“Start Strong, Finish Strong“ L Launching hi a Healthcare H lh Capital C i l Project P j
June 5, 2009
Agenda • Your presenters • Overview of capital project delivery process, process specifically project launch and transition planning phases • Critical steps in project launch phase/lessons learned • Introduction to Baptist Hospital East Project • Top 10 success factors • Questions and answers
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Your Presenters • John E. Barrett – Director of Construction, Construction Baptist Hospital East – Responsible for all aspects of project development at Baptist Hospital East and their other properties
• William Willi R. R M McMahon M h – Co-Owner, President and COO of KLMK Group, LLC – 21 years of Healthcare project management experience from both the contractor’s and the owner’s side – KLMK Group provides comprehensive facility planning solutions to visionary healthcare owners
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Key Takeaways • Define the healthcare capital project delivery process • Discuss and understand the importance of the project launch phase (conducting a SPLRA) and transition planning phase • Gain a basic understanding of pre-design, project launch and transition planning elements • Relate theory to the “real world:” lessons learned from the Baptist Hospital East project (Louisville, (Louisville KY) • Top Ten Success Factors in a Project
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Introduction to Baptist Healthcare System
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Introduction to Baptist Hospital East • Baptist Hospital East, located in Louisville, is a member of Baptist Healthcare System, y , one of Kentucky’s y largest g not-for-profit p healthcare providers • 519-bed acute care hospital with specialized services for women's h lth cancer, hheart,t orthopedics, health, th di neurosciences, i emergency care, rehabilitation, sleep disorders, occupational health, and behavioral health, including psychiatric and chemical dependency care. • Louisville market includes Baptist Hospital East, BaptistWorx®, Baptist Medical Associates, Baptist Urgent Care, Baptist Eastpoint and Baptist East/Milestone Wellness Center. Center
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“The Project” • Major expansion to the facility on the main campus which consists of over 265,000 square feet of new construction. • Includes a 66,137- squarefoot Ambulatory Surgery Center (ASC) on the 2nd floor.
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“The Project” • Six 24,000 square q foot private patient room floors above. Each patient floor consists of 24 private patient rooms. • The budget for this project was $128 million
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Preamble: Prioritize and Plan • In today’s environment, projects must be prioritized and well planned. planned Capital should be invested when the project: – Furthers the strategic goals of the organization, – Generates a positive ROI, ROI and / or – Involves critical infrastructure upgrades. • Define what you want and what you need…spend based on what yyou need.
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Preamble: Avoid Paralysis • • • • • •
Continue to plan Plan smart and be efficient Prioritize B creative Be ti Assess the situation from all angles Don’t rest…your competition isn’t
“In In business, business the competition will bite you if you keep running; if you stand still, they will swallow you”. William Knudson, Jr. – Former Ford Motor Company Chairman
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The 5 Major Phases of the Capital Delivery Process
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What is Project Launch?
Importance of Project Launch Phase A well developed implementation plan is vital to the successful completion of a project Objective is to start and finish strong for project success! “The pain won’t last but the memories will” - John Maclean, Maclean Ironman hall of famer
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The End Depends on the Beginning… • • • • • • •
Begin with the end in mind Define strategic intent Define financial goals and limitations D fi facility Define f ilit opportunities t iti Be realistic on timing End with design and construction Bridge the gap with SPLRA
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Make Changes Early to Avoid Costly Impacts Later
Early Decisions = Less Cost Impact Highest 100
Degree of Impact on Cost (%)
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Ability to Make Changes
Cost of Making Changes
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Costt C of Construction ($)
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Lowest 0
Project Launch
Design Project Delivery Process 14
Construction
What is SPLRA?
Benefits and Objectives of SPLRA: Hit Your Target • • • • •
Identifies main elements necessary for strategic project launch Assesses what hat is kno knownn and what hat is not kno knownn Begins defining gaps in launch elements and process to date B i defining Begins d fi i implementation i l t ti plan l andd critical iti l elements l t Aligns assumptions of project stakeholders
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You Don’t Know What you Don’t Know • • • •
Consider each “spoke” on the SPLRA wheel Assess what is currently known and unknown Identify gaps in expectations versus realities Id tif priorities Identify i iti andd develop d l a roadmap d to t ffollow ll when h bridging gaps • Assess a hospital’s level of readiness to get a project off the ground SPLRA is the number one thing the Hospital can do to ensure project goals are met and vision becomes reality.
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Major Phases of a SPLRA: The Doctor is In Discovery (History & Physical): • What information is currently available? Gap Analysis (Diagnosis): • What is known and unknown? What is done? What needs to be completed or contemplated? Implementation Plan (Treatment Plan): • Observations and recommendations on how to bridge the gaps in order to ensure everyone’s expectations are aligned.
