Tamworth Hospital Redevelopment - Driving transformational change

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With the Tamworth Health Service Redevelopment nearing completion and a range of hospital services moving from their current facilities into the new building over the next two months, Marg MacPherson, Change Manager, Hunter New England Health District, details the redevelopment and how it is driving transformational change.

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The Tamworth Health Service Redevelopment is a $220 million government funded project, with $120 million funded by the Australian Government and the remaining $100 million from the NSW Government. The redevelopment which the emergency department, the intensive care unit, operating theatres, maternity and birthing services and more, is a mix of new and refurbished buildings and will ‘future proof’ facilities to ensure services have space to grow to match the needs of the community.
The result is that some services will be built with spare space that will not be used at first, and as more treatment space is needed, we can purchase new beds and equipment and employ additional staff to expand services in coming years, in line with demand. The redevelopment will mean we literally have room to move in coming years.
Identifying opportunities for transformational change
Transformational change has played a major role in the success of the project so far. The strategies used to identify the opportunities for transformational change include involving manager and key leads across the campus from the very beginning in the early stages of the project.
In 2010 we held a change management workshop to identify the changes the redevelopment might bring about and to discuss how to create an integrated model of support for clinical services across the campus. Instead of just seeing this as a new hospital we see it as a new health service and developed structures and models of care that supported this integrated service delivery. This included a much closer alignment of primary and community health with acute services, integrating medical records, thinking about our workforce and positioning ourselves for the future in terms of a big focus on expansion and community based services.
A big part of our methodology was brainstorming in teams and then assigning rating priorities. This resulted in 11 key changes to models of care that we implemented across the redevelopment.

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“The strategies used to identify the opportunities for transformational change include involving manager and key leads across the campus from the very beginning in the early stages of the project.”

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Key challenges
One of the biggest challenges we have faced throughout he project so far is around change management. Before the redevelopment started in early 2010, there was a culture of passivity towards change and staff seemed happy to continue doing things the same way.
The redevelopment involved not only changes to existing buildings, but re-locating services to new buildings or new areas of the campus; in addition to the implementation of new technologies – all of which impacted the way staff operate and deliver care.
To overcome this, we have ensured both the design user groups and model of care groups have been multidisciplinary. All health service staff, including doctors, nurses, allied health staff and support staff, have been taking time to review the way they have traditionally worked together to provide service and ask ‘is this the best way to do it.
By identifying more efficient and effective evidence-based ways of providing services, staff can provide better care to patients and improve patient outcomes.
Creating a culture change to deliver the project on time and within budget.
For any facility development, good leadership is essential for change. You need a clear vision continuously communicate to the staff through the process and then an exceptional leadership team continuing to promote that culture of change. With everyone on board, it is easier for project deadlines to be met.
The strategy we used to achieve this includes:

1. An integration management committee to directly sponsor employees to help manage and deal with changes associated with redevelopment. In our case, sponsors are the senior executives who authorise change, execute decisions and mitigate risk. By embedding a sense of sponsorship by the executive, it has allowed the whole project team to understand what’s happening along all part of the project and it’s really made a big difference to the project’s success.


2. Training to understand the process of redesign and what is expected of each individual in their role. Early on in the project we sent all senior executives to a two-day aim training day. The objective of this was to ensure they understood their role as a sponsor, the process of redesign and the objectives of the organisation as a whole during the redevelopment.


3. Strong communication strategy so all user groups are involved in the design process. Communication has been a key to delivering our project within the time frame we set. Monthly meetings are one way we encourage open communication to talk about the redevelopment. Newsletters are also sent out regularly to staff, in addition to staff and community presentations every quarter. These sorts of initiatives have been a great way to engage clinicians and stakeholders in the redevelopment


4. Strong governance and planning process to ensure all bases are covered. We work closely with the building and project managers so that we can help them achieve their objectives, which ultimately ensure business continuity.

Lessons learnt
One of the biggest lessons we have learnt is to learn from other projects. It’s important to make good contacts, listen to them well and engage with those contacts. Given our hospital is located in a rural location; some of our staff have only ever worked in Tamworth. As a result, change can be very foreign for some of our staff, especially when it comes to new design.
To combat this issue, we sent a number of staff off-site to visit other redevelopment projects and to speak first hand to other staff working on these different projects. This has really opened their eyes to some of the possibilities and helped them become more accepting of the redevelopment. It’s been impressive to see how people as a result have opened up about what has worked and what hasn’t at other sites, which we have then adapted to our own processes and plans.