ensuring successful hospital project handing over

HOSPITAL PROJECT

COMMISSIONING & HANDING OVER

Dr. Maarof Sudin

Planning Division

Ministry of Health, Malaysia

October 2016

Health Facilities in Malaysia

• Health facilities are complex buildings

• Designed to accommodate various functions

• Designed to follow certain operational policies

• Various disciplines involved

• Basically to provide curative care to patients

• Cost - large sum of money

• Expensive to operate & maintain

• Important to do commissioning and take over • in the correct manner • so that future problems are

minimized.

• Done by :

– PWD as designer and/or supervisor

( for bigger projects)

– MOH’s Engineering Services Division

( for Smaller Projects or Special Projects)

• Strive for functionality & sustainability

Hospital Development in Malaysia

Project Implementation in Malaysia

• Conventional– Design, built & equipped by

different parties– Eg. design by PWD, built by private

contractors & equipment procurement by MOH

• Design & Built– Design & built by private

contractors– Equipment procurement by MOH

• Turnkey– Design, built & equipped by one

party eg. private contractor– Package Deal

Macro & Micro-PlanningMalaysia advocates both macro &

micro-planning

• Macro-planning is important to decide on the building blocks that include – Zoning according to spatial

relationships

– Segregation and compartmentalization for security and administrative controls

– Master planning to address expansion, phasing and future needs

• Micro planning using loaded room data sheets– With end-user involvement to

include preferences and local requirements

Site Requirements

Critical success factor

Land and site issues must

be settled and finalized

before project can be

considered

• Site must be free from

encumbrances

• Vacant possession of site

• Boundaries must be

delineated

Funding


• Adequate funding– Complete or phased

implementation

• Planned and timely cash flow– To match progress and

payment

– Capital contribution

– Infrastructure contribution

EquipmentCritical success factor

• Important to include the cost and availability of consumables and fuel during commissioning and acceptance phase

• Important to have competent personnel from both the vendor and end-user to ensure successful testing and commissioning of major equipment

• Important to have reliable electricity supply during the testing of major or sensitive equipment

• Important to make provision for proper storage of major and sensitive equipment pending T&C and taking over

• Important to define and sort out third party rights, responsibility and licensing especially with regards to ICT

Commissioning Plan


• Must be considered

from Day one of the

project

Health Facility Project- Implementation Process

Approved Projects

SON & Medical Brief/Design Brief

Architectural Drawings/Design Development

Tender

Construction

Testing & Commissioning & Handing Over

Evaluation

DLP / Operation & Maintenance

Commissioning

• Commissioning is a quality process

• A process to ensure building’s systems operate as per intent of the design scope

• Functional Testing – building system operate & function as designed

• A systematic and documented process• building systems perform interactively

• to design intent and user needs

Benefits of Commissioning

-Ensure system works the way it is supposed to

-Coordinates, functionally test and fine tune systems before handing over

-Smooth transition to M&O

-Fill the gap between construction & operation

-Reduced utility consumption and operational costs

-Reduced occupant complaint

Commissioning Responsibility

-Contractor

-Consultants

-Owner/User – verificationP&D, Engineering Div, Users,Support services provider

Testing & Commissioning

– Two main components» Functional component (individual / may not be real)

» Operational component (actual/integrated)

– Five project phases» Facility program phase

» Design phase

» Construction phase

» Acceptance phase

» Post-acceptance phase

1. Facility Programme / Scope Phase

-Identify and set-up T&C Team and their Working Group of Professionals

-Identify roles & responsibility

-Set-up commissioning plan

-Define issues based on experience and ways to avoid/overcome

2. Design Phase

-Identify systems appropriate for commissioning

-Define commissioning specifications

-Interaction with design and construction team

-Develop test documents

-Develop T&C schedules

3. Construction Phase

-Interaction with the construction team

-Review relevant system submission by contractors

-Familiarization to system

-Develop contractor’s commissioning requirements ie contractor checklists

-Get ready for Functional Testing

4. Acceptance / Occupancy & Operation

-Doing Functional Testing

-Field verify the operation of each commissioned system

-Function,Standards,Safety etc.

-Training review

- Operation and Manual verification

5. Post Acceptance /Continuous Commissioning Phase

-Monitoring of systems in operation

-Issues/Problem identification before warranty expires

-Monitor system maintenance

T & C – 5 PROJECT PHASES

END-USER’S ROLE IN :

- HOSPITAL DEVELOPMENT

- T&C

- PROJECT HANDING OVER

Hospital Development

• Main Success Factors:

– Teamwork

– Communication

– Professionalism

– Clear Direction Towards Common Goal

• Team Players:

– Project Manager/Director (PWD/MOH Engineering Division)

– Developer / Builder

– Owner (MOH and End-Users)

End-User’s Role in Hospital

Development

• End-user’s role and contribution is fully acknowledged by MOH Malaysia

• Recognized as important partner in hospital design and development

• This is to ensure end-user’s and local needs are considered in the design and development of the facility


DevelopmentWHY ?:

• MOH (with P&D)

– Capital funding and Project Administration

– Set building and design norms and practice guidelines

– But does not have capacity to monitor closely all projects

• Role of state or local health office

– Coordination and administration

• End-user

– Responsible to run facility once completed and in operation

– Vested interest in ensuring facility built and commissioned to high standards

– Sense of ownership


DevelopmentWHEN?

