Endoscopy Department Refurbishment Project At St James Hospital Construction Essay

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The purpose of this assignment is to demonstrate the delivery of an Endoscopy department refurbishment project at St James's Hospital Leeds. All steps involved to achieve this outcome will be included, aided by various project management tools, software and reference material. The project was delivered within a set timescale and budget in accordance with the clients brief. The intention was to utilise the Project Charter as described in Project Management Body of Knowledge (PMBOK 2000) to plan the project from start to finish adhering to the methodology throughout to execute the project successfully.

The Project Management Institute defines project management as "the application of knowledge, skills, tools and techniques to project activities to meet project requirements" (PMBOK 2000). A project by definition is 'A unique set of co-ordinated activities, with definite starting and finishing points, undertaken by an individual or organisation to meet specific objectives within a defined schedule, cost and performance parameters' (Lester 2007). This typically involves 4 phases (Heerkens 2001);

Initiation phase, where the need for a project is identified.

Planning phase, where the solution of the project is further developed.

Execution phase, this is where the prescribed work actually takes place.

Close out phase this is where the project satisfies the original requirement and is completed successfully.

NHS capital projects background

Capital Estates are responsible for delivering all projects at Leeds Teaching Hospitals NHS Trust, in accordance with the NHS Capital Investment Manual (DoH 2006). In general terms the Trust has a capital plan derived from identified projects. This forms part of the business planning process and includes all building, engineering, IT, and health & safety related capital expenditure programmes. Each scheme is allocated to a unique specific programme from which funding can be sourced either from the strategic health authority, central government or charitable funding streams. Foreseeable capital expenditure schemes are outlined in a 5 to10 year plan however this is more clearly defined between 1 to 3 years. The capital plan reflects the Trust's strategic direction and these agreed clinical service plans are confirmed at the commencement of the financial year.

Scheme funding requirements

A full business case has to be presented to the Trust Board for all schemes where cost is in excess of £25,000 but less than £500,000. Where the schemes are in excess of £500,000 they must also be presented to the Strategic Health Authority, in all cases the following items must be addressed;

Case of need including utilisation, clinical governance and capacity issues.

Implications to the trust's image of non provision.

Revenue implications to the trust including whole life costings.

Does the bid meet with the strategic plan requirements.

History of equipment

Benefit of provision of the scheme

Itemised Specification

Capital cost including source of funding

Risk factors

Project Business Case

Health Technical Memorandum (HTM) 01-01 2007 is a core standard on safety and best practice which all hospital trusts in the UK should be aiming to achieve. It states that "The effective decontamination of re-usable medical devices is essential in reducing the risk of transmission of infectious agents." There were a number of decontamination areas within the hospital that did not currently meet this standard. These areas of non compliance are where existing departments did not meet the minimum recommended decontamination requirement standards, coupled with a failure in wash areas to separate clean and dirty decontamination routes. This scheme made all services operating within the David Beevers Day Unit (DBDU) compliant to this relevant HTM. If the case had not been agreed the opportunity to achieve compliance would have been lost. This would have an adverse affect on the Trust's image as a national leader in health care provision.

Project Description

The proposal was for capital and operational estates teams to reconfigure an existing area in DBDU into a compliant flexible endoscope reprocessing unit. This was completed successfully and is now shared by three user groups Endoscopy, Day Surgery Unit and Hysteroscopy. The scheme included the provision of all required infrastructures, and was designed to ensure that correct workflow through the decontamination area was possible to stop cross contamination of clean and dirty endoscopes. Three compliant washer disinfectors and three endoscope storage cabinets where purchased to replace non compliant obsolete equipment. The bronchoscopy service at Leeds General Infirmary was also transferred to DBDU as part of the reconfiguration ensuring that this service also became compliant. The two existing wash rooms were converted back to an office and seminar room to re-provide what was lost by the reconfiguration. The scheme had minimal impact on activity within DBDU whilst being implemented. Alternative sessions were made available within Bexley Wing to minimise the impact on service. This was by prior arrangement with the users and the project team to accommodate unavoidable noisy works which resulted in an interruption of some activities in the operating theatre area.

Project Charter

This defines the clear roles, responsibilities and limits of authority of the project manager. Stakeholders were fully aware of their roles and that of the project manager had during this particular project as suggested by Lester (2007) These roles of responsibility can be found in appendix 1.The Charter also provided as defined in PMBOK (2000);

A project vision: To centralise services and replace obsolete non complaint equipment.

Key objectives: Pinkerton (2003) suggests that 'these objectives should be clear and unambiguous' There were two key objectives for this project.

Specification - This objective was to refurbish the department within a set timescale, cost and quality standards. This required completion of the project before 06/11/2009 ready for outpatient appointments on 09/11/2009 within a budget of £500,000 this outcome was achieved successfully.

