CHRISTINE GARSDEN from the Sunshine Coast Hospital and Health Service explains how the redevelopment of the Nambour General Hospital was successfully commissioned using a framework comprising 7 Cs.
The Nambour General Hospital (NGH), an acute regional hospital on the Sunshine Coast in Queensland provides a broad range of services for a catchment of about 340,000 people. A master plan compiled in 2007 identified the need for expansion due to population growth and pressure on existing healthcare facilities.
The new four-level 96-bed ward block was completed in August 2010, three months ahead of schedule and well under budget. The subsequent redevelopment included extensive internal refurbishments and expansion of pathology, the pharmacy, medical imaging, the emergency department and the maternity areas.
A new front entrance and reception area were located on level one, and corridors on levels one and two connected the new building with existing facilities. The new ward block provided the following services:
- outpatients’ clinics
- infection control
- renal training
- medical offices and lounge
- antenatal clinic
- special care nursery
- paediatric ward
- general wards
- respiratory ward
- learning development unit
- clinical training
- computer training room, and
- staff facilities.
Between August and September 2010, a floor-by-floor approach was adopted to move departments into the new areas. The process was expedited because contractual requirements stipulated that the builder required access to areas designated for the next stages of the redevelopment.
Departments involved in relocations included:
- medical records
- nuclear medicine
- cardiac investigations
- operational services, and
- building engineering maintenance services.
MAINTAINING EXISTING SERVICES USING 7 Cs
When existing healthcare facilities undergo major construction or redevelopment works, they must remain open. This requires concurrent management of existing health services and construction activities. There are two levels of commissioning related to construction and redevelopment – building and operational.
The building contractors must ensure all the systems and structures are working properly, which is the final step in the building development process following master planning, design and construction.
Clinical staff must move into the new areas while continuing to manage patient care. This final phase of operational commissioning is a critical and complex activity that requires a high level of commitment from experienced people. Many of the same people within an organisation could be involved in all phases of the project, including commissioning.
The 7 Cs framework illustrates how the NGH successfully maintained existing services throughout construction.
Extensive coordination and advance planning is required to manage the logistics involved in commissioning a healthcare facility. A detailed schedule that illustrates involvement of all the stakeholders is also required. The NGH project required the support of staff from the following departments:
- information technology
- equipment purchasing
- administration services
- operational services (wardspersons, cleaning, linen waste services)
- medical records
- risk management
- occupational health and safety
- media and communications, and
Between August and September 2010, 13 units were shifted into the new building. The first move occurred on the same day as practical completion. The reception, four 24-bed wards, special care nursery, speciality outpatients and antenatal clinic, infection control, renal, doctors’ offices and education facilities were all moved in a six-week period.
Communication within the project was multifaceted. It was vital to engage key stakeholders early, define the steps and stages, provide a clear definition of roles and responsibilities, monitor project milestones and report on progress. The following groups were involved in disseminating information:
- overarching steering committee
- project advisory group
- site liaison meetings
- site meetings, and
- user groups for up to 30 different disciplines.
Strategies employed to enhance communication included:
- circulation of a detailed program of activities
- transition forums for information sharing
- production of a survival toolkit
- decanting process flow charts
- move timetable, and
- a dedicated staff noticeboard.
Providing adequate resources and appropriate numbers of trained people was essential during the move to maintain the energy, commitment and enthusiasm of staff. The staffing budget supported moving, installing, testing and cleaning the equipment. An external removalist company was used to move large items and equipment.
One of the biggest challenges during the process was the competing demand for employees’ time and attention. This was due to multiple concurrent major projects underway in the Sunshine Coast Hospital and Health Service (SCHHS), including redevelopment at Caloundra Hospital and planning for the $1.8 billion Sunshine Coast University Hospital (SCUH). Construction begins in 2012 and the SCUH will be operational by 2016.
5. Change champions
The commissioning process could not have been managed without the enthusiastic support of ‘change champions’ or ‘local heroes’ in each department, who took on the local planning and coordination activities, as well as the celebrations.
Planning and commissioning a healthcare facility in accelerated timeframes created significant pressure. A large number of items had to be addressed for redesign and/or rectification. Some issues became negligible as staff adjusted to a new environment or workflow, but others created a protracted contractual review process.
The integration of new and existing systems, such as nurse call stations and patient televisions, created technical challenges that were not resolved until after occupation. Essential and non-essential services, such as electricity, water and medical gases, also required shutdowns for rectification activities.
A complaints management process and tracking system was implemented. Regular feedback was provided to relevant departments on the status of the complaints.
Commitment was sought at all levels in the organisation to manage the challenges and the expectations of all stakeholders. Contingency plans, flexibility and a strong ‘care factor’ across the board were critical for the success of the commissioning process. A post occupancy evaluation was completed 12 months after the new building was occupied and a process for dealing with outstanding issues was created.
ADEQUATE PEOPLE AND TIME ALLOCATION KEY
Hospital commissioning is a critical activity with unique requirements. The experience at the NGH highlighted the importance of commencing early and allocating adequate people and time for all associated tasks. The experience was an effective practice run providing valuable lessons for the major commissioning activity to be undertaken in 2016 when the SCUH opens.
Christine Garsden is the project manager at the Sunshine Coast Hospital and Health Service.