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One thing that is important if you want to have project success is having a consistent methodology across the whole organization. The alternative of allowing different methodologies or no methodology is often inefficiencies, higher costs, longer schedules and of course higher risk. Consistency means having a standard way of managing all projects. It ensures that all aspects of the project are considered, evaluated and documented. This methodology should start with the business processes before any project is started and ideally should look at projects as part of a portfolio of Endeavour’s that the business wants to achieve. In addition the methodology should look at projects that are part of a programmer and treat them as such because there are different requirements in that scenario. Methodology is a collection of agreed processes, methods and tools to accomplish an objective. It becomes a road map for managing projects, programmers and the project portfolio as well as providing guidance to project teams. Advantages abound in that you can achieve common:-

● Training
● Understanding and communication
● Process
● Tools and techniques
● Measurements

You can also ensure you are doing the right projects at the right time and that the business benefit is identified and measurable A key advantage of a methodology and associated processes is that the risk of failure is reduced. As more projects are completed using the methodology it becomes part of the fabric of work, speeds up the project process and can help to reduce change management issues as more of the work force understand the process, where to find information and who to communicate with. The methodology does not need to be rigid and can be modified to suit the particular projects although the core process should remain. The tools and techniques become a tool chest from which the right tool can be chosen for the right job. One essential tool on any project or programmer of a reasonable size is suitable software to help manage the project. The number of projects across a business, as well as the number of tasks and resources being managed within a project becomes very difficult without some software to assist particularly once changes start coming in that may require some re-planning.

A lot of the available software now unifies the complete process from portfolio to individual project management. A lot of organizations will take a common method such as that from ‘PMI’ or ‘Prince’ and adapt it to their own requirements without losing the essence of the methodology. The organizations behind these have over recent years included project portfolio management and programmer management guides and processes allowing an enterprise project management process EPM to be constructed. The adoption of a methodology can of course go wrong and this is generally a result of over enthusiasm by following methodologies to the finest detail regardless of the size of the project or the capability and type of the organization.

Other problems occur when core elements are bypassed usually as a result of weak project management. Setting up a methodology in the first instance does require commitment in terms of resource and money. The most important aspect is buy-in from top management and if it isn’t driven top down then it will fail. After the agreement in principle to implement, there are decisions on the method, the adaption of it, the training requirements and communication to the business. In most cases external consultancy help is needed in choosing the methodology and in helping to introduce it into the company.

We have read Schumann et al’s article (1) and have several questions regarding their methodology and results. First, the formulation of their primary objective doesn’t seem very clear. Three elements are needed to formulate an objective (2): first, the study factor, which corresponds to the exposition or interest intervention; second, the criterion of evaluation or variable of response that the effect or the association are to be measured with; and finally, the study population or individuals with whom measurements will be done. Likewise, from their primary objective, which “was to incorporate multimodal analgesia including preemptive antinociception into the analgesic regimen of patients undergoing open gastric bypass surgery,” we deduce it should be expressed by the content of the work and according the criteria above mentioned as “to determine if the postoperative multimodal analgesia (study factor) produces better results than the classical analgesia (study factor) on the pain control (evaluation criterion) of the patients undergoing gastric surgery for obesity treatment (population).”

Second, in the Methods section in their article, we cannot find the estimated number of individuals needed to be included in the study to determine the desired effect, or, citing an example, an important previous calculation to obtain results(3). We do see an attempted objective in that the “primary end-point of this study was to assess the analgesic efficacy of a multimodal approach compared with the standard unimodal approaches in patients undergoing gastric bypass surgery.” In the Results section, the authors point out significantly that “VAS pain intensity scores between groups differed in the PACU and at 36 h after surgery” on analyzing the visual analog scale (VAS) variable. But what is the value that they expected to find as a difference: 6 points, at 0 h between the group of analgesia with morphine (Group C) and the group with epidural analgesia (Group B), or 1 point, which is the difference after 36 h between the group with local analgesia (Group A) and the one with epidural analgesia (Group B)? For which of the two values is the sample size done?

