Endoscopy Department Refurbishment Project At St James Hospital Construction Essay

The intent of this assignment is to show the bringing of an Endoscopy section renovation undertaking at St James ‘s Hospital Leeds. All stairss involved to accomplish this result will be included, aided by assorted undertaking direction tools, package and mention stuff. The undertaking was delivered within a set timescale and budget in conformity with the clients brief. The purpose was to use the Project Charter as described in Project Management Body of Knowledge ( PMBOK 2000 ) to be after the undertaking from start to complete adhering to the methodological analysis throughout to put to death the undertaking successfully.

The Project Management Institute defines undertaking direction as “ the application of cognition, accomplishments, tools and techniques to project activities to run into undertaking demands ” ( PMBOK 2000 ) . A undertaking by definition is ‘A alone set of coordinated activities, with definite get downing and completing points, undertaken by an person or administration to run into specific aims within a defined agenda, cost and public presentation parametric quantities ‘ ( Lester 2007 ) . This typically involves 4 stages ( Heerkens 2001 ) ;

Initiation stage, where the demand for a undertaking is identified.

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Planing stage, where the solution of the undertaking is farther developed.

Execution stage, this is where the prescribed work really takes topographic point.

Near out stage this is where the undertaking satisfies the original demand and is completed successfully.

NHS capital undertakings background

Capital Estates are responsible for presenting all undertakings at Leeds Teaching Hospitals NHS Trust, in conformity with the NHS Capital Investment Manual ( DoH 2006 ) . In general footings the Trust has a capital program derived from identified undertakings. This forms portion of the concern planning procedure and includes all edifice, technology, IT, and wellness & A ; safety related capital outgo programmes. Each strategy is allocated to a alone specific programme from which support can be sourced either from the strategic wellness authorization, cardinal authorities or charitable support watercourses. Foreseeable capital outgo strategies are outlined in a 5 to10 twelvemonth program nevertheless this is more clearly defined between 1 to 3 old ages. The capital program reflects the Trust ‘s strategic way and these agreed clinical service programs are confirmed at the beginning of the fiscal twelvemonth.

Scheme support demands

A full concern instance has to be presented to the Trust Board for all strategies where cost is in surplus of ?25,000 but less than ?500,000. Where the strategies are in surplus of ?500,000 they must besides be presented to the Strategic Health Authority, in all instances the undermentioned points must be addressed ;

Case of demand including use, clinical administration and capacity issues.

Deductions to the trust ‘s image of non proviso.

Gross deductions to the trust including whole life costings.

Does the command meet with the strategic program demands.

History of equipment

Benefit of proviso of the strategy

Itemised Specification

Capital cost including beginning of support

Hazard factors

Undertaking Business Case

Health Technical Memorandum ( HTM ) 01-01 2007 is a core criterion on safety and best pattern which all infirmary trusts in the UK should be taking to accomplish. It states that “ The effectual decontamination of re-usable medical devices is indispensable in cut downing the hazard of transmittal of infective agents. ” There were a figure of decontamination countries within the infirmary that did non presently run into this criterion. These countries of non conformity are where bing sections did non run into the lower limit recommended decontamination demand criterions, coupled with a failure in wash countries to divide clean and soiled decontamination paths. This strategy made all services runing within the David Beevers Day Unit ( DBDU ) compliant to this relevant HTM. If the instance had non been agreed the chance to accomplish conformity would hold been lost. This would hold an inauspicious affect on the Trust ‘s image as a national leader in wellness attention proviso.

Undertaking Description

The proposal was for capital and operational estates squads to reconfigure an bing country in DBDU into a compliant flexible endoscope recycling unit. This was completed successfully and is now shared by three user groups Endoscopy, Day Surgery Unit and Hysteroscopy. The strategy included the proviso of all needed substructures, and was designed to guarantee that right work flow through the decontamination country was possible to halt cross taint of clean and soiled endoscopes. Three compliant washer disinfectors and three endoscope storage cabinets where purchased to replace non compliant disused equipment. The bronchoscopy service at Leeds General Infirmary was besides transferred to DBDU as portion of the reconfiguration guaranting that this service besides became compliant. The two bing wash suites were converted back to an office and seminar room to re-provide what was lost by the reconfiguration. The strategy had minimum impact on activity within DBDU whilst being implemented. Alternate Sessionss were made available within Bexley Wing to understate the impact on service. This was by anterior agreement with the users and the undertaking squad to suit ineluctable noisy plants which resulted in an break of some activities in the operating theatre country.

