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Practices in Project Management Essay

Abstract

The St. Dismas Medical Center (SDMC) Assisted Living Facility (ALF) Project was authorized to create a new service line to counteract a decline of inpatient activity. The project objectives are to build 100 light- and heavy-assist units in a standalone residential facility with a sheltered connection to SDMC by late-July 2001 and within an $11 million budget. The particular deliverables, constraints, assumptions, exclusions, and work breakdown structure are outlined in the Project Scope Statement. Brainstorming and scenario analysis will be used in the risk strategy, while cost-benefit analysis will be the primary tool in project quality management.

A project work list and milestone schedule illustrates the critical path for the 102-week construction phase. And, the $10 million budget is detailed by activity and quarter to reconcile the multiple cost perspectives of team members. Project monitoring will primarily use earned value metrics along with the Gantt chart and budget. Data will be analyzed and reported weekly to the team, and significant deviations from the plan are subject to the control strategy; milestone status reporting and meeting with the Board of Trustees and submission of change requests to get the plan back on track. The plan will conduct a formal closeout process to include an audit, closeout meetings, a final report, closeout meetings, and record archival.

Project Purpose and Justification

Over the past few months, there has been a steady decline of the inpatient population at St. Dismas Medical Center (SDMC) due to the increased usage of seatbelts and bicycle/motorcycle helmets. A planning retreat was held to identify business opportunities and a solution was proposed to build an assisted living facility on the St. Dismas campus. The purpose of the project is to plan and implement Assisted Living Facility (ALF) as authorized by the Board of Trustees in May 1999. The project is being completed in order to create a new service line to take advantage of the opportunity presented by the shortage of medically-focused and highly specialized facilities available throughout the country and a growing geriatric population.

We project that the ALF, the for-profit subsidiary of SDMC, will bring in a net income between $9,000 and $12,000 per unit and a net cash flow of about $1,500,000 annually. Both outpatient referrals and inpatient population are expected to increase. Furthermore, we hope that the project will have an added benefit of strengthening the organizational focus on reimbursable preventive and wellness programs for healthier aging community.

Project Requirements

The ALF Project Steering Committee has identified several actions and processes that need to be met, including: facility design and construction;
operational needs for food services, housekeeping, and staffing; development of operational policy and procedures;
creation of an operating budget;
creation of payroll and accounting systems;
characterization and set up of telecommunications and information system needs; preliminary marketing plans, with community and staff communications plans; development of medical assessment tools for incoming residents; designation of clinical services offerings;

development of an organizational structure;
identification of government regulations and industry standards.

Primary Project Objectives

The primary project objectives of the ALF Project are as follows: The cost objective is to fall in between $8.5 to $11 million for the construction of the facility. The time objective was to complete construction and open by July 2000, but was later revised to a duration of two years, with completion by late July 2001. The scope objectives are to build a standalone residential facility with a sheltered connection to SDMC that can access the cafeteria and hospital services, containing 100 units that accommodate up to 150 single and couple residents with 15 to 30 “heavy-assisted” units and the remaining units “light-assisted”.

Assumptions and Constraints

The following is assumed:
Project funds will be released in a timely manner.
Project team members and resources will be available as needed. Contractors will have the skills and experience needed to complete the project. The constraints are as follows:
The construction cannot begin until after the November 1999 city elections. The facility needs to open by late July 2001.
Operational and administrative policies, procedures, and systems need to be created and regulations and standards need identification.

High-Level Risks

As with all projects, there is a risk of running over budget, over schedule, and/or falling short on scope. There are several high-level risks for the ALF project. One particular area of concern was the short seven-month time period for the complex construction project, but that has been extended about another year. Further, the organizational complexity is high with the number of people involved across many functions and the decision-making body being the Board of Trustees. This complexity may lead to delays in decision-making.

The project is also much larger than SDMC has handled in the past with only one team member having construction experience. The operational and administrative regulations and standards for construction and healthcare industries will be complex and have not yet been identified. Construction projects have a strong potential to impact the local ecology which will add a risk factor to the project. Further, weather poses a high-level risk to the project and may negatively impact the schedule by delaying supply deliveries and construction work.

Major Project Milestones

Major project milestones include:
1. Facility design and construction
2. Identification of operational needs
3. Project and operating budget development
4. Creation of payroll and accounting systems
5. Define telecommunications needs and system setup
6. Define information systems and system setup
7. Creation of a preliminary marketing plan and communications package

8. Organize major ground breaking event
9. Clinical Services
10. Design of assessment tool for incoming residents
11. Identification of demands for clinical services
12. Development of facility’s management structure
13. Identification of governmental regulations and industry standards

Preliminary Budget Estimate

The preliminary budget estimate for the completed project is between $8.5 and $11 million, which includes the land purchase, facility construction, facility furnishings, and construction of the sheltered connection from the assisted living facility to the Medical Center.

Key Stakeholders

Illustrated below is the key stakeholder analysis matrix, which demonstrates the key stakeholders, their levels of power and interest, and an engagement plan. The matrix is followed by a communications chart that outlines stakeholders, their responsibilities, and their communication needs.

