Mindful project management: a framework to enhance underperformance managing large hospital builds by incorporating principles adapted from High Reliability Organizations

The aim of this research is to present and discuss enhancing management of complex hospital construction builds by adapting mindful principles found in High Reliability Organizations (HRO) as soft skills to supplement traditional project management tools and techniques. Significant hospital building construction projects to support initiatives such as improving and replacing aging facilities, improving patient access, adding new technology and services, increasing market share, etc., has resulted in seemingly unabated hospital construction with $1 billion+ projects becoming commonplace worldwide (Robeznieks, 2010). For example, multiple hospital systems across the globe have $1 billion+ (US dollars) hospital new construction, with two recently announced expansions in excess of $2 billion+ (Paavola, 2017). This researcher recently worked for a 12-hospital healthcare system in the Middle East that had three separate $1billion+ replacement hospital builds under construction simultaneously. These large building projects have become a global challenge for healthcare organizations, as significant cost overruns and considerable schedule delays, among other issues, has resulted in far too many being seen as ineffectively managed by the organization. A survey of US-based healthcare executives found that nearly 40% of their construction projects had budget and/or schedule issues (Burmahl et al, 2017, p.21), which is further evidenced by a seemingly interminable public reporting of cost and/or schedule overruns or related issues related to large hospital construction projects. The literature confirms that modern projects have become increasingly complex, with large hospital construction projects being among the most complex. Yet, traditional project management tools and methods employed to manage large construction projects are engineering-based linear processes designed to manage projects with a clearly defined scope and foreseen or limited risk. With complex projects, however, the environment is dynamic therefore unforeseen or unexpected issues are unavoidable. High Reliability Organizations (HRO) have achieved operational and safety success in extreme hazard environments such as nuclear power plants by employing increased anticipation and quick adaption and resolution of unexpected events. Researchers Weick and Sutcliffe identified five mindful principles based on cognitive processes used by HROs for managing the unexpected - failure, simplification, operations, resilience and expertise (2001, 2007, 2015). Concepts from HROs are being studied and adapted in organizations and by professional fields not traditionally defined as HROs, such as healthcare, where HRO concepts are being applied to improve clinical quality and patient safety outcomes exacerbated by increasingly complex medical issues, technology, clinical processes, etc. Through an action research study consisting of data collection of expert panel members in an initial Pilot Study followed by Real-Time Delphi Study, with qualitative and quantitative analysis of the data, a conceptual framework was designed to enhance managing large hospital builds. The framework, coined by this researcher as Mindful Project Management, was determined applicable and useful to improve managing major hospital building projects regardless of location or country of origin. The action research study thus resulted in providing theory-in-practice value in the form of a framework for practitioners to implement soft skills derived from high reliability principles, concepts and practices to enhance managing large hospital building projects.