WA Health Infrastructure Development

Process

This process is designed to ensure that infrastructure development is determined and driven by health service need. The process does not simply focus on the building and facility components of infrastructure development. It also takes into account the need to review working practices, capacity and demand, operational policies and workforce plans in order to ensure that infrastructure developments are successful in meeting the health service need they have been designed to address.

The following diagram illustrates the infrastructure development process and indicates key stages at which reviews and approval is required. Decisions to forward projects to DTF/ERC will be recommended by the Health Infrastructure Sub Committee (HISC), the peak decision making body at state level, once it is satisfied that the appropriate stages of the infrastructure development process have been met and business cases have been subject to rigorous evaluation and all components of the business case requirements have been met.

Although the process described in the below diagram is the expected path for all infrastructure projects, it is recognised that in exceptional circumstances there may be deviations from this path due to circumstances outside of Health’s direct control.

This process has been developed in line with the ‘Strategic Asset Management Framework’ policy published by the Department of Treasury and Finance.

Gateway Reviews

Gateway Reviews give HISC, SHEF and the Director General confidence that a project can progress successfully to the next stage. While the review process focuses on major asset investment projects, it can also be applied to projects that procure services, construction / property projects and ICT-enabled business change projects. The Gateway Review process ensures departmental asset investment is well spent, meets business and government’s strategic objectives and achieves value-for-money outcomes.

The Gateway Review process ensures:

appropriate skills and experience are deployed on the project
all project stakeholders fully understand the project status and the issues involved
more realistic time and cost targets for projects are achieved
the project is ready to progress to the next stage of development or implementation.

Some form of review should be conducted at each major decision point in a project’s lifecycle to determine how it is progressing. The sign off requirement for each stage will vary depending on the definition of the stage, key stakeholders and the value of the project.

For further information on the infrastructure development process and review stages, click on the box of interest.

A. Clinical Services Planning

Clinical services planning provides a global health services framework, including site role delineation and showing the service development path over time. Activities include:

Information and analysis
Review of bed needs
Initial global Clinical Framework including role delineation
Strategic resourcing analysis
Broad consultation
Clinical Services plan

The WA Clinical Services Framework 2005-2015 has been finalised following an intense period of consultation during which time a wealth of information, recommendations and suggestions were gathered, reviewed and used to inform the final decision-making process.

Significant elements of the final WA Health Clinical Services Framework 2005-2015 include:

Clear role delineation for each health service and care facility;
A description of the bed numbers planned for the metropolitan region;
Location of the central tertiary hospital site at the QEII Medical Centre;
New southern tertiary hospital to be developed as a collaborative initiative between Fremantle Hospital and Royal Perth Hospital;
Building up the general hospitals;
Investment in education and research;
A foreshadowing of work on models of care with a greater emphasis on prevention, primary care and providing care in the most appropriate setting; and
Advancement of country health service role delineation in alignment with metropolitan plans.

The WA Clinical Services Framework 2005-2015 along with information on the consultation process can be viewed at Clinical Services Framework 2005-2015 page.

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B. Program Planning

Key infrastructure needs arising from the WA Health Clinical Services Framework 2005-2015 have been incorporated into the 10-year capital investment plan. This plan is reviewed annually as part of the budget process, however, any changes or additions to the 10-year capital investment plan must be approved by the ERC.

Approvals for changes to the cost allocation or project scope listed within the 10-year plan require a submission which outlines the justification for the change and the cost variations. New projects to be included in the 10-year plan will require approval of a Project Concept (PDF 26KB).

A project concept should therefore be compiled for all projects that are not already listed on the capital investment plan. It may also be required for projects that are of a large scale, complex in nature and multi-staged (determined by the HISC on advice from the Infrastructure Consultant). The project concept must be presented in a way that provides key decision makers with all the relevant and most appropriate information upon which to base approval decisions.

Gateway Review 1 is only applicable in situations where the capital investment plan is to be revised or if the project is very large and multifaceted. The Gateway Review enables the HISC, the Director General and ERC to be satisfied that the business requirement has been adequately researched and fits within the department’s overall business strategy and/or whole-of-Government policies.

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Gateway Review 1 – Project Concept / Feasibility

The Project Concept, if required, needs to be provided to the HISC (via the Infrastructure Consultant) and the Director General for review and approval prior to submission to ERC and subsequent business case development.

