- Over the past ten years, the Government of B.C. has invested more than $7 billion in capital projects at hospitals, care homes and other health facilities throughout the province.
- These projects have ranged from small investments such as electrical system improvements and medical equipment purchases, to major hospital expansions or replacement projects.
- Active major capital projects include:
- At Surrey Memorial Hospital, a new, multi-storey building accommodating an expanded, emergency department, neonatal intensive care unit and additional inpatient beds. The project is valued at approximately $500 million and will be complete in 2014.
- At Fort. St John, a new 55-bed hospital and 123-bed residential care facility replacing older, outdated facilities. The new project is valued at approximately $300 million and will be open for patients in 2012.
- The Interior Heart and Surgical Centre in Kelowna, a new inpatient surgical and cardiac care facility at Kelowna General Hospital. The project is valued at approximately $400 million and the overall project will be complete in 2017.
- A major capital project - such as the redevelopment of St. Paul's Hospital - is a large undertaking that takes a series of planning steps to ensure the facility is designed appropriately; is tendered and constructed for the least cost possible; and most importantly, is scheduled properly to ensure the continuity of health care at the existing hospital is maintained during the construction period.
- Redevelopment at hospitals is typically guided by an overall site master development plan. Creating a master plan involves extensive consultation with health care providers, as well as with the public and the local municipality to set out a "road map" of how a hospital may change over a period of 15 to 20 years in the future.
- Out of a hospital master plan emerge individual capital projects which require detailed planning to properly define the size of a project, it's cost to construct and operate, the schedule of development, and the plan to construct the building - particularly if it is on a tight hospital site where construction might have to be done in phases to maintain health care services. Individual projects are developed in the following steps:
STEP 1 - CONCEPT PLAN
- This lays out the general plan for redevelopment for a specific project. In the case of St. Paul's it will define the buildings that will be demolished, those that will be built, and those that will be upgraded.
- Government is presently working with Providence Health Care and the Vancouver Coastal Health Authority to update the concept plan to address a number of items such as confirmation of patient demand projections which impacts how much building is built; scope of clinical programs and services; scope of work for renovations; verification of project construction phasing plan and associated capital cost estimates; and refinement of the project schedule.
- In the special case of St. Paul's - an urban hospital, on a small footprint in a highly developed area in downtown Vancouver - there will also be planning for how to maintain care and services while the work is undergoing.
- In the case of St Paul's, a draft concept plan has been developed but requires updating and confirmation of the plan details with the Ministry. This work is happening now.
- Once government completes the review and approval of the Concept Plan - the Ministry will give the green light to move forward with the Business Plan.
STEP 2 - BUSINESS PLAN
- The business plan stage expands substantially on the work started in the concept plan. In addition, it provides more detail on:
- The spaces required in the new facility and how they are grouped for efficient service
- An initial (indicative) design of the new facility to ensure it fits on the site in the way expected from the concept plan.
- A more detailed estimate of the capital cost and how the project will be financed.
- A risk management plan
- A detailed development schedule
- Options for tendering and constructing the project in order to allocate project risks to the parties (either contractor or hospital) best suited to manage the risks.
- A more detailed estimate of operating costs
- Staffing and human resource planning
- A detailed communications plan to ensure stakeholders understand how the project will develop and how they can provide input and receive feedback.
- The business plan is an extensive document and forms the basis for future decisions that commit significant amounts of public funding.
- It is expected the detailed business plan for St. Paul's Hospital will be completed by 2014.
- Once the Business Plan has been reviewed and a decision has been made by government, the Ministry will provide the approval for the project to begin the next step - Project Procurement.
STEP 3 - PROJECT PROCUREMENT
- Given the size and complexity of the St Paul's Redevelopment, government will consider various procurement options such as Design, Build, Finance, and Maintain along with more traditional approaches to ensure that the Province gets the best value for money.
- The project development is governed by a Project Board consisting of senior executives from the Ministry of Health, Providence Health Care, Vancouver Coastal Health Authority, Partnerships BC and the Ministry of Transportation and Infrastructure. The Project Board is accountable to the Ministry of Health to ensure the project is properly scoped, estimated and scheduled.