• Through-out development period

• As early as possible

- Planning and conceptual stage

- Design stage

- Construction stage

- Commissioning

- Post acceptance stage

• Especially towards handing-over stage

• Take-over and ‘live’ systems testing

• Defects Liability Period (DLP)

• Post Occupancy Evaluation (POE)


Development• HOW?

– Carefully Planned and Organized

– Identification and appointment of core team and key contributors

– Clearly defined Roles and Responsibilities

– Empowerment

Organization of End-User’s Team

• Core Team Organization (preferably full time)

– Team Leader (Ideally future hospital director)

• Senior Staff member

• Leadership qualities

• Decision making capability

– Permanent Team Members (hospital ‘main’ departments)

• Nursing staff

• Administrative staff

• Engineering personnel

– Co-opted Members (When required)

Empowerment of End-User/Core Team

• Delegation of overall responsibility

• Early involvement– Incorporate user needs

– Familiarize with project scope, design, process & contract

– Develop/foster relationships with other team members

• Training eg. T&C briefing etc.

• Adequately resourced

• Decision support – open line of communication with MOH (P&D) for major decisions

Core Team’s Roles and

Responsibilities

• Main Role 1 – Early

– MOH Permanent

Representative for project

– Coordinate end-user

inputs

• Service planning

• Design development

• T&C planning


ResponsibilitiesMain Role 2 :

– Prepare hospital operational policies & procedures

– Identification & procurement of equipment

– Identifying staffing needs and recruitment

– Ensuring smooth transition of facility

• T&C and building hand-over

• Prepare to take-over

• Coordinate and transfer equipment and services from existing facilities if required


ResponsibilitiesMain Role 3 :

– Ensure smooth transition of facility

• T&C and building hand-over

• Prepare to take-over

– Prepare for Opening and beginning operation at the new premise

• Determine Opening Sequence and phased opening if desired

• System/equipment shakedown

– Coordinate activities during DLP

Activities Towards Practical

Completion• Contractor established commissioning

programme

• T&C by contractor completed

• Documentation: Compilation and distribution– For reference and verification

• Training & briefing for commissioning team

• Joint inspection (PWD,MOH/Core Team)– Identify and document defects (Snag list)

– Verify T&C report / witness T&C

• Rectification of defects by contractor

• Joint inventory checking (PWD, MOH/Core Team)

– Document defects / outstanding equipment

– Seal room/department

Room to room inspection

Equipment T&C by the contractor

Produce defect lists report (snag lists)

Rectification works done

based on defects lists

Room to room inspection

Equipment T&C by the contractor & JKR

Produce defect lists report



Room to room inspection &

equipment T&C by MOH

Produce defect lists report



Room to room equipment inventory

counting by the contractor

Room to room equipment inventory

counting by MOH

Seal room

Handing Over

OVERALL T&C PROCESS

1. Equipment/System Testing & Commissioning

Process :

1. T&C by contractor

2. Rectification by contractor

3. T&C Verification by JKR / MOH

(Engineering Division / Radicare / Users/Core Team)


5. Acceptance by JKR / MOH

(Engineering Division / Radicare / Users/Core Team)

MOH /Core Team Checklists

1. Request for T&C schedule

2. Schedule agreement with MOH

partners

3. Ensure contractor has done

their internal T&C by checking

their reports

4. Know system/equipment and

parameters to be tested & their

standards

5. If in doubt, request for re-testing

through JKR

6. Document ALL comments in the

T&C forms

2. Room To Room Inspection

Process :

1. Inspection by contractor


3. Inspection by JKR / MOH Defects List (major & minor)

(Users/Core Team/Planning & Development Division)

4. Rectification by contractor (all defects major or minor)




1. Request for Inspection schedule

2. Schedule agreement – realistic,

convenient

3. Ensure contractor has done their

own inspection

4. Sufficient team members from

contractor to support inspection

teams

5. Floor plans ready for references.

Room data sheet pasted in each

room

6. If in doubt, request for re-testing

through JKR

7. Document ALL comments /defects

and submit to JKR officially

3. Inventory Checking

Process :