Purpose of the Review

The purpose of this review is to:

Review the business need and identify whether a project or a program of projects.
Ensure the program or project is supported by users and stakeholders.
Ensure that a summary of potential options have been documented along with a summary of their perceived benefits and estimated costs (capital and recurrent).
Ensure that details for the next steps of developing the business case are described.
Enable financial provision to be made for the project.

Gateway Review 1 sign-off: ERC.

Gateway Review 1 sign-off: ERC

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C. Project Business Planning

All projects which have been included on the capital investment plan must be justified by a business case. Key components should include:

Local clinical plan based on global plan
Audits / studies of sites / existing facilities
Service options analysis and recurrent cost
Project definition plan
Master plan with facility options analysis and capital cost
Workforce plan
Operational policies
Risk analysis
Business case

The business case must detail the identified health service need and clearly demonstrate an assessment of a range of potential options. The expected outcomes and benefits the preferred option will deliver for a specific financial investment should be outlined.

The business case sets the parameters for the delivery of a project and is used as a point of reference throughout the life of a project and at key decision making points during its implementation. The business case also acts as a benchmark against which the project is reviewed post-implementation to evaluate whether it has successfully achieved the anticipated outcomes and benefits.

Prior to proceeding to Gateway Review 2, the business case needs to be endorsed by the Area Chief Executive, the Infrastructure Consultant and the Health Infrastructure Sub Committee (HISC). For further guidance on business case development refer to the Business Case Guidelines (PDF 662KB).

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Gateway Review 2 – Business Case

Although approved on the 10-year capital investment plan, business cases need to be presented to ERC for approval in order for the funding to be released for facility planning and implementation. All business cases require approval by the Area Chief Executive and HISC prior to formal submission to the ERC.

Purpose of the Review

Confirm that the business case is robust (i.e. it meets the business need, is affordable and achievable, with appropriate options explored and likely to achieve value for money).
Ensure a clear demonstration of how the project fits within the strategic direction of Health and contributes towards efficiencies anticipated by the Health Reform Committee, which should result an overall operating growth target of 5.5%.
Confirm that potential options have been identified and analysed and appropriate expert advice has been obtained as necessary.
Ensure major risks have been identified and risk management plans have been developed.
Ensure adequate consideration of governance, in particular the establishment of a rigorous monitoring framework with reliable performance indicators to ensure that efficiency reforms are achieved and expected benefits realised.
Satisfactory coverage of the costs and benefits of each option, in particular the issue of cost completeness and completion of lifecycle costing where appropriate.
Confirm that the scope is realistic, clear and unambiguous.

Gateway Review 2 sign-off:

Projects $10 million and under – considered as part of the Treasurer’s Delegation process. This may enable the DOH to commence action on projects prior to receipt of ERC approval (This will be determined on a case by case basis – for advice contact the Infrastructure Unit).
Projects over $10 million – requires ERC approval.

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D. Project Facility Planning

This step includes the development of facility design and documentation, including:

Project Definition Plan (for capital works with a value over $5M)

After the business case has gained approval from Government, Project Definition Plans (PDP) are required to be prepared for the purpose of communicating to stakeholders a clear understanding of a project’s desired objectives and a plan of its implementation. It establishes the agreed parameters that the design team require, in order to formulate the most suitable asset solution to meet the agency’s service delivery requirements.

Each PDP must be prepared to a level of detail that is appropriate to the value and risk profile of the project.

The PDP for building works must be submitted to the Department of Housing and Works before a project can proceed to the Delivery phase. Endorsement by the Department of Hosing and Works, to ensure the project scope and budget are aligned, will be required prior to capital funds being released to the agency by the Department of Treasury and Finance.

Schematic design

The Schematic Design includes the preparation of preliminary sketch designs, plans and cost estimates and is to be in accordance with the PDP brief.
The Project Control Group and DHW Appointed Project Manager’s approval must be obtained in all building and infrastructure services aspects including:

functional relationships, agreed cost benchmark, physical form (aesthetics), buildability and compliance with the Australasian Health Facility Guidelines, WA Health Facility Guidelines for Engineering Services 2006, WA Facility Guidelines for Infection Control 2006, Building Code of Australia standards, ICT standards, codes and other prevailing standards relating to Occupational & Safety and Disability Accessibility issues

preliminary detailed time programme

preliminary cost plan including elemental cos

Design Development

This is the next phase of design where the schematic design drawings are developed further as a basis for preparing working drawings / contract documentation. The functional aspects are checked and reflected in the developed drawings.
The budget and cost estimates in terms of the agreed brief must be matched and agreed by the PCG before proceeding to the next stage.

