Site management and Organization

Introduction

The Royal Liverpool & Broadgreen University Hospitals by the NHS Trust is aimed to provide general
and special services including cancer services for Merseyside, Cheshire and beyond. In 2007-08 the
trust had a turnover of 342 million, treated 47,957 inpatients and 30,916 cases, and saw 571,299
outpatients and 126,127 emergency attendance. The service provided is critical for Liverpool,
however, the existing facility had several issues since it started working. The most critical were the fire
safety non-compliance and deteriorating engineering infrastructure, putting in risk the Trust service.

The Liverpool PCTs Strategic Commissioning plan 2009-14 drawn on a Joint Strategic needs
Assessment was produced with the City Council in 2008, confirming the strategic goals with
government policies in high quality care for all. To accomplish this goal, it was necessary that a new
hospital that comply with certain standards be built. The proposal for a new hospital is the result of:

Technical reports of the Royals physical state.

Disruption to patient care
Comparison of costs

The new infrastructure must have an impact on Liverpool, on the city regeneration. Also it will provide
employment and development for the health care of the area. The trust partners and stakeholders
recognize the social benefit. As a big project, all people related to the hospital including staff, partners,
public were consulted so they could been involved in the project.

This report presents the site management and organisational strategies of the project.

Strategic Framework

The Liverpool PCTs Strategic Commissioning Plan and the Royal Liverpool & Broadgreen Hospital the
Trust (RLBUHT) have important aims for A New Health Service for Liverpool.

Mission

Develop a new hospital that will provide 21st century healthcare services for the people of Liverpool

Objectives

Create a world class state of the art hospital for Liverpool

Improve facilities and service delivery
Improve health outcomes
Improve patient experience and satisfaction
Impact on wider society

Priority themes

As every construction project try to meet costs, time and quality objectives, the NHS board was
committed to offer benefits for Liverpool, as in the following priority themes:

Health, safety and security

Create employment and opportunities in the area
 Sustainability and development
Legacy

Delivery Strategy

The project is subjected by two important parties, the construction company, Carillion, and the client,
NHS. To deliver the project on time there were some relevant driving forces that have to be
accomplished. A delivery strategy for the organization of the project became necessary.

Highly visible public profile

Avoid repetition of issues from last hospital project
Deliver a functional hospital
Avoid conflicts of multiple companies involved
Preserve the reputation of NHS and the investors

The delivery strategy is based on certain objectives.

Getting the right people

Meeting the budget.
Nailing down the scope, programme, budget, and funding early and sticking to it.
Early and prompt decision making; saving time will save money.
Allowing delivery partners to deliver.
Active risk management from start to finish.
Transparency and pro-activity in internal and external communications.
Maintaining a collaborative approach

People and Delivery capability

The construction Company Carillion will deliver in certain amount of time the RLUH. The company
have a plan to ensure the leadership of all leaders in the project, guiding proactive works and safety
attitude in a consistent approach across the project. The goal is to inspire performance improvement.

Fig. 1 Top management organization

Early and prompt decision making

The investors mandated the construction company to ensure early planning to avoid cost overruns.
The aim of the program is to target completion in the shortest reasonable time with the vast majority
of works finished before the opening of the hospital.

It is important to complete the works in the dates required, the delay of the new structure could affect
local people in social services and health. An increase in delivery time will increase the projects
budget. For this reason, the use of project management tools and management software to control
decision in early stages was ensured.

Risk management

Internal and external issues can affect projects time. To deliver the hospital on time the Senior
Manager was saddled with the responsibility of anticipating and managing risk. It was important to
recognize the changing nature of risk in the project progress, the managers had a clear understanding
of possible issues and also planned contingency solutions. Some probable risk on the project include:

External influences on the scheme and PBR, PFI Policy, interest rates, inflation
Impact to/from Foundation Trust application
Failure of external stakeholders to agree and deliver works
Inability to achieve planned performance targets

Communications

The development of the hospital has many interested parties, therefore the communication between
them have to be clear and transparent. The NHS recognises the importance of public and staff opinion.
Every change in the project was communicated to all parties concerned so they can participate in the
project progress. Partnership between the local community, suppliers, decision makers and external
stakeholders was taken as key to the success of the project.

Also the managers regularly communicated the progress and project milestones to the hospital staff
and local community.

A wide range of mechanism used to communicate the work of the project include:

The Routine Project update report to the Trust Board circulated and discussed at the
monthly Clinical Directors and Senior Management meetings
Insight, the Trusts bimonthly magazine for staff and patients, which routinely includes a
page of news on the Project
The Projects newsletter, New Royal News, is distributed on the same basis as Insight with
10,000 copies issued to staff, GP practices, public areas and partner organisations, along with
interested individuals, local residents, community groups and companies on the Projects
database
Project notice boards are being established at both the Royal and Broadgreen sites
Leaflets were distributed to 1,500 homes within the Kensington Fields area as part of the pre
Outline Planning Application Consultation
 Fig 2 Reporting schedule

Programme organization

The overall organization of Carillion, NHS and other parties to drive the project is shown in the
following figure.

Fig. 3 Compliance structure

Roles of the partners

Client

As a client and sponsor for the construction programme, NHS and RLBUH team are responsible for
setting policy and ensuring that programme outcomes will be delivered on time. Specific
responsibilities included.