Purpose - The objectives of the surgical directorate are the long-term provision to treat all endoscopy outpatients at the St James's Hospital, thus centralising endoscopy services in the region.

Scope and deliverables

To complete the refurbishment on time and in line with the technical specification outlined by the design team in the project brief.

Minimise disruption to theatre's activity adjacent to works through liaison with surgeons, clinical staff and planners. Where this was not possible services were transferred to Bexley Wing during the project.

To complete works in accordance with budgetary figure.

Stakeholder roles and responsibilities.

To assist the project manager to execute the program efficiently and to communicate any concerns regarding the work carried out in theatre areas.

The project charter also defined the direction and limits of the project. There are three main uses of the Project Charter (PMBOK 2000);

To authorise the project.

This work was authorised in accordance with the Trust's Strategic Plan. An authorisation certificate was signed by the Chief Executive who was the sponsor (Kemp 2004) and issued by the Trust Board.

It also served as the key selling point for the project.

This scheme has provided a platform to treat more patients. Hence DBDU has become a centre of excellence for endoscopy treatment.

Providing a focus point for the duration of its life.

The scheme has now provided an efficient service as well as an enhanced patient environment and experience. This has resulted in shorter waiting lists.

Scope Statement

Scope is the work content within the project and scope management is a process by which the deliverables and work carried out to produce them defined and identified by Heerkens (2001). Scope is broken down using following and found in appendices 2 & 3:

Responsibility Assignment Matrix (RAM)

Work Breakdown Structure (WBS)

The Scope Statement also includes PMBOK (2000);

Product - This relates to the internal re-structuring of the department. The renewal of all services and upgrading of all infra-structure and building works to provide an area suitable for the activity of endoscope examinations.

Justification - This was defined in the project description and relates to the business need. In this case the requirement was the centralisation of endoscope decontamination services and to increase capacity to treat more out patients with the need for endoscope interventions. Thus increasing turnover and improving on Government targets of 18 week referral to treat treatment pledge.

Deliverables - Work was completed over several phases to minimise disruption. Project deliverables are under the following main headings;

Project identification - Feasibility study

Outline Design - Business case and seek approval to commence

Detailed Design - Design drawings, full cost appraisal

Site Investigation - Examination of infrastructure and services

Procurement Process - Tendering process, Contract issue and Purchasing of equipment.

Construction - Installation

Completion - Commissioning and Handover

Project Management Strategy

The Project Management strategy consists of four main elements in accordance to (APM BOK 2006) these were closely followed during the scheme.

Brief: The Key driving force behind the project was clinical need to centralise services. The project manager reviewed the project brief with both the clinical team and the project team undertaking the work. This ensured that any alterations to the programme were communicated to all parties.

Organisation: All members of the contractor's team undertaking works were approved in accordance with hospital site rules and regulations for contractors. This included participation in asbestos awareness and hospital induction training. The project site manager was informed of the reporting and contact procedure required during the projects duration and was requested to pass this information on to all team members.

Control: Several control mechanisms were put into place to ensure that the project stayed within the prescribed timescale and budget. One measure employed was there could be no reduction in quality or deviation from the design specification. Another measure was that schedules may alter due to operational issues however the completion date may not. Other measures included were cost controls which are discussed later in this report.

Procurement

The procurement of services was implemented on a quality basis as described by Pinkerton (2003) and included the following considerations:

Supplier selection

Only services and suppliers on the trusts official supplier register were used.

Placement of orders and purchasing

Three competitive tenders were sought before any orders were placed with an individual supplier. This was in line with the trust's standing purchase orders.

Guarantees and Warranties

All specialist equipment suppliers offered extended guarantee periods at no extra cost along with product training. However this had to be followed with an agreement of a service contract of two years post guarantee period. This was agreed by the users at the tender period.

The principle design team selected for this project was DSSR and the principal contractor Wood Mitchell who was the main point of contact for the project manager, designers and operational estates. The appropriate project manager who had all necessary skills and expertise to facilitate the project was selected, and also acted as the contract administrator responsible for all financial and contractual advice. This was in accordance with the NHS Capital Investment Manual (DoH 2006).

Key Staff Required and Main Stakeholders

The Trust Board was directly responsible for the success of the project and as previously stated the Chief Executive was project sponsor. The Board authorised the implementation of the full business case, provided policy and guidance to capital estates that in turn provided feedback and progress with all participants particularly the financial position to ensure that the Strategic plan was achieved. The head of capital estates was nominated to act as the project director whose authority was delegated from the Trust Board. The project manager was appointed to manage the project from start to finish on behalf of the trust, and provided regular progress reports and feedback to all stakeholders. This ensured that the project met all the criteria for quality, risk, and cost. A list of all key stakeholders can be found in appendix 4.