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Have You Evaluated Your Plan? SPLRA • Data collection and interviews followed by work sessions • Include key hospital leaders and others • Collect C ll t allll information i f ti • Written gaps analysis & implementation plan j • Address and pprovide workingg direction on major items impacting the “Big 3” – scope, schedule, & budget • Key benefits: aligns expectations with objectives and validates plan of action moving forward – get everyone moving in the same direction
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Address The “Big Three”… • Scope - Guides detailed programming and design & confirms budget with available funds • Schedule - Sets expectations p and deliverables parameters • Budget - Drives project scope to budget limit
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…and Develop an Implementation Plan to Get There • Roadmap moving forward to address all gaps, gaps issues, issues & key findings • For each gap: – – – – –
Recommended plan of action Recommended timeline Identification of responsible party Potential costs Draft summaryy work
• Revised Master Program Schedule 21
Lessons Learned from BHE during Project Launch •
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Establish budget and schedule prior to design to ensure realistic goals are established and maintained Engage major players of the project team early in design process: – Construction Manager to provide preconstruction services and ensure project is designed within budget – Medical Equipment q p pplanner to assess needs early and confirm budget
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Result: Project was completed two months ahead of schedule and was well under budget because of up front planning effectiveness!
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The 5 Major Phases of the Capital Delivery Process
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Major Phases and Elements of Transition Planning
Phase I Transition Readiness & Team / Schedule & Team / Schedule Development
A. Transition Readiness Assessment B. Team Development C. Schedule Development
D. E. F. G. H.
Phase II
Phase III
Transition Management
Post‐Occupancy Activities
Operations Integration & Implementation Medical Technology & Equipment Asset Tracking Community Outreach, PR, & Communication Facility Readiness, Activation, & Commissioning Move Management / Relocation
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I. Occupancy Troubleshooting J. Post‐Occupancy Activities
Phase I: Major Components
Phase I Phase I Transition Readiness & Team / Schedule Development
A. Transition Readiness Assessment B Team Development B. C. Schedule Development 25
A. Transition Readiness Assessment Assess the facility’s ability to transition operations, staff and equipment Discovery (History & Physical): • What information is currentlyy available? Review all information, documents, plans, etc. Gap Analysis (Diagnosis): • What is known and unknown? What is done? What needs to be completed or contemplated? Implementation Plan (Treatment Plan): • Observations and recommendations on how to bridge the gaps in order to ensure everyone’s expectations are aligned.
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A. Transition Readiness Assessment – Steps • Transition Team Structure Review: Roles, responsibilities who’s responsibilities, who s in charge? • Stakeholder and Staff interviews: Gauge understanding of and preparedness for transition • Evaluate data and existing transition tools: Identify gaps and outline plan for bridging the gaps
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B. Transition Team Structure Development: Example
Project Delivery Team (e.g. FPC, CM, A/E, PM)
Transition Steering Committee
Operational Integration Core Group
Clinical Operations
Support Services
Ancillary Services
Administrative Services
Facilities Readiness Core Group
PR & Community Outreach
Information Technology
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Medical Equipment & FF&E
Legal & Regulatory
Plant Ops, Materials, Biomed
Move Coordination & Vendors
B. Keys To A Successful Transition Team • Identify a leader for each group • Set clear expectations, p , roles and responsibilities • Set meeting schedule and have clear agendas and objectives for each meeting • Involve staff from all disciplines and external resources • Communicate between teams and with project delivery team members • Begin B i meeting ti as early l as possible ibl – by the end of design / start of construction 29