Contract documentation

The preparation of tender documentation based on the outcome of the design development stage including architectural, engineering and other documentation components with sufficient quantity, quality, details, consistencies and coordination across all consultants so as to obtain a fair and equitable competitive tender.

A final crosscheck on the cost estimate to match the approved budget before going to tender is essential. Any countenanced deviation from the Budget or from the Brief, must be formally confirmed and approved by the Project Control Group before proceeding to Tender.

Transition planning

The process that will be undertaken to ensure smooth transition of services must be outlined. This includes not only the cost of transition and the management of these, but also a plan for managing patient flows, communication to patients, staff and other stakeholders, workforce transition, ICT requirements, transfer of recurrent and capital funding between Area Health Services and facilities and other project specific issues.

The schematic and development design will need to be signed off by the Area Chief Executive to ensure they have been appropriately undertaken to inform the content of the contract documentation. He/she will be expected to continually review recurrent and capital costs at all stages of facility planning and resolve any issues within the approved scope, cost, time and quality parameters.

Throughout each of the above stages from PDP to Contract Documentation, the Department of Housing and Works or their representative who is the appointed Project Manager for DOH projects and the Principal’s representative, will advise on the Government procurement policies and appointment of consultants and statutory requirements concerning native title, heritage and site contamination.

The DHW Project Manager will support the Project Director, and will work closely with the consultancy team on day-to-day management and coordination of the project from PDP stage to final completion of the project.

Only the Minister for Housing and Works can call tenders and award contracts for public works in accordance with the 1902 Public Works Act. This power does not reside with the Minister for Health. The Area Chief Executive must, therefore, ensure that the Department of Housing and Works (DHW) are involved in facility development planning at the earliest opportunity.

The facility development planning stage culminates in the production of contract documentation in preparation for the tendering of building and construction work.

In addition, the Area Chief Executive must also ensure that developments are aligned to government policy, for example in relation to infrastructure planning, sustainability, regional development and environmental protection. The DHW will provide advice on government policy and statutory requirements concerning native title, heritage and site contamination.

The building and facility aspects of the new development are only one factor in determining the success of the project to meet its objectives. Recruitment, retention, workforce development, redirection of resources, service redesign and the revision of operational policies will all impact on the success of the new project. Therefore the Area Chief Executive is responsible for ensuring these factors are appropriately planned, risks to implementation identified and contingency plans developed. This will be achieved through appropriate methods of communication, consultation and organisational engagement across the Area Health Service on all aspects of infrastructure development.

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Gateway Review 3 – Pre Tender Assessment

Prior to tenders being called and contracts being awarded, the Area Chief Executive (on advice from the Area Infrastructure Steering Group) confirms with the Infrastructure Consultant that the documentation is within the approved budget allocation.

Purpose of the Review

Ensure that schematic and development design has been undertaken to inform the content of contract documentation.
Ensure that developments are aligned to government policy (i.e. Infrastructure planning, sustainability, regional development and environmental protection).
Ensure that contract documentation is in line with the business case direction.
Ensure input has been received from the Department of Housing and Works and agreement has been made to manage the tendering process.
Confirm that transition planning for the new facility has commenced.

Gateway Review 3 sign-off: Infrastructure Consultant.

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E. Facility Implementation

This stage of the infrastructure development process includes tendering, construction and commissioning of the new facility. The Area Chief Executive is responsible for ensuring that these are conducted with due process and as per statutory requirements and in accordance with the approved scope, time, cost and quality of the project.

The Area Chief Executive will be expected to continually review recurrent and capital costs during these stages and resolve any issues within the approved scope, cost, time and quality parameters.

During this stage, the Area Chief Executive must ensure:

that the Department of Housing and Works manages the procurement process as required by statute and supports the Area Health Service during the construction and commissioning phases of the project.
the availability of appropriate resources to support the transition to the new facility.
there is a change management strategy in place to support the successful implementation of the new facility. This will involve planning for changes in staffing structures, working practices, the commissioning of new facilities and equipment, revising policies and procedures and undertaking necessary training and education to support the operation of the new facility.
that the impact of the transition to a new facility on service provision is clearly identified and understood and disruption is minimised. The transition plan will need to be communicated to staff and other key stakeholders, including patients and their relatives where necessary.

