HOSPITAL PROJECT COMMISSIONING & HANDING OVER Dr. Maarof Sudin Planning Division Ministry of Health, Malaysia October 2016
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
Critical success factor
• 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
Critical success factor
• 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
End-User’s Role in Hospital
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
End-User’s Role in Hospital
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)
End-User’s Role in Hospital
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
Core Team’s Roles and
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
Core Team’s Roles and
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
Rectification works done
based on defects lists
Room to room inspection &
equipment T&C by MOH
Produce defect lists report
Rectification works done
based on defects lists
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)
4. Rectification by contractor
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
2. Rectification 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)
5. Acceptance by JKR / MOH
(Users/Core Team/Planning & Development Division)
MOH /Core Team Checklists
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
2. Rectification by contractor
3. Inventory checking & counting by JKR / MOH
(Users/Core Team/Planning & Development Division)
4. Rectification by contractor
5. Acceptance by JKR / MOH
(Users/Core Team/Planning & Development Division)
6 Seal Room
MOH /Core Team Checklists
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
Activities Towards Practical
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 -
Activities Towards Practical
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
Activities Towards Practical
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