Health Facilities Capital Program Manual Version 1.0
TABLE OF CONTENTS TABLE OF CONTENTS... 2 1.0 INTRODUCTION... 9 1.1 Health Facilities Capital Program... 9 1.1.1 Major Capital Projects Total Project Cost $5 Million or Greater... 9 1.1.2 Minor Capital Projects Total Project Cost Less Than $5 Million... 9 1.1.3 Infrastructure Maintenance Program... 9 1.1.4 Property Transactions Program... 10 1.2 Health Facilities Capital Program Organizational Roles... 10 1.3 Overview of Manual... 11 1.3.1 Guiding Principles... 11 1.3.2 Manual Objectives... 11 1.3.3 Scope of the Manual... 11 1.3.4 Intended Audience... 12 1.3.5 Manual Access... 12 1.3.6 Organization of the Manual... 12 1.4 Manual Amendments... 13 1.4.1 Responsibility for Manual Amendments... 13 1.4.2 Manual Amendment Process... 14 2.0 PROVINCIAL HEALTH PLANNING & CAPITAL MANAGEMENT... 16 2.1 Legislative Authority... 16 2.1.1 Alberta Health and Alberta Infrastructure... 16 2.1.2 Alberta Health Services... 17 2.2 Health Services Policy and Planning Context... 18
2.3 Memorandum of Understanding (MOU): Roles and Responsibilities... 19 2.4 Health Facilities Capital Program Governance and Management... 19 2.5 Health Facilities Capital Program Communications Framework... 20 3.0 CAPITAL PLANNING & PROJECT APPROVAL PROCESS... 22 3.1 Government of Alberta Annual Capital Planning Process... 22 3.1.1 Overview... 22 3.1.2 Components of HEALTH s submission into GoA s annual CPP.... 22 3.2 Steps in Health Capital Planning and Project Approval Process... 23 3.3 Alberta Health Services Multi-Year Facility Infrastructure Capital Submission... 25 3.3.1 Purposes of the AHS Multi-Year Facility Infrastructure Capital Submission... 26 3.3.2 Description of the Alberta Health Services Capital Submission... 26 3.3.3 Needs Assessment... 29 3.3.4 Submission and Review of the Alberta Health Services Capital Submission... 30 3.3.5 Business Case... 31 4.0 ALBERTA INFRASTRUCTURE CAPITAL PROJECT DELIVERY... 35 4.1 Project Start-up and Planning... 36 4.1.1 Major Project Oversight... 36 4.1.2 Project Management Framework... 37 4.1.3 Project Organization and Approach... 37 4.1.4 Joint Decision Points and Key Documents... 44 4.1.5 Project Planning Documents... 47 4.1.6 Changes to Approved Project Parameters... 49 4.1.7 Site Selection, Land Acquisition and Divestiture of Assets... 52 4.1.8 Functional Program... 54 4.1.9 Project Funding... 57 4.1.10 Alternative Capital Funding... 60
4.1.11 Furniture and Equipment, Information Technology Planning and Procurement... 61 4.2 Project Procurement and Design... 61 4.2.1 Standards and Guidelines... 61 4.2.2 Procurement Planning... 62 4.2.3 Capital Project Design Process... 63 4.2.4 Leadership in Energy and Environmental Design (LEED ) Planning... 66 4.3 Project Construction... 67 4.3.1 Contract Management... 67 4.3.2 Roles and Responsibilities... 68 4.3.3 Contracting, Procurement and Supply Management and Information Technology 70 4.3.4 Infection Prevention and Control... 70 4.3.5 Access Management... 71 4.3.6 Insurance and/or Risk Management... 72 4.3.7 Occupational Health and Safety... 73 4.3.8 Project Reporting... 75 4.4 Commissioning, Handover and Warranty... 76 4.4.1 Building Commissioning and Manuals... 76 4.4.2 Facility Handover... 79 4.4.3 Operational Commissioning and Move-in Planning... 79 4.4.4 Warranty Resolution... 81 4.4.5 Reimbursement of Alberta Health Services Facilities Maintenance and Engineering Expenses... 82 4.5 Evaluation and Project Closeout... 84 4.5.1 Project Performance Measures... 84 4.5.2 Best Practices and Lessons Learned Review Process... 85 4.5.3 Post-Occupancy Evaluation... 86
4.5.4 Building Performance Evaluation (BPE)... 86 4.5.5 Project Closeout... 86 5.0 MINOR CAPITAL PROJECT DELIVERY... 89 5.1 Organizational Roles and Responsibilities... 89 5.1.1 Tri-Party Oversight... 89 5.1.2 Alberta Health Services... 90 5.1.3 Alberta Health... 91 5.1.4 Infrastructure... 91 5.2 Project Funding Guidelines... 91 5.2.1 Pre-conditions for Grant Payments... 91 5.2.2 Grant Payment Process... 92 5.2.3 Eligible Minor Capital Project Costs... 92 5.2.4 Project Administration Funding... 93 5.2.5 Third-Party Funding... 93 5.3 Project Oversight... 94 5.3.1 Reporting Requirements... 94 5.3.2 Auditing... 94 5.3.3 Site Visits... 95 5.3.4 Contracting Principles... 95 6.0 INFRASTRUCTURE MAINTENANCE PROGRAM (IMP)... 96 6.1 Organizational Roles and Responsibilities... 96 6.1.1 Health Capital Joint Steering Committee... 96 6.1.2 Health Capital Joint Operations Committee... 96 6.1.3 Alberta Health Services... 97 6.1.4 Alberta Health... 97 6.1.5 Infrastructure... 97
6.2 Eligibility Criteria... 98 6.2.1 General Program Eligibility Criteria... 98 6.2.2 Ineligible Projects... 99 6.2.3 Eligible Facility Types... 99 6.2.4 Eligible Infrastructure Maintenance Program Project Costs... 100 6.3 Prioritization of Projects... 100 6.4 Development of an Infrastructure Maintenance Plan... 102 6.4.1 Project Activity in Current Fiscal Year (Year 1)... 102 6.4.2 Proposed Projects for Future Years (Years 2 and 3)... 102 6.4.3 Project Information Requirements... 102 6.4.4 Timelines... 103 6.4.5 INFRA Review... 103 6.4.6 Plan Approval and Payment of Grant Funds... 103 6.5 Project Oversight... 105 6.5.1 Reporting Requirements... 105 6.5.2 Auditing... 105 6.5.3 Site Visits... 105 6.6 Contracting Principles... 106 7.0 FURNITURE, EQUIPMENT AND INFORMATION TECHNOLOGY... 107 7.1 Organizational Roles and Responsibilities... 107 7.1.1 Tri-Party Oversight... 108 7.1.2 Alberta Health Services... 108 7.1.3 Alberta Health... 108 7.1.4 INFRA... 109 7.2 Equipment Classification... 109 7.3 Capital Project Eligibility Criteria... 110
7.3.1 General Program Eligibility Criteria... 110 7.3.2 Ineligible Equipment Costs... 111 7.4 Business Case Development... 112 7.5 Project Organization and Communication... 112 7.6 Program Delivery Equipment Plans... 113 7.6.1 Equipment Plan and Budget Preparation... 113 7.6.2 Risk Management Plan... 115 7.6.3 Procurement Plan... 117 7.6.4 Delivery and Installation Plan... 117 7.7 Financial Administration... 119 7.7.1 Budget Oversight... 119 7.7.2 Budget Development... 119 7.7.3 Cost Information... 120 7.7.4 Equipment Reuse... 121 7.7.5 Unassigned Contingency... 121 7.7.6 CPSM Administration Allowance... 122 7.7.7 Variance Management... 123 7.7.8 Third-Party Contributions... 123 7.7.9 Auditing... 124 7.8 Grant Processes... 124 7.8.1 Grant Funding Agreement... 124 7.8.2 Grant Payment Process... 124 7.8.3 Reporting Requirements... 125 7.9 Program Delivery Equipment Installation Framework... 126 7.10 Diagnostic Imaging Requirements... 126 SCHEDULE 1... 127
