Victoria’s health system comprises 80 health agencies, in over 2,000 buildings, across 150 campuses in metropolitan Melbourne and regional Victoria with an approximate asset fair value of $16.6 billion. Historically, the primary focus of Victoria’s health system has been on the delivery of clinical services without extensive oversight of the physical assets behind these services.
In 2018, the Victorian Department of Health embarked on a journey to uplift the sector’s capability in understanding and managing asset risk and determining the portfolio investment needs through a program of work to collate and capture asset data from all agencies.
As part of the department’s efforts to uplift asset management maturity, a major program was established to improve asset information management capabilities across the sector.
The program’s strategic framework is based on three pillars:
- Establishing asset information governance strategy
- Rolling out an asset condition assessment program
- Developing a centralised Asset Information Management System (AIMS).
Additionally, two enablers were established to foster the program’s implementation
- Promoting asset management culture through establishing communities of practice
- Uplifting health services’ asset information management maturity through an asset management plan submission program.
The diagram below (Figure 1) illustrates the program framework:
The department developed an Asset Information Governance Strategy (AIGS) to inform relevant stakeholders about governance requirements for asset data generated and disseminated by the department. The strategy was designed to ensure completeness, accuracy and confidence in asset information supporting the department’s stewardship role to ensure a clear line-of-sight to health services and assets maintained and managed in the portfolio.
The AIGS applies to data collated during all phases of the asset life cycle defined in the asset management framework. The diagram below (Figure 2) shows the role and relationship of the asset information life cycle within the asset information management system.
Asset Condition Assessment Program (ACAP)
ACAP is a staged approach program to collect asset data from 150 major hospital campuses, 118 mental health facilities and 18 aged care facilities across Victoria. The program objective was to gather information on the current condition of the asset base at a high level to enable the understanding of current infrastructure risks.
The program scope targeted three major asset classes: engineering plant, building structures and medical equipment. The program included multiple phases as shown below (Figure 3).
The figure below shows the distribution of Acute Hospital Sites across Victoria covered by ACAP (Figure 4):
Site visits were preceded by a detailed review of available documentation and the prepopulating of site assets onto data capture devices using a standardised template. Assets were inspected and measured against the following metrices:
- Remaining useful life – physical condition rating of assets based on visual inspection and maintenance documentation benchmarked against industry standards.
- Criticality – rating based on criticality of asset per type and magnitude of clinical services delivered.
Both metrics are used to determine asset risk which is a weighted matrix of remaining useful life and criticality (Figure 5).
The data collection process was followed by a quality assurance plan (Figure 6) to ensure integrity of final reports.
Key to the success of the program was early engagement with health services to coordinate site audits and review existing documentation. One of the biggest challenges was site access during the pandemic, with travel restrictions and special access conditions in place, highlighting the importance of establishing dynamic scheduling capabilities, especially in rural areas. The project team was agile and adapted quickly to changed circumstances.
AIMS was established with three key strategic objectives:
- obtain visibility over the asset portfolio’s condition, performance and risk
- perform strategic long-term planning
- uplift asset information management capabilities across the sector.
The department as a system steward does not undertake operation and maintenance functions where these functions are performed by health services, therefore it was necessary to design AIMS at a portfolio level, absorbing data from all health services’ asset information management systems. A data collection framework was developed in line with asset management maturity across the sector as illustrated in the diagram below (Figure 7).
As part of robust stakeholder engagement, health services were closely involved in the codesign of the system through a project advisory group during the implementation stages. Health services are being trained and onboarded to the system in a staged manner to allow interaction with their data to determine future asset replacement needs.
The system can produce heat maps to predict asset failures based on multiple investment scenarios. It also provides the department with a long-term view of the portfolio need (Figures 8, 9 and 10).
The department developed a program to collect asset management plans (AMPs) from all health services to provide an overview of asset replacement need. The program was used as a tool to advocate to health services the importance of managing asset information. The team evaluated the submitted documentation and provided tailored feedback to encourage ongoing improvement. Submitted AMPs were evaluated against three key areas:
- Background, asset base, operational context and demand forecast
- Asset information management and asset lifecycle
- Risk management, resourcing, assurance and improvement planning.
VHAMCoP were initiated to establish a culture for continuous improvement and uplift asset management capabilities across the sector. They create opportunities among health services to improve asset management practices by providing an environment where participants can share knowledge and experiences, develop and discuss areas of interests and build a sense of community.
Through these forums, health services are able to build connections to solve operational issues at local levels and return to their chapter with experiences and lessons learnt.
The VHAMCoP discussions led to the development of multiple guidance documents including asset criticality, asset performance indicators and an asset management plan template.
