How to open a new hospital

Successes and lessons at

North Bristol NHS Trust

Ian Triplow

Associate Director of Programme Management Office

Overview

This presentation will provide an overview of the learning from the building, commissioning, move and opening of the new £432m Brunel building at Southmead Hospital, North Bristol NHS Trust.

On 28th May 2014, the Brunel building – with 800 beds, 24 operating theatres, over 7000 staff, costing £432m – was declared fully open. This was the culmination of almost a decade of design, building, planning and business transformation at North Bristol NHS Trust, and a final 3 months spent commissioning the new building, installing over £12m of equipment and finally moving all the services (and 540 inpatients) to their new home.

This talk will present a summary of the final report from the move & transformation programme which oversaw the final few months from February to May 2014. This will include an overview of the journey that the organisation went through to build and open the Brunel building, lessons learned along the way, and changes that were made to project and programme governance through its timeline. Why a single SRO is never sufficient

What to do with gateway review outcomes

How to maintain control but also empower on an organisation-wide scale

Background

Background - NHS

Since its launch in 1948, the NHS has grown to become

the world’s largest publicly funded health service. It is

also one of the most efficient, most egalitarian and most

comprehensive.

The NHS was born out of a long-held ideal that good

healthcare should be available to all, regardless of

wealth – a principle that remains at its core.

Background – Acute Hospitals

Formal definition

Acute care may require a stay in a hospital emergency

department, ambulatory surgery centre, urgent care centre or

other short-term stay facility, along with the assistance of

diagnostic services, surgery, or follow-up outpatient care in the

community

Informal

It’s a place you wish not to go to but need to know its there for

you to keep you healthy from age 0 to 100+

It’s the specialised end of the NHS – specialising in emergency

unplanned care – and the follow up through in and outpatient

work

North Bristol NHS Trust

North Bristol NHS Trust

North Bristol NHS Trust is the largest hospital trust in the

South West of England, providing hospital and

community healthcare to the residents of Bristol, South

Gloucestershire and North Somerset.

We are also a specialist regional centre for a number of services

including neurosurgery, renal medicine, plastics, burns,

orthopaedics and major trauma.

The Trust provides services to a local catchment

population of 905,000

The Trust has a wider catchment population of

approximately 3 million for our specialist services

Facts and figures

The Trust has a workforce of over 9,000 with a funded

establishment in 2013/14 of 7,753 whole time

equivalents.

Medical Staff – 928 wte

Nursing, midwives healthcare assistants – 3,085 wte

Scientists and Therapies – 1,299 wte

Ancillary and estates – 885 wte

Administration – 1,395 wte

Managers – 161 wte

Frenchay Hospital History

The hospital, situated in the grounds of a Georgian mansion, Frenchay Park, started life as a TB hospital in 1921

In 1931, five purpose-built buildings were constructed to extend the hospital beyond the original house. Concerns about the possibility of heavy bombing casualties led to the hospital being greatly

expanded between 1938 and early 1942. Although Bristol was severely bombed, the new facilities remained unused

When US forces arrived in 1942, the city handed the new hospital facilities over to the Americans. Further expansion to the facilities including 27 wards, occurred in late 1942. The Americans

used the hospital mainly as training facility for their medical staff.

After D-Day the hospital was used in earnest. Casualties were flown into Filton or arrived by train from the channel ports. Between 5 August and 31 December 1944 a total of 4,954 patients were discharged from

Frenchay.

The National Health Service acquired the hospital in 1948

Over the last 60 years, the hospital facilities have been slowly modernised, but many wartime buildings were still very much in evidence this year

New and old together

A New Hospital

New Facilities

A decision was made in 2005 to create a single acute

hospital at Southmead and transform the Frenchay

hospital into a community facility

In 2010, Carillion was formally selected to design and

build the new hospital and construction work began

Completion of the main building was in March 2014

The Brunel building comprises 114,000 m2 with a capital

cost of £432 million

It includes 800 beds, 24 theatres and a full range of

services for a population of 400,000 people.

Brunel Building Programme

The Brunel Building is a private finance initiative (PFI)

After 10 years of focus on the completion of the new

acute hospital at Southmead the Brunel building was

handed over to North Bristol Trust on 26th March 2014.

