First, do no harm. This oath guides a doctor's hand—and is the maxim behind a patient's treatment.
But in the modern healthcare system, each doctor plays a relatively small role. As patients shuffle between hospitals for tests and treatments, their unique needs—and even their medical records—can get lost in transition. Public inquiries in Australia and the U.K. have shown that this type of fragmented and disrupted care hurts a patient's chance of recovery.
In Queensland, Australia, this was the reality for some of the state's sickest kids. Reviews conducted in 2005 and 2006 found that Queensland Health, the state's health agency, needed to centralize and consolidate pediatric services to improve its quality of care and reduce death rates among Queensland children, says Graeme McKenzie, program manager for project management firm Aurecon, Brisbane, Australia.
Spread across three hospitals, two public and one private, the state's pediatric services were inefficient—and often redundant. To provide more specialized pediatric care and attract world-class medical talent, Queensland Health launched the Lady Cilento Children's Hospital (LCCH) project in Brisbane in 2006.
Delivering this ambitious project wasn't easy. The project team had to orchestrate major organizational change, navigate a barrage of stakeholder requests and safely relocate patients from three hospitals across the city. But the project's potential benefits kept the team focused and moving forward. In addition to improving care for the state's children, the project also promised to cut public healthcare costs, says Matthew Skeen, project director, Aurecon, Adelaide, Australia.
“By consolidating three health services into one, we delivered a substantial savings to the public purse,” he says. “So fewer tax dollars are now required to fund what had been a geographically diverse and less efficient system.”
2006: Queensland Health announces Lady Cilento Children's Hospital (LCCH) project
2007: Aurecon awarded project management contract
2008: Project plan approved, construction begins
2009: Auditorium and first parking garage open
2010: Final business case approved
2011: Design development approved
2012: New health agency Children's Health Queensland created
2013: Children's Health Foundation building completed
September 2014: Construction completed
November 2014: LCCH opens to public
Both public and clinical stakeholders agreed that Queensland needed a new pediatric facility to provide better patient care. But finding consensus on where the new hospital would be located wasn't as simple.
Initially, two potential project sites were on the table, one adjacent to the existing public hospital and the other next to a private facility—each on a different side of the Brisbane River. The patients and staff from both hospitals lobbied hard in favor of their own location throughout the planning stages, creating a schism in the community. But the project team also needed clinicians to collaborate from the outset, working together to determine how they would merge their services and models of care.
“One of the biggest challenges for the project was that of organizational change,” Mr. Skeen says. “We were merging a public organization with a private organization into a brand new facility. Critically, both organizations needed to continue the delivery of healthcare services throughout the entire development life cycle of the Lady Cilento Children's Hospital project.”
Throughout the merger, the project team focused on bringing stakeholders from the two previous organizations together. The entire project team shared one office space to foster unity with stakeholders from all sides. This helped people build relationships and stay up-to-date, rather than work in isolated team silos. The Aurecon team also facilitated the development of a number of stakeholder agreements that defined how all the involved parties would work together, Mr. McKenzie says.
PHOTO BY AARON TAIT
From left: Graeme McKenzie, program manager, Aurecon; Kayla Bolton, project manager, Aurecon; Susie Pearn, client director health and education, Aurecon
“We had an excellent line of sight to the leaders. They were accountable, visible and bold in their decision-making.“
—Kayla Bolton, Aurecon, Brisbane, Australia
“It took more than 12 months of tough negotiation to resolve and establish all of the commercial parameters and the ways of working into the future,” he says.
And when the site was selected—in Southbank, Brisbane, adjacent to the private hospital—this ongoing collaboration helped ease the transition to a single organization. Mr. Skeen attributes much of the success of the project to the relationships built by the project's executive sponsor, who had previous experience working at the existing public and private hospitals.
“The executive sponsor was well-placed to win the confidence of the staff, the clinicians, the families and the community to drive the change through the organization,” he says.
The team also aimed to keep reliable information flowing to the project sponsor, so it distilled project updates to a one-page report that clearly identified critical decisions, deliverables and milestones in a simple, easy-to-read manner. These summaries allowed executives to review, escalate and make decisions as necessary—and increased involvement across the entire team, says Kayla Bolton, project manager, Aurecon, Brisbane, Australia.
“Everyone went far over and above their deliverables; we had an excellent line of sight to the leaders,” she says. “They were accountable, visible and bold in their decision-making.”
OUNCE OF PREVENTION
The site selection delay also created significant schedule risks for the LCCH project. To hit Queensland Health's delivery deadline, the team needed to get the design phase underway, Ms. Bolton says.
“There was a political commitment made that the hospital would open in 2014,” she says. “We appointed the contractor under an early engagement process. That meant that they could commence the design process and early works, and we could stay on track for delivery.”