Undertaking Charter

This defines the clear functions, duties and bounds of authorization of the undertaking director. Stakeholders were to the full cognizant of their functions and that of the undertaking director had during this peculiar undertaking as suggested by Lester ( 2007 ) These functions of duty can be found in appendix 1.The Charter besides provided as defined in PMBOK ( 2000 ) ;

A undertaking vision: To centralize services and replace disused non ailment equipment.

Cardinal aims: Pinkerton ( 2003 ) suggests that ‘these aims should be clear and unambiguous ‘ There were two cardinal aims for this undertaking.

Specification – This aim was to renovate the section within a set timescale, cost and quality criterions. This needed completion of the undertaking before 06/11/2009 ready for outpatient assignments on 09/11/2009 within a budget of ?500,000 this result was achieved successfully.

Purpose – The aims of the surgical board of directors are the long-run proviso to handle all endoscopy outpatients at the St James ‘s Hospital, therefore centralizing endoscopy services in the part.

Scope and deliverables

To finish the renovation on clip and in line with the proficient specification outlined by the design squad in the undertaking brief.

Minimise break to theatre ‘s activity adjacent to works through affair with sawboness, clinical staff and contrivers. Where this was non possible services were transferred to Bexley Wing during the undertaking.

To finish plants in conformity with budgetary figure.

Stakeholder functions and duties.

To help the undertaking director to put to death the plan expeditiously and to pass on any concerns sing the work carried out in theatre countries.

The undertaking charter besides defined the way and bounds of the undertaking. There are three chief utilizations of the Project Charter ( PMBOK 2000 ) ;

To empower the undertaking.

This work was authorised in conformity with the Trust ‘s Strategic Plan. An mandate certification was signed by the Chief Executive who was the patron ( Kemp 2004 ) and issued by the Trust Board.

It besides served as the cardinal merchandising point for the undertaking.

This strategy has provided a platform to handle more patients. Hence DBDU has become a Centre of excellence for endoscopy intervention.

Supplying a focal point point for the continuance of its life.

The strategy has now provided an efficient service every bit good as an enhanced patient environment and experience. This has resulted in shorter waiting lists.

Scope Statement

Scope is the work content within the undertaking and range direction is a procedure by which the deliverables and work carried out to bring forth them defined and identified by Heerkens ( 2001 ) . Scope is broken down utilizing following and found in appendices 2 & A ; 3:

Responsibility Assignment Matrix ( RAM )

Work Breakdown Structure ( WBS )

The Scope Statement besides includes PMBOK ( 2000 ) ;

Product – This relates to the internal re-structuring of the section. The reclamation of all services and upgrading of all infra-structure and edifice plants to supply an country suitable for the activity of endoscope scrutinies.

Justification – This was defined in the undertaking description and relates to the concern demand. In this instance the demand was the centralization of endoscope decontamination services and to increase capacity to handle more out patients with the demand for endoscope intercessions. Therefore increasing turnover and bettering on Government marks of 18 hebdomad referral to handle intervention pledge.

Deliverables – Work was completed over several stages to understate break. Undertaking deliverables are under the undermentioned chief headers ;

Undertaking designation – Feasibility survey

Outline Design – Business instance and seek blessing to get down

Detailed Design – Design drawings, full cost assessment

Site Investigation – Examination of substructure and services

Procurement Process – Tendering procedure, Contract issue and Purchasing of equipment.

Construction – Installation

Completion – Commission and Handover

Project Management Strategy

The Project Management scheme consists of four chief elements in conformity to ( APM BOK 2006 ) these were closely followed during the strategy.

Brief: The Key driving force behind the undertaking was clinical demand to centralize services. The undertaking director reviewed the undertaking brief with both the clinical squad and the undertaking squad set abouting the work. This ensured that any changes to the programme were communicated to all parties.

Administration: All members of the contractor ‘s squad project plants were approved in conformity with hospital site regulations and ordinances for contractors. This included engagement in asbestos consciousness and hospital initiation preparation. The undertaking site director was informed of the coverage and contact process required during the undertakings continuance and was requested to go through this information on to all squad members.