SCHEDULE 2... 130 APPENDICES... 132
1.0 INTRODUCTION Chapter 1.0 provides an overview of the Health Facilities Capital Program (Capital Program) components and the roles of the key organizations involved in the Program. This Chapter also includes an overview of the Health Facilities Capital Program Manual (Manual) structure and describes the process for amendments to the Manual. The Manual has been developed collaboratively by Alberta Health (HEALTH), Alberta Infrastructure (INFRA) and Alberta Health Services (AHS) (the Parties). The Parties work together to build the right facilities in the right communities to meet Albertans health needs now and into the future. The Manual is developed in accordance with the priorities outlined in the Memorandum of Understanding and under the guidance of the Joint Steering Committee. It describes responsibilities, accountabilities and processes for the planning and delivery of the Program. This Manual supersedes the Health Capital Planning Manual, 3 rd Edition (Revised April 2005). 1.1 Health Facilities Capital Program The Capital Program refers to all health facilities capital programs and projects planned and funded through INFRA and managed jointly by the Parties, including: 1.1.1 Major Capital Projects Total Project Cost $5 Million or Greater Capital Projects with Total Project Costs (TPC) of $5 million or more are normally delivered by INFRA. However, in some cases the Parties may agree that AHS will deliver the project. (See Chapter 4 for more information). 1.1.2 Minor Capital Projects Total Project Cost Less Than $5 Million Capital projects under $5 million are normally delivered by AHS. However, in some cases the Parties may agree that INFRA will deliver the project. (See Chapter 4 for more information). 1.1.3 Infrastructure Maintenance Program The Infrastructure Maintenance Program (IMP) is an ongoing funding program for the maintenance and renewal of health facilities. AHS is responsible for the delivery of IMP projects; however, some IMP projects may be delivered by INFRA for reasons of efficiency, Health Facilities Capital Program Manual Version 1.0 June 2013 Page 9
particularly where there may be efficiencies in implementing an IMP project in conjunction with a capital project. (See Chapter 4 for information on project delivery and Chapter 6 for more information on the IMP process). 1.1.4 Property Transactions Program This program oversees the requirements and conditions that apply to the acquisition and disposal of land and/or buildings owned by AHS. 1.2 Health Facilities Capital Program Organizational Roles The lead organizations within HEALTH, INFRA and AHS and their roles in the Capital Program are described in Table 1 below. Staff from these organizations have participated in the development of this Manual. Table 1 Health Facilities Capital Program Organizational Roles 1 Organization HEALTH Financial and Corporate Services Division, Health Facilities Planning Branch INFRA Capital Projects Division, Health Facilities Branch AHS Capital Management Roles Provides health capital policy direction and capital planning oversight. Develops priorities and recommendations for strategic capital funding in support of AHS delivered health programs on behalf of the Province, in consultation with INFRA and AHS Develops Business Cases and implements approved major capital projects. Provides oversight of IMP and minor capital projects on behalf of the Province. Develops annual AHS Multi-Year Capital Submissions including Needs Assessments and proposals for health facility project projects necessary to support AHS operational priorities. Participates in capital program and project planning, and delivery. 1 Other supported Capital Management staff in AHS participated in the development of the Manual, including Contracting, Procurement and Supply Management (CPSM), Facilities Maintenance and Engineering (FM&E); and Information Technology (IT). Health Facilities Capital Program Manual Version 1.0 June 2013 Page 10
Manages IMP projects and Minor Capital Projects. Operates health facilities. 1.3 Overview of Manual This Manual provides a description of the processes and responsibilities for the management, planning and delivery of the Capital Program. Organizational roles and responsibilities are based on the Responsible, Accountable, Support, Consult, Inform (RASCI) Matrix agreed to by the Parties. (See Appendix 3). 1.3.1 Guiding Principles There are five principles that guide the integrated three-party management, planning and delivery of health facility projects and programs: supports health service and operational needs; provide value for money through the use of sound fiscal and risk management principles and practices; demonstrate strong accountability in a flexible process; maintain patient safety; and protect the public interest. 1.3.2 Manual Objectives The following objectives guide the development and maintenance of the Manual: describe and clarify inter-organizational processes consistent with over-arching policy or funding eligibility requirements Capital Program; outline the responsibilities of the Parties, and the information requirements that support decision-making relating to Capital Program; and provide links to relevant documents and templates that are used during project or program planning and delivery of the Capital Program for health facilities. 1.3.3 Scope of the Manual This Manual focuses on capital project planning and delivery processes, the IMP process, and the inter-organizational decision-making involving the Parties for the Capital Program. Processes for decisions that are clearly internal to one organization and those processes that do not influence the actions or responsibilities of either of the other two entities are out of Health Facilities Capital Program Manual Version 1.0 June 2013 Page 11