After transition to the new facility, the Department of Housing and Works will undertake an end of defects liability review 12 months after the facility is completed.

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Gateway Review 4 – Readiness for Service

This review will be signed off by the Area Chief Executive, based on advice provided by the Project Director/Manager.

Purpose of the Review

Confirm that commissioning plans have been developed, and that they are in line with the organisation’s policy and industry best practice.
Ensure that the commissioning plans identify and address key areas, such as:
- strategic plans for the organisation that cover the commissioning period
- building is fit for purpose (i.e. utilities, emergency and communication systems)
- occupational health and safety
- business continuity systems and business integration
- change management
Check that the commissioning plans are affordable and robust.
Confirm risks associated with the commissioning plans are identified.
Check that the current phase of the contract is properly completed.
Ensure contractual arrangements are up to date.
Check that the business case is still valid and unaffected by internal and external events and that the original projected business benefit is likely to be achieved.
Ensure processes and procedures are in place to ensure the long-term success of the project.
Confirm that all necessary testing (e.g. commissioning of buildings, business integration and user acceptance testing) is done to the end-user’s satisfaction and that the Project Director is ready to approve implementation.
Check that there are feasible and tested contingency and reversion arrangements.
Ensure that all ongoing risks and issues are managed effectively and do not threaten implementation.
Evaluate the risk of proceeding with the implementation, and resolve any outstanding issues or ensure plans for risk management are in situ.
Confirm the business has the necessary resources and is ready to implement the services and the business change.
Confirm that client and supplier implementation plans are still achievable.
Confirm that there are management and organisational controls to manage the project through implementation and operation.
Confirm that all parties have agreed plans for training, communication, rollout, production, release and support as required.
Confirm that defects or incomplete works are identified and recorded.
Check that lessons for future projects are identified and recorded.

Gateway Review 4 sign-off: Area Chief Executive.

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F. Health Service Operation

The Area Chief Executive will be responsible for ensuring the transition to the new facility is successful and the objectives of the development are achieved. The transition planning undertaken from the business planning stage through to facility development implementation will be key to the successful operation of the health service.

An evaluation of the infrastructure project should take place following its completion. This review can be multifaceted, focusing on project process as well as physical facilities and health service operation.

The Area Chief Executive should ensure that the infrastructure development process for specific projects is reviewed and any lessons learnt incorporated into the planning and development process for future projects and works in progress. A formal post occupancy evaluation may be commissioned to identify improvements in efficiency and effectiveness that have been achieved via changes in design or operation of the facility.

The Area Chief Executive will be responsible for the on-going management and maintenance of the new facility and will need to ensure that appropriate resources are available for this purpose. This will involve:

Implementing policies, standards and guidelines in accordance with DOH requirements and in response to changes in legislation and government policy.
Asset maintenance and review to support changes in health care practice.
Develop and implement risk management strategies.

The Area Chief Executive will also need to ensure that the aspects of the project associated with the recurrent cost model are managed and maintained as required. This will require ongoing monitoring of the service delivery model and workforce plan and the introduction of modifications were required to ensure the objectives of the project are continually achieved.

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Gateway Review 5 – Benefits Evaluation

The Area Chief Executive is responsible for evaluating the project following its completion. The extent to which projects achieve benefits outlined in the business case submission should be evaluated commensurate with the value of the project. Major projects (with an estimated cost of more than $5 million) should be subject to the rigorous evaluation methodology described in the DTF ‘Project Evaluation Guidelines’ (PDF). Projects with a value of less than $5 million may be subject to a less rigorous evaluation

All evaluation reports should be provided to HISC for information.

Purpose of the Review

Assess the extent to which the project has met the identified health service need as outlined in the business case.
Confirming the total project costs aligns with costs outlined in the business case.
Assessment of the extent to which the project aligns with the DOH strategic frameworks.
Ensure lessons learnt are documented for use with future planning and development processes.
Monitor ongoing operational costs and assess additional resource requirements.

Gateway Review 5 sign-off: Area Chief Executive.

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G. Project Completion

This stage signals the end of the procurement contract.

On completion of the project, a Project Completion Form (PDF 167KB) needs to be completed and submitted to the Health Infrastructure Sub Committee for information.

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