At some point, almost every healthcare organization has undergone the exhaustive process of delivering a major capital project. In many cases, larger institutions have ongoing capital projects to meet the needs of their internal and external customers. As healthcare owners position themselves to remain competitive while adapting to the ever-changing technological advances in the market, the necessary evil of developing, designing and constructing new space keeps many administrators busy. Healthcare owners are goal and metric driven; it is in their DNA. For those who have undertaken this journey, they have no doubt been confronted with the questions regarding performance to the project goals during and at the conclusion of the project. Did the contractor, architect, engineer and consultants meet their performance demands? Were the budget and schedule goals achieved? Was the project scope adequate for its intended use? Hopefully, if this is you, your answer is “Yes”.
However, another major question should be asked… “How did the owner perform”? The answer to this question likely has the most significant impact on the entire project. Regardless of the external team’s performance, an owner’s actions are critical to the project’s success. The organization of the owner’s internal team can dramatically affect delivery. To truly assess a healthcare organization’s internal structure, one must not merely look at an organizational chart to confirm that all the parts and pieces are in place, but rather must explore the internal processes, tools, and intra-departmental communication.
Where to begin?
The first step in conducting a healthcare “Organizational Study” is to truly understand how the internal team is organized and the internal staff capabilities. Identifying and validating the existing structure and strengths will assist in improving operational efficiencies. Some of the questions that should be answered are as follows:
• Is there a group leader that is empowered to make critical decisions?
• Is there a “Project Management Staff” that is solely dedicated to hospital projects?
• Are there enough Project Management Team Members to handle the capacity?
• Do Project Management Team Members divide their time managing other daily job duties?
• Does the team have the proper support roles (i.e. planning, medical equipment, space allocation, etc.) in place to leverage the internal team?
• Is there a process in place to maintain project controls across the system to ensure that the scope, schedule and budget are communicated and understood?
Having the proper organization in place is the key to developing and streamlining processes and/or process improvements. It starts with a clear understanding of the internal team and the development of comprehensive job descriptions that define duties and expectations for each individual’s role. Interviewing the entire staff that interfaces with the life cycle of a project will be beneficial to identifying gaps in the organizational chart. When completing the final analysis of the internal structure, a benchmark comparison of similar structures with similar capital programs is suggested. The accompanying chart displays the organizational structure for a large health system with a robust capital program indicating functional responsibility and lines of communication.
Running parallel to the internal team organization should be a solid inventory of tools and processes. Particular analysis of the adoption and use rate for these tools is paramount. Having the best tools in the world will not help your team if they are not properly trained and/or have not “bought in” to the use of them. In addition, it is critical to evaluate and understand the following reporting requirements:
• Capital projects reporting
• Master program budget reporting
• Master program schedule reporting
• Departmental and operating budgeting
• Cash flow projections for projects
• Workflow or process models
With this information readily available, it will be easier to gauge the complexity and breadth of the department’s responsibilities and identify opportunities for process enhancements. In addition, by reviewing and analyzing this data, benchmarks and comparisons can be established.
Often overlooked in a study of this kind is the interaction between the Planning/Development office and the other hospital departments. The group should not function in a silo but must interact with finance, risk management, engineering, materials management, and of course, the Executive Suite. There should be clear lines of communication with all of the aforementioned parties not only at the beginning of the project, but throughout. Do not assume that everyone communicates. Understand the channels and means for sharing information. As often is the case in many organizations, there is a severe lack of standardization as it relates to communication and reporting tools. Processes, tools and documents must be thoroughly examined to determine their usefulness and their level of effectiveness. The exploration of this process during an Organization Assessment is perhaps the most important element of the study. The following must exist within an organization to enable clear communication:
• Standard meetings with project management staff, department heads and finance
• Uniform budget reporting tools
• Master schedules, near term schedules and project calendars
A deliverable from this investigation is a listing of all the tools and reports that the department utilizes throughout the course of a project. This provides the organization with a better understanding of the reporting capabilities within the department as well as identifies “gaps” in their communication process.
The impact of technology
As previously mentioned, more and more healthcare owners have to adapt to the ever-changing medical equipment technological advances. This is also true in project management software. Gone are the days of the overwhelming Excel spreadsheets that contained cell and data entry errors and were hard to maintain and update. Many facilities now have migrated to web based project management software to manage their capital projects. However, given the complexity and financial commitment of these programs, it is equally important to make sure that all stakeholders are using it to the fullest extent possible. In other words, is the hospital getting the maximum return on investment with the project management software? This is another aspect of an Organizational Study that must be explored. The functionality of this type of software is too vast to review in this article and the owner can only determine its usefulness. However, when evaluating software, the following should be considered:
• Are the end users trained in using the program or software?
• Is there clear understanding of the capabilities of the program/ software?
• Are there standard reports that are generated from the program/software?
• Is there adequate budget and schedule information modules?
One common issue that we have identified in conducting Organizational Studies is that while healthcare organizations have incorporated some type of project management software system, they are still relaying on other methods of budget and schedule management. This results in a duplication of effort and dual data entry, which needlessly overburdens the Project Management Staff. The other negative, and perhaps the most important, is that there is no central or “Master List” of projects and project data, which often leads to massive confusion and unnecessary errors.
The term “Organizational Study” can mean different things to different people. To engage a third party to explore efficiencies as well as process gaps may lead to extensive findings and conclusions. This information can be so overwhelming, that corrective measures are never implemented. To ensure that the study is worthwhile and provides value, begin by identifying the departments, areas and tools that need to be evaluated. The best approach is to treat this like a project. Inform the team, communicate the objectives and establish regular meeting times. This will streamline the process and aid in adopting corrective measures. In conclusion, a true “Organizational Study”’ is more than just confirming the placement of the boxes on an organizational chart. Rather, it is an assessment of the procedures, tools and interaction within the organization that guarantee the delivery of a successful capital project.
Steve Higgs is senior managing director and Gary Wilkinson, is director of project management at CBRE Healthcare.