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The Facilities and Services department within the Lancashire Teaching Hospitals NHS are employed to undertake the effective management and running of ancillary services in the hospital environment. These ancillary services include cleaning, portering, catering and estates. The latter is split into two departments, being operations & maintenance and capital projects, of which operations and maintenance are tasked with the maintenance of the building and engineering services whereas the capital department are tasked with the delivery of temporary and unique projects. The tasks that operations and maintenance undertake are repetitive and to some extent without an end.
Projects within the NHS are determined by an overall strategic plan that is aimed at providing an excellent quality of health care for the general public. The drivers for projects can be government, advances in health care technologies, local needs of the population etc.
WHAT IS PROJECT MANAGEMENT
A project can be defined as 'a temporary endeavour undertaken to create a unique product or service'.
The roles of operations and maintenance and capital projects often overlap and they share many characteristics, however the roles performed by operations and maintenance generally have no end whereas capital projects roles are usually temporary and unique.
Within the Trust projects are performed by the Capital Project Dept which manages small projects to multi-million pound schemes. The smaller schemes are designed and project managed in-house, however the larger schemes require the services of outside design consultants in order for the design staff to perform a project management service.
It is a requirement of the trust to provide health care to the local population. In order for them to perform their tasks in an effective manner the infrastructure of departments require maintaining, updating and expanding.
This project is concerned with updating and expanding of the engineering services within the Sterile Services Department in order that the Trust can deliver health care now and in the future. The sterile services within the trust are to be amalgamated within a single unit located on a single site; currently the sterile services are located across two sites. This is so that compliance with department of health guidelines and standards can be achieved.
The scope of the project is to install two new washer disinfectors and replace a redundant steam steriliser in the Sterile Services Department (SSD) at Chorley and South Ribble District General Hospital. In order to secure this service other engineering plant and equipment is required, these are a steam generator, a reverse osmosis water treatment plant and a ventilation plant.
The work will require the need to perform building alterations to the SSD, upgrade existing engineering services that serve the new equipment and perform commissioning/validation and training of this equipment, all while the department remains operational.
PROCUREMENT IN THE NHS
Procurement of projects in the NHS follows a number of different procurement methods. Primarily the procurement of a project will follow procedures laid down in the Capital Investment Manual. There will be a number of different stages that will need to be signed off after each stage by all relevant parties before the next stage can proceed.
For projects in excess of £1m ProCure21 is adopted. ProCure21 offers a partnering method of construction under the NEC Contract Option 2 and follows the recommendations laid down by the Egan report. ProCure 21 stands alongside the Private Finance Initiative (PFI) and the Local Investment Finance Trust (LIFT) initiative to deliver the future of NHS facilities.
More recently the NHS has developed ProCure21 Minor Works. This is a new contract from ProCure21 for schemes under £1m separate to the Major Works Contract which the ProCure21 Minor Works contract allows the NHS Trust to manage all tasks under one contract with one contractor. This can speed-up the delivery of a minor project which has traditionally been costly and time consuming to administer.
There is also the traditional route to procurement of a project generally using outside design consultants and in-house staff performing the project management.
This project will be use the traditional form of procurement.
DESCRIPTION OF PROJECT
The project is to install 2 washer disinfectors and 1 steam sterilizer into the existing SSD. The SSD processes surgical instruments and other devices in order that they can be reused in surgical operations. This requires them to be cleaned and bacterially sterilized so that they are safe to be used on humans.
Part of the decontamination process is automated hence the use of automatic washer disinfectors and steam sterilizers.
The project also includes the alteration of the department in order to make room for the installation of the washers; the sterilizer is to replace an existing redundant one therefore the will be no alterations to the fabric of the department.
Washer disinfectors PROCESS the surgical instruments and then disinfect them. This is so the instruments are safe to handle prior to them being sterilized. The sterilizer is then used to ensure that there are no viable micro-organisms left on the surgical instruments or other equipment processed. The project will include the installation of a second steam generator, a reverse osmosis water treatment plant and a ventilation system which will be located in a plant room. These engineer items are integral to the operation of the new equipment to be located in the SSD.
The Project Charter, sometimes know as terms of reference, is a statement of the scope, objectives and participants/stakeholders in a project. The document would normally be written by the Project Sponsor in order to formally authorise the project.
The charter should give:
Reasons/business needs for undertaking the project.
Objectives and constraints of the project.
The direction of the project.
The main stakeholders.
