Waterfall and Agile Project Management: Cost-Efficient and Collaborative Approach for Renovating Operating Theater in District General Hospital Negombo

The Main operating theatre (OT) at the District General Hospital (DGH) in Negombo, Sri Lanka, a crucial healthcare facility near the Bandaranaike International Airport (BIA) and export processing zone (KEPZ), was non-functional for over five years due to structural safety issues.
An initial proposal for a new OT at Sri Lankan Rupees (LKR) 1,500 million was deemed financially unfeasible due to economic constraints [1], which necessitated a cost-efficient solution. Focus group discussions (FDGs) were held with the stakeholders, and Key Informant Interviews (KII) were conducted. SWOT analysis was conducted to propose alternative solutions. The most cost-efficient intervention was implemented through public-private collaboration with pro bono expertise [5]. The cost estimate was LKR 70 million.
Employing a hybrid project management approach (Waterfall and Agile) [5], this project included civil engineering improvements, electrical and air conditioning (AC) upgrades, and an advanced medical gas supply. A Work Breakdown Structure (WBS) and Gantt Chart supported phased execution and timely resource allocation [7].
The project was physically started on 05.01.2025. Major risks such as contractor coordination, economic constraints, end user perspectives, and material preference were addressed through daily meetings, change control, Radio Frequency Identification Device (RFID) tracking, [1], and pre-approved payments. Close stakeholder engagement was vital, particularly with the Ministry of Health (MoH) and hospital staff. As a result, 90% of physical progress was achieved at the end of March 2025.
Successful renovation demonstrates the significance of adaptive and agile project management, [5] fiscal responsibility, and stakeholder collaboration in public healthcare infrastructure projects. It provides an example of cost-efficient hospital renovation in resource-limited settings [3]. Recommendations include deploying a dedicated project manager and a wider stakeholder consultation to manage the triple constraints of the project [5].