Twenty-seven-chapter events were held over the last two years, totalling around 300 delegates from over 80 organisations from metropolitan and regional Victoria.
Uplifting asset information management capability enabled the department to conduct asset investment planning with a balance of cost, risk and performance. Additionally, the data collection process enabled a proactive management of risks, leading in turn to reduced service disruption, better quality in services delivered and consequently staff and patient satisfaction in the wider community. The long-term asset planning also enabled the department to direct investments using an evidence based prioritised approach.
Furthermore, active engagement and onboarding of the health services to a centralised system ensured consistency and accuracy of data across the sector. Health services’ access to information and modelling outcomes provided clarity in decision making between the department and health services which is a key factor in a devolved stewardship model.
Opinion as to specific contribution made by the nominated individual/team/organisation
The Asset Performance and Compliance team within the Department of Health is responsible for establishing and growing the asset management practice across the Victorian Health System. Since its inception the team has embarked on a major journey to build the key foundations for a comprehensive asset management system. Working from a system steward perspective and interacting with over 80 independent health organisations, the team’s biggest focus was on how to influence the sector to promote the asset management culture in the healthcare community. Continuous efforts to build key relationships and establish the links between asset management and the quality of clinical services delivered have enabled the team to uplift the asset management maturity level in less than three years.
The team began its asset management journey through a large-scale program to establish asset management across the department and the sector, by establishing key system artefacts in accordance with the Victorian Asset Management Accountability Framework (AMAF). Published by the Victorian Department of Treasury and Finance, the framework strongly aligns with the ISO55000 suite of standards. The project comprised four workstreams: strategy, data, business processes and competency and focused on improving accountability of health services, increasing visibility of the performance and utilisation of assets and lifting asset management capability of the health sector. The diagram below (Figure 11) outlines the strategic framework within which the team is operating.
The team was nominated for the Secretary’s Making an Impact Award within the Department of Health’s 2021 Reflection and Recognition Awards. This award recognises exceptional teams that drive excellence internally or for external clients and bring to life the department’s values. The nomination was a recognition of having uplifted asset information management capabilities across the sector, with the team having led the development of an Asset Information Management System which will systematically transform how we look at and manage health infrastructure in Victoria. A first for the department, AIMS currently houses more than 60 million data points for 86,000 assets from 86 hospital campuses within Victoria’s health portfolio covering engineering assets, buildings, land and medical equipment. The team has also managed a condition assessment program auditing more than 150 hospital campuses across the state in the last three years, while navigating site access challenges through COVID without impact to services. The Asset Management Communities of Practice initiative has grown from its launch in June 2019 to an attendance of more than 300 with an 85 per cent participation rate from health services. In the last two years the team organised 27-chapter events, engaging with 83 health services during more than 54 hours of discussion around important topics such as how to develop asset management plans and determine assets’ criticality.
The team contributions played a key role in changing how asset management is perceived in the sector, with strong emphasis on how managing asset information is a key success factor in driving improvements that will collectively achieve the department’s objective of providing world class care to all Victorians.
Unlike other sectors, the health sector does not have a long history in asset management. It is nonetheless considered asset intensive since the asset base in the State of Victoria comprises over 80 Health Services, over 2,000 buildings expanding across a floor area of more than four million square meters gross. This is in addition to the fleet and stations maintained by ambulance services.
Historically there has been a primary focus on health services’ clinical operating performance and financial position rather than on managing assets as part of their core business. Moreover, the health sector is unique in its challenges which were exacerbated during the time of the pandemic, where the focus of senior leadership shifted drastically to deal with the continuously and rapidly changing environment. Asset management in the health sector is therefore challenging and requires a cultural and behavioural shift to longer term thinking and planning to ensure the best possible decisions are made regarding the assets.
Adding to the complexity, the health asset base is heavily utilised compared to other government sectors, since assets are running in a non-stop 24/7 environment providing critical services to patients and wider community.
Uplifting asset information management capability was the cornerstone for creating momentum in establishing asset management systems across the sector. Acquiring asset information enabled the team to tell the compelling story of the system risks and needs as well as the great opportunities lying ahead to drive improvements across the system as a whole.
The asset management journey is continuing in the Victorian Health Sector with more work planned in the information management space. The next phase in the condition assessment program will grow and expand in scope as a key instrument for collating reliable asset data. Similarly, the Asset Information Management System will further integrate with other government agencies to incorporate asset data with other relative planning information.
It became evident across the sector that having a robust asset management system in place across all health services drives better clinical services outcomes, which was the main driver for the current investment by many leading health services across Victoria in building their own capabilities and bringing onboard skilled asset management resources. This exemplifies the major change in maturity level since the journey started.