This work was undertaken by the NBT capital planning

team with a mix of specialists in building, clinical design,

operational pathways and more

The majority of this team were recruited from with the

NHS and more specifically NBT

Brunel Building – December 2010

Brunel Building – June 2011

Brunel Building – July 2012

Brunel Building – August 2013

A new way of working

Change programme

A major change programme “Road to 2014” was set up to design and delivery services in new ways of working in time for the new building utilising the new facilities, capability and staffing models that the building allowed

This programme “Building Our Future” was resourced through a mix of project managers internal and external to the NHS – supported with clinical redesign experts

To deliver this Building Our Future was set up as a completely independent governance structure to the Trust Seperate Board, SRO, Management Team and Standing Orders

and SFI’s

What had to change?

The clinical models changed for Inpatients

Both emergency and elective

Outpatients

Equipment

Storage

Support

The workforce models (and teams) changed for Wards

Theatres

Administration

Support

Gateway Review

All into One programme

The Project Assessment Review Team, in December

2013, recognised that the separate components within

the overall Move Programme had to be combined single

entity, with one critical path and one governance.

In effect the building and the services that were going to be

together – now needed to be together

Building Our Future was no longer needed – the Future had arrived

The Trust concentrated on the Move and the building alone

Suspension of a lot of national reporting and controls

The Move and Transformation Programme was formed –

and run at high pace from January 2014 until June 2014

Governance Structure

Trust Board

MOVE and Transformation

Board

MOVE Delivery Board

Existing Sub-structure

Reporting Workstreams

Single Programme

Plan

Brunel Construction

MOVE projects

Facilities Portfolio

IM&T projects

Themes

Directorates

JIGSAW

Service Transfers

Summary Reporting – Exception Based

Brunel Construction

MOVE projects

Facilities Portfolio

IM&T projects Themes Directorates JIGSAW Service

Transfers

Single Programme Summary and Highlight report

Risk review Action

Chasing Programme Overview

Decision Planning

Interdependency Management

Communication Assumption

Management Upward

Reporting

WORKSTREAMS

PMO

INTRANET SITE

(WEEKLY)

All heading in the same direction

Governance - detail

Risk management Both Move and BAU are managed through the single overview

Riskweb system

All Trust risks recorded, now including high-level CCG risks

Weekly check of high risks, daily chasing of mitigating actions

Issue management Central issues log for Move, daily chasing of mitigating actions

Decision management All Committee / Executive level and significant decisions logged

Daily system to remind decision makers and record decisions

Centralised daily reporting by PMO on all matters

Single programme plan established with critical tasks for Move identified and tracked

Business as Usual incl. Capital Programmes

Governance All directorates continue to have monthly performance executive

review meetings covering the balance reporting of performance / activity / quality / workforce / finances

This continued throughout the Move preparation and into the new hospital

All other capital developments managed through our “Jigsaw Programme”

Integrated Performance Report The Trust had an integrated performance report covering all

executive performance reports to the board in a single format

This is used throughout the organisation and board

The report will continues to develop based on evolving issues and areas of focus – with a rotation through other areas as applicable by time in reporting year

Simple Reporting

Go/No Go checklist Last date for Go No Go decision: 30 March 2014 RAG

Reason: Leaflets advising the public of the dates of the move will be issued.

General

1

The building will be handed over in a good state of repair, with all key systems fully functioning (lifts, heating,

lighting etc) and free of major defectsGreen

2

The list of items on the snagging list requiring remedy are acceptable in terms of volume and complexity for

operation of the building Green

3 The fire strategy for Brunel has been approved Amber

4 Contingency plans are in place for major incidents to enable business continuity Amber

5 Critical operational policies are in place Amber

People and Services

6 The order of moves is finalised and all services know the date of their move Green

7 Move plans for each service are in place and understood by the service teams Green

8

All necessary transport arrangements for transferring patients are in place and are in conjunction with the order

of moves, and there is written commitment from the service provider to meet the requirementsAmber