scope. The reader may need to consult organization specific documentation to clarify or confirm internal project administration processes. 1.3.4 Intended Audience This Manual is a high-level reference document for all new and existing employees of HEALTH, INFRA and AHS who are engaged in the management, planning or delivery of the Capital Program. 1.3.5 Manual Access This Manual may be accessed through links available on INFRA s Internet website. HEALTH and AHS also provide links to the Manual through their respective sites. This document employs hyper-links to facilitate movement between sections. The Manual will be updated regularly through an annual review process (see section 1.4). Staff should use the manual that is available through the Internet as the reference document rather than a printed copy to ensure they are viewing the most recent information. Updates to the Manual (either annual or interim) will be made using tracked changes and will be left as such until the next annual update. In addition, updates will be listed inside the front cover with the corresponding Manual version number. 1.3.6 Organization of the Manual The information in this Manual is organized as follows: Chapter 1: Introduction - Background information and an overview of the Manual s contents. Topics include the purpose and scope of the Manual, intended audience, Manual access, and the amendment process; Chapter 2: Provincial Health Planning and Capital Management - Information regarding the context for provincial health capital planning and management, including an overview of important legislation, tri-party agreements, health service policy and planning documents and communications guidelines; Chapter 3: Capital Planning and Project Approval Process An overview of the AHS Multi-Year Facility Infrastructure Capital Submission (AHS Capital Submission) process and requirements, the HEALTH Capital Plan submission, and the Government of Alberta s (GoA) Capital Planning Process (CPP); Health Facilities Capital Program Manual Version 1.0 June 2013 Page 12
Chapter 4: Alberta Infrastructure Major Capital Project Delivery A description of the processes for project planning and design, project administration, project construction, and project review and closure for projects with TPC of $5 million or greater; Chapter 5: Minor Capital Project Delivery A description of the processes for planning of projects under $5 million which AHS is responsible for delivering; Chapter 6: Infrastructure Maintenance Program Guidelines - Specific guidance for the management oversight of the IMP process. Topics such as planning and reporting, eligibility criteria and urgent and emergent projects are covered; Chapter 7: Furniture, Equipment and Information Technology A description of the organizational responsibilities and processes for the management of capital equipment in support of capital projects; Chapter 8: Property Transactions A description of the requirements and conditions that apply to the acquisition or disposal of land and/or buildings owned by AHS; and Appendices A complete list of important supporting documents, including policy documents, committee Terms of Reference (TOR) and templates that are available through links in this Manual. 1.4 Manual Amendments Users are invited to submit amendments to the Manual at any time through their organizational representatives as listed below: Anna Ellert, Alberta Infrastructure (Anna.Ellert@gov.ab.ca ); Calvin Maxfield, Alberta Health (Calvin.Maxfield@gov.ab.ca); and Steve Fowler, Alberta Health Services (Steve.Fowler@albertahealthservices.ca ). 1.4.1 Responsibility for Manual Amendments INFRA s Health Facilities Branch is responsible for: maintaining the Manual; coordinating annual and interim updates; and document version control. Health Facilities Capital Program Manual Version 1.0 June 2013 Page 13
1.4.2 Manual Amendment Process There are two processes for amendments: annual updates; and interim updates. Annual updates The INFRA Health Facilities Branch uses the following process to update the Manual beginning in April: the Parties assign representatives to a Joint Operations Sub-Committee for the Manual (see section 2.4 for more information on the roles of committees); the Joint Operations Sub-Committee participates in ongoing review of amendments submitted by users and decides, in consultation with the submitter, if the recommended amendment requires immediate attention or if it could be deferred to the annual review/update process. (See Interim Updates below for more information); the organizational representatives canvas their organizations users on an annual basis to gather suggested amendments to the Manual; proposed amendments are analyzed by the Joint Operations Sub-Committee and submitted to the Joint Operations Committee together with a recommendation concerning their implementation; the Joint Operations Committee may refer matters that impact finance, organizational responsibilities or inter-organizational decision-making to the Joint Steering Committee. (See section 2.4 for more information on governance and management of the Capital Program); and upon approval, the updates are incorporated into the Manual and the Joint Operations Committee members inform their respective organizations that the Manual has been updated. Interim updates For emergent issues or for changes requiring immediate amendment, the following process is followed: the organizational representatives submit a request with supporting information and documentation to the Joint Operations Sub-Committee with a request for an immediate amendment; Health Facilities Capital Program Manual Version 1.0 June 2013 Page 14
the Sub-Committee reviews and clarifies the submission and will consult with the submitter as appropriate; if the submission requires an immediate amendment, a proposal is submitted to the Joint Operations Committee together with a recommendation concerning delivery; the Joint Operations Committee may refer matters that impact finance, organizational responsibilities or inter-organizational decision-making to the Joint Steering Committee. (See section 2.4 for more information on governance and management of the Capital Program); and upon approval, the updates are incorporated into the Manual and the Joint Operations Committee members inform their respective organizations that the Manual has been updated. The decision making/manual update process will be responsive and as timely as possible recognizing the emergent or urgent need for direction. Health Facilities Capital Program Manual Version 1.0 June 2013 Page 15
