traditional manual handling system. In December 1991
BAE
AutomaticSystemswascontractedtodesignandimplementtheautom
ated
systeminanestimated2.5-yeartimeframe.
By August 1994 the system was 11 months late and was
severely
hamperingairportoperations.Managementdecidedtobuildanaltern
ative,
more traditional baggage system as a backup at an additional
106. $50million
cost, and only United would use the BAE system for its own
terminal
concourse.InJanuary1995afull-
scalepracticerunoftheBAEsystemwas
successfully executed, and in February 1995 the airport was
opened—16
monthslate.
Building the airportwasmostly a typical large construction
project; in
terms of NTCP it would be classified as follows: Novelty—
Platform;
Technology—Low-tech; Complexity—Array; Pace—
Fast/Competitive. The
snagintheprojectwasthatoneelement—theautomaticbaggage-
handling
system:itwasnewtechnologyand,thus,riskierthantherestoftheproje
ct,
ariskthatwasnotconsidered.Thesystemwasthefirstof itskind(ithad
beenusedbeforeonlyonamuchsmallerscale)andrequiredseveraldes
ign
cyclesandintensivetesting.Itthereforeshouldhavebeenconsidered“
High-
tech” andmanaged accordingly. As discussed later in the book,
high-risk
projectsneed tobemanageddifferently fromlow-
riskprojects.TheNTCP
profilesofthetotalprojectandthebaggage-
handlingsystemareillustrated
inFigureI.6.
FigureI.6“Diamond”profilesfortheDenverAirportandfortheBagga
ge-HandlingSystem.
107. Source:ShenharA.andDvirD.ReinventingProjectManagement:Th
eDiamondApproachto
SuccessfulGrowthandInnovation.Cambridge,MA:HarvardBusine
ssSchoolPress;2007.
QuestionsAbouttheCase
1. In what ways should High-tech projects bemanaged
differently from
Low-techones?
2. BAEAutomaticSystemsisareputablehigh-
technologycorporationand
wasfamiliarwithbuildingautomatedbaggage-
handlingsystems.What
might have convinced them to accept a schedule of 2.5 years for
designingandconstructionofthebaggage-handlingsystem?
3. If an NTCP analysis had been done and the profile of the
baggage-
handlingsystemidentified,whatshouldtheprojectmanagerhavedon
e
tohelpensureprojectsuccess?
4.
ExplainhowtheNTCPmodelmakesprovisionfor144differenttypeso
f
projects.
Endnotes