- The detailed work of the project planning team is lead by a project director who reports to the Project Board.
- The project procurement process involves a series of consecutive pieces of work to identify the contractor to build the facility - the sequence of this work is as follows:
- Request for Qualifications (RFQ) - this stage is a general notification for companies interested in entering the request for proposals process to submit their qualifications for consideration and shortlisting. These companies are typically large firms that can organize the financing, design, construction and facility maintenance of complex hospital buildings. Submissions are evaluated by the project planning team and a shortlist of the three most qualified proponents are identified for approval of the project board.
- During the RFQ stage, the project planning team finalizes a detailed set of performance specifications from which proponents will develop their bids.
- Request for Proposals (RFP) - this stage involves the shortlisted proponents preparing their proposals. Proposals are developed based on detailed performance specifications prepared by the project planning team. RFP submissions are then evaluated fairly and a preferred proponent is identified and recommended to the project board. The RFP process is not always a low bid situation. While price is a very important part of the evaluation, the winning proponent will have the best mix of design and other attributes.,
- Preferred Proponent, Final Approval & Financial Close - this stage involves the Providence Health Care negotiating the finer details of the project agreement with the preferred proponent. Once the project agreement details are settled, the project board reviews and approves the agreement and forwards to the Ministry and the Province for finaldecision. Assuming approval is granted, the project proceeds to Financial Close - the day that contracts are signed between Providence Health Care and the Preferred Proponent.
- The procurement phase typically can last up to 12 months however, once completed, construction activity starts on site within a few weeks.
- Construction Phase - Final design and construction of the facilities begins immediately after Financial Close
STEP 4 - CONSTRUCTION
- After the contracts are signed with the Preferred Proponent, the final design and construction work begins and goes at a rapid pace.
- In the case of St. Paul's Hospital - there are significant challenges due to the age of the facility, its downtown location, and the work that will be required to enhance seismic stability.
- It is typical for major hospitals to be constructed in phases, or stages, to ensure the continuity of health care services. In the case of St. Paul's Hospital, the redevelopment project is likely to involve demolition of an older building, construction of a new facility, and once completed, renovation of interior areas of the existing hospital buildings.
- The entire project will take a number of years to fully complete due to the phasing of the work necessary to maintain the delivery of health care services in the existing hospital.
- This process is similar for most new health facilities - such as the redevelopment of Royal Columbian Hospital in New Westminster and the Kelowna General Hospital - though each has their own characteristics, like location, available land and community interests that need to be taken into account.
- Some may be frustrated with the amount of planning work required and may simply want the government to get on with constructing the new facility. Hospitals are highly complex facilities with many interconnected systems, services and equipment to ensure patient care is appropriately and safely delivered. While there is a lot of planning work required, it is necessary to undertake the work properly to ensure the new hospital facilities are designed and built correctly and work properly each and every time they are required.
AN EXAMPLE OF A CAPITAL PROJECT TIMELINE - SURREY MEMORIAL HOSPITAL
- Approved - December 2005 - however this was a broad strategy that recommended first proceeding with the Jim Pattison Outpatient & Surgery Centre (opened for patients in 2011) then followed by the Surrey emergency depart & critical care tower.
- Start - Early 2008
- Approved - December 2008
- Start - February 2009
- Complete - December 2010
- Start - January 2011
- Emergency Department open for patients - September 2013
- Full building completion - June 2014
AN EXAMPLE OF A CAPITAL PROJECT TIMELINE - KELOWNA GENERAL HOSPITAL - CENTENNIAL BUILDING
- Approved - May 2006
- Start - June 2006
- Approved - May 2007
- Start - June 2007
- Complete - July 2008
- Start - August 2008 (soil pre-loading on site)
- Building construction - March 2009
- UBC Med School component open - December 2009
- Full building completion - May 2012
Photo of St. Paul's Hospital:
Find out how government is ensuring B.C. provides world class health care today, tomorrow and for future generations by seeing where health capital projects are underway and completed. Visit health.gov.bc.ca/cpa/mediasite/building-patient-care/
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