Planning for Works as part of Health Facilities Management

Post date: Oct 18, 2009 2:43:41 AM

INTRODUCTION

Health Facilities has been one of the most important facilities in nation building and the Government of Malaysia have spent substantially where as for the 9th Malaysia Plan, a total of RM10.7 Billion has been allocated to construct 132 health clinics. Aside from that, the Ministry of Health (MOH) is getting their three new hospitals and three more replacement hospitals which cost the Government up to RM2 Billion. In addition to all these, the ministry had allocated RM14.8 billion which includes RM11.2 billion as management and RM3.6 billion as development expenditure. (The New Straits Times, 15th January 2010).

The Government of Malaysia is aware of the requirement of WHO which indicates that, a country should spend a minimum of 5-6% of GDP on healthcare whilst the total healthcare expenditure of the world is around 7.9% of world GDP in 1997.

Based on WHO ranking, Malaysia spends around 4.40% of its GDP in 2007. However, the total general government expenditure on health out of the total government expenditure in 2007 was 6.90%.

Based on Health Fact 2008 published by MOH, the total Healthcare budget was RM 12,901,865,000.00 which is 7.29% of the National Budget. (4.70% spent on Health as a percentage of GDP).

In 1996, the privatization of other services including facilities maintenance has skyrocketed from RM140 Million to RM450 Million at the following year.

Based to MOH Strategic Plan 2006-2010, one of the strategic goals would be to enhance the healthcare delivery system and underlined to increase the use of evidence through research to support all levels of decision making as part of their strategies. This makes it a challenge for MOH where there are 130 Hospitals throughout the nation wide which consist of 33,004 beds.

Therefore, it has been the Government’s intention to provide health services for the countrymen and it has been the main aim for the facility management to avoid delay or stoppage in delivering their services.

PLANNING FOR REHABILITATION WORKS WITHIN A HOSPITAL

The rehabilitation works are part of the scope of works for the facilities maintenance department to ensure the continuity of the facility in undertaking/providing services. Such scope of work is not substantial for newly opened or operated facilities but it would be one of the main challenges in managing the older facility which had lapse their serviceability period. In conjunction to periodical expansion via replacement hospitals or upgrading through new construction within the vicinity; the only choice left would be to perform addition, rectification, rejuvenation or rehabilitation works on the facilities.

The rehabilitation works would vary depending very much on the current requirements, quantum of defects or the forecast of possibilities. The options are closely related to sustainability period, cost and quality in providing remedies. This also depends very much on appraisal and recommendation of the forensics and/or specialist.

Regardless of the type of rehabilitation works which need to be performed on the facility, the key issue of maintenance or rehabilitation would be the impact of such works toward the operation of the hospital. Bear in mind that such work need to be executed with the hospital still operating in various or at most departments. In regards to this factor, a well working plan is compulsory so that it would not cease or halt any operation of the hospital and it must correspond to the Standard Operation Procedures (SOP) of the hospital/facility. It is highly recommended that work sequences and timing should be well programmed to mitigate risks including those which are categorized as intangible (it is a public place and it also governed by humans with behavioral patents). This is due to the main factor that hospital is the main facility for the Health Ministry (which carries the highest financial weightage and expenditure in the service sector), precautions and provisions should be coupled with clear considerations.

In determining the appropriate work program of any work at health facilities and/or hospitals, the main issue to be taken care would be the efficiency of the hospital during execution of the work(s). The efficiency of the hospital and their management would be determined (aside from the key indicators for health status) through the Length of Stay of every patient.

This should be reviewed in the light of the Value Stream Mapping and their data. This will ensure that work will not disturb the process or prolong the processes. This will contribute toward the shifting of value from the initial process sigma thus increase in Length of Stay. Therefore it would be best to collaborate with the facility manager to maintain the process sigma if not allow for small deviation from the initial value.