Authorization of the project manager
The charter will be a document that will serve as a reference of authority through the life of the project.
PROJECT MANAGEMENT APPROACH/STRATEGY
PROJECT SCOPE MANAGEMENT
Project scope management is the processes required to ensure that the project includes all the work required, and only the work required, to complete the project successfully.
Initiation is the process of formally authorising a new project or that an existing project continues into its next phase. In the NHS projects are authorised by the trust board or the CEO following a feasibility study in the form of a business case.
Scope planning refers to a project management process that defines boundaries and deliverables. Scope planning consists of four main inputs:
Product description - For this project the product description is described in section 1.3
Project charter - Section 2.1 contains the project charter.
Constraints - Limit the project management team's options. These can be budget constraints, environmental considerations, staffing and contractual constraints. Some of the constraints will be identified in the risk management plan, Section 6.
Assumptions - for the purpose of forming a project plan assumptions may need to be made. These may be for example, that a piece of equipment will be delivered on a certain date or that a task will be completed by a certain time or that a task will cost x. All of these assumptions may affect the outcome of the project but at the start key information may not be known.
One of the first and most important steps in project management is to flesh out a scope statement which identifies and describes all work necessary to produce the final product. The scope definition should identify the major project deliverables in order to make the components of the project more manageable. It should also identify the project objectives. The scope definition is meant to ensure that everyone on the team understands what is expected of them during the project. The project manager will monitor each process on an ongoing process to ensure that only the work required to be done is carried out.
Scope verification is the process of obtaining formal acceptance of the project scope by the stakeholders. It is important to get the approval of stakeholders before proceeding further.
For the purpose of this project the formal acceptance will for the project to precede will be by the CEO and the Board of Directors.
SCOPE CHANGE CONTROL
In almost any successful project management endeavour it is conceivable that some change in scope might be necessary. Altering from the initial scope of the project could potentially cause costs to mount or deadlines to be missed.
It will be the responsibility of the project manager to identify any changes to the project deliverables by monitoring the project at regular intervals. The project manager will inform the project team of the changes and will then formulate a strategy to bring the project back on target.
COST MANAGEMENT PLAN
The cost management is set out in the Trust's standing financial instructions. The Project Director will have full control of the Project costs and will update the Finance Director of expenditure on a regular basis. (see section 7 - Subsidiary Management Plan: Procurement)
HUMAN RESOURCE MANAGEMENT PLAN
Human resource management will be the responsibility of the Project Manager. The project manager in conjunction with the HR Department will ensure that all statutory legislation, working time directives and trust policies are adhered to. Regular meetings will be scheduled to discuss HR issues relating to the project.
A risk management plan will be developed for the project and reviewed at regular intervals. See Section 6 for the risk management plan.
Project Communications Management plays a key role in keeping all members of the project management team informed. Without communication among all team members and project stakeholders there can be a breakdown in processes which could have a negative impact on the final product.
The project manager shall determine the information required to be conveyed to each of the stakeholders and at what level. The project manager will arrange suitable meetings to convey this information with the suggested time frames and relevant stakeholders as follows:
Communication between key individuals will not be limited to meetings but will include some or all of the following depending on the situation:
written or oral
The project scope statement refers specifically to the input output mechanism that serves the purpose of providing a narrative description of the entirety of the scope for the respective project.
The existing sterile services within the trust have been performed by the Sterile Services Department which has two units located at each of the two sites. It was proposed in 2007 that the Trust enter into a joint venture with a third party in order for the third part to conduct the sterile services function for the Trust. This would ensure that the Trust would satisfy the Care Quality Commission and legal requirements. In December 2008 the third party proposed variations to the contract which when analysed proved to be an unacceptable risk for the Trust and would potentially increase costs. For this reason the joint venture was cancelled.
The Trust looked at options to build its own contingency which will require a phased investment in the current Sterile Services Department. The existing sterile services departments in order to satisfy the Care Quality Commission and legal requirements would need to be ISO accredited. It has been established that the SSD on site 2 cannot meet ISO accreditation therefore the SSD at site 1 will be developed as the SSD for the Trust and will become ISO accredited. The proposal put forward was to improve the current Sterile Services Department at site 1 in order that the sterile services department at site 2 could close. This would be an interim measure in order that a second phase could be planned to meet the sterile service needs of the Trust in the future. This project will be concerned with the interim measure.
In order for the Trust to continue to perform an SSD function the upgrade of the SSD at site 1 will need to be undertaken. Refer to section 1.5 for a description of the project product.