Control: Several control mechanisms were put into topographic point to guarantee that the undertaking stayed within the prescribed timescale and budget. One step employed was there could be no decrease in quality or divergence from the design specification. Another step was that agendas may change due to operational issues nevertheless the completion day of the month may non. Other steps included were cost controls which are discussed subsequently in this study.

Procurement

The procurance of services was implemented on a choice footing as described by Pinkerton ( 2003 ) and included the undermentioned considerations:

Supplier choice

Merely services and providers on the trusts official supplier registry were used.

Placement of orders and buying

Three competitory stamps were sought before any orders were placed with an single provider. This was in line with the trust ‘s standing purchase orders.

Guarantees and Guarantees

All specialist equipment providers offered drawn-out warrant periods at no excess cost along with merchandise preparation. However this had to be followed with an understanding of a service contract of two old ages post warrant period. This was agreed by the users at the stamp period.

The rule design squad selected for this undertaking was DSSR and the chief contractor Wood Mitchell who was the chief point of contact for the undertaking director, interior decorators and operational estates. The appropriate undertaking director who had all necessary accomplishments and expertness to ease the undertaking was selected, and besides acted as the contract decision maker responsible for all fiscal and contractual advice. This was in conformity with the NHS Capital Investment Manual ( DoH 2006 ) .

Cardinal Staff Required and Main Stakeholders

The Trust Board was straight responsible for the success of the undertaking and as antecedently stated the Chief Executive was project patron. The Board authorised the execution of the full concern instance, provided policy and counsel to capital estates that in bend provided feedback and advancement with all participants peculiarly the fiscal place to guarantee that the Strategic program was achieved. The caput of capital estates was nominated to move as the undertaking manager whose authorization was delegated from the Trust Board. The undertaking director was appointed to pull off the undertaking from start to complete on behalf of the trust, and provided regular advancement studies and feedback to all stakeholders. This ensured that the undertaking met all the standards for quality, hazard, and cost. A list of all cardinal stakeholders can be found in appendix 4.

Risk Management Plan

Risk direction consists of five phases that if followed, enabled the undertaking director to obtain a better apprehension of the possible hazards involved. The phases are as identified in table 1 by Lester ( 2007 ) ;

Phase 1

Risk consciousness, this is the phase at which the undertaking squad begins to appreciate that there are hazards to beconsidered.

Phase 2

Hazard designation, this is where all undertaking hazards are identified

Phase 3

Risk appraisal, the qualitative phase at which the two chief properties of hazard, chance and impact are examined. Identified hazards are so categorised as Low, Medium or High.

Phase 4

Hazard rating, one time categorised the hazard can be give a value. Using the trust analysis matrix this is scored 1 to 5to the chance andimpact of each hazard as identified.

Phase 5

Risk direction, all listed and evaluated hazards are established in a tabular array of precedences the determination has to be made how to pull off these hazards

Table 1

Jenkins ( 2006 ) identifies ‘risk is anything important that could perchance travel incorrect with the undertaking ‘ . The execution of a hazard direction program was put into operation to understate or extinguish those hazards avoiding their effects. The identified cardinal hazards for this peculiar undertaking were identified and scored utilizing the Trust hazard analysis matrix, and the Evaluation Impact of Project Risks ( tabular arraies 2 & A ; 3 ) .

Hazard Score for a particular hazard

Badness

Probability

1

2

3

4

5

5

5

10

15

20

25

4

4

8

12

16

20

3

3

6

9

12

15

2

2

4

6

8

10

1

1

2

3

4

5

Table 2

Hazard Analysis Matrix16-25

8-15

1-6

Low Medium High

Hazard ( Probability )

Impact ( Severity )

Hazard factor ( R x I )

To direct all endoscopes necessitating decontamination to the private sector.

This would be dearly-won in footings of the demand to increase the supply of flexible endoscopes and the contract demands in footings of response for pressing acute Scopess from an offsite location.

3 ten 4 = 12

Medium

Not finishing the undertaking on clip.

