Individual Assignment

2013 PMI PROJECT OF

THE YEAR

AWARD

FINALIST

The Nemours Children's

Hospital team knew

stakeholders needed

to be heard—so it

used strict change

management to keep

the project on track.

BY LOUIS LA PLANTE

PORTRAITS BY PRESTON MACK

IT TAKES

AVILLAG

hen launching a muitimillion- doilar project, it's tennpting to go

with industry norms. But the teann behind the Nennours Children's

Hospital project decided to break with tradition.

For one thing, the new hospital aimed to be user-friendly by offering a more

integrated approach. Project leaders knew it was tough enough for parents to

deal with sick children. They shouldn't also have to contend with shuttling their

children—and all the medical documentation—to various providers across a

health campus or even at another site.

"We wanted to remedy that situation," says Roger Oxendale, CEO, Nemours

Children's Hospital, Orlando, Florida, USA. "We wanted to have them all here

and, to the greatest extent possible, on the same floor."

That was the vision for the US$397 million Nemours Children's Hospital

project. But the team knew it wouldn't mean much without stakeholder buy-in.

So it brought in the experts: parents and children as well as staff who would be

working at the facility.

Of course, then the team had to manage all the changes and risks that stake-

holder input posed.

5 2 PM NETWORK DECEMBE v2013 WWW.PMI.ORG

"One child noted a reflection in the ceiling above the bed, which may have been scary to see from that vantage

point. We acted on that feedback and removed that reflection for them."

i- —Cina Altieri, Nemours Foundation, Wilmington, fe Delaware, USA

«tat

.Jλ

\

44_.

"We were designing a hospital, creating all trie

operational processes, starting to procure

equipment... all without the input of the key

physicians and clinicians who would actually be

using the space." —Susan Voltz, PMP, Nemours Children's Hospital

FAMILIES FIRST To gather feedback from hospital users, the team created an advisory council of

patients and parents. Design choices were then presented to the members at an

off-site preview center with inpatient and outpatient rooms and an emergency

department. Children tested several mattress choices, for example—allowing

the team to gauge preferences without disrupting the project timeline.

"Because we were giving them options versus allowing

them to redesign the room, it didn't affect the schedule.

Instead, it allowed us to gather input that would make fami-

lies more comfortable in the room," says Susan Voltz, PMP,

senior director, strategy and project management, Nemours

Children's Hospital.

Those discussions fueled the look, feel and function of

the facility, from the paint colors to the furniture. "One

child noted a reflection in the ceiling above the bed, which

may have been scary to see from that vantage point. We

acted on that feedback and removed that reflection for

them," says Gina Altieri, vice president, corporate services,

Nemours Foundation, Wilmington, Delaware, USA, the

not-for-profit behind the project.

The team also used the center to generate excitement and answer questions

about the project with the general public. More than 3,800 visitors toured the

center before the hospital's ribbon-cutting ceremony in October 2012.

PM NETWORK DECEMBER 2013 WWW.PMI.ORC

STAFFING SURGE

In 2012, the final year of the project, Nemours hired 700 physicians and

nurses vetted by executives and members of the family advisory council.

The staff surge had been anticipated since the project's launch, but there

viias prep work to be done. "We had several hundred new physicians, surgeons

and nurses who would be going through the Florida licensing board, and we

did not want to overwhelm the board," says

Ms. Voltz.

The team assigned three associates to

expedite licensing issues: one built relation-

ships with state agencies, a second assisted

out-of-state physician hires, and a third

aided nursing hires.

The project team also appointed three phy-

sician liaisons to accompany the new hires on

more than 3,275 visits to 510 local practices.

These introductions allowed the new hospital

staff to build relationships with the physicians

who would refer patients to Nemours.

KEEPING CHANGE IN CHECK While stakeholder management helped the

team shape project scope, change man-

agement kept scope from creeping out of

control—especially when it came time to

buy equipment.

The team had created its original US$32

million equipment list back in 2008. But

two years later, when the team was ready to

order the 9,000 items from the list, the rap-

idly changing nature of medical technology

meant many of the desired pieces no longer

fit the spaces they were designed for.

Project leaders called together stakehold-

ers from across the team, from the con-

struction manager to purchasing experts,

for an equipment summit. Every stake-

holder weighed in. "Our materials manage-

ment department knew what items they

could get from vendors below list price if

they negotiated correctly, and our con-

struction team showed us where we could

modify interior walls and where we could

not," says Ms. Voltz.

