Closing the Gap: Health Facilities Development Strategies

1. Asset Management Council Maintenance Engineering Society of Australia Inc Strategic Project Management 29 July 2009

2. Contents • Industry Examples of • Closing the gap between service delivery and project scope • Establishing the project team, structure and communications protocols • Selecting the appropriate delivery model • Risk assessment and management • Project planning and controls and how to inform design • Planning and controlling programs and major rollouts • Project tracking and how to have the upper hand when disputes arise • Building capability to meet corporate objectives • Sorry no PMBOK today.

3. Closing the gap between service delivery and project scope • Development of Health Facilities • Starts with understanding the services needs: • A Health Service Plan is developed that prioritises current or future service delivery issue and/or gap. • Examples could be patients needing to travel to city hospitals for routine orthopedic surgery, or, excessive waiting times for orthopedic surgery. • This is submitted for approval by the Area Health and the NSW Health • Inputs into Service Delivery Needs • APPI which provides data relating to trends and projection of the orthopedic services needs • IPART, which provides data about the supply and demand for services • NSW Health Population Projections, which provides population data to 2038

4. Closing the gap between service delivery and project scope • Development of Health Facilities • Develop the Asset Strategic Plan • identifies current buildings and services which may or may not be suitable for expansion to cater for the new orthopedic service, or • A new building required.

5. Closing the gap between service delivery and project scope • Development of Health Facilities • Service Procurement Plan (SPP) • Instigated once the proposed service development is aligned with the NSW State Health Plan and Future Health Directions for NSW to 2025, • The NSW Process of Facility Planning (POFP) is the guideline to develop an SPP. • The objectives of the SPP are to: • Identify the preferred option to meet the service gap • Identify the strategy for the preferred option (capital or non-capital) • Identify both capital and recurrent costs for the preferred option

6. Closing the gap between service delivery and project scope • Development of Health Facilities • SPP Development involves an intensive iterative consultation process in which service, clinician and community needs and wants are investigated and reviewed within the NSW Planning parameters. • Tools used to clarify and confirm the preferred recommended options include: • Value Management Study • Economic Evaluation • Financial Impact Statement • Gateway Review

7. Closing the gap between service delivery and project scope • Development of Health Facilities • SPP Development Challenges: • The range and number of stakeholders included in this iterative process. • Stakeholders have a diverse range of expectations, needs and wants • Education of stakeholders about their roles, responsibilities and accountabilities for their input into the SPP • Stakeholders often expect to address service delivery issues with a capital solution • Mismatches about service requirements can occur • Personnel changes which can impact on the timeframe and cause rework • Meeting Government’s timeframes to submission and approvals • Stakeholder agreement on the preferred options. The Value Management Study is the process used to address and reach agreement.

8. Closing the gap between service delivery and project scope • Development of Health Facilities • NSW Health uses the SPP recommendations to populate the NSW Health Forward Asset Acquisition Plan for NSW Treasury and if required Cabinet approval. • Approvals for each planning phase are confirmed annually during the NSW Budget process in Budget Paper 4.

9. Closing the gap between service delivery and project scope • Development of Health Facilities • Development of the Project Definition Plan (PDP) • PDP consists of but is not limited to the development of a design brief, service model, operational policies, site planning, room sizes, equipment requirements and project budge • Once the PDP is approved you start schematic Design. • The PDP continues to be the base scope document that is used for change control for the life of the project. • The process from start to completing a PDP can be between 1.5 years to 3 years.

10. Establishing the project team, structure and communications protocols • Development of Health Facilities • Establish the Project Team • considered all available options when planning the core project team including any potential conflicts and available time; • Determine what may influence their preferences and thinking on the current project; • Ddetermined the ability to influence to the project outcomes; • Established some common short term core project team KPI’s • Workshop and agree success criteria and lessons learned from previous projects • Plan for the high likelihood of changes within the core project team;

11. Establishing the project team, structure and communications protocols • Development of Health Facilities • Structure and Communications Protocols • Prepare a Governance Plan and communications strategy and agree them • The Communication protocols are in two parts, • Internal Project team • External and media statements and responding to the community groups

12. Unite Team with Clear Statement of Outcome and Purpose of Project that has universal buy-in Project “Leaders” focus on Outcomes / Results – “doing the right things” AND “doing things right” Project “Administrators” focus on Outputs / Objectives i.e. “doing things right” often at the expense of “doing the right things”

13. Have an agreed vision • Supplement • “To build a modern, 3-storey Police Quarters in Bathurst” • with • “To enhance the image, professional and emotional well-being of our police force by successfully completing the development of a state-of-the-art office complex in Bathurst on time and within budget. This will give them a place they can look forward to going to work every day and enhance the public’s perception that their security is assured by a police force that is forward looking and in touch with its needs. In the journey of completing this magnificent project, I see stakeholders who are proud of their achievements, and have considerable belief in what they can achieve, if they believe. My organisation’s already glowing reputation is enhanced even more by the highly efficient and effective job we have done. The next project with our client is already well advanced in its planning. I feel a great sense of pride that my team members have had a fantastic learning experience – they have stepped up to every obstacle with tremendous teamwork. The group dynamics are positive and stimulating. We have been nominated for several industry awards and this is truly the icing on the cake.” • CREATES FOCUS & MOTIVATION

