The Ridge Hospital handing over issues – A study in poor project management?

Joseph O. Cruickshank

The February 15, 2017 issue of the Daily Graphic contained an article titled: “Contractors yet to hand over refurbished Ridge Hospital.” In the article, various defenses were put up by people associated with the commissioning of the hospital as to why it was not yet ready to be handed over. Delays are not unusual when a complex project is undertaken and my intent here is not to dwell on the fact of the delay itself.

What caught my interest though were some of the reasons put forward by the authorities with regard to some specific items that supposedly justified the delay. Below, using excerpts from the article, I will attempt to analyze each reason given and pose some questions which I believe might shed some light on what appear to me to be some very deplorable project management practices exposed on this project. Since my intention is to make a technical point without aiming to embarrass anybody in particular, I have removed names of individuals that were used in the original Daily Graphic article.

The interesting parts of the article start out as follows (quoting verbatim from the Daily Graphic): “The Medical Director of the facility told the Daily Graphic in an interview that, some of the equipment installed did not come with spare parts, especially those that would require frequent replacement. There are also no service manuals for some of the equipment.”

The first question that arose in my mind was how this could be. On a well-managed project, no equipment would arrive on site without the owner’s representative signing off on the equipment certifying that what was being delivered met the exact specifications in the contract. The number and types of spare parts and or service manuals delivered to the site are not items that should be the subject of discussion and complaints at the end of the project. The absence of such items, if they were required by contractual agreement, should have been documented at the time of delivery and at the very least part payment should have been withheld until such time as the contractor made good on the items. Even more surprising is the statement that there were no service manuals for some of the items. Anybody who has ever opened a brand new box of anything knows that they come with all relevant manuals and servicing documents. Only “used” items are likely to have such items missing which could lead one to the suspicion that perhaps the items delivered were not new or maybe they were new and did come with the equipment but were carelessly tossed aside, which does not reflect positively on the project management team.

The article continues: “He said during the inauguration last year, two timers could not be located in the parasitology and immunology laboratories.” Ok, so were these delivered to the hospital? Shouldn’t there be signed documentation to that effect with the responsible human being’s name attached, if they were delivered? The statement gives the impression that nobody knows whether the items were delivered and are now lost, or were never delivered. All we know is that “they could not be located”!

Continuing, the Medical Director says: “Other issues of concern are about the color of work benches at the laboratory. The black color could make it difficult to detect and identify spillage easily.” This is an interesting statement and it begs the question: Did the Ministry of Health specify a particular color only to find at the end of the project that the contractor used a different color? Where was the project manager representing the Ministry of Health when the work benches were being painted? Was black what was specified? Indeed was any particular color specified? If this was left to the discretion of the contractor, then MoH has no grounds to complain and the contractor would be well within his rights to tack on extra charges to repaint the benches, if MoH insists on it.

The article further says: “Dr … further mentioned the lack of instruments for the various specialist units such as General Surgery, Neurosurgery, Paediatric Surgery, Urology, Thoracic, Trauma and Orthopaedics units.” Again one is left to ask the obvious question. Did the Ministry of Health specify any particular instruments? How many? Which kind? How many spare parts were to accompany them? On a well-managed project, such instruments would be specified in great detail as to number and type sometimes even to the level of specifying the manufacturer and specific model. In addition, there would be a set delivery schedule to make sure that the equipment arrives at specific points during construction, if they are large enough requiring installation before the building is closed. Such a schedule would be enforced by the project manager with, in some cases, financial penalties if the agreed upon schedule is not met. Some of these instruments sound like the kind that may be difficult to bring into a building after construction has ended without breaking walls and removing doors etc. The absence of such apparently crucial equipment is not something that one ought to discover at the end of the project.

Further on in the article, it says: “He said the Radiology Unit had requested that the PASCH computer, which was in grey scale, be replaced with a coloured one since having one grey scale would not be beneficial to their work.” I have no idea what difference the color of the scale makes, but here again, was the color specified in the contract documents? Again, where were members of MoH’s project management team when this scale arrived, assuming it did not meet the color requirements? Did they reject it and document such rejection?

Finally, the article goes on to say: “There are also lack of urine bottles, oxygen cylinder for emergency beds, difficulty in the manual handling of some beds and table over beds which the director said were not properly assembled.

There have also been concerns over blood/fluid warmers using cassettes because a non-availability of the cassettes would render the warmers useless.

The CO2 cylinder installed for the Endoscopy Tower at the Urology Unit was too small and needed backups.”

From all of the above, one gets the feeling that either the Ministry of Health called up some contractor and said “Hey, buddy, build me a hospital”, with minimal documentation or specifics in whatever contract was signed or the Ministry of Health’s project management team, assuming they had any on site, went AWOL. Furthermore, one gets the feeling that there may have been no coordination between those who were responsible for specifying the necessary equipment and the medical officers who would be using it. A charitable way to understand all of the Medical Director’s complaints is to assume that he was not included in the loop when decisions were being made as to how to equip the hospital which would be shocking if true. I hope such apparently dysfunctional contracting and project management procedures are not emblematic of how Ghana government institutions function on a routine basis. If that is the case, then we have some very serious problems. The science of Project Management is no “rocket science”. That is the more reason why the case of the Ridge Hospital, as detailed above, leaves cause for some concern.