Defining the programme brief and project (baseline report and priority themes)
Managing stakeholders and monitoring programme delivery
Providing assurance to investors and other stakeholders that outcomes would be achieved
Approval of changes

Construction Company

Carillion is responsible for the delivery of the project to budget and required time. Its responsibilities
included.

Programme-managing the delivery of all infrastructure and venues

Management of supply chains
Progress reporting
Change control
Project delivery

The investors worked with the construction company, which is responsible for the delivery of the
project.

Site Management

The project from the beginning requires space management and organization. Projects time life might
consider for each stage different organization due to the construction progress, the space has to be in
order. The hospital does not have free space in the surroundings and the work area is limited.

Planning the organization area would reduce project issues. Tower cranes, concrete plants, materials
storage and unloaded areas have critical position for the project progress. Also, the planning will
improve the safety of construction workers, hospital staff, neighbours and university students.

Site Survey

Surveying the area at an early stage of the project was important to finding mistakes on drawings,
design restrictions, local restrictions, determine environmental issues and land contamination,
historical usage, etc. It is important to revise the historical usage of the land, some areas had other
usage in the past and during the project some contamination sources were found.

Setting up of Site Boundaries

To establish working areas, the project must have boundaries that separate the project from the
outside. This was important for the project progress to reduce disruptions from outside. The
boundaries also protected local people, as they could be harmed by machinery and construction
processes.

The project is between the University of Liverpool, Kensington neighbourhood, student

accommodations and other buildings. Carillion and NHS have a legal obligation to obtain an insurance
on the project. Hoarding and signage was ensured to meet given specifications for the safety of local
people and on site workers.

Fig 4 Overall site layout boarded with red marking

Site Offices and Provisions

The management team and work force were provided a suitable area for site offices. The right place
was provided to avoid changes of cabins locations and disruptions in the construction progress. The
best solution was to maintain them in the same place.

Adequate facilities for project workers will keep the workers welfare in high standards. This practice
encourage and sustain a good work ethic. Also the facilities should have some provisions, plenty of
space and a good environment for the required amount of people. Provisions as Wi-Fi, catering,
adequate changing rooms were provided, and the benefits were evident in the workers productivity.

Minimising Impact on Neighbours

The impact on neighbours from the project must be avoided. It was important to ensure construction
activities doesnt interfere with normal activities of university students and local neighbours, including
nearby roads. An analysis of the peaks hours of students and traffic stream was developed to avoid
delays, rout disruptions and possible accidents.

It was ideal to minimize short and long term impacts in the area. Possible negative effects would be
traffic disruption due to materials load, noise and vibration and tower crane works. Avoiding negative
effects of the project could prevent additional costs from damages.

Carillion has an important commitment to the local community, no matter how small. An example was
evident in some children complaining about 10 trees cut on the corner of the street. This led to several
children asking for reasons and Carillion had to provide answers to the questions.
Tower cranes

In the project Carillion installed 5 tower cranes in strategic zone to move materials. The company
requested permission from the local council and neighbours but some issues with the negotiation
restricted the crane works. In the tower crane 3 and 5 the radius of movement was limited due to
legal issues with some neighbours in the area. They did not allow to move loads above their buildings.
To ensure the cranes do not cross boundaries, they were restricted by software. The figure below
shows the tower crane distribution.

Fig 5 Tower cranes distribution

Site logistics

Organization on the site logistic is critical. The hospital has big amounts of materials that are going to
be used during the project. They will be carried as they are requested, needing space to be unloaded.
The storage of materials is another issue, big amounts cannot be kept in the working area. The space
will take construction at some point of the project life. Limited amounts of materials needed per time
could only therefore be requested. Also, Carillion were saddled the responsibility of managing the
goods that come for the Hospital especially special deliveries of liquid nitrogen and oxygen, which
could disrupt construction activities. The site logistic was organised to resolve this issues so as to avoid
delays, accidents and other negative impacts.

If the site is not in order, activities will be disrupted, and also, the environment will become an unsafe
and inefficient working site. The delivery of materials was carried out in small volumes, prior to the
start of the activities, in a Just in Time supply system. Delivery dates were planned to avoid delays on
site caused by a lack of materials.

Other issues related to the site logistic are the project and hospital deliveries that could affect the
traffic stream in the local area, Daulby Street and Pembroke Road. The traffic load should not be
interrupted. Then, the parking area for the hospital staff was also an issue, the number of cars which
were around 300 were relocated by Carillion.

Fig 6 Layout and logistic of moving staff car parks

On Site Work Culture

An adequate welfare of workers can encourage a culture of good work and ethic. This will improve
productivity, encourage healthy work consciousness and safety. Smart working was enhanced by
morning meetings, and explaining several advantages of a good work culture. This was also used to
discourage other workers to create a mess.

Other methods used to improve work cultures include providing a good quality offices and cabins,
ensuring the communications and involvement all parties including subcontractors, technicians, etc.
Ensuring engagement was important to ideas development and avoidance of work-related issues.

Conclusions

This key study analyse considerations that were undertaken for site management and project
organization in the new Royal Liverpool & Broadgreen University Hospitals.
This project has been challenging due to the nature of the site and complexity of it. The new
hospital is the new face of the Royal that had had many functional issues since its opening in
1978. Although the hospital was working, it was necessary to build a new hospital due to the
lack of compliances.
Effective site management was employed to avoid increase in the projects budget and also
to evade accidents with special hospital deliveries, project deliveries and traffic streams.