9 Contingency plans are in place in the event of unavailability of planned transport Amber

10 All staff have been trained to use and orientated to the building Green

Equipping & Environments

11 Any certificates, licenses and approvals necessary in advance of building occupation or use have been issuedAmber

12

All equipment necessary to run Brunel is ordered, in place (including transferred equipment) and

commissioned ready for useAmber

13 There are sufficient fittings in place to provide a comfortable environment for patients Green

14 The removals company has an agreed and finalised schedule of equipment moves for the full move period Green

15 Contingency plans are in place with the removals company to manage delays, increases in activity etc Green

16 All specialist removals companies have an agreed and finalised schedule of transfers for the full move periodGreen

Go/No Go checklist IM&T

17 All essential IM&T systems are in operation including wireless system, Cerner etc Red

18 Sufficient hardware (and software) necessary to get services underway within Brunel is in place Amber

19 All corporate IM&T systems are amended for the new operation in Brunel Green

20 Telephone systems are operational Green

Facilities Management

21 The building has had a clinical clean and has been signed off as ready for use by infection control Green

22 The soft FM team are trained to operate in Brunel Green

23

The building is stocked through a first fill and ready for operation for all areas - pharmacy and each zone

(theatres, critical care, wards etc)Amber

24 Catering systems and prep areas are cleaned, stocked, tested and ready to feed patients and staff Amber

25 A process flow is in place to govern safe flow of instrumentation between SSD and Brunel Amber

26 The service yard is operational with an agreed schedule of deliveries and management processes in place Green

27 A system is in place to move supplies, consumables etc through the building (e.g. AGV) Amber

28 Parking arrangements for patients and visitors are in place Green

29 Transport arrangements for staff are in place Amber

Communications

30

Communications are prepared and processes in place ready to communicate the date of the move to patients

and the public (including GPs, patients, general public)Green

Operational

31 All schedules and staffing rotas are in place for theatres, outpatients and specialist diagnostics Green

32

There is sufficient staffing in place to operate a safe service across all key areas: outpatients, inpatients,

theatres, diagnostics, emergency department, critical careAmber

33 Administrative processes are in place to safely manage patients through the systems Red

34 Activity profiles are agreed in the period up to the move to Brunel to minimise risk to move Amber

35 All staff are allocated to their area of work Green

36 All staff have been trained in how their service will operate in terms of every task in the working day Amber

Highlight Narrative This week: 1,026 staff have completed Orientation Tours of the Brunel Building in the first week from

Monday 31 March. Use the button above to book a tour by logging into MLE. Outpatient booking: Reporting has been improved and automated to track precisely the

number of patients waiting to be rebooked for new clinics in the Brunel Building. As of 4 April there were 24,187 patients waiting for a Brunel appointment to be rebooked. Of those: 4,789 are booked into an incorrect clinic and need to be rebooked; 19,122 are waiting to be booked from a request queue; 253 patients are waiting to be booked from a paper-based pending list in Renal. The overall number of patients waiting to be rebooked has increased in the last week. This is likely to be the result of short-term follow-up appointment requests being added to a request queue rather than booked directly into a Brunel clinic slot.

Move & Transformation Board worked through the sign-off process for new staff rosters and for staffing plans for the Move period and beyond the Move.

The first Clinical Governance Day was held on 3 April for teams to access Theatres, the ED and other departments for orientation and simulation.

Priorities for next week: From 7 April information about Move will be appearing on paper bags used in Pharmacies

around the city. From 8 April, a new Frequently Asked Questions page will be available on the NBT intranet and

staff will be able to submit any questions for answers to be published. Continued focus on the development of contingency plans for the Move, for Patient

Entertainment and for the Trinity House Outpatient Appointments move. Cerner rebuild: The rebuild for outpatients is due to be completed on 10 April and the rebuilds

for Theatres and the Emergency Department are due to complete on 11 April. The PMO will be following up to ensure: the completion of all critical Standard Operating

Procedures ready for training; a trajectory of staffing is produced following overseas recruitment; that the final order for Theatre instrumentation is placed.

Risks and Issues

There are 142 new FP-10 Prescription printers that have been delivered but do not fit well on the desks in the new offices. A solution to this – either re-siting the printers, amending the existing desks or buying different desks – will be worked through.

There are intermittent issues with the telephones installed in the Brunel Building lifts which are taking some lifts out of service. The IM&T department are working to fix this and equipment deliveries and orientation tours are working around the issues.