Risk Management Plan

Risk management consists of five stages that if followed, enabled the project manager to obtain a better understanding of the potential risks involved. The stages are as identified in table 1 by Lester (2007);

Stage 1

Risk awareness, this is the stage at which the project team begins to appreciate that there are risks to beconsidered.

Stage 2

Risk identification, this is where all project risks are identified

Stage 3

Risk assessment, the qualitative stage at which the two main attributes of risk, probability and impact are examined. Identified risks are then categorised as Low, Medium or High.

Stage 4

Risk evaluation, once categorised the risk can be give a value. Using the trust analysis matrix this is scored 1 to 5to the probability andimpact of each risk as identified.

Stage 5

Risk management,all listed and evaluated risks are established in a table of priorities the decision has to be made how to manage these risks

Table 1

Jenkins (2006) identifies 'risk is anything significant that could possibly go wrong with the project'. The implementation of a risk management plan was put into operation to minimise or eliminate those risks avoiding their consequences. The identified key risks for this particular project were identified and scored using the Trust risk analysis matrix, and the Evaluation Impact of Project Risks (tables 2 & 3).

Risk Score for a specific risk

Severity

Probability

1

2

3

4

5

5

5

10

15

20

25

4

4

8

12

16

20

3

3

6

9

12

15

2

2

4

6

8

10

1

1

2

3

4

5

Table 2

Risk Analysis Matrix16-25

8-15

1-6

Low Medium High

Risk (Probability)

Impact (Severity)

Risk factor (R x I)

To send all endoscopes requiring decontamination to the private sector.

This would be costly in terms of the need to increase the supply of flexible endoscopes and the contract requirements in terms of response for urgent acute scopes from an offsite location.

3 x 4 = 12

Medium

Not completing the project on time.

This would mean the cancellation of outpatient appointments. This will affect the trusts ability of achieving the 18 week referral to treat treatment pledge

2 x 4 = 8

Medium

Not completing within budget.

Other projects of as equal importance may not receive funding.

5 x 5 = 25

High

Do nothing.

This would impact adversely on the reputation of the Hospital with the publication of the Health Care Commission annual report on the Trust's failure to act on an identified deficiency.

5 x 5 = 25

High

Table 3

The control of these risks is essential for a successful project outcome. Ensuring the trust does not suffer any adverse publicity or risk impact to clinical services.

Cost Reporting

It was the responsibility of the Project Manager to conduct regular finance meetings with the Project Director and the finance department to monitor costs ensuring the project remained within budget. A monthly report was produced to highlight cash flow during the project. A report on cash flow and a cost table for the whole project can be found in appendix 5 & 6. This highlighted the following;

Details of latest agreed spending.

Up to date expenditure

Projected costs

Project costs were broken down to WBS to form basis for a cost account. The cost account was then to be used to:

Track actual costs against planned cost

Give early warning of any overspend

Show total cost of Project to date

Allocate individual budget areas

Cost Management

Project cost control must adhere to the NHS Capital Investment Manual (DoH 2006) and the Trust's Standing Financial Instructions. The project was managed with the approved budget. Regular cost reporting facilitated the best possible estimate in accordance with following:

All ongoing risks to costs were identified.

The anticipated final cost of the budget.

Future cash flow was estimated.

Establish a final project cost.

Project Communication

During the project good lines of communication existed between all the stakeholders. This was achieved by the regular holding of meetings, during these meetings progress was discussed and potential pitfalls or problems were resolved by the project team and manager. The methods of communication outside of these meetings were by letters or e-mails and occasional conference calls. This ensured that all stakeholders were kept informed of the projects progress or any other relevant information (Lester 2007). The meetings were held as follows;

Project team- monthly

Clinical staff and all users - monthly

Finance team - monthly

Design team - monthly

Site progress - weekly

Handover and commissioning- Daily with all users

Following all meetings the project manager published minutes which were then distributed to all team members. Also during this process Gantt charts were produced to record the projects major milestones, critical path way base line progress, and tracking these can be found in appendices 7 to 10. Co-operation between capital estates and operational estates was vital for continuity of service and to avoid possible disruptions. This was achieved by the estates liaison officer and the project manager contacting each other on a daily basis. During these contact periods discussions regarding all other schemes in the vicinity were addressed so full support from other hospital staff could be sought. This regular communication ensured that the project progressed to a successful conclusion.

Subsidiary Management Plan

Quality can be divided into three main areas, quality planning (QP), quality assurance (QA) and quality control (QC) (Lester2007). This is further broken down as shown in table 4 below (PMBOK 2000).

Table 4

All work during the project complied with all the relevant statutory requirements some examples of the legislation followed are listed below:-

Latest Building Regulations.

The requirements of the Health and Safety Executive.

The requirements of the Local Authority Planning Department, District Surveyor or equivalent.

The Water Authority Regulations.

