Project changes are natural and virtually inevitable and they can be necessitated as a result of suggestions made by the project team members or project stakeholders, shift in organizational priorities, regulatory changes, inadequate planning, process improvements, newly identified risks, and a number of other reasons. Since project changes may have a significant impact on the project scope, cost, schedule, and quality it is extremely important to manage, control and document changes. The project manager should thoroughly review proposed changes, evaluate potential impact, inform affected stakeholders, and implement only justified change requests approved by the project sponsor. The process for submitting, evaluating, approving or rejecting, documenting, tracking, and controlling changes needs to be clearly defined and communicated to all project stakeholders. It is true that not all changes have negative consequences and many changes are made for very good reasons, but it should be recognized that in general, the cost of project changes increases significantly as the project progresses towards completion.
The three essential project variables or constraints are project cost, scope and available time to complete the project. If one of these variables has to be changed, at least one of the remaining two variables may also change. For example, if the time available to complete the project is reduced this could result in increased project cost or reduced project scope. If neither one of the remaining two variables is changed the quality of work and/or patient satisfaction may be affected. The framework for evaluating competing project demands is known as the Triple Constraint or the Project Management Triangle.