1. Distribution, inspection and counting by contractor


3. Inventory checking & counting by JKR / MOH





6 Seal Room


1. Request for inspection schedule

2. Schedule agreement with users

3. Ensure contractor has done their internal

checking and counting

4. Equipment lists available for each team

5. Ensure contractor have representative in each

team

6. Ensure equipment are distributed as agreed by

all parties

7. Check each equipment quantity, brand and the

required accessories

8. What you see is what you get. Do not make

assumption

9. Document ALL comments in the T&C forms

10. Do not seal room/department which is not fully

equipped

Reference Document Required

For Testing & Commissioning

1:100 floor plans (fully loaded)

Room inventory equipment list

Specification and catalogues of equipment

As-build drawings

Relevant checklists

Other relevant documents

AVOIDING PITFALLS

Pitfalls in commissioning a facility can be avoided be taking

the following measures:

Establish the commissioning team and the working groups

as early as possible

Plan and schedule all activities carefully and realistically

Avoid taking any shortcuts in the T&C process

Ensure documentation of T&C records are done properly

Maintain motivation and cooperation among members

Of the T&C team

Tips On Doing T&C

-Do not proceed T&C if the contractor/consultant has not done their part

-Do not proceed T&C if ‘T&C team’ is not complete

-Do not proceed T&C if T&C forms and other relevant documents

specified earlier are incomplete

-Document/record all findings and do not accept

contractor’s reasoning/excuse

-You should satisfy yourself and not the contractor

-Take your time to do the T&C

-Get clarifications if required from the relevant supervisory officer

eg. P&D dev., JKR, Engineering div. etc.

Issues/Problems In T&C

-Poor documentation of commissioning specificationin the project document

- standards/parameters- references

-Lack of experience of the commissioning team-insufficient team members-engineers etc-unsure of processes-unsure of standards & requirements,policies

-Roles & responsibility of team (including contractor) not clear

-Poor commissioning plan – sequence, duration

-Reliability to the contractors system performance report

-Poor documentation of the defects

-Taking ‘short-cut’ – not comprehensive


Completion• Pre-Handing Over Meeting (PWD)

– Connection and commissioning

– Licenses, certifications and documentation

– Defects Liability Period (DLP) maintenance management process

– Training sessions

– As constructed information

– Handing over of keys

– Security transition

– Sealing of rooms and equipment

- HANDING OVER CHECKLIST -


Completion

• Preparation to Take-Over Hospital by Core Team

• Ensure clear demarcation of responsibilities

• Security

– Handing over key process (master key system)

– Ready to takeover building security


Completion

• Utilities– Meter reading (water,

electricity, gas etc)

– Arrangement to fill-up gas tanks (medical gas, LPG)

• Outsource services– Privatized support

services eg. Engineering, Biomedical etc.

– Kitchen

Issuance of CPC

• Building fulfill– Contract requirements

– All statutory requirements

– Reasonably suitable for habitation

– No major defects

SOLE PREOGRATIVE OF PROJECT MANAGER (PWD) with or

without consultation with OWNER (MOH/Core Team)

Defects Liability Period (DLP)

• Starts from the issuance of CPC

• Duration : 2 years (for new Public Hospital Buildings in Malaysia)

• Scope – Making good minor omission

and defects outstanding during handover

– Rectifying defects identified during DLP

– System & equipment maintenance

Defects Liability Period (DLP)

• System & Equipment Shakedown / Life Testing

– Portion of the building

– Complex equipment system

– Simulate hospital operation before hospital opening

– Ensure patient safety & prevent possible malpractice suits

– Eg. medical gases, power back-up system etc.

Defects Liability Period (DLP)Management

• Documentation of new defects

• Management of rectification works– Defects reporting mechanism/procedures– Rectification/repair works verification

procedures– Onsite supervisors

• Monitoring of maintenance activities– Update records

• Regular meetings with PWD– Monitoring– Resolve issues

BY END OF DLP, BUILDING SHOULD BE FULLYOPERATIONAL AND ALL DEFECTS AND OMMISSIONS SHOULD HAVE BEEN FULLY ADDRESSED.

ISSUES / CHALLENGES1. The quality of T&C done

- Lack of guidelines/standards

- Process not integrated

- System unable to meet functional needs

- Professionalism / Transparency

2. System/Equipment not properly maintained

- Subcontractor / Supplier not paid by Main Contractor

3. Gap between CPC and building takeover by MOH

- ‘Shortened’ DLP & Equipment Warranty

- Utility Payment

ISSUES / CHALLENGES4. Tendency to delayed rectification works

towards the end of DLP

- Poor monitoring

- Limited enforcement

- Hesitant to take action / 3rd party

5. Personnel and authority

- Important to clearly designate and delineate those with authority to approve and sign off on behalf of MOH

- Coordination and working as a cohesive team is important with good communication throughout the project and acceptance phase

6. Independent T&C Consultant

- Accreditation body

- Training

- Licensing

TERIMA KASIH

ensuring successful hospital project handing over

Documents