MOVE Weekly Highlight Report. 4 April 2014 54 days 8 weeks

Until Brunel fully open

Decisions required

Guide to this report

Decisions Log

Issues Log RiskWeb

Email PMO

Progress Reports

Version 1

Plan

Workstream Lead

Last

Week

RAG

This

Week

RAG

Move Coordination & Planning, People & Services, Equipping & Environments

PFI Timeline Tricia Down Green Green

Move Coordination & Planning Tricia Down Green Green

Communications Tim Bartlett Green Green

Jigsaw - Neuropathology interim move Steve Brown Green Green

Jigsaw - Offsite records Steve Brown Amber Amber

Jigsaw - 'Sherston' Building Projects Steve Brown Green Green

Jigsaw - Other homeless services Steve Brown Green Green

IM&T

IM&T - Infrastructure (e.g. Data Network, Telephony) Mike Brooks Amber Amber

IM&T - Enabling (e.g. Kiosks, Cerner Rebuild) Mike Brooks Red Red

IM&T - Move (e.g. Printer Provision, Switchboard, Jigsaw) Mike Brooks Amber Amber

IM&T - Post-MOVE (Decommissioning, Retained Estate upgrades) Mike Brooks Green Green

Facilities Management

Facilities - NHRP incl buffer store Nicholas Jones Red Amber

Facilities - SSD Paul Jenkins Amber Amber

Facilities - Security Travel & Parking John Smith Red Amber

Facilities - Soft FM Chris Lawson Amber Amber

Facilities - Estates Matt Chick Red Amber

Operational - Themes and Projects

Patient Flow Theme Anne Morris Amber Amber

Rehabilitation Project Anne Morris Red Amber

Outpatients Theme Claire Weatherall Red No RAG

Theatres and Surgery Theme Rosanna James No RAG Red

Centralisation of specialist paediatrics Tasha Swinscoe Amber Amber

Imaging Theme (Formerly Diagnostics) Sharon Nicholson Amber Green

Imaging Day Case Unit Sharon Nicholson Amber Amber

Medical Workforce Theme Chris Burton No RAG Amber

Vascular Service Review Karen Maxfield Green Amber

Patient Care Administration Theme Rob Gittins Amber Amber

Non Medical Clinical Workforce Theme Louise Smith Amber Amber

Breast Centralisation Rosanna James Green Green

Pathology David Gibbs No RAG Amber

Operational - Directorates

Core Clinical Services Directorate Sharon Nicholson Red Amber

Medicine Directorate Anne Morris Amber Amber

Musculoskeletal Directorate Rosanna James Amber Amber

Surgical Services Directorate Rosanna James Amber Red

Neurosciences Directorate Diane Cornish Amber Amber

Renal Directorate Claire Weatherall Amber Amber

Women's and Children's Services Directorate Natasha Swinscoe No Report No Report

Go/No Go ChecklistLast week

RAG

This week

RAG Date Outstanding

Move Coordination & Planning

1

The building will be handed over in a good state of repair, with all key systems

fully functioning (lifts, heating, lighting etc) and free of major defectsComplete Complete

2

The list of items on the snagging list requiring remedy are acceptable in terms of

volume and complexity for operation of the building Green Green

3 The fire strategy for Brunel has been approvedGreen Complete

4 Contingency plans are in place for critical incidents to enable business continuityAmber Amber

5 Critical operational policies are in placeAmber Amber

6

Communications are prepared and processes in place ready to communicate the

date of the move to patients and the public (including GPs, patients, general Green Green

People and Services

7 The order of moves is finalised and all services know the date of their moveComplete Complete

8 Move plans for each service are in place and understood by the service teamsGreen Green

9

All necessary transport arrangements for transferring patients are in place and are

in conjunction with the order of moves, and there is written commitment from the Complete Complete

10 Contingency plans are in place in the event of unavailability of planned transportComplete Complete

11 All staff who need to have attended compulsory Move trainingGreen Green

Equipping & Environments

12

Any certificates, licenses and approvals necessary in advance of building

occupation or use have been issuedGreen Green

13

All equipment necessary to run Brunel is ordered, in place (including transferred

equipment) and commissioned ready for useAmber Amber

14

There are sufficient fittings in place to provide a comfortable environment for

patientsGreen Green

15

The removals company has an agreed and finalised schedule of equipment moves

for the full move periodComplete Complete

16

Contingency plans are in place with the removals company to manage delays,

increases in activity etcGreen Green

17

All specialist removals companies have an agreed and finalised schedule of

transfers for the full move periodGreen Green

IM&T

18

All essential IM&T infrastructure projects are complete: fixed network; wireless

network; phone number strategy; intercoms; multitone paging; AGV comms and Green Green