2.0 PROVINCIAL HEALTH PLANNING & CAPITAL MANAGEMENT Chapter 2.0 provides an overview of the provincial context for the Capital Program. It identifies: key legislation that govern the roles of the Parties; the health services planning documents that guide the planning and development of the Capital Program; the processes that facilitate management oversight of the Capital Program as well as the roles and responsibilities of the three Parties; and the communications framework for dealing with requests for information about the Capital Program. 2.1 Legislative Authority 2.1.1 Alberta Health and Alberta Infrastructure The legislated responsibilities of HEALTH and INFRA for the planning and management of the Capital Program and Projects are outlined in the Acts and Regulations noted below. Under these statutes and regulations, HEALTH is responsible for setting the strategic direction for the Provincial Health System, and for implementing policy, legislation, standards and funding for provincial health services. Health legislation, as related to health infrastructure, provides for the approval and operation of health facilities, the purchase and disposition of assets and properties, the design and construction of health infrastructure, and the provision of health capital grants. INFRA is responsible for provincial infrastructure design, construction and delivery. The Ministry has responsibility for the provision of services relating to the project planning, design, construction or renovation of a health facility. In many cases, specific regulations or sections contained within regulations are jointly administered by both HEALTH and INFRA. Hospitals Act Part 2 Operation of Approved Hospitals This act relates to the construction, renovation or alteration of real property (buildings, land) and requires that AHS obtain government approval for acquiring or changing physical plants. Under this Act, the Hospitalization Benefits Regulation 244/1990 governs the management of the Consolidated Cash Investment Trust Funds (CCITF) by AHS. Nursing Homes Act Parts 1, 2, and 3 relate to how nursing homes are owned, operated and contracted to the private section. Mental Health Act - Part 7 relates to the development of treatment centers and other facilities to provide mental health services. Health Facilities Capital Program Manual Version 1.0 June 2013 Page 16
Public Works Act This act is administered by Infrastructure and governs the acquisition, disposition and management of facilities, the sale of lands and the provision of services relating to the design, construction, alteration, extension, upgrade, repair or demolition of public facilities, including health care facilities. Government Organization Act This act delineates the roles and responsibilities of all government departments, boards and agencies. The Infrastructure Grants Regulation #AR56/2003 provides the Minister of Infrastructure authorities to issue grants. The Health Grants Regulation #AR146/2002 and the Seniors Grants Regulation #AR192/2005 provide the Minister of Health authorities to issue grants. Regional Health Authorities Act This act enables the Minister of Health to make regulations respecting the provision of health services, the undertaking of capital construction projects and the operation of facilities. Financial Administration Act This act outlines the financial management requirements for government departments, agencies and boards in relation to capital and operating funds. As well, funds such as the Consolidated Cash Investment Trust Fund (CCITF) are governed under this act. Builders Lien Act This act applies primarily to work undertaken by AHS; however, it does apply to Infrastructure s work where the ministry is managing projects on AHS properties. It defines key contracting issues such as liens, claims and substantial performance. 2.1.2 Alberta Health Services Under the Alberta Public Agencies Governance Act (APAGA), the AHS Board is the governing body and regional health authority responsible for the delivery and operation of health services to Albertans and ownership and operation of health facilities that support the delivery of health services. As well, the Alberta Health Services Roles and Mandate Document provides enhanced clarity on roles, responsibilities and service delivery goals. Another key act is the Regional Health Authorities Act which provides AHS the authority to plan, operate and manage health facilities. Under this act, the Regional Health Authorities Regulation, AR 15/95, requires AHS to obtain the written consent of the Minister of Health to enter into a capital development project that has a value in excess of an amount specified by the Minister in a directive. It also requires AHS to comply with written policies and rules issued by the Minister. Health Facilities Capital Program Manual Version 1.0 June 2013 Page 17
Relevant statutes and regulations can be found on the HEALTH web site for health-related legislation and the INFRA website for the Public Works Act. The Builders Lien Act can be found on the Service Alberta website. 2.2 Health Services Policy and Planning Context The Capital Program operates within a larger provincial health services planning context. Key health services planning documents that inform and guide the Capital Program are listed in the following chart. The Parties review and reference these documents as necessary during planning and delivery of the Capital Program. Table 2 Key Planning Documents by Organization HEALTH Organization Key Planning Documents* HEALTH Business Plan ** Becoming the Best: Alberta s Five Year Health Action Plan Creating Connections: Alberta Mental Health and Addictions Strategy Continuing Care Strategy: Aging in the Right Place INFRA INFRA Business Plan ** AHS AHS Health Plan & Business Plan ** * Additional GoA or ministry specific documents may need to be referenced to fully inform the planning process. Additional documents will be listed as they are approved by the Parties. ** These documents are updated annually. Health Facilities Capital Program Manual Version 1.0 June 2013 Page 18
