Healthcare system improvement project management: what's the right balance?

I now live in London, UK, and work for a rather famous hospital, renowned for its medical reputation internationally. My role is a project manager on 2 system improvement projects. Such projects are also labeled as "transformation" or "modernisation" projects, depending on where you work. The idea is to work with doctors, nurses, managers, clerical and administrative staff, as well as patient families, who live and breathe the hospital, so that this group of people take ownership of the problems and solutions. We meet one day a week for a full day, and project managers like me and lean improvement facilitators are thrown into the mix to try to help the projects move along. The key is all about implementation, which may make some external management consultants jealous, since they almost never get to implementation. It is a luxury as one can see one's work flourish.

Great idea, isn't it?

Is the team too big?

• 20% of 8-12 people's time is huge! On paper, the staff are 'back filled' for that 20% of work, but in reality, finding the right people with the right skill mix to do 1 day's work is quite difficult. Therefore, these people often end up working 120%. Commitment to the team starts high but then lacks off a bit.
• With the amount of time invested, people outside the group have very high expectations. They want to see things getting churned out from the team quickly, and often ask "when are you going to deliver what". When in reality, such projects have a research nature to them. There may be the best of project plans, but research will always take as long as it does until you can move onto solutions.
• Keeping 8-12 people 'entertained' and interested in the same topic is challenging. Some people are very detailed. Some want to talk big concepts. Some just want to start getting into the issues and start tearing it apart. Keeping everybody happy is never easy.
  
• Big groups also suffer from democracy. It takes time for everybody to have their say, and one person can dominate the whole discussion and shut others up. The good facilitators will still find this difficult.

But is the team too big? I've definitely experienced the same group, but with fewer people, and we were very productive for the small group days. True, everybody in the team should be there because of their functions within the hospital, but perhaps they don't need to all be there every week.

Ideas on how to tackle the big group:

• We are now trying to break the team into smaller groups to be efficient, and to break the group dynamic. Each sub group also has a sub lead, so more people can feel true ownership within the team. We then reconvene after half a day to update each other on progress. It seems to be working so far.
• Send team members out to the hospital to observe, collect information, shadow someone else, and then update. It breaks the 'classroom' feeling when in a meeting room.
• Of course there are many facilitative ways to deal with it as well when they are all doing this: :)
  

I find these projects are shaping like way more people talking than actually doing the work. It is especially frustrating for the ones who actually joined up for doing the work. I've definitely done successful projects in the past that didn't involve such an elaborate set up. This way of working should make implementation easier. I am waiting and seeing.