19

All essential IM&T Enabling projects are complete: Cerner Rebuild; Non-Cerner

clinical systems rebuild; check-in and patient calling; patient records flow; Red Red

20

All essential IM&T Move projects are complete: Commissioning; PC Provision;

Printing Provision; Switchboard including double-runningGreen Green

21 All corporate IM&T systems are amended for the new operation in BrunelGreen Green

Facilities Management

22

The building has had a clinical clean and has been signed off as ready for use by

infection controlGreen Green

23 The soft FM team are trained to operate in BrunelGreen Green

24

The building is stocked through a first fill and ready for operation for all areas -

pharmacy and each zone (theatres, critical care, wards etc)Amber Amber

25

Catering systems and prep areas are cleaned, stocked, tested and ready to feed

patients and staffGreen Green

26

A process flow is in place to govern safe flow of instrumentation between SSD and

the point of use in BrunelAmber Amber

27

The service yard is operational with an agreed schedule of deliveries and

management processes in placeGreen Green

28 A system is in place to move supplies, consumables etc through the buildingGreen Amber

29 Parking arrangements for patients and visitors are in placeGreen Green

30 Transport arrangements for staff are in placeAmber Amber

Operational

31

All schedules and staffing rotas are in place for theatres, outpatients and specialist

diagnosticsAmber Amber

32

There is sufficient staffing in place to operate a safe service across all key areas:

outpatients, inpatients, theatres, diagnostics, emergency department, critical careRed Red

33

Administrative processes are in place to safely manage patients through the

systemsAmber Amber

34

Activity profiles are agreed in the period up to the move to Brunel to minimise risk

to moveGreen Complete

35 All staff are allocated to their area of workGreen Green

36

All staff have been trained in how their service will operate in terms of every task

in the working dayAmber Amber

37 Completed transfer of paediatric inpatient service to UH BristolGreen Green

DEC-025 Business Case: Frenchay Disposal Strategic Outline Case 10/04/2014 EAMCPG

DEC-065 Business case: Pathology interim proposals 10/04/2014 EAMCPG

DEC-071 Procurement: Energy procurement for Brunel 10/04/2014 EAMCPG

DEC-072 Procurement: Southmead demolitions tender approval 10/04/2014 EAMCPG

DEC-142 Outline Business Case: Sherston Buildings Project 10/04/2014 EAMCPG

Book a tour

Move Period

Manager Checklist - April

Final sign-off from General Managers

To be completed pre-Move for every area

Includes:

Workforce

Training & Orientation

SLAs with Support Services

Workflows, Systems & Processes

Equipment, storage & consumables

Information technology

Clinician Checklist - April

Final sign-off from Clinicians

To be completed pre-Move for every clinical area

Includes: Clinical assessment tools

Documentation

Clinical pathways

Medical records flow

Information flow

Team Processes

SLAs with other services

Clinical rotas

Clinical competencies

Clinical equipment

Training, Orientation and

System Test

36

Order of Moves

• Southmead moved first

• Elective

• Logistically more straightforward

• Requirement for rapid decommissioning

• Frenchay followed

• Maintain Emergency Department access

• Clinical dependencies paramount

• Key Partners

• Harrow Green

• SWAST

• RAF

37

38

39

Order of Moves - detail

• Key services always

available

• Testing of clinical model

possible

• Minimal downtime

• Patients not left isolated

• Allocated access, lifts, routes

• Max 120 patients move in a

day

M T W T F S S M T W T F S S M T W T F

05-May 06-May 07-May 08-May 09-May 10-May 11-May 12-May 13-May 14-May 15-May 16-May 17-May 18-May 19-May 20-May 21-May 22-May 23-May