The project scope is to build a standalone residential facility for the purpose of providing assisted living services to up to 150 single and couple residents. The product will also include a sheltered connective structure that provides access to St. Dismas Medical Center’s cafeteria and hospital services. The facility will contain 100 residential units with 15 – 30of those units that accommodate residents that need heavy assistance and the remaining units categorized as “light-assisted”. The cost to construct the facility should fall within $8.5 to $11 million range. Acceptance of the project requires that construction may not begin until after city elections in November 1999 and the facility must open to the public by late July 2001.

Project Constraints

The construction cannot begin until after the November 1999 city elections. The facility needs to open by late July 2001.
Operational and administrative policies, procedures, and systems need to be created and regulations and standards need identification. The budget cap is $11 million.

Project Assumptions

There are several assumptions that may also impact the implementation of the project if they prove to be false (Project Management Institute, 2013): Project funds will be released in a timely manner.

Project team members and resources will be available as needed. Contractors will have the skills and experience needed to complete the project.

Project Deliverables
facility design and construction;
operational needs for food services, housekeeping, and staffing; development of operational policy and procedures;
creation of an operating budget;
creation of payroll and accounting systems;
characterization and set up of telecommunications and information system needs; preliminary marketing plans, with community and staff communications plans; development of medical assessment tools for incoming residents; designation of clinical services offerings;

development of an organizational structure;
identification of government regulations and industry standards.

Project Exclusions

Items that are not included in the scope include:
design and construction of a parking lot or garage
design, construction, and furnishings of patient entertainment and activity areas design, construction, and furnishings of exercise and fitness areas design and development of landscaping, walking paths, and gardening areas design, construction, and furnishings of private visiting areas design, construction, and furnishings of salon and barber services area design, construction, and furnishings of dining area

Project Risk and Quality Management Strategy
Project Risk Strategy

The project team has held a brainstorming session with a group of consultants in several relevant areas of expertise to identify an exhaustive list of risks by questioning what could go wrong with tasks. The scenario analysis method has also been utilized to identify, analyze, and prioritize risks from high-to-low impact. This method entails utilizing critical thinking skills to realize events that may likely impact the project (Mantel, Meredith, Shafer, & Sutton, 2011). Additionally, the work breakdown structure (WBS) and project profile were scrutinized to further identify highly probable risks as suggested by Mantel et al. (2011). The following highly probable risks have been identified:

Bad weather

Inadequate staffing
Inadequate budget
Project management team inexperience
Regulatory and industry requirements
Cost estimation errors
Complex organizational structure and decision-making process

Broad set of stakeholders that have yet to weigh in on the project Environmental impact from construction
Project communication and coordination issues
Inadequate deliverables (e.g. parking garage)
Inadequate time schedule

The strategy for handling risks is to develop a risk response plan as advised by Mantel et al. (2011). The risk response plan will include contingency plans to handle events that do happen, with more than one contingency plan and supporting logic charts developed for high-impact risk. Furthermore, risk identification and response planning will be ongoing through the project duration.

Project Quality Management Strategy

The ALF project quality management strategy is to follow the Project Management Institute (PMI) (2013) guidelines: identify quality requirements, document compliance levels of quality requirements, perform quality assurance auditing, and control quality by taking action to address poor quality measurements. Inevitably changes will have to be made to manage events or unsatisfactory quality results. The ALF Project change management strategy is to include provisions in the original contract to accommodate change as suggested by Mantel et al. (2011). An integrated change control process will be created and implemented, as advised by PMI (2013) to reduce project risks through holistic analysis of proposed changes. This process will outline how change requests will be reviewed, approved or denied, and how those changes will impact other aspects of the project (policies, documents, plans, etc.) (Project Management Institute, 2013). Two tools that will be used to manage quality are:

cost-benefit analysis, which compares the cost of the proposed change to the expected benefit. cause-and-effect diagrams which utilizes the question “why” to discover the root cause of a problem in order to correct it. Cost-benefit analysis will be useful in presenting problems and their possible changes to the decision-making body in order for them to fully assess their options and identify the solution that best suits their requirements. The cause-and-effect diagram will be beneficial in recognizing the true problem that needs to be addressed. Finding a solution for the root cause will help the team avoid unnecessary costs, time, efforts, and rework in addressing the wrong issues.

Construction Phase Milestone Schedule

Below is the work list and milestone schedule for the construction phase of the St. Dismas Assisted Living Facility project. The critical path (B-C-D-E-F-G-H-I-K-L-O-P-S-T) is illustrated in green on the milestone schedule. The project is scheduled to be completed in 102 weeks, just shy of two years. The assumptions for this schedule are the following: The milestone schedule will be approved by the Board of Trustees. The project will begin in August 1999 after action plans are submitted. Project funds will be released in a timely manner.

Project team members and resources will be available as needed. Contractors will have the skills and experience needed to complete the project.