2.3 Memorandum of Understanding (MOU): Roles and Responsibilities The MOU (Appendix 2.1) is an agreement signed by the Ministers of HEALTH and INFRA, and the Board Chair of AHS. Building on the RASCI (Appendix 3), it outlines the roles and responsibilities of the Parties regarding planning and delivery of the Capital Program. The MOU agreement governs the processes and responsibilities described throughout this Manual and provides for resolution of disputes. The MOU will be reviewed every three years by the Parties (HEALTH, AHS and INFRA). 2.4 Health Facilities Capital Program Governance and Management Governance and management oversight of the Capital Program, including authorities and responsibilities are described in Table 3 below. A Health Capital Joint Steering Committee and a Health Capital Joint Operations Committee have been established according to the MOU. The membership of each committee comprises representatives from each of the Parties. These Joint Committees are integral to the over-arching governance structure for the Capital Program. Through these committees, the Parties collaborate to facilitate management oversight and inter-organizational decision-making. While respecting organizational authorities and responsibilities, the committees undertake the collective review, consultation and determination of courses-of-action that enable program level oversight and effective project management. Sub-committees have been established to manage specific tri-party activities and/or programs, such as the Capital Manual, Capital Planning, IMP, Standards and Guidelines and Furniture, Equipment and Information Technology Sub-Committees. See Appendix 2.2 and Appendix 2.3 for the TOR for the Joint Committees. Sub-Committee Terms of References are held in Appendix 2.4, Appendix 2.5, Appendix 2.6 and Appendix 2.7 Health Facilities Capital Program Manual Version 1.0 June 2013 Page 19
Table 3 Health Facilities Capital Program Governance Authority and Responsibility Levels Authority Responsibilities Reference Documents Ministers Chair AHS Board Deputy Ministers AHS CEO HEALTH and INFRA Assistant Deputy Ministers and AHS Senior VPs Executive Directors Health Facilities Planning (HEALTH) Health Facilities Branch (INFRA) VP Capital Management and Government Integration (AHS) Establish overarching roles and responsibilities of the Parties. Provides organization level oversight Provides a forum for executive level oversight including inter-organizational decision-making and issue resolution. Provides a forum for process and management oversight, and the resolution of issues concerning the Capital Program. Alberta Public Agencies Governance Act (APAGA) mandate and roles (see section 2.1.2) RASCI (Appendix 3) MOU (Appendix 2.1) Joint Steering Committee TOR (see Appendix 2.2) Joint Operations Committee TOR (see Appendix 2.3) 2.5 Health Facilities Capital Program Communications Framework The roles and responsibilities of the Parties for communications with stakeholders are as follows: INFRA takes the lead for sharing project-specific information; AHS takes the lead for sharing program-specific information; Key communications staff from all three organizations has been identified to interface with the media and lead messaging to the public and special interest groups. These staff work together to share project and program updates as well as manage media requests and responses; and All communication requests or needs should be directed to key communications staff within the organization where the request was received. In addition to communications with media and stakeholders, ongoing communications between HEALTH, INFRA and AHS are essential during all phases of a project s lifecycle. Project Managers, at the early stages of a project will develop a communications plan that Health Facilities Capital Program Manual Version 1.0 June 2013 Page 20
addresses the details of formal and organized communications between all parties involved in the planning and delivery of the facility. Health Facilities Capital Program Manual Version 1.0 June 2013 Page 21
3.0 CAPITAL PLANNING & PROJECT APPROVAL PROCESS Chapter 3.0 describes the planning and approval process for major health facilities capital projects. It specifically addresses the AHS Multi-Year Facility Infrastructure Capital Submission and HEALTH s submission into Government of Alberta (GoA) annual Capital Planning Process (CPP). It identifies the roles and responsibilities of the Parties in the GoA s annual CPP. 3.1 Government of Alberta Annual Capital Planning Process This section describes the GoA annual CPP and the HEALTH Capital Plan submission to the CPP. 3.1.1 Overview Each year the GoA undertakes the CPP. The CPP is led by the Ministry of Infrastructure based on direction from TBF and is supported by the program ministries. The process typically begins in the spring of each year after the provincial budget is tabled. The CPP is used to inform the development of government s 3-year Capital Plan which is part of the annual provincial budget and also to inform the development of a long-term capital plan for government. Like all program ministries, HEALTH is responsible to prepare their submission into government s annual CPP based on directions provided by TBF and INFRA. INFRA supports HEALTH s submissions confirming facility solutions and project costing. The AHS Multi-year Facility Infrastructure Capital Submission is a very important document used by HEALTH to prepare their submission into government s annual CPP. (i.e., Infrastructure projects) 3.1.2 Components of HEALTH s submission into GoA s annual CPP. HEALTH s submission into the GoA s CPP typically includes the following: updated cash flow information on existing projects; identification of the priority health capital projects, including related project costs, recommended for capital funding approval consideration; updates to the IMP requirements, typically over a five-year period; and a 10-year Capital Plan of all unfunded health capital projects. Health Facilities Capital Program Manual Version 1.0 June 2013 Page 22