Clinical Equipment Services SMD FHY

Social Workers SMD

Rheumatology Offices (Beeches) SMD

ED Offices

MSK Offices SMD

Staff Change NEW

Medical Illustration SMD FHY

Transport Dept and Offices SMD

Anaesthetic Offices SMD

Surgery and Urology Offices SMD

Medical Offices (incl. other rheum) SMD

Renal Offices SMD

Imaging Office SMD

AOC Theatres SMD

CPU NEW

Seminar Rooms NEW

Post Room SMD

K Annexe (Seas Press) SMD

C Ward (Resp) SMD

D Ward (Resp) SMD

Elgar 2 (CCU) SMD

Cardiac Testing SMD

Respiratory Testing SMD

Elgar 4 (C of E) SMD

H@N SMD

ICU SMD

CSMs Stage 1 SMD

Bereavement Services SMD

Chew SMD

Severn incl. rheum day case SMD

Frome SMD

AOC Admissions Unit SMD

T Ward SMD

Carrington SMD

Sanctuary SMD FHY

Body Store SMD

Main Admissions SMD

Dexa Scanner SMD

Physio and offices SMD

SL&HT and offices SMD

OT and offices SMD

Dietetics SMD

K Ward (Inf Dis and Haem) SMD

Health Psychology SMD

Malvern (Dementia) SMD

Elgar 1 (Medicine and CoE)) SMD

F Ward (Seas Press) SMD

Surgery Offices FHY

Neuro Offices FHY

Imaging Offices FHY

Anaesthetic Offices FHY

Core Clinical Offices FHY

Registrar of Births and Deaths SMD

Cashier SMD

League of Friends SMD

General OP, incl derm, and assoc offices SMD

Rheum OP SMD

AOC OP, Plaster Room and admin SMD

G Ward OP and SAA SMD

Audiology and Cochlear Implant SMD FHY

Urology OP SMD

Urodynamics SMD

Lithotripsy SMD

U Ward (Urology) SMD

Woodlands (Surgery) SMD

Theatres 1,2,3,4 &8, U1&U2 SMD

Neurosciences OP (Ward 16) FHY

SL&HT and offices FHY

Physio and offices FHY

OT and offices FHY

Dietetics FHY

Social Workers FHY

Neurosciences OP (Ward 20) FHY

CSMs Stage 2 SMD

Health records SMD FHY

J and L Wards (Day Case) SMD

Day case Theatres x 2 SMD

Endoscopy SMD

Endoscopy Decomtamination SMD

Day Hospital closes FHY

Plastics OP, POD, Admin and Skin Ca Nurses (Ward 11) FHY

Plastic Dressings Clinic FHY

Burns / Plastics Offices FHY

Renal OP SMD

Vascular Testing SMD FHY

Cardiac Testing FHY

Haematology Day Unit SMD

RDU and Day Case Unit SMD

Neurophysiology FHY

Neuro Theatres 1,2,3 FHY

Theatre 7 FHY

Spinal Theatre 6 or Theatre 5 FHY

ICU - retaining a number of beds at FHY for emergencies FHY

Plastics Trauma Clinic FHY

Emergency Dept incl MIU and plain film SMD FHY

Ward 105 (MAU) FHY

Ward 106 (MAU) FHY

Ward 107 (SAU) FHY

Ward 103 (CCU) FHY

Cardiac Testing FHY

Ward 18 (Neurology and Stroke) FHY

Ward 19 (Neurology and Stroke) FHY

IP therapy equipment within neuro FHY

Ward 1 (Neurosurgery) FHY

Ward 2 (Neurosurgery) FHY

Ward 3 (Neurosurgery) FHY

Ward 4 (Neurosurgery) FHY

Ward 12 (Neurology) FHY

IP therapy equipment adj to Ward 207 FHY

Ward 201 (Trauma) FHY

Ward 202 (Trauma) FHY

Plaster Room and # clinic FHY

Ward 104 (Burns and Plastics) FHY

Ward 204 (Burns and Plastics) FHY

Ward 203 (Surgery) FHY

Plast Theatres 1 and 2 FHY

Burns Theatre FHY

Gen Surgery Theatre 8 FHY

POA (Ward 5) FHY

MSK Offices FHY

Hand and Upper Limb Centre FHY

Ward 13 (Stroke) FHY

Ward 15 (Stroke) FHY

Ward 205 (Medicine and C of E) FHY

Ward 206 (Medicine and C of E) FHY

Ward 207 (Medicine and C of E) FHY

Day case Theatres 1 -4 FHY

Neuro Physio and OT adj to neurology offices FHY

Burden (Neuropsychiatry) to Avonmead and Brunel FHY

MacMillan (Pall Care) FHY

Retained ICU FHY

Endoscopy FHY

Endoscopy Decomtamination FHY

Ward 30 (Seasonal Pressures) if still open FHY

Registrar of Births and Deaths FHY

Pharmacy FHY

Cashier FHY

Medicine Offices (incl. rheum) FHY

Mortuary FHY

Bereavement Services FHY

Theatre 4 FHY

Laser Centre FHY

Immunology OP and HIV (Brecon) SMD

Cardiac Rehab (offices) SMD FHY

Diabetes Unit SMD

POA (Brecon) SMD

CSMs Stage 3 FHY

40

Reflections and Lessons

42

Move Reflections – CEO comments

Moving into the Brunel hospital showed North Bristol NHS Trust at its very best. Over 500 patients, 24 of whom were critically ill, were successfully and

safely moved from Frenchay or Southmead into the new hospital over a two week period.

