The Hospital Wing That Cannot Wait
You are the newly appointed project manager for a 40-bed hospital wing. The business case was approved 14 months ago at a budget of 22 million, with a planned opening tied to a government funding deadline in 18 months. On day three you discover the approved business case assumed a single-storey build on land the trust has not yet acquired; the landowner now wants 30% above the price used in the case. You also learn the original sponsor left the organisation six months ago and no replacement has been formally appointed. The design team has already produced 60% drawings against the single-storey assumption. Clinical directors are expecting the opening date to hold because they have already recruited 25 nurses. The board wants a recommendation within two weeks.
1. What should you do first, and how do you frame the recommendation to the board?
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The first action is to establish decision authority and facts, not to redesign. Two structural problems exist: no accountable sponsor and an invalidated cost and land assumption. Without a sponsor, no one can approve a change to scope, budget, or schedule, so any design work you commission is unfunded risk.
Practical sequence:
- Request written confirmation of who holds sponsor authority, or ask the board to appoint one within the two-week window. Escalate that this is a governance gap, not a design issue.
- Commission a rapid options appraisal covering at minimum: acquire land at the higher price; relocate to an alternative site; retain the site but move to a multi-storey design.
- For each option, quantify cost delta against the 22 million, schedule impact against the 18-month deadline, and clinical consequence (the 25 recruited nurses, service continuity).
- Freeze design work on the single-storey assumption so you stop spending against a base case that may not survive.
The board recommendation should state plainly that the approved business case is no longer valid, present the three options with cost and date consequences, and ask for a decision on land and design in one meeting. Framing it as "the case needs re-baselining" is honest; framing it as "we can still hit the date" without evidence is not. The nurses are a stakeholder issue to manage in parallel, not a reason to distort the analysis.
2. The clinical directors insist the opening date cannot move. How do you handle this stakeholder pressure while protecting the project?
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Acknowledge the pressure as legitimate and make it visible in the decision record, but do not let it override the evidence. The opening date is a constraint they care about because they have made real commitments; treating their concern as emotional rather than practical will damage the relationship you need for the next 18 months.
Steps:
- Meet the clinical directors together, explain the land and design findings factually, and ask what the operational consequence of a delay actually is. You may find the true need is bed capacity by a date, not a finished wing by that date.
- Explore mitigations that preserve service: phased handover of part of the building, temporary capacity elsewhere, or sequencing so clinical fit-out starts before full completion.
- Record their requirement formally as a project constraint with an owner, so that if the board chooses a slower option the trade-off is documented rather than absorbed silently by the project team.
- Do not commit to the date. Say clearly that you will bring them the fastest credible option and its confidence level.
This protects the project because the schedule pressure is now a board-level trade-off with a named owner, not an informal expectation the team is quietly failing to meet.