14. Document Roles & Responsibilities Position Description ‘Org’ Chart

15. RACI / RASCI Chart R  =  Responsible - owns the problem / project A  =  to whom "R" is Accountable - who must sign off (Approve) on work before it is effectiveS  =  Supportive - can provide resources or can play a supporting role in implementationC =  to be Consulted - has information and/or capability necessary to complete the work  I =  to be Informed - must be notified of results, but need not be consulted

16. Be Aware of the 5 dysfunctions of Teams Source: Lencioni, P (2002), “The Five Dysfunctions of a Team”, John Wiley & Sons

17. Communications Protocols • Face-to-face wherever possible (including videoconference) • Confirm through email for audit trail • Communicate relevant information to right parties • If you need to escalate an issue, it could mean that either you have not communicated urgency clearly or your relationship with stakeholder is weak • Be aware about possible negative impact of escalations,

18. Meeting Guidelines • Have a clear objective and agenda • Be thorough and well-prepared • Know your audience • Variety creates vitality • Celebrate success • Give feedback • Keep it short • Consider emotional states created • Convey confidence and certainty

19. Selecting the Appropriate Delivery Model • Major Airport Facility • Time is critical as new A380 Planes arriving • Facility to be upgraded while occupied • Need flexibility to suit ongoing operational needs • OH&S risks are significant • Typical factors that affect selection of Delivery Model • Time pressures • Risk allocation and sharing • Flexibility required in ongoing design, construction and existing operations • Potential for innovation • Cost management • Early involvement of contractors

20. Selecting the Appropriate Delivery Model • Typical models • Fully documented • D&C • DD&C • GMP • CM • MC • Allowancing • Combination of the above • Other considerations • Staging of works • Early works / packages • Site management when more than one contractor engaged

21. Risk Assessment & Management • What is Risk Management? • The culture, the processes, and the structures that are directed towards realizing potential opportunities whilst managing adverse effects. • What is Risk Management Process: • Establish Context • Identify Risks • Analyse Risks • Evaluate Risks • Treat Risks, and • Always Communicate, Consult, Monitor and Control

22. What is Risk? • The chance of something happening that will have an impact on objectives. • Risk = Consequence X Likelihood Probability or Frequency of an event (qualitatively or quantitatively) • Outcome or impact of an event

23. Establish the Context MONITOR AND REVIEW COMMUNICATE AND CONSULT Identify Risks Analyse Risks RISK ASSESSMENT Evaluate Risks Treat Risks Risk Management Process

24. Analyse Risks (Qualitative) Qualitative methods for generating information for risk analysis include: • Evaluation using multi-disciplinary groups; • Specialist and expert judgment; and • Structured interviews and questionnaires. Qualitative Representation

25. Analyse Risks (Semi-Quantitative) In Semi-Quantitative methods, qualitative scales such as those described are given values. Semi-Quantitative Representation

26. Analyse Risks (Quantitative) • Quantitative analysis uses numerical values for both consequences and likelihood using data from a variety of sources. • These may include: • statistical analysis of historical data • influence diagrams • life cycle cost analysis • simulation and computer modelling • statistical and numerical analysis • probability analysis

27. Treat Risks What is Risk Treatment? process of selection and implementation of measures to modify risk Options for treating risks with negative outcomes: Avoiding the risk Changing the likelihood of the risk Changing the consequences Sharing the risk Retaining the risk Action Plan defines: RESPONSIBILITY, RESOURCES, BUDGET, TIMETABLE, REVIEW, COMMUNICATION, and Cost-Benefit Analysis.

28. 10d --/--/-- 8d 10d 15d Monte Carlo Simulation • 3 Point estimate for Duration and Cost • Takes Uncertainty Into Account

29. Monte Carlo Simulation • Distribution Graph shows the likelihood (probability), if any, of completing the project by the planned finish date (Deterministic).

30. Monte Carlo Simulation • Tornado Graphs - helps identify the tasks that impact the planned finish date the most

31. Case Study 1 – BBA • Ballina Bypass Alliance (Leighton) • Project scope: 4 lane bypass, total of 12.5 km, a number of bridges • Project duration: 4 years • Project TOC: $400m • Problem • Sensitivity of construction programme to RAIN • Possible solutions • Deterministic Analysis • Probabilistic Analysis

32. Case Study 1 – BBA • Deterministic Analysis • Rain days per year based on the rain database from 1892 to 2006 Number of rainy days in the construction programme??? Historical Rainfall Database for Ballina (1892 - 2006) Statistical information Mean = 56 Median = 52 Max = 176 Rain Contingency Number of rain days (56 NW days/year) Managerial review and judgment