And therefore, what is the clinically important difference? Although a difference of 1 point is statistically significant, does it have a clinical importance in this case? These questions are difficult to answer if the calculation of the sample size is not previously done and the expected or clinically relevant result is estimated. On the other hand, the authors subdivided Group A into patients who responded and those who didn’t, and they applied statistical techniques to compare the results of a subgroup where the average sample size is 10 individuals, at each time period. They found significant differences among groups that range from 0 to 6 points. Would it not be more suitable, considering the minimal power of a test with such small sample sizes, to correctly identify this difference as such and not to apply statistical tests that only have a relative validity and that can confuse the reader by saying the results are “statistically significant”? The authors have also determined differences generically among analgesia groups, and statistical tests have been applied one after another to see whether one variable or the other was different in a significant way.

We cannot see in any case that they have taken into account the so-called “submachine gun effect,” which increases alpha error as many times as the test is applied and that can be corrected by the Bonferroni or Newman-Keuls’s methods (4). If these methods had been used, this could have been avoided. Finally, as we have commented above, it would be rash to conclude that the infiltration of the incision can be an effective component of a multimodal analgesia for obese patients undergoing an open gastric surgery. These results are only shown for a small number of patients, and the real validity of the results and their clinical importance are ignored; therefore, it seems to us too risky to highlight that as the first conclusion of the work. Despite our comments, which we hope can help authors to improve the quality of articles published in this publication, we would like to sincerely congratulate the authors for the originality of their work.

Referring to project [management] methodologies, Jason observes that: “Over the years, even those involved in managing projects have observed that projects have common characteristics that can be formalized into a structural process, which allows them to manage projects more effectively. Each phase can typically be brought to closure in some logical way before the next project phase begins; and each phase results in discrete milestones or deliverables, which provide the starting point for the next phase. [And c]ost and schedule estimates, plans, requirements, and specifications should be updated and evaluated at the end of each phase, sometimes before deciding whether to continue with the project.”[9] Moreover, Jason emphasizes that:

“Adopting an incorrect methodology or having no project framework in place can very easily cause you to have: * Schedule and cost slippages
* Miscommunication within the team
* Wasting [of] time on administrative tasks that have no purpose * [Reliance] on technical wizardry to get projects done [and] * Project management burnout”[10]
This is an important lesson that many managements seem to fail to understand. Or is it that the project management community has failed to get the message across to senior management? In the same context, Jason briefly explains the capability maturity model (CMM) and its five levels, not as a methodology in itself but as sets of strategies for improvement. The CMM levels from 1 (low) to 5 (high) are: Initial, Repeatable, Defined, Managed and Optimized. He observes that if project management is to take a leading role in a company, it needs to be good in a few areas:[11] * Project management philosophy is firmly entrenched

* Project management is a core competency
* The company is focused on making projects succeed
* Processes and infrastructure are in place
* Effective reporting is established
* Both project methodology and development methodologies are well documented
* Project staff is provided continuous training
* Project information is communicated continuously
* Projects are monitored against performance
* Quality and delivery excellence are built in
* Projects are routinely audited

That’s a substantial list. Even so, he might have added:
* A cost collection, reporting and forecasting system is in place, and * A project deliverables benefits measuring system is also in place Chapter 3 is titled “Project Management Frameworks”. By this, Jason means the project management methodologies referred to earlier. Interestingly, he finds only four, namely: the Rational Unified Process (arguably an IT/software development methodology); PRINCE2, a true framework developed and instituted in the UK under the Office of Government Commerce (OGC) a government agency; System Development Life Cycle (SDLC), the classic “waterfall” approach (also arguably a software development methodology); and Solutions-based Project Methodology, a simplified approach for consultants to work with their clients.

Possibly there may be hybrid combinations of these. To this list, Jason could have added the TenStep methodology, at least that would have made five. Nevertheless, when it comes to project management frameworks, there appear to be only two or three that are generally applicable. This confirms our contention that there really are very few truly generic project management methodologies out there. And this should come as no surprise, because correctly executed the management of a project should follow a well-established and well-worn path.