This would intend the cancellation of outpatient assignments. This will impact the trusts ability of accomplishing the 18 hebdomad referral to handle intervention pledge

2 ten 4 = 8

Medium

Not finishing within budget.

Other undertakings of as equal importance may non have support.

5 ten 5 = 25

High

Make nil.

This would impact adversely on the repute of the Hospital with the publication of the Health Care Commission one-year study on the Trust ‘s failure to move on an identified lack.

5 ten 5 = 25

High

Table 3

The control of these hazards is indispensable for a successful undertaking result. Guaranting the trust does non endure any inauspicious promotion or hazard impact to clinical services.

Cost Coverage

It was the duty of the Project Manager to carry on regular finance meetings with the Project Director and the finance section to supervise costs guaranting the undertaking remained within budget. A monthly study was produced to foreground hard currency flow during the undertaking. A study on hard currency flow and a cost tabular array for the whole undertaking can be found in appendix 5 & A ; 6. This highlighted the followers ;

Detailss of latest agreed disbursement.

Up to day of the month outgo

Projected costs

Undertaking costs were broken down to WBS to organize footing for a cost history. The cost history was so to be used to:

Track existent costs against planned cost

Give early warning of any overspend

Show entire cost of Project to day of the month

Allocate single budget countries

Cost Management

Undertaking cost control must adhere to the NHS Capital Investment Manual ( DoH 2006 ) and the Trust ‘s Standing Financial Instructions. The undertaking was managed with the sanctioned budget. Regular cost coverage facilitated the best possible estimation in conformity with followers:

All on-going hazards to costs were identified.

The awaited concluding cost of the budget.

Future hard currency flow was estimated.

Establish a concluding undertaking cost.

Undertaking Communication

During the undertaking good lines of communicating existed between all the stakeholders. This was achieved by the regular retention of meetings, during these meetings advancement was discussed and possible booby traps or jobs were resolved by the undertaking squad and director. The methods of communicating outside of these meetings were by letters or electronic mails and occasional conference calls. This ensured that all stakeholders were kept informed of the undertakings advancement or any other relevant information ( Lester 2007 ) . The meetings were held as follows ;

Project team- monthly

Clinical staff and all users – monthly

Finance squad – monthly

Design squad – monthly

Site advancement – weekly

Handover and commissioning- Daily with all users

Following all meetings the undertaking director published proceedingss which were so distributed to all squad members. Besides during this procedure Gantt charts were produced to enter the undertakings major mileposts, critical way manner base line advancement, and tracking these can be found in appendices 7 to 10. Co-operation between capital estates and operational estates was critical for continuity of service and to avoid possible breaks. This was achieved by the estates liaison officer and the undertaking director reaching each other on a day-to-day footing. During these contact periods treatments sing all other strategies in the locality were addressed so full support from other hospital staff could be sought. This regular communicating ensured that the undertaking progressed to a successful decision.

Auxiliary Management Plan

Quality can be divided into three chief countries, quality planning ( QP ) , choice confidence ( QA ) and quality control ( QC ) ( Lester2007 ) . This is farther broken down every bit shown in table 4 below ( PMBOK 2000 ) .

Table 4

All work during the undertaking complied with all the relevant statutory demands some illustrations of the statute law followed are listed below: –

Latest Building Regulations.

The demands of the Health and Safety Executive.

The demands of the Local Authority Planning Department, District Surveyor or equivalent.

The Water Authority Regulations.

In add-on to the statute law all installings and the stuffs used for the plants carried out were in full conformity with the appropriate Specifications and Codes of Practice issued by the British Standards Institution. During the life of the undertaking the undermentioned ordinances were besides adhered to ;

Control of Asbestos at Work Regulations 1987,

Workplace ( H, S & A ; Welfare ) Regulation 1992,

Management of Health and Safety Regulations 1992

Noise at Work 1989,

Personal Protective Equipment Regulation 1992

Manual Handling Operations Regulations 1992

Fatal Accidents Act 1976

Quality Assurance

Quality confidence ( QA ) is the procedure that ensures that equal quality systems, procedures and processs are in topographic point ( Lester 2007 ) . The decontamination machinery supplied met the current ISO 9001 Quality Systems – Model for Quality Assurance in design and development, production, installing and service ( 2008 ) . Other cardinal ISO Quality Assurance demands were besides followed during the undertaking ;

The users worked in close concurrence with operational estates to guarantee that the testing and proof of the decontamination machines was completed successfully.