Keeping the AU$1.5 billion project on budget meant the project management team also had to tightly control scope changes. Under intense pressure to manage requests coming in from all directions, the team implemented a strict change review process that involved both the executive project director and clinical representatives, says Ms. Bolton.
“We had a really impressive governance framework within which we operated. This enabled us to implement rigorous management processes and procedures,” she says. “This governance framework ensured that no changes occurred which were not considered, priced and understood by the entire project team.”
The team also leveraged the Queensland government's gateway process to make sure the project would deliver the intended benefits. At each gateway throughout the life cycle of the project, members of an independent panel reviewed the project and made recommendations to improve the likelihood of success, Mr. Skeen says.
project director, Aurecon
Location: Adelaide, Australia
Experience: 20 years
Other notable projects:
1. Wesley Hospital Redevelopment in Brisbane, Australia, one of Queensland's largest private hospital projects, completed in 2012. Mr. Skeen was project director for design, construction and commissioning phases.
2. The Alfred Centre Development, an AU$200 million project in Melbourne, Australia that delivered the country's first elective surgery center, completed in 2010. Mr. Skeen was project manager.
Career lesson learned:
“Transformational change does not come about by chance. It involves people and is therefore inherently complex. To achieve ultimate success on our projects, we must manage the people side of change with the same vigor that is applied to our technical solutions.”
“By consolidating three health services into one, we delivered a substantial savings to the public purse.”
—Matthew Skeen, Aurecon, Adelaide, Australia
PHOTOS BY CHRISTOPHER FREDERICK JONES, COURTESY OF AURECON
“A panel was established from people with experience,” he says. “They've lived and breathed these sorts of projects before, so they brought a wealth of knowledge and expertise to the program and look at it with a fresh set of eyes.”
This process kept the lines of communication open and made it easier to remain upfront and honest with the client team about any problems that came up, says Mr. McKenzie.
“It's not unusual for a client to want to hear good news,” he says. “However, the only way to get a successful completion of a project is to be honest, and to deal with those risks and issues that may impact your ability to meet budget and schedule or achieve program goals.”
One of the greatest risks the team planned for involved moving patients from the three existing hospitals to the LCCH location. Planning started almost 12 months before the actual move and included the clinicians, the ambulance service, and the personnel who would be responsible for transporting and caring for the patients on the big day.
Leveraging a computer simulation model during the final stages of construction helped the team plan for the patient move and mitigate risks. The move simulation allowed the team to test different patient transport routes, figure out how to handle potential disruptions and map the move schedule for the move day with military precision, Mr. Skeen says.
“With the strength and the vision of the leadership team, we were able to maintain all of the future-proofing elements.”
—Graeme McKenzie, Aurecon, Brisbane, Australia
“We undertook risk management workshops to look at what could go wrong and what were our key risks for that move day,” he says. “We were able to develop a response plan to minimize the impacts of those risks on move day.”
FIT FOR THE FUTURE
The project team wasn't just focused on meeting the needs of the new hospital's patients on day one. It also aimed to serve future generations as the community's pediatric medical needs evolved.
The design included empty floors in the hospital and a research facility that can be fitted out as the hospital grows. The project also made capital investments in a central energy facility and cutting-edge IT-enabled components, such as specialized clinical systems, that would allow models of care to adapt to future tech advancements, Ms. Bolton says.
“We built in future-proofing options,” she says. “We zoned a future development site. We allocated space for family accommodations, and we included capability for IT and engineering services redundancy.”
Although there was a strong business case for the future-proofing elements, they were the first items on the chopping block when budgets got tight, Mr. McKenzie says.
“In the value management phase of the project in the early design phases, there was a lot of pressure to cut budget,” he says.
The project team built strong sponsorship buy-in to push back against the cuts. For instance, the project team convened earned value management workshops to foster a collaborative process that achieved best-for-project solutions.
“With the strength and the vision of the leadership team, we were able to maintain all of the future-proofing elements,” Mr. McKenzie says.
By creating a state-of-the-art facility that provided pediatric services in a central location, the team was able to improve the quality of care for children and families. Streamlining services helped make sure no one fell through the cracks—and the improved facilities lured more top-tier medical specialists to Brisbane.
“We attracted global specialists and healthcare professionals, and that made us a world-class facility,” Ms. Bolton says.
The project closed on time and on budget, but the best outcomes served the hospital's patients. In its first year, LCCH treated 180,000 outpatients, 38,000 inpatients and 64,000 emergency presentations. Children who came in for the first time smiled and laughed as they took in artwork and the colorful play areas. They were happy to receive all the care they needed in one warm, welcoming hospital—and that made all the hard work worth it, Ms. Bolton says.
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“Over 3,000 days of work life, we remained committed to delivering the best possible care and outcomes for Queensland's sickest children. We delivered that successfully, on time and on budget. That's a legacy we'll leave in Brisbane and in the landscape.” PM