Project deliverables refers specifically to the unique products, elements or items produced at the conclusion of the project. This project deliverables are:
Installation of new Plant and Equipment
Training (Maintenance Staff)
Project objectives are the quantifiable criteria that must be met for the project to be considered to be successful. For this project the project will be considered successful if the following criteria are met:
Project budget of £575,000.00 is not exceeded.
The project is delivered on time
The SSD service to the Trust is maintained throughout the project time frame
The SSD satisfy the Care Quality Commission and becomes ISO accredited.
KEY STAFF AND STAKEHOLDERS
Project stakeholders can be anyone who is involved in the project or who may be directly affected by the project either positively or negatively.
The stakeholders for this project are:
CEO and Trust Board of Directors, Project Director, Project Manager, Architect, M&E Consultant, Contractors, Equipment suppliers, Sterile Services Department, Users, Maintenance staff, Authorising Engineer
CEO and Trust Board of Directors
The Chief executive Officer and the Trust board have the overall responsibility for the project. They are also the sponsors of the project but will delegate project responsibility to the Project Director.
The project director keeps an overall eye on the project and acts as liaison between the project manager and the CEO/Trust Board. He will be responsible for the financial aspects of the project
The project manager is responsible for the day-to-day management of the project. He will be responsible for co-ordinating the various stakeholders and the project team as and when required, he will report directly to the project director.
The design team will be responsible for developing the project brief and providing a workable design for the project. The team will consist of: architect, M&E consultant, Specialist consultant.
There will be a number of contractors employed to conduct the work which will include; mechanical contractor, electrical contractor, building contractor and specialist contractors who will install the sterilizer, washers etc.
The mechanical contractor will be appointed the main contractor and will coordinate the other contractors as required. All other contractors will be known as sub-contractors.
Sterile Services Department,
The sterile services department will be the end users of the equipment installed. They will require updates to the progress of the project and will be involved at key stages of the design, installation, commissioning and training phases of the project.
The users are defined as those that will use the processed equipment produced by the SSD. These are the Theatre Department, patients undergoing operations.
The theatre manager will require informing of the projects progress and any possible service interruptions that may arise due to the project.
The maintenance staff employed by the Trust will be tasked with maintaining and periodically testing the equipment. These staff will require involvement in the end phase of the project particularly during the commissioning phase and training.
The commissioning engineer will be responsible for undertaking the specific tests and checks required to be done on all the engineering equipment. This may require more than one commissioning engineer as the equipment to be commissioned is varied.
RISK MANAGEMENT PLAN
As with all projects there will be risks associated with this project and a risk management plan will be produced. The purpose of developing a plan is to identify risks that may occur and assess the severity that risk will have on the overall project delivery. The risk management plan will be produced by the project team.
Any risks identified may have a negative impact on the projects' costs or the project duration, should the risk becoming a reality. A contingency sum of 5% will be added to the projects estimated cost to allow for any additional costs.
A risk register has been produced in order to identify risks associated with the project - Appendix B
SUBSIDIARY MANAGEMENT PLAN (PROCUREMENT)
The procurement management plan will describe how the procurement process is managed and will include:
Type of contracts.
Budget plan & Finance departments' role in this project with respect to procurement.
The Trusts Standard financial instructions and documentation.
Management of project providers.
Coordination of procurement with respect to other project aspects.
Descriptions of the procurement processes in the NHS have been described in section 1.4 of this document. This project uses the traditional procurement process in which the Architect will prepare full construction documentation in conjunction with the design team and then offer contractors to tender for the works by competitive tender.
The tenders will be opened by the CEO and Trust Board so that they can be evaluated by the Project Director and Project Manager.
The successful contractor will then be appointed as the main contractor and will take over the management of the contract deliverables and all other contractors and suppliers for the duration of the contract.
Throughout the project, liaison between the Finance Department and the Project Director and Project Manager will be maintained in order that the budgeted costs for the project are met. The project manager will provide a report on a monthly basis to the finance department identifying the current expenditure, provide any projected underspend/overspend on the project and details of the agreed expenditure.
A budget cost proposal will be provided to the Finance Department for the project which will include budget costs for the capital monies required to complete the project and revenue monies that are required to maintain and run the new equipment/department (see 7.3).
