Early Warning Signs in hospital construction projects

Abstract

In Dutch hospital construction projects, the project goals are not always met, budgets are overrun, delays in planning, and the progress of the projects do not proceed the way that is expected. The complexity of the hospital construction projects influence the possible outcome of the projects. Project failure is often linked to the hard sides of project management, but especially the soft factors and skills, such as negotiation, team capabilities and communication also appear to influence the outcome of a project.
A wide range of signs can indicate possible problems long before they actually occur: Early Warning Signs (EWS). EWS are indicators for potential negative future developments. The signs consist mostly of soft signals which grow stronger over time. When EWS occur in a project, they are mostly process-related, linked to human behaviour and ‘gut-feeling’. Some research is performed on the subject, but the ability to identify and act on these EWS is in its early stages. Research on EWS and the response to EWS mainly focuses on the infrastructure construction sector. EWS-Research related to hospital construction projects is lacking. This research wants to make an attempt to fill the research gap and aims to answer the following research question:
“Which Early Warning Signs can be identified in Dutch hospital construction projects, and how can acting on Early Warning Signs be stimulated to mitigate possible problems?”
The exploratory research is split into two sections; a theoretical study and an empirical study are conducted. The theoretical study consists of a literature review. The findings of the theoretical study are explored in practice in the empirical study, which consists of a case study, including semi-structured interviews, and an expert panel.
The findings show that EWS appear in hospital construction projects and that they are related to human factors, such as gut feeling, communication and culture. Project management can benefit from taking EWS into account: identifying and responding to EWS can have a positive effect on the process of hospital construction.
Before responding to EWS, they must first be identified and barriers must be minimised. To stimulate acting on EWS, there must be awareness of which barriers can occur in hospital construction projects.
Nine categories of EWS in hospital construction projects are found: 1) Infeasible project goal, 2) Postponing decision making, 3) Diminishing cooperation, 4) Unfit team composition, 5) Lack of communication, 6) Lack of quality of documents, 7) Deteriorating connection with internal stakeholders, 8) Excessive workload, and 9) Resistance of external stakeholders.
Eight barriers are found that may prevent recognising or acting on EWS in hospital construction projects: 1) Inadequate management style, 2) Uncertainty avoidance, 3) Effects of board/politics, 4) Optimism bias, 5) Lack of time for reflection, 6) Underestimated project complexity, 7) Deteriorating relationship with contractors, and 8) Fragmentation.
To minimise possible problems in a hospital construction project, the three most impactful barriers can be managed by incorporating possible solutions regarding proactive and reactive approaches applying both soft and hard aspects of project management.