INFRA may request additional information as part of the HEALTH s submission to GoA annual CPP. 3.2 Steps in Health Capital Planning and Project Approval Process The major steps in the planning and project approval process are as follows: proposed health capital initiatives are generated at the Ministry level as a response to an identified program need. One of the key sources for identifying the needs is the AHS Multi-Year Facility Infrastructure Capital Submission AHS develops their annual AHS Multi-Year Facility Infrastructure Capital Submission (AHS Capital Submission) and provides it to HEALTH and INFRA by May 31 of each year. Figure 2 provides the high-level workflow and responsibilities of the Parties for the Health Capital Planning and Approval Process; throughout the year AHS develops Needs Assessments for their unfunded priority health capital projects and submits them to HEALTH; through the Capital Planning Sub-Committee, HEALTH consults with AHS and INFRA to determine the next appropriate step for each Needs Assessment submitted. if a Needs Assessment is accepted by HEALTH, then Deputy Minister of HEALTH will write to Deputy Minister of INFRA requesting that INFRA prepare an appropriately rigorous Business Case or Business Case equivalent. INFRA leads the preparation of the Business Case, gets the appropriate sign-off from AHS and then sends it to HEALTH. Once a Business Case is completed, HEALTH, through the Planning Sub Committee, consults with AHS and INFRA to determine the next appropriate step for the Business Case. AHS submits their annual Multi-year Facility Infrastructure Capital Submission to HEALTH and INFRA. This submission identifies all unfunded priority health capital projects for which AHS is requesting capital funding approval consideration. Each of these unfunded priority projects must be supported by an appropriately rigorous Business Case in order to be eligible for capital funding approval consideration. HEALTH makes a submission into GoA s annual CPP as per direction provided by TBF. The information in the AHS Multi-year Facility Infrastructure Capital Submission and the supporting Business Cases provided to date are used to inform HEALTH s submission. Health Facilities Capital Program Manual Version 1.0 June 2013 Page 23
INFRA, on behalf of government, leads the GoA s annual Capital Planning Process which informs the development of the government s 3-year Capital Plan within the annual Provincial Budget. Government tables the Provincial Budget. The Provincial Budget identifies any new health capital projects or new health capital programs. Legislature votes on estimates approximately 3 to 4 weeks after Provincial Budget tabled the Ministers of HEALTH and INFRA jointly write the Board Chair of AHS informing him/her of any approved health capital projects in the Provincial Budget and conditions of the approval. Figure 2 illustrates the health capital planning and approval process. Health Facilities Capital Program Manual Version 1.0 June 2013 Page 24
Figure 2 Health Capital Planning and Approval Process ALBERTA HEALTH SERVICES (AHS) Prepares annual Multi-Year Facility Infrastructure Capital Submission, including Needs Assessment ALBERTA HEALTH (HEALTH) Reviews AHS submission and develops HEALTH Capital Plan ALBERTA INFRASTRUCTURE (INFRA) Prepares Business Cases as required for the HEALTH Capital Plan INFRA and HEALTH DEPUTY MINISTERS APPROVAL INFRA DM signs off on technical and cost information HEALTH DM reviews and approves the Capital Plan TREASURY BOARD Reviews cross-ministry capital plan submissions. Recommends priority health projects for inclusion in GOA Capital Planning Process (CPP) GOA CABINET APPROVAL AND ALLOCATION OF FUNDS Cabinet informs Treasury Board of approvals Treasury Board informs Ministers of HEALTH and INFRA. Ministers of HEALTH and INFRA inform AHS. 3.3 Alberta Health Services Multi-Year Facility Infrastructure Capital Submission Multi-year capital planning is the process of identifying current and future capital needs and developing strategies and proposals to address those needs. AHS develops a Multi-year Facility Infrastructure Capital Submission (AHS Capital Submission) that supports the AHS Health Plan, which outlines how AHS intends to deliver health services. The AHS Capital Submission is sent to HEALTH annually. Health Facilities Capital Program Manual Version 1.0 June 2013 Page 25
3.3.1 Purposes of the AHS Multi-Year Facility Infrastructure Capital Submission The purpose of this submission is to: outline the overall planning and management of health infrastructure; communicate the capital expenditures needed to effectively maintain the existing asset base and modify it as needed to support service delivery strategies; provide the Ministers of HEALTH and INFRA with the information needed to recommend appropriate future funding levels for health infrastructure; provide a rational context to HEALTH and in turn to TBF, for annually assessing individual project recommendations relative to provincial capital proposals (including all the ministries capital submissions) and priorities; and when possible provide a preliminary estimate of operating costs for the proposed capital investments. 3.3.2 Description of the Alberta Health Services Capital Submission The AHS capital submission is updated and submitted annually to Alberta Health, at a minimum the information required as follows: Executive Summary The executive summary provides an overview of the AHS Capital Submission and identifies the highest priority projects being requested in an appropriate format for review and approval by AHS senior executive and the Board. Introduction This section describes the operational directives that will influence all capital initiatives. The objective of capital investment, and all capital projects, is to support service delivery needs. AHS is responsible for delivering a range of core health services, as set out in AHS' Vision, Strategic Plan and Health Plan. This, along with addressing existing infrastructure issues (safety, physical and functional obsolescence) is the central factor driving the CPP. The link between the AHS Capital Submission and its Health Plan should be clearly articulated by including: a descriptive overview of the mandate, core services and priorities in the health plan; an explanation of how the capital submission supports AHS Health Plan; and where relevant, a summary of how the AHS Capital Plan links to broader government strategic priorities. Health Facilities Capital Program Manual Version 1.0 June 2013 Page 26
