Part III: Managing the Build

Nov. 15, 2011
In hospitals today, resources (human, financial, technological, and other) as tight as ever. At the same time, hospital leaders are facing the need to build out to support burgeoning inpatient care, and many are turning increasingly toward specialized information technology solutions as they move forward on new construction projects nationwide.

In hospitals today, resources (human, financial, technological, and other) as tight as ever. At the same time, hospital leaders are facing the need to build out to support burgeoning inpatient care, and many are turning increasingly toward specialized information technology solutions as they move forward on new construction projects nationwide. With existing physical plants unable to support many of the newer technological needs, the planning for new construction, as well as updating of existing facilities, is becoming increasingly reliant on specialized construction planning tools.

One tool that is easing the pain is known as PMIS (Project Management Information Systems), project-specific applications that let hospitals manage the construction project effectively with detailed information and parameters on cost, schedule, resources and quality, while providing total visibility into cost and cash forecasts to avoid overruns or delays.

These project management information systems don't improve quality, reduce cost or keep a project on schedule in and of themselves; the detailed information they can provide, however, gives hospital executives the toolset to stay on track when building a new wing - or a new hospital.

Mike Boutet

One organization whose leaders are keeping its new build on track is Childrens Hospital of Los Angeles, affiliated with the USC Keck School of Medicine of the University of Southern California. Its new 460,000-square-foot inpatient facility is currently under construction and is expected to increase the hospital's ability to provide care for critically ill and injured children. Since opening in 1914, Childrens has grown to include 29 outpatient clinics and laboratories, its emergency department treats nearly 58,000 patients a year, and the hospital admits nearly 11,000 children. The hospital's most recent physical plant, built in 1964, was too small and old to meet these expanding demands.

Childrens brought in the Minneapolis-based Aspen Advisors to help work on the build and transition to a new site. Senior consultant Mike Boutet is managing critical parts of the project, including all the system applications. According to Boutet, though the hospital initially put together a Microsoft (Redmond, Wash.) Word-based “catalogue” for the project, it is about to move the project management onto Microsoft's Project Server 2007, an enterprise-level application that will allow Childrens to account for all its resources and tasks, integrate milestones, and send e-mails where necessary. It will be integrated with Microsoft Sharepoint and e-mail. “We'll use it for all the projects that we've identified with the costs,” says Boutet. “My team also put together a skills matrix to keep track of and identify the resources,” says Boutet, adding that Project Server 2007 will also be used for Childrens management to track the impact on internal resources. “It's being implemented as we build out the project,” he notes.

Identifying available project resources is key, says Boutet, to keeping a project on track and accounting for what the project teams are doing week by week, including how many hours are allocated to particular tasks. “There's no other way to find that out other than people bringing their pain points to their managers,” says Boutet. “This is a way to quantify that.”

Part of what makes the identification and tracking of project resources so critical is that it isn't possible to apply a cookie-cutter approach to new facility construction, say those who have managed new builds. “If you've seen one clinic, you've seen exactly that - one clinic,” says Rich Pollack, vice president and CIO of Virginia Commonwealth University Health System in Richmond. Pollack, who signed on as CIO in 2005, has become a major participant in the construction planning process for a new 15-story hospital-including in the area of staffing. “You have to set the right expectations among your staff,” he says. That also means making sure enough staff is available to work on the project.

To track staffing at Childrens, Boutet put together a skills matrix to manage the staffing changes and identify the status of available resources. “Any changes that need to be made are catalogued,” he says. “It's a way for management to track what is the impact on internal resources and to find out if we are short on external resources.”

Though staffing issues are often top of mind in capital projects, (especially these days, with implementation staff in short supply), keeping fiscal control over the project on all fronts is important - and there are technology tools to help manage that. One of these is the Ft. Lauderdale, Fla.-based e-Builder, which manages all aspects of a hospital projects while interfacing with key accounting systems such as Lawson Systems (St. Paul, Minn.)

And as a sign of the times, e-Builder recently teamed with the Atlanta-based group purchasing organization MedAssets to launch a construction portal that uses industry best practices in delivery of architectural design, contractor RFPs, and equipment planning.

These automated solutions could prove helpful in numerous project areas, say those who are using them; yet fundamentally, they remain tools, and as such, are only as good as the people using them. In that regard, Aspen Advisors' Boutet emphasizes that the fundamental issues are strategic - and revolve around overall approach, team leadership and clinical transformation. He also notes that the hospital industry remains somewhat behind other industries in terms of the use of IT to support project management for new construction, just as it lags behind other industries in the use of IT overall.


  • Hospital leaders are increasing making use of project management information systems (PMIS), which are built around documentation and communication of project-specific information.

  • PMIS solutions are being applied to the daunting challenge of managing the large volumes of information involved in new construction projects.

  • Project management tools usually utilize a portal.

  • These tools can interface with administrative systems for best effect.

  • CIOs and other senior executives emphasize that good leadership and execution are fundamental to success, and that automated project management tools are supports, not substitutes for good strategic planning and execution.

Boutet goes on to say that though most hospitals know all the standard best practices when it comes to building - things like starting early, having the right training and holding people accountable - he says the project management tools are really secondary when it comes to bringing home a successful project. “I've worked on many different hospitals and it's not really about the tools; the secret sauce is in the approach and the execution that overshadows the tools themselves and provides the value for the CIOs.” He says. “Don't let the tools run the project -it's still about the leadership and the execution of the project.”

Healthcare Informatics 2010 May;27(5):20-21

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