C. Transition Schedule: Example Process
1. Transition Organization and Move Planning
2. O 2 Operational ti l Readiness
• Kick-off
• Communication Plan
• Move checklists
• Policies / procedures / staffing
• Mover selection • Move milestones • Schedule workshops
3. F 3 Facilities iliti Readiness
4. The Move
• Regulatory and Approvals
• Detailed move schedule
• Information Systems
• Move Manual
• Operations / Training and Orientation
• Biomedical
• Mock moves
• Security
• Command & Control
• Command team plan
• EVS- Cleaning
• Transport
• Flow diagrams and value-stream value stream maps
• Infection Control
• PR, C Communications, i ti Events
• Equipment / FF&E • Commissioning • Punch lists
• Cleaning • Commissioning • Move day
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5. PostOccupancy
• Decommissioning • Transition issue report • Post Occupancy Audit
C. Transition Schedule: Sample Schedule
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Phase II: Major Components
Phase II Transition Management
D. E. F. G. H.
Operations Integration and Implementation Medical Technology and Equipment Asset Tracking Community Outreach, PR, and Communication Facility Readiness, Activation, and Commissioning Move Management / Relocation 32
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D. Operations Integration & Implementation - Steps • Develop Implementation Plan – – – – –
Prioritize pprocess changes g Train staff on new processes, technology and equipment Orient staff to physical facility Link plan to the Master Transition Schedule Update procedure / policy manuals, move manuals and checklists related to these operational changes
• Id Identify tif individual i di id l accountable t bl for f managing i checkpoints h k i t iin regards d tto Master Transition Schedule • Ensure that the building is leveraged as it was intended to enhance efficiency and quality • Manage operational handoffs
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E. Medical Technology & Equipment Asset Tracking • Develop a clear Technology Integration and Activation Plan • Coordinate for all medical technology equipment and FF&E: – – – – –
Equipment installation matrix Delivery Installation Activation final ownership of medical equipment, fixtures and furniture
• Ensure that all items are operational and in-place prior to operations 38
F. Facility Activation and Commissioning Commissioning
Records
Control
• Design review complete • Submittal review complete p • Construction checklists complete • Pre-functional Pre functional testing performed • Functional testing pperformed • Training in place and active
• Inspections have taken place and passed • Licensure and permits issued • Temporary Certificate of Occupancy (CO) issued • Permanent CO Issued
• Ensure ample time for activities • Develop schedule • Coordinate with construction and project schedule • Allow time for failures mitigation • Continually monitor and adjust
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G. Community Outreach and Communication • Ensure that communication and outreach activities are coordinated • Develop a communication strategy for community, physicians and staff to address frequently asked questions about the move • Develop the plan for visitors, community members and photographers on patient move day • Coordinate C di t volunteer l t participation ti i ti for f th the move • Design new collateral and signage to addresses new hours of operation, p contact information, directions, maps, and entry points
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H. Move Management / Relocation Move Teams Coordination Transition Sequencing & Move Routes
Command, Control, & Security
Move Day
Volunteer & Community Coordination
Patient, Staff, Final Equipment Move
Relocation Specialist / Mover
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Mock Moves & Simulations
H. Move Mgmt. / Relocation: Sample Routing Diagram
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Phase III: Major Components
Phase III Post‐Occupancy Activities
I. Occupancy Troubleshooting and J Post-Occupancy J. Post Occupancy Activities
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I. Occupancy Troubleshooting Immediate post-occupancy
Call Center / Hot Line For Trouble Calls
Collect Punch list Items
Triage Items
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Route to Appropriate Vendor / Department
Monitor and Document Issue, Action & Resolution
J. PostPost-Occupancy Clean occupied space and perform “clean sweep� of vacated spaces Remove surplus FF&E and equipment (sell, donate, trash) Decommission & secure vacated spaces Distribute employee / departmental surveys Compile lessons learned Perform Post Occupancy Operational Audit Issue a full close out report
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Typical Timeline
Phase I
Phase II
Phase III
Transition Readiness & Team / Schedule & Team / Schedule Development
Transition Management
Post‐Occupancy Activities
2-4 Months
12-15 Months+
2-4 Months
Months 1 ‐ 4
Months 5 – 20
Months 21 ‐ 24
Begin at End of Design or Start of Construction Recommend a Minimum of 18 24 months prior to Occupancy Recommend a Minimum of 18 – 24 months prior to Occupancy 46
Lessons Learned • • • • • • • • • •
Train about what has changed, not just what is new Prepare for security needs on move day Involve Marketing and PR early Prepare for organizational culture changes Assign “owners” to each piece of equipment Prepare for equipment activation, not just delivery Allow for adequate stakeholder input Focus on vacated space too Secure adequate resources for the move Plan for IT systems activation and commissioning
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Lessons Learned from BHE during Transition Planning •
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Establish Roles & Responsibilities early – “Buy in” and accountability from key planning members is critical Emphasize the importance of Operations Integration & Implementation – Don’t wait too late to begin planning how the facility will f ti once open function Schedule – Provide adequate time after facility completion to finalize it items suchh as punchlists, hli t cleaning l i & training prior to occupancy
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Critical Success Factors – Hit your Target Start planning as early as possible Assess your readiness for transition by identifying gaps and developing plans to bridge them Establish a structure and schedule – Stick to it! Allocate sufficient time and resources Clearly define the roles, roles responsibilities and expectations Establish clear lines of communication Integrate operational process with facilities readiness Track installation and activation of critical technology and medical equipment Educate the staff, physicians and community about project status Finish strong and make a lasting impression!
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What Should You Do Now? • • • • •
Collect as much information as possible Talk with ith the “C” ssuite ite & listen Rigorously analyze & prioritize F Focus on th the “Bi “Big 3” Identify gaps & develop an i l implementation t ti plan l • Keep moving methodically and logically • Don’t D ’t ddo it alone l – welcome l assistance i t
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Questions Baptist Hospital East 4001 Kresge Way Suite 122 Louisville KY 40207 Louisville, Phone: 502.897.8089
KLMK Group, LLC 100 West Franklin Street Suite 200 Richmond VA 23220 Richmond, Phone: 804.343.0161
www.bhsi.org bh i John.Barrett@bhsi.com
www.klmkgroup.com kl k bmcmahon@klmkgroup.com
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