In addition to the legislation all installations and the materials used for the works carried out were in full compliance with the appropriate Specifications and Codes of Practice issued by the British Standards Institution. During the life of the project the following regulations were also adhered to;

Control of Asbestos at Work Regulations 1987,

Workplace (H, S & Welfare) Regulation 1992,

Management of Health and Safety Regulations 1992

Noise at Work 1989,

Personal Protective Equipment Regulation 1992

Manual Handling Operations Regulations 1992

Fatal Accidents Act 1976

Quality Assurance

Quality assurance (QA) is the process that ensures that adequate quality systems, processes and procedures are in place (Lester 2007). The decontamination machinery supplied met the current ISO 9001 Quality Systems - Model for Quality Assurance in design and development, production, installation and servicing (2008). Other key ISO Quality Assurance requirements were also followed during the project;

The users worked in close conjunction with operational estates to ensure that the testing and validation of the decontamination machines was completed successfully.

The users have pursued the continual improvement of the system. Thus ensuring evaluation of its performance is in line with the design brief.

Quality Control

As defined by Lester (2007) is the means to control and measure characteristics of a component and the methods employed for monitoring and measuring a process or facility. All procured equipment was installed in accordance to the manufacturer's specifications. All other works were extensively inspected and tested against the design specification. This was carried out by the clerk of works who also monitored rectification and regularly reported to the project manager any deficiencies and defects.

Project Completion and Life Cycle

The scheme was conceived as part of the Trust Strategic Plan. The particular project does not have a clearly defined life cycle due to the ever changing clinical environment. However as most of the buildings at St James's were built in the early part of the twentieth century. These often require extensive renovation work to bring them in line with current building regulations and other standards. Additionally to this the trust's long term plan is to reduce the size of the hospital estate and to centralise services wherever possible. This particular project was extremely challenging due to both financial and operational constraints. However the scheme was completed successfully both under budget and within the allotted timeframe.

Appendix 1

Appendix 2

Appendix 3

Appendix 4

Key Stakeholders

Company

Name

Position

Leeds Teaching Hospital Trust

Trust HQ

St James University Hospital

LS9 7TH

Julie Mc Farlane

Andy Tunstall

Endoscopy

Bronchoscopy

Corporate Planning

Leeds Teaching Hospital Trust

Ashley Wing

St James University Hospital

LS9 7TH

Chris Tobin

Project Manager &

Contract Administrator

Leeds Teaching Hospital Trust

Old Nurses Home, LGI

LS1 3EX

Jim Hatfield

Architect

DSSR

Windsor House

Cornwall Road

Harrogate. HG1 2PW

Andy Nicholls

M &E Design consultant

Gleeds

Town Centre House

Merrion Centre

Leeds. LS2 8ND.

Ian Rhodes &

Matthew Hill

Quantity Surveyors

Summers Inman

4240 Park Approach

Thorpe Park

Leeds. LS15 8GB

David Blakey

Adam Wall

CDM Co Coordinators

Wood Mitchell Building Group

Sunnyfield Works,

Low Town, Pudsey,

Halifax. HX15JB

Simon Dodgson

Contract Manager

Mechanical, Elect &Plumbing Sub Contractor

H &C Moore

Low Hall Road.

Horsforth, Leeds. LS18 4EF.

Roy Scargill

Contract Manager

Leeds Teaching Hospital Trust

Old Nurses Home, LGI

LS1 3EX

Gary Thirkell &

James Parkinson.

Infection Prevention

Triple Red RO Water

Unit D4, Drakes Park,

Long Crendon Ind Park,

Long Crendon,

Bucks HP18 9BA

Nick Porat

Commissioning Manager

Lancer UK

1 Pembroke Avenue

Waterbeach

Cambridge

Cambridgeshire

CB25 9QP

Chris Hill

Commissioning Manager

Leeds Teaching Hospital Trust

Estates Management Offices

St James Hospital

LS9 7TH

Andrew Hallam

Estates Manager Specialist Decontamination services

Leeds Teaching Hospital Trust

Estates Management Offices

St James Hospital

LS9 7TH

Peter Aldridge &

Mark Cox

Trust Fire Officers

Leeds Teaching Hospital Trust

Estates Management Offices

St James Hospital

LS9 7TH

Alison Stephenson &

Matthew Fahy

Asbestos Management

Leeds Teaching Hospital Trust

CAD Office

Estates Management Offices

St James Hospital

LS9 7TH

Malcolm Stitch

AutoCAD Manager

Contacts/User Groups

Emma Johnson

Foluke Ajayi

Karen Tweed

Alison Peacock

Linda Warner

Matron

Directorate Manager

Decontamination Advisor

Day Surgery Co Ordinator

Day Surgery Team Leader

Appendix 5

Appendix 6

Appendix 7

Appendix 8

Appendix 9

Appendix 10

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