Project Budget
Below are the summary-level budget and detailed budget for the St. Dismas ALF Project. The assumption from examining the provided cost information chart is that the Chief Operating Officer and the Construction Project Manager provided the estimates for the facility design and construction activities of the ALF project, and upper management dictated the administrative and contingency budgets, and both did so honestly. Bottom-up budgeting utilizes the work breakdown structure in a way that cost estimates of each activity are completed by the team members responsible for carrying out those tasks, while top-down budgeting produces estimates based on the judgments and experiences of top managers (Mantel et al., 2011). The combination use in this project of top-down and bottom-up budgeting is ideal, according to Mantel et al. (2011). The advantage of top-down budgeting is that it generally has a high degree of accuracy, although it can include considerable miscalculations for low-level activities; bottom-up budgeting is opposite in that it provides accuracy for low-level activities and the possibility of considerable miscalculations for high-cost activities (Mantel et al., 2011).

The detailed budget is also divided by task and expected quarter of expenditure to address the multiple perspectives of cost between the project manager (PM), the accountant, and the controller. Mantel et al. (2011) point out that the PM is concerned with commitments made against the budget, accountants track costs as they are incurred, and controllers are responsible for the organization’s cash flow. Dividing costs by activity and quarter allow all three parties to understand their relationship to the project. In this budget, the bulk of the detail outlines only one deliverable from the project’s scope statement and work breakdown structure—facility design and construction. The other deliverables are clumped into the central and direct administrative costs categories.

Although the budget may sufficiently cover the costs of the labor that needs to go into the other deliverables (identifying needs and regulations, and developing plans, systems, and budgets), it may insufficiently cover the costs for other aspects of some of the deliverables, such as setting up telecommunications and information systems, and organizing a major ground-breaking event. Furthermore, consideration should be given to the fact that project exclusions from the Project Scope Statement, such as design and construction of a parking area and activity and entertainment areas, are not factored into this budget. The current budget totals $10,000,000, which is still $1,000,000 under the original estimated budget and leaves some room to add deliverables if necessary.

Project Summary Budget

Project Monitor and Control Strategy

The ALF Project monitor and control strategy is as follows. The project team will continuously monitor schedule progress via the Gantt chart and monitor budget progress via the detailed budget. Monitoring these will give the team a comparison of the time period against the actual plan. However, the team will utilize earned value (EV) metrics to not only compare the current situation with the plan, but also consider the actual progress at the point of evaluation (Mantel at al., 2011). The data from these control tools will be collected and analyzed weekly and reported to the team on a weekly basis as stated in the communication chart. The project management team will assess if any deviations from the plan are significant enough to employ control measures. If the project management team feels that intervention is necessary, data (including the project milestone status report), assessments, and suggestions will be communicated with the Board of Trustees, and change requests will be submitted with the aim to reduce the differences between the plan and the actual circumstances.

Earned value metrics is the ALF Project preferred monitoring tool for the purposes of monitoring and controlling. Earned value metrics allow the team to compare the plan with the actual progress at any given point in the project, to see how efficiently our schedule and costs are being maintained, and providing an estimate of cost if the project is continued at the current rate (Mantel et al., 2011). Utilizing a go/no-go control, such as the milestone status report, allows us to compare the project output (using milestones as checkpoints) to the existing standard, assess what are needs are in terms of physical assets, human resources, and/or finances for particular tasks, and employ the necessary steps to meet those needs in order to get the project schedule, budget, and/or scope aligned with the plan (Mantel et al., 2011).

Project Closeout

The ALF Project will conduct a formal project closeout primarily to “help the organization improve its project management skills on future project” (Mantel et al., 2011, p. 273). The formal project closeout will allow SDMC to understand project mistakes, accomplishments, performance, and project team and management efficiencies and deficiencies, and document these in the organizational knowledge base. Furthermore, a formal close out deals with all those involved in the project in a way that has positive impact on morale and trust. The organization and the project managers show they are reliable when they finish what they start, communicate to each department that it is time to finalize their project activities, and deal with project staff and their reassignments in a tactful manner. The project closeout will follow the suggestion of Mantel et al. (2011).

After the project manager ensures that all project work is complete, the project must go through the project acceptance phase. Acceptance needs to be gained from the Board of Trustees, and project management team, and officially recorded. A detailed audit will be performed to assess the progress and performance of the project’s plan through examination of “its methodology and procedures, its records, properties, inventories, budgets, expenditures, progress, and so on” (Mantel et al., 2011, p. 275). Audit findings as well as the complete project history will be written in a final report. The final report will include the project failures, successes, and lessons learned.

The final report will also document the project activities and management techniques, the location of the organization’s assets, and recommendations for improvement. The final report will be distributed to stakeholders upon completion. Closeout meetings with contractors and department heads (financial, legal, purchasing, organizational, facility, etc.) will be head to notify them of project termination, provide direction to clear the project activities in which they are responsible, and address final issues. A closeout meeting with project personnel will be conducted to address reassignments and stress, and provide closure. Finally, the project books will be closed, organizational assets will be updated, and records will be archived.

References
Mantel, S., Meredith, J., Shafer, S., & Sutton, M. (2011). Project Management in Practice (4th ed). Hoboken: John Wiley & Sons. Project Management Institute. (2013). A Guide to the Project Management Body of Knowledge (PMBOK® guide) (5th ed). Newtown Square: PMI Publications.


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