Budget Cost Proposal
Budget Capital Costs:
Plant and Equipment
VAT @ 15%
Budget Revenue Costs
3 Extra SSD Staff
VAT @ 15%
Standing Financial Instructions
At all times the Trusts standing financial instructions will be adhered to. These instructions can be obtained by accessing Trusts intranet and for further guidance/clarification on the policies the finance department should be contacted.
Management of project providers.
The variation of costs for any category will need to be validated by the project director before permission for payment is granted. The project director will be given authority to transfer monies between budgets in order to pay categories that have exceeded their budget estimates.
It is not expected that the overall budget for the project will be exceeded but in the unlikely event that this should happen then the approval for further funding will be required from the Finance Director and the CEO.
The Project Director does not have authority to exceed the budget costs unless the CEO and Trust Board specifically delegate this responsibility to him.
Coordination of procurement with respect to other project aspects.
The project will be considered in the overall capital program of works with respect to ensuring the expenditure within the planed financial year is not exceeded. This will be the responsibility of the Project director and the Finance department. Regular meetings will be planned between the Project director and the Finance department where the budget statements of all ongoing projects will be inspected in order that the capital program does not exceed the set budget for the financial year.
APPENDIX A - BUSINESS CASE
Business Case Form
Please complete the form below and submit it to your project sponsor.
Background to the project (PLEASE KEEP BRIEF)
The Trust entered into a joint venture with a Third party for the provision of Sterile Services. This joint venture was terminated following contractual alterations by the third party which posed an unacceptable risk to the Trust. The Trust was therefore obliged to rethink the sterile service provision and decided that the way forward was to upgrade one of the Sterile Service Departments and to close the other. This would be an interim measure (phase 1) so that a completely new provision could be developed (Phase 2). This project will be concerned with phase 1.
The aims of this project are to provide extra capacity for processing sterile products through the SSD, therefore enabling the other SSD to be decommissioned. The project will ensure that the Care Quality Commission and legal requirements are met.
Failure to deliver the project will jeopardise the ability to process surgical equipment and other items required for the provision of health care.
The cost associated with outsourcing the SSD will be considerable causing budget provision to be overspent.
Delays in processing surgical equipment will cancel operations therefore reducing revenue to the Trust and lowering the Trust's public opinion.
18 week waiting list for operations will be compromised.
The third party may pursue for lost revenue due to the cancellation of the joint venture.
To modernise the decontamination facility and increase the capacity of the SSD output.
Ensure that the SSD is compliant with Care Quality Commission and become ISO accredited.
Benefits of running with this project
To provide the Trust with a Decontamination facility, that will enable the Trust to perform its Health Care function.
Initial estimates of cost and time
Total project cost.
Time: Six Months for the project start date
Outcome of the business case
The project will; provide additional capacity for the provision of SSD, allow the second SSD unit to close, allow the SSD service to achieve accreditation, allow phase two of sterile service provision for the Trust to be developed.
Decision from (CEO and Trust Board)
APPENDIX B - RISK REGISTER
Score as follows, for Likelihood and Impact: High = 3, Medium = 2, Low = 1
Nature of Risk or Uncertainty
Actions required and who will take responsibility to manage the risk
Project manager to monitor contractors and ensure that all health and safety regulations are complied with. Contractors to ensure that they comply with regulations. Failure in compliance will lead to termination of the contractor and may delay project completion.
Asbestos survey to be conducted. If asbestos is found there will be additional costs and time added to the project duration. Trust is responsible for asbestos survey to be done.
Delay in achieving project deliverables
Project manager to ensure that the project deliverables and milestones are met. Delays may be brought back into line by contractors employing extra staff.
All parties with particular emphasis on project manager are responsible for communication. The failure to communicate may lead to delays and extra expenditure.
External (Suppliers and Contractors)
Non delivery of supplies or equipment
Contractors and external suppliers of equipment are responsible for timely delivery. Delays in project completion may arise.
Contractors poor performance
Failure of the main or other contractor's performance may result in a project delay. By careful selection of trusted contractors this will be minimised.
Contractor going into liquidation
Main or other contractor going into liquidation will have a serious effect on the costs and project duration.
Failure in accurately estimating the projects budget. Costs of the project may increase therefore a contingency sum has been set aside to account for this.
Costs to project may increase due to inflation or VAT increase. Contingency sum set aside to allow for some increase.
Non compliance with building regulations
Changes to existing building regulations may require alterations to design brief. May require additional funding or extension to project duration.
Termination of Contract
Legal fees associated with termination of contract should it be necessary.
APPENDIX C - MICROSOFT PROJECT SHEETS