Project Management How it delivered at Auckland City Hospital

From corner room on the ninth floor of the new Auckland City Hospital, the view down over office towers, across the green hump of Rangitoto to the island-dotted, boat-trailed expanse of Hauraki Gulf has to be one of the best in town.
This is what birthing mums get – and in the public health system, says Dr Nigel Murray. It’s with no small degree of pride that he points out other features – the spa-like “comfort” bath and ensuite toilet/shower – in the airy, as-yet-unoccupied delivery suite.
When National Women’s services shift from Greenlane to their quiet and comfortable new quarters later this year, it will mark the final phase of what is the biggest ever construction/redevelopment project in the history of New Zealand’s health sector. And as overall project director, Murray has every reason to be proud.
With the bulk of what has been huge, complex, seven-year effort now complete, he can lay claim to the holy grail of project management – on time and within budget. Management, board and shareholders (the Crown) were “absolutely passionate” about sticking to the $500 million project price tag, says Murray.
“Unfortunately when you study the legacy of large complex public projects there have been lots of failures – lots of carcasses along the path. That undermines people’s faith in the ability of the public sector to deliver strong project management.”
So how did he succeed?
First step, says Murray, was having goal clarity and strategy alignment between owner, board and management.
“We’ve enjoyed fantastic support to deliver against requirements on time and in budget and it was crystal clear from day one six years ago that this is what had to happen. As long as those boundaries are clearly stated then you know what platform you’re working on. Many projects start without clear path – so defining what are the boundaries at all tiers of governance is vital.”
Second, he says, is to create culture of accountability.
“We work by what I call individual accountability and collective responsibility. So you can be collectively responsible for making good decisions but, in the end, one person in the line has to be accountable for it and often that is missed. People defer to wider group to seek solace and comfort in hard decisions and often that undermines the decision.”
Next and absolutely essential are good people.
“High quality people are vital to the success of complex long-term projects. The longer they last and more complex they are, the more vital that is. We have been very particular in selecting people to the project team – and making sure we incentivise them to stay.”
Losing key people part way through project is recipe for losing continuity, consistency, momentum, and institutional memory, says Murray.
“So you need to ensure they are impassioned about the project and feel valued. We’ve been blessed by very low turnover of key staff. All seven of our core team have been with me for six to seven years.”
Much the same applies to the wider team which, including external consultants, numbers around 160.
“We set out to make sure that every worker on this job felt their input to the hospital was important and valued.”
Another important principle is that the management team has to be very close to the detail. While tasks are divvied up according to individual skill sets, the expectation is that each senior manager has good grip of their area and how it fits in the whole scheme.
“That’s why we operated with management board strategy. Every Friday for the past six years we’ve had management board meeting to go through every cost line and address every issue, summoning in people to resolve them.”
The project as whole fell into three major components: building the business case and arguing it to generate the necessary funds; the implementation or design-and-build phase; and the migration or shifting phase.
Both second and third phases had huge project management component and while external project management specialists (Carson Group) handled several aspects of the project programme, overall direction remained with Murray and his team.

Getting it right
Two important success factors throughout the project management process, says Murray, were extensive customer input and regular peer review.
“One of the biggest challenges was making sure we built something that was right and the way we handled that was to create user groups to provide input along the way.”
End customers – both health professionals and patients – were consulted on initial design and had the opportunity to check full-size mock up of generic ward set up in Glen Innes warehouse.
“We had around 1000 staff and public through to comment on how the design worked – everyone came in with clipboard to check it all out, tell us what was wrong and make suggestions. So users developed sense of ownership.
“The other approach that has been really helpful is peer review because in big project spanning several years, you can lose your way – and become so passionate about things that you lose perspective.
“Because we knew that was danger, we set points at which we got other people to look at what we’d done. It was no-holds-barred, non-defensive approach.”
The preliminary design was put in front of team of Australian specialists during two-day intensive critique. similar exercise was carried out further down the track and the detailed “migration” planning was subjected to similar expert review.
“That was great because it provides you with fresh viewpoint. For instance, someone might suggest different sequence would work better and save money. You could have been staring at that particular problem for some time then someone completely fresh comes up with solution. That’s the beauty of peer review.”
Risk management is big factor in any project, particularly one of this size. Before embarking on the journey, it’s worth setting some foundation governance rules, says Murray.
“We created contingency funds and, because we had programme of work, we had lot of projects each of which had some contingency and I had some above that. But it was structure so it couldn’t readily be accessed – like term deposit – until certain times. So we had very layered and disciplined structure about access to those emergency funds.
“Setting those rules up beforehand was contributor to success.”

Sticking to budget
One of Murray’s most difficult challenges was managing expectations.
“The biggest danger for us was that our users’ expectations could have wildly exceeded the budget. Building new public hospital is one of those opportunities that only comes once every 50 or 60 years so it’s lifetime opportunity for some of the clinical departments to get it perfect. That’s strong instinct. And when you’ve got $500 million sitting there, everyone wants their department to be really really nice and really really big.
“Our job was to ensure that everyone’s really nice, really big department actually fitted within budget so expectation management was the biggest challenge.”
It was case of injecting hard dose of realism right up front.
“We went through an exhaustive negotiating phase about four years ago which went down to the finest detail and set the platform for success on meeting budget.”
The sheer scale of the project brought fair amount of market clout to pricing – Murray went for best sole-supplier deals on every bulk-use item from carpets to doorknobs. The result – “the cost per square metre of this hospital is phenomenally effective”.
The downside was that the enterprise scale created its own inflation as it sucked in building resources creating shortages that were then exacerbated by Auckland’s building boom.
“We had to go hard and fast to get as many contracts nailed then let fly with the building programme knowing later projects would come under fiscal pressure because of the heating market.”
It’s all part of risk management though some factors – like the housing pressure from increased migra

Visited 8 times, 1 visit(s) today

Business benefits of privacy

Privacy Week (13-17 May) is a great time to consider the importance of privacy and to help ensure you and your company have good privacy practices in place, writes Privacy

Read More »
Close Search Window