There are many ways in maintaining the processes which will ease the work planning at certain department or location. First is by reviewing the average visits per shift graph to make sure the lowest traffic (lowest point in the graph) in visits. This is a provision where the cycle will not affect the processes as the patients per cycle will not be affected. Aside from utilizing shift graph in achieving the target completion and work schedule, the next particular data which would assist would be the time and day of patient visit. Exploit the lowest traffic by selecting the day which indicates the ‘valley’ of the average graph and also maximized work productivity during at ‘valley’ hours of each location.

It is recommended that planning engineers should leverage daily labor during ‘peak’ hours to distribute the possibilities of prolonging the initial/set quality and critical processes of the whole facilities. Therefore the, entry of resources should start 2 hours (very much depending on resources behavioral) before reaching the ‘valley’ hours because this is a given allowance for multi-tasking resources to familiarize and gradual increase in productivity.

The manipulation of the ‘valley’ side of visit based on day should be the duly general guide in established the best work program in relation to the contract or work execution. This will also contribute less toward the shifting of the process sigma. At these ‘valley’ days, any delay in the facility’s processes will not be highly affected as it is at the low side. Nevertheless, in mitigating delays of the whole facility processes in relation to unavoidable work(s), it is would be the best policy to negotiate with Facility Manager or/and the management itself. It is reckoned that, regardless of the capability of the planning engineer and contractor, it is inevitable to reduce certain delays caused by certain activities; discussion with facility management would assist in reducing the possibilities of prolonging the processes at the facility.

As known to many, the process sigma is a calculation based on resources optimization; therefore to ensure the yield of the whole calculation will not shift, another method of optimization involving the intervention of the facility management would be highly recommended. The increase of process resources will also contribute toward maintaining the process sigma and yield from shifting as earlier set. The time allocation as shown in Value Stream Mapping will revert back as usual thus will maintain the whole process sigma.

For example, a planned activity will increase the time lost in treatment or diagnosis. It would be wise to request for the facility to allocate extra resources in registration, triage and recording prior to evaluation and treatment. Since the mapping is a series of processes, reduction in time at the earlier processes will balance back the whole Length of Stay thus will ensure the process sigma remain unchanged.

Pushing through with conventional planning would not only a recipe for delay; it will start to initiate other problems and complication which could be unforeseen by the contractor. It is advisable to avoid intangible risks by adhering working trend/culture/patent at the hospital to avoid complication(s). Never ever try to steer progress through conventional method which is by emphasizing heavy weightage activities instead stress on hourly leverage of resources and pre-planned preparation.

THE UNKNOWN ASSISTANCE AND INTERVENTION

Being ignorant as a contractor is proven to be futile. Not known to many contractors, they are also holding the golden key in solving the whole problem and render solution for the facility. The Contract Document holds the ultimate procedures in mitigating risk or possibilities which may affect the whole processes of the facility. Therefore it will be wise of the contractor to take advantage of such provision within his capability to integrate it in his execution.

It would be easy if the Contract spelled out the Work as a Design and Build Work as it could be made available during the preparation of Preliminary Detail Abstract (PDA) prior to price negotiation. Procedures and methods in mitigating risk(s) and possibilities of event that would contribute to time shall be spelled out in details at the Preliminary and General Section. It is kind off tricky for those who are getting Works through tender process and bind a Contract in PWD203A format. There are steps and techniques in acquiring it to absorb in the contract during the pre-tender processes.

Aside from that, a tactical modus should be executed at post tender stage which will gradually enable the contractor to assist and facilitate the facility managements at the receiving end in order to mitigate possibilities of delay of the project or increasing the Length of Stay and/or slump in facility’s efficiency.

The Clauses of Contract PWD203A to be emphasize and related to this modus, viz:-

· CoC 10 Obligation of Contractor

· CoC 11 Inspection of Site

· CoC 22 Design

· CoC 24 Variations

· CoC 25 Valuation of Variation

· CoC 43 Delay and Extension of Time

· CoC 44 Claims for Loss and Expense

· CoC 45 Investigation by the Government

· CoC 52 Termination on National Interest

· CoC 76 General Duties and Performance Standard

For more and detailed explanations and planning, please contact the MCS Principal.