The users have pursued the continual betterment of the system. Therefore guaranting rating of its public presentation is in line with the design brief.

Quality Control

As defined by Lester ( 2007 ) is the agencies to command and mensurate features of a constituent and the methods employed for monitoring and mensurating a procedure or installation. All procured equipment was installed in conformity to the maker ‘s specifications. All other plants were extensively inspected and tested against the design specification. This was carried out by the clerk of plants who besides monitored rectification and on a regular basis reported to the undertaking director any lacks and defects.

Undertaking Completion and Life Cycle

The strategy was conceived as portion of the Trust Strategic Plan. The peculiar undertaking does non hold a clearly defined life rhythm due to the of all time altering clinical environment. However as most of the edifices at St James ‘s were built in the early portion of the 20th century. These frequently require extended redevelopment work to convey them in line with current edifice ordinances and other criterions. Additionally to this the trust ‘s long term program is to cut down the size of the infirmary estate and to centralize services wherever possible. This peculiar undertaking was highly disputing due to both fiscal and operational restraints. However the strategy was completed successfully both under budget and within the allotted timeframe.

Appendix 1

Appendix 2

Appendix 3

Appendix 4

Key Stakeholders

Company

Name

Position

Leeds Teaching Hospital Trust

Trust HQ

St James University Hospital

LS9 7TH

Julie Mc Farlane

Andy Tunstall

Endoscopy

Bronchoscopy

Corporate Planning

Leeds Teaching Hospital Trust

Ashley Wing

St James University Hospital

LS9 7TH

Chris Tobin

Project Manager & A ;

Contract Administrator

Leeds Teaching Hospital Trust

Old Nurses Home, LGI

LS1 3EX

Jim Hatfield

Architect

DSSR

Windsor House

Cornwall Road

Harrogate. HG1 2PW

Andy Nicholls

M & A ; E Design adviser

Gleeds

Town Centre House

Merrion Centre

Leeds. LS2 8ND.

Ian Rhodes & A ;

Matthew Hill

Measure Surveyors

Summers Inman

4240 Park Approach

Thorpe Park

Leeds. LS15 8GB

David Blakey

Adam Wall

CDM Co Coordinators

Wood Mitchell Building Group

Sunnyfield Works,

Low Town, Pudsey,

Halifax. HX15JB

Simon Dodgson

Contract Manager

Mechanical, Elect & A ; Plumbing Sub Contractor

H & A ; C Moore

Low Hall Road.

Horsforth, Leeds. LS18 4EF.

Roy Scargill

Contract Manager

Leeds Teaching Hospital Trust

Old Nurses Home, LGI

LS1 3EX

Gary Thirkell & A ;

James Parkinson.

Infection Prevention

Triple Red RO Water

Unit D4, Drakes Park,

Long Crendon Ind Park,

Long Crendon,

Vaulting horses HP18 9BA

Nick Porat

Commissioning Manager

Lancer UK

1 Pembroke Avenue

Waterbeach

Cambridge

Cambridgeshire

CB25 9QP

Chris Hill

Commissioning Manager

Leeds Teaching Hospital Trust

Estates Management Offices

St James Hospital

LS9 7TH

Andrew Hallam

Estates Manager Specialist Decontamination services

Leeds Teaching Hospital Trust

Estates Management Offices

St James Hospital

LS9 7TH

Peter Aldridge & A ;

Mark Cox

Trust Fire Officers

Leeds Teaching Hospital Trust

Estates Management Offices

St James Hospital

LS9 7TH

Alison Stephenson & A ;

Matthew Fahy

Asbestos Management

Leeds Teaching Hospital Trust

CAD Office

Estates Management Offices

St James Hospital

LS9 7TH

Malcolm Stitch

AutoCAD Manager

Contacts/User Groups

Emma Johnson

Foluke Ajayi

Karen Tweed

Alison Peacock

Linda Warner

Matron

Directorate Manager

Decontamination Advisor

Day Surgery Co Ordinator

Day Surgery Team Leader

Appendix 5

Appendix 6

Appendix 7

Appendix 8

Appendix 9

Appendix 10