33. Case Study 1 – BBA • Probabilistic Analysis • Deterministic Analysis plus Quantitative Risk Analysis Number of rainy days in the construction programme??? Historical Rainfall Database for Ballina (1892 - 2006) Statistical information Mean = 56 Median = 52 Max = 176 Rain Contingency @ Activity Level Programme Level Probability Distribution Simulation Quantitative Risk Analysis Managerial review and judgment

34. Case Study 1 – BBA • Forecast from Probabilistic Analysis

35. Case Study 1 – BBA Deterministic Analysis: 56 days Probabilistic Analysis: 68 days – 85% Management Decision: 63 days Actual for first year: 72 days • Actual results after one year

36. Project Planning & Control and How to Inform Design • Understand Project Strategic Requirements and Why They Are Important to the Client, such as • Most efficient time frame to deliver a project • Contractual obligations handover and staging • Penalties

37. Project Planning & Control and How to Inform Design • The opportunity exists to identify and promote alternatives that may improve on the original first pass and / or Project Strategic Requirements. • Location of elements such as expansion joints or common areas, may enable various construction methodology options • Reducing the complexity of the design while still achieving the brief such as a consolidated structural design as compared to many integrated structural types • Altering the design while still achieving the brief such as pre cast in lieu of masonry walls • Relocating critical elements off the main work flow such as removing complex plant room services from the roof plant room to the basement plant room

38. Project Planning & Control and How to Inform Design • Case Study 1: Energy Australia Zone Substation • The original design consisted of: • A full basement level • Additionally the basement was stepped, the lower level was approximately 2.8 m deeper for the 132 KV cabling • Structural design from ground level consisted of insitu concrete columns integrated with reinforced concrete blocks • Gross construction time: 19 months • Revised design based on feedback provided by blueVisions consisted of: • No step to the basement level • Step to the 132 KV cable room now located at the ground level to maintain height requirements • Precast concrete structural walls from ground level • Gross construction time: 17 months

39. What is a program? “a temporary flexible organisation created to co-ordinate, direct and oversee the implementation of a set of related projects and activities in order to deliver outcomes and benefits related to the organisations strategic objectives.”

40. What is Program Management? Program management is the management of a group of projects and or operations to achieve business targets, goals, or strategies, and may or may not have a defined end point. (James. T Brown, The Handbook of Program Management)

41. Program Life Cycle Examples of program life cycles Identifying a programme Defining a programme Delivering the capability Realising the benefits Closing a program Formulate Organise Deploy Appraise Dissolve

42. Program Management Standards • Project Management Institute (PMI) Program Management standard and its associated professional exam, PgMPSM (Program Management Professional) • Managing Successful Programmes (MSP), published by the Office of Government Commerce in the UK

43. What is Benefits Management? The process of organising and managing, so that potential benefits, arising from investment in change, are actually achieved. www.sigma-uk.com … a continuous management process running throughout the programme. OGC (2007): Managing Successful Programmes

44. What is Benefits Management? Benefits realisation management is common sense but not common practice. Gerald Bradley (2006): Benefit Realisation Management:A Practical Guide to Achieving Benefits Through Change Measurable improvement resulting from an outcome which is perceived as an advantage by a stakeholder. Benefits are anticipated when a change is conceived. OGC (2007): Managing Successful Programmes

45. Begin with the End in Mind • Successful benefits management begins with clearly defined end goals and a properly planned route to reach them • It is not that organisations do not know the goals they seek – more that the goals are often poorly framed: • Expressed in terms of delivering a capability • Seldom adequately shared or owned • Frequently unrealistic with no defined route map • Often requires a leap of faith – waiting for miracles • Horse before cart – define outcome, identify capability

46. A Continuous Process • Not about ticking boxes and validating past decisions • Active & dynamic process to maximise future returns • Make adjustments to meet strategic objectives • Derive new benefits in flight, minimise unwanted side effects • Re-deploy resources freed up through efficiencies delivered … a continuous management process running throughout the programme. OGC (2007): Managing Successful Programmes

47. Benefits Management Process Organisational Goals & Targets Benefits Management Strategy Benefits Realisation Plan Benefits Identification Review & Maximise Benefits Optimise Benefits Mix Track & Realise Benefits

48. If you don’t know where you’re going, any path is as good as another … but you won’t realise you’re lost, you won’t know what time you’ll get there, you might unknowingly be going in circles, and other won’t understand how they can help. And, since you could pass by without knowing it, you won’t get the satisfaction of having arrived! Lewis Caroll: Alice in Wonderland

49. Planning and controlling programs and major rollouts • Case Study : BER Program Stimulus Package • 2 regions. • 10 sub-regions • 374 schools • Multiple buildings per school • Multiple phases per building • Multiple disciplines / trades per phase • The challenge is to have consistency, efficiency of resources and accurate and appropriate reporting.

50. Planning and controlling programs and major rollouts • Consolidated programme • Managing interrelated projects • Cross-project links • Critical Path Investigation across the Program not Project • Sharing resources across projects • Resource leveling and optimization at the Program level