This information provides important context to government decision-makers. Major Health Trends This part briefly summarizes the health status of Albertans and the challenges and influences currently impacting the delivery of care. Overview of Infrastructure Asset Base This part of the submission provides an inventory of all infrastructure used by AHS, including owned, leased and contracted facilities. This inventory information: allows for more meaningful comparisons between assets; may help form the basis for ranking or prioritizing proposals; helps determine the nature, cost and timing (urgency) of work required; and supports the development of capital strategies that meet service needs in the most cost effective and efficient manner (e.g. by identifying and capitalizing on excess/underutilized capacity). AHS and INFRA jointly develop and annually update a comprehensive asset inventory. The land and building information for each asset includes: ownership status (e.g. owned, leased or contracted); location; structural type; size (land area, square meters, capacity); age (year of original construction for each component structure) and history (e.g. significant rehabilitation, repairs, additions, renovations); replacement value; current use; and any other significant issues. Data on structural type, size and age is submitted to INFRA and maintained in the Evaluation module of the Building and Land Inventory Management System (BLIMS). Replacement Values are typically calculated by INFRA s Project Services Branch. Appendices (e.g. Facility Condition Index (FCI) report, Real Estate Capital Asset Priority Planning (RECAPP) report etc.) may be included to provide additional descriptive or statistical detail. Health Facilities Capital Program Manual Version 1.0 June 2013 Page 27
Capital Submission Parameters The AHS capital submission overview describes key program and service delivery strategies and objectives for the next three years or longer. The AHS capital submission must show evidence that capital strategies are directly linked to operational strategies. It should also identify and briefly describe the most significant factors underlying AHS needs for capital expenditures (e.g. demographics, technological change, program change, etc.) Capital Priorities Capital Submission Priorities translate the AHS strategic priorities into proposed short and long-term project plans by providing information on the major capital proposals and divestiture initiatives needed to implement the strategies outlined. This section describes in detail AHS' highest priority projects for provincial capital funding approval, listed in priority order, and including the following information for each proposal: the location and name of the facility or proposed location of a new facility; the ranking of the proposal relative to other proposals in the plan; a brief description of the proposed scope of work; a description of the link between the proposal and the capital strategies; a description of how the project is to be procured (e.g. by a traditional or an alternative capital funding approach); when possible an order of magnitude estimated capital cost of the project and the provincial contribution required (stated in constant dollars). This estimate would be developed in consultation with INFRA and would explain the impact on provincial capital funding requirements of any proposed alternative capital funding or alternative sources of funds (e.g. partnership with private, voluntary or public sector organization); when possible an order of magnitude, an estimate of the additional annualized operating cost, the reasons for the increase and an indication whether AHS can support the increased expenditure in future years' program and operating budgets. Alternately, an estimate of annualized operating savings following completion of the project and the reasons for such savings; summary of any investigative analyses or planning completed to date (master plan, feasibility study, Business Case, etc.) and related reports that are available for review; Health Facilities Capital Program Manual Version 1.0 June 2013 Page 28
identification of the funds required and the year in which funds are needed if a Needs Assessment has not yet been completed or if some other type of investigative study is needed; and if all preliminary planning is complete and the identification of the year in which approval for the project is being requested. Information of any future capital proposals that may need to be initiated in a two to three year horizon plus potential projects beyond that time frame (four to ten years). It is understood that these projects may lack detail and be subject to significant change. Asset Divestiture Plan This section provides an overview of any surplus or underutilized infrastructure and describes plans for its disposition or alternate use. Appendices The AHS Capital Submission must include, at a minimum, a Needs Assessment for each of the high priority projects identified in the document (may be submitted separately from the Capital Submission). Appendices may include summaries and status of projects identified in previous capital submissions. Supporting reports or studies for projects identified in the current Capital Submission may also be included. 3.3.3 Needs Assessment Purpose of a Needs Assessment AHS leads the development of Needs Assessments. A Needs Assessment provides an analysis of the clinical needs and is in turn used for the identification and development of health capital project proposals. It informs and supports proposals identified in the annual AHS Capital Submission, and is consistent with health service delivery plans (see section 2.2). A Needs Assessment involves: articulation of clinical needs; identification of gaps between current conditions and desired conditions; identification of problems, deficits, weaknesses, opportunities and strengths in service delivery; and identification of possible operational solutions to address the stated need or gap in service delivery. Health Facilities Capital Program Manual Version 1.0 June 2013 Page 29
Components of a Needs Assessment A Needs Assessment includes the following components: problem or opportunity; background or current situation; strategic and environmental alignment; desired end-state; gap analysis (e.g. savings in staffing, time, costs, etc.); and risk assessment of alternative service delivery options. For a detailed description of each of these components see the Needs Assessment Template and Flow Chart (Appendix 5.1 and Appendix 5.2). Process for Approval of a Needs Assessment HEALTH is responsible for reviewing a completed Needs Assessment and where appropriate, requesting the development of a Business Case by INFRA. This includes: reviewing of each Needs Assessment to determine compliance with provincial health strategies and service delivery plans; and identifying priority Needs Assessments, congruent with provincial health strategies priorities. 3.3.4 Submission and Review of the Alberta Health Services Capital Submission The AHS Capital Submission is approved by AHS and then formally submitted by the Board Chair to the Ministers of HEALTH. The response is led by HEALTH with consultation with INFRA and signed by both Ministers. The response may comment on: the general acceptability of the AHS Capital Submission; whether or not all information requirements have been met; and individual proposed projects included in the AHS Capital Submission. Where the Ministers indicate that information requirements have not been met, the specified information should be forwarded as soon as possible to AHS senior executive. Upon receipt of the AHS Capital Submission, the Joint Operations Capital Planning Sub- Committee will initiate an assessment and review of the specific proposals identified in the AHS Capital Submission to determine or update the current status of the proposals, and to reach consensus on the appropriate next steps, as follows: Health Facilities Capital Program Manual Version 1.0 June 2013 Page 30
