Building delays compounded Lady Cilento ICT budget blow-out
Significant delays in building and commissioning Brisbane's Lady Cilento Children's Hospital (LCCH) caused excessive workloads on ICT staff both during the build and at the time of practical completion, leading to a budget blow-out and reduced scope of integration, the final report into the commissioning of the hospital has found.
The report, released by Queensland Health Minister Cameron Dick yesterday, led to the resignation of the chair of the board of Children’s Health Queensland Hospital and Health Service (CHQ HHS) Susan Johnston last week and to the government and the opposition blaming each other for the problems outlined in the report, which found that a rush to open on the designated date had compromised the hospital's opening despite repeated warnings.
The report describes clinicians waiting around loading docks in the days before the opening, hoping that vital equipment would arrive on time, and that clinical equipment was late arriving, staff were still being hired in the days leading up to the opening, and that the phone system wasn’t working properly.
However, the report agreed with an earlier clinical review led by NSW chief paediatrician Les White that there were no serious adverse events that caused long-term harm on the day of the move or during the first two weeks of operation.
The hospital, first announced in 2006 following several recommendations over the years that a single tertiary paediatric facility be built to take the place of the Royal Children's Hospital (RCH) and the Mater Children's Hospital (MCH), had $40 million allocated to ICT infrastructure in its original budget in 2008-09.
No expensive clinical systems were envisioned, with the RCH's Cerner system installed as the medical record and the MCH scanning its paper records into the Cerner integrated electronic medical record (ieMR).
However, the original budget was subsequently revised to $54 million in 2010-11 and then blew out to $93 million in 2012-13 to accommodate private contractor spend and project scale, the report found.
This was caused by “continual delays and repeated revision of achieving forecast practical completion dates”, the report found, which resulted in the ICT testing and integration work needing to be administered within a significantly reduced timeframe.
“The achievement of Practical Completion on the 26th September 2014 and the opening date of the 29th November 2014, provided a significantly challenging environment for the commissioning of the ICT program,” the report found.
“The delivery and commissioning of the ICT program by the [LCCH project office] saw ICT staff undertaking excessive workloads to meet an agreed set of minimum requirements.
“The constraints associated with the capacity of the Health Services Information Agency (HSIA) to provide adequate resources, required the engagement of external contractors to assist with the completion of the ICT works, which affected the total spend.”
The ICT program was not helped by the nurse call system vendor going broke during the build, with a new, less integrated system having to be introduced instead.
There was also a problem with emergency department Wi-Fi handset numbers not being ready as close as three days prior to opening, which the report found had a “significant potential impact” on internal hospital communication capabilities and with the Queensland Ambulance Service.
“This issue was to be resolved prior to opening day, but should not have been a risk so late in the commissioning process,” it found.
Data integration and training
The report found that it was acknowledged in September, two months before the doors opened, that ICT works would need to continue afterwards. There were extensive data integration, convergence and information sharing requirements between the RCH and MCH, with data uploads to be completed on November 28 and reconciliation on December 12.
However, the late finalisation of the data uploads and the need for reconciliation processes “placed unnecessary risk of inaccurate and incomplete information” on the operational effectiveness of the LCCH.
Training on clinical and administrative systems was also affected as staff from both RCH and particularly MCH did not have adequate access to training and familiarisation.
“Significant delays in workforce recruitment, delays to the completion of building works and delays to the delivery and installation of equipment compounded the ICT commissioning requirements,” the report found.
“The ICT program was repeatedly challenged by limited access to areas for ICT works to enable testing, integration, training and user acceptance processes to be undertaken.
“On the day of opening of the LCCH, there were numerous staff, especially MCH staff, who were unfamiliar with a number of key Queensland Health applications and even more who were self reportedly less than proficient in their use.
“Again CHQ HHS compromised on their original plan and prioritised training on clinical applications rather than provide comprehensive training on all applications.”
The report details some lessons learned, including:
- that an ICT program of work is a significant project in itself, and must be appropriately governed, risk profiled, budgeted, resourced and managed
- changes to the ICT scope must be closely monitored along with milestones, risk and implications for health service operations
- clinical engagement and leadership in the ICT development, specification, design and implementation is key to enable ICT systems to meet the clinical needs of the hospital; and
- management of multiple vendors and contractors requires strong governance, effective performance monitoring capabilities and a consistent approach.
The report panel recommended that in future, Queensland Health use an integrated risk approach to ICT delivery in which the total weight of the combined risk, operations and interdependencies is appropriately assessed and managed.
It also recommended that they adhere to adequate commissioning timeframes, especially post practical completion, to enable the comprehensive integration of ICT systems and staff training and familiarisation with equipment, systems and processes.
Health Minister Cameron Dick said the review showed there was enough evidence in June and July last year to delay the November opening of the hospital.
“What the report found was that rushing the hospital opening put patient safety at risk,” Mr Dick said. “The fact that nothing adverse happened was due to the fantastic efforts of the staff.”
Mr Dick said that the purpose of the review had been to learn the lessons for the future and to ensure that when large health infrastructure projects in Queensland are commissioned they meet world’s best practice.
“We have another major hospital to commission on the Sunshine Coast next year,” he said. “The findings from this report will assist in delivering a successful opening.”
Opposition leader Lawrence Springborg, who was health minister at the time of the opening, told the Courier-Mail that he had relied on the advice of the health service board that the hospital was ready to open and that the report found no evidence of any political interference from him to open the hospital prematurely.
Instead, Mr Springborg blamed the problems on the former Beattie government's decision to build the hospital in the first place.
The report was carried out by Australian Commission on Safety and Quality in Health Care CEO Debora Picone, Health Consumers Queensland chairman Mark Tucker-Evans, and Ernst and Young Asia-Pacific health sector leader David Roberts.
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