From that summit, the project team cre-

ated a tightly controlled change-control pro-

cess to vet requested equipment changes.

"You've got processes that you think are going to work, but you haven't had a chance to test yet. So the question becomes, 'How do you bring all that together and test it before you're actually there taking care of real patients?"'

—Roger Oxendale, Nemours Children's Hospital, Orlando, Florida, USA

DECEMBER 2013 PM NETWORK 5 5

CRITICAL CARE PATH

Nemours Children's Hospital receives

final state approval

Construction begins-

November2010: Hospital operations

project planning begins

April-August 2012: More than 700 new associates hired and

trained

Project launches

Design work begins

The project team's change management practices not

only stopped equipment needs from breaking the budget

but also prevented stakeholder feedback from creating

scope creep.

StiU, changes were bound to happen. Because Nemours

didn't hire medical staff until months before the hospital's

scheduled opening, a critical stakeholder group had been

left out of the initial feedback loop.

"We were designing a hospital, creating all the opera-

tional processes, starting to procure equipment, procure

and install IT systems, go through regulatory processes,

designing space and creating space—all without the input

of the key physicians and clinicians who would actually be

using the space," says Ms. Voltz.

Each hire brought knowledge and expertise that could

change the scope of critical project components, such as

the medical equipment. Their requests might be worth-

while—but it was up to team members to make their case.

Under the change-control process, they were required to

fill out a document detailing the proposal, its reason and

the impact it would have on the project schedule.

An oversight committee of subject-matter experts,

including legal staff with extensive knowledge of the

health-care regulations of 32 state and federal agencies,

reviewed the requests to differentiate nice-to-haves from

must-haves. "The items that were included in must-haves

were anything that was required from a regulatory compli-

ance perspective or a patient safety issue," says Ms. Voltz.

If the equipment was a must-have, Nemours would buy

it. If it was simply a personal preference, the team pro-

posed a more cost-effective alternative. A group of nurses,

for example, submitted a change request to incorporate

wireless medication carts in patient rooms. Tbe proposed

change meant addressing IT integration issues, but ulti-

mately, it would improve patient safety, so it was approved.

A pathologist, on the other hand, submitted a request form

for a new software application to share lab information

among staff members. "The application that we had was

being used in the Delaware hospital and it wasn't causing

bad clinical care," says Ms. Voltz. Therefore, the change

was rejected.

To mitigate the risk that the oversight committee would

be inundated with last-minute requests, the project team created a shared docu-

ment designed to help new hires understand the rationale behind the chosen

equipment. The document tracked the history of the decision made and listed

the considerations taken in selecting a piece of equipment.

"At a certain point in the project, we had to show people that actually moving

a wall, for example, just isn't practical," says Ms. Voltz.

August 2010: Topping- out ceremony conducted

_ May 2011: Senior leadership team hired

. June 2012: Construction completed

October 2012: Hospital opens

3 6 PM NETWORK DECEMBER 2013 WWW.PMI.ORG

rHMÍ|n''•"?*•

ALL SYSTEMS CO

Because much of the hospital's technology would be brand-new, not all medi-

cal staff would be fully proficient in it when the doors opened. Properly training

staff—a core project requirement—meant more than simply explaining the

new equipment.

"YouVe got teams that have just gotten to know each other and work

together," says Mr. Oxendale. "You've got processes that you think are going to

work, but you haven't had a chance to test yet. So the question becomes, 'How

do you bring all that together and test it before you're actually there taking care

of real patients?'"

The answer: trial runs. In the weeks leading up to the hospital's opening,

the project team conducted simulations so staff could test-drive equipment

and processes in a variety of scenarios, from patient registration to medica-

tion administration.

"One thing we learned was people needed more training," says Ms. Altieri. Proj-

ect leaders formed a subcommittee to document training needs and then create

informational packets and additional educational opportunities.

On 22 October 2012, the 630,000-square-foot (58,529-square-meter), 137-

bed hospital opened—on time, within budget and ready to serve children and

their families on day one. "We were brought together for the sole purpose of

taking care of sick children," says Ms. Voltz. "It was extremely satisfying to see

it all pull together." PM

"We were brought together for the sole purpose of taking care of sick children. It was extremely satisfying to see it all pull together." —Susan Voltz, PMP

DECEMBER 2013 PM NETWORK 5 7

Copyright of PM Network is the property of Project Management Institute and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.