the Needs Assessment for the proposal is reviewed in consultation with AHS staff. Consensus is reached on the most appropriate next step; new proposals in the plan, not previously identified by AHS, will be assessed by HEALTH for compliance with provincial capital guidelines based on information provided in the Needs Assessment; proposals that comply will be prioritized; INFRA reviews and confirms the costing information for proposals that had been submitted for consideration in prior years; for higher priority proposals, recommendations will be prepared to proceed with the appropriate next step in the CPP; and a recommendation drafted by the Joint Operations Capital Planning Sub-Committee is presented to Joint Operations for their approval on which Business Cases are to be developed by INFRA. The timing for proceeding with the appropriate next step for an individual proposal may involve the consideration of issues that are not contemplated in the AHS Capital Submission. It is possible that the arguments for proceeding with a proposal are well documented and compelling, but other provincial infrastructure priorities may take precedence. 3.3.5 Business Case Purpose of a Business Case A Business Case is a systematic process to evaluate different options and develop a facility solution that meets the requirements identified in a Needs Assessment (see section 3.3.3). The Business Case includes associated risks or impacts and cost benefits of each option. HEALTH uses the results of the Business Case to develop its submission to the annual GoA CPP. Components of a Business Case A comprehensive Business Case includes the following components: executive summary; current situation; project description; strategic alignment; environmental analysis; alternatives; Health Facilities Capital Program Manual Version 1.0 June 2013 Page 31
business and operational impacts (including estimated projected incremental capital maintenance and operating costs); project risk assessment; cost/benefit analysis that incorporates both capital and estimated operating costs, including Furniture and Equipment/Information Technology (F&E/IT) estimated costs; conclusions and recommendations; implementation strategy; and appendices. For more information, see Business Case Template and Process Flow Chart (Appendix 6.1 and Appendix 6.2). As the process owner, INFRA leads the development of the Business Case in close collaboration with AHS. Each party is responsible for providing background data to support the Business Case development, according to their area of responsibility. For example, user requirements and operational costing data is supplied by AHS, while capital infrastructure development data is provided by INFRA. Process for Developing a Business Case The Joint Operations Capital Planning Sub-Committee prioritizes Needs Assessments for Business Case development. INFRA: determines the requirement for a consultant; obtains funding for the Business Case development; procures a consultant (if required); assembles a project team comprised of planning representatives from the Parties. The AHS Strategic Planner would be responsible for coordinating input from staff in other AHS operational areas such as FM&E, Financial Services (for operating costs), Zone Clinical Staff/User Groups and CPSM to address F&E/IT requirements; and schedules a start-up meeting with the project team and/or the consultant. INFRA/Consultant (if hired), in collaboration with the project team: schedules and facilitates project team meetings; develops a draft Business Case for review by the Parties; Health Facilities Capital Program Manual Version 1.0 June 2013 Page 32
in collaboration with AHS identifies the plausible alternatives and the corresponding infrastructure development; and in collaboration with AHS identifies and recommends the preferred facility solution option. The Business Case will include a set of assumptions/parameters upon which it is developed. Since such assumptions may directly impact the analysis and outcome of the Business Case, it may be necessary for the Business Case development team to consult with their respective organizations, including the affected AHS Zone/Provincial Program representative, to ensure the assumptions are both comprehensive and valid. HEALTH is responsible for providing correspondence to INFRA and AHS to formalize Business Case development decisions, consistent with the prioritized plan developed by the Capital Planning Sub-Committee and endorsed by the Joint Operations Committee. Process for Business Case Approval Since the Business Case may inform future capital submissions to the Ministry of TBF, the Parties must ensure sufficient review and rigor in the analysis of the information, including the cost/benefit analysis and selection of the preferred option. The Joint Operations Capital Planning Sub Committee reviews the Business Case and if there are issues with the Business Case it is brought forward to the Joint Operations Committee. If there is no issue with the Business Case it is sent directly to HEALTH after AHS and INFRA sign off. Once a Business Case has been completed, the Business Case is signed and dated by the Parties as follows: AHS (CEO or delegate) will sign the Business Case as recommended ; INFRA (DM or delegate) will sign as reviewer ; and HEALTH (DM or delegate) will sign as approver. See section 3.1 and section 3.2 for more information on the CPP. Health Facilities Capital Program Manual Version 1.0 June 2013 Page 33