The values of our staff were fundamental to making this undertaking go so well. But significantly our approach to planning; which was inclusive, honest, when things needed attention, rigorous but not overwhelmingly bureaucratic, with decisions being taken quickly and communicated widely was pivotal in aligning effort, and building confidence as we got nearer to move date.

We had, and have, some brilliant skills and expertise but bringing in outside perspective and skills was a pivotal decision, it showed us willing to be open and to learn, and it helped us provide a single critical path, to ensure objective oversight and a single point of contact when things could fall between individuals or overlap.

So what were the lessons?

Communications

In an organisation over multiple sites communication (and

rumour control) are key and difficult

Keep it simple

Keep it frequent

1 page highlight is all that is needed

When moving – email isn’t there

Every external group will ask questions

There is never enough reassurance

Lessons Continued

Single Change Programme

The need for strong governance with a single SRO and single

critical path

That supports – not demands

The benefits of running the Command Centre structure

The lack of concern about hierarchy, meritocracy got things

done, not rank

Control with Empowerment

Delivering decisions and sticking to them

Monitoring and making clear and bound decisions is crucial, as

is the recording of these

Gateway reviews (internal and external) are crucial

Lessons Continued

Operational Focus

Target Standard Operating Procedures (SOPs) should be bedded in and routine before any physical move

Greater clinical & surgical design involvement would have avoided rumours and distraction

All major cross cutting work should be have an operational and clinical lead (if not the same person) and where identified project support for the life of the work

Ambitious timescales

That a 6 week period from handover to move was a real challenge

You can move a hospital in 2 weeks (just)

People have lives, the impact of 7 day working should not be overlooked - we need to look after all our people

Lessons Continued

Resources

Annual Leave control works

The importance of building a strong sense of team, based on

continuity – colleagues, programme, suppliers and business –

the positive attitudes and cooperative interpersonal skills

exhibited have been a real success

There is a difference between subject matter expert and project

management

And BOTH are needed

External support when needed should be used

Last Thoughts

49

50

Fun things that you would never predict

Trainers

Everyone involved in the move needed comfy shoes

But all are healthily now!

Helicopter testing

Start small and increase in size

Big means BIG

Swipe access doors

Great for security

Not so much for tours

The restaurant

Serious things we learnt

We did lose beds

Not patients – but beds

Boxes boxes everywhere

100’s just dissappeared

Packing everything

Even the clocks – you can’t spring clean enough

Less meetings is good

And sticking to it

No really

Final thoughts

It’s a beautiful building

With outstanding staff

Its here for the population of Bristol

For a long time

But don’t come if you don’t need to

Q&A

Workshop

Workshop

As with every project and every organisation we’ve all

worked in – there is no one right answer to the tough

questions

In fact the right answer for one – may be the wrong for another

Project governance is not about sticking to a playbook

Its about ensure that the plays deliver the goals

Neithertheless – lets see if we can all go away with some

more plays

Group sessions

From now to 3.25 – split into 3 groups

At 3.25 we will discuss each topic as a room – so before

that pick / punish a speaker

Ten minutes feedback and Q&A per topic

Workshop Groups

1. Why a single SRO is never sufficient . . .

Conflict v collaboration – top tips?

What’s the best way to deal with multiple leaders?

2. What to do with gateway review outcomes?

Who addresses the outcomes?

Who reassurance on the actions?

3. How to maintain control but also empower on an organisation-wide scale . . .

How do projects empower?

What control is then needed?

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at an APM event

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