Stakeholder Participation in Work Breakdown Structure (WBS) Development: A Case Study of the Dharmais Cancer Hospital Construction Project

General Description of the Research Object

This study was conducted within the Dharmais Cancer Hospital construction project, one of Indonesia’s strategic healthcare infrastructure projects. According to project planning documents and project profile records, the project is executed by PT PP (Persero) Tbk as the main contractor and involves multiple technical disciplines and stakeholders. The project includes the development of an integrated healthcare facility comprising inpatient wards, emergency units, operating rooms, laboratories, pharmacies, and supporting facilities. Project implementation covers earthworks, structural construction, architectural works, the installation of mechanical, electrical, and plumbing (MEP) systems, and the integration of specialized medical equipment. Based on project schedules and planning documents, the implementation period extends beyond 18 months, requiring a structured planning and coordination mechanism. These project characteristics provided the contextual basis for examining stakeholder participation in Work Breakdown Structure (WBS) development. The multidisciplinary nature of the project required coordination among contractors, consultants, project owners, and hospital representatives to ensure that technical requirements and operational needs were adequately reflected in the planning process. Furthermore, the complexity of medical facilities and the interdependence among work packages increased the need for collaborative decision-making during WBS preparation. Evidence obtained from project documents, field observations, and interview data indicated that project coordination mechanisms played an important role in facilitating stakeholder participation. Formal coordination meetings and technical discussions served as platforms through which stakeholders exchanged information and aligned project requirements. Consequently, the case of the Dharmais Cancer Hospital provided a suitable setting for investigating how project characteristics and organizational arrangements influenced the forms and levels of stakeholder participation in WBS development. Within the context of project management, the implementation of a Work Breakdown Structure (WBS) serves as an essential instrument for decomposing the project scope into measurable and controllable work units. In this project, the WBS functions not only as a technical planning tool but also as a communication medium among stakeholders. The project organizational structure demonstrates a matrix configuration involving various strategic roles, ranging from managerial positions to operational field personnel. The involvement of multiple stakeholders constitutes a significant foundation for examining how the WBS is developed through a participatory approach. Evidence compiled from both semi-structured interviews and project system logs confirms that the integration of digital technologies directly reshaped stakeholder participation. Lean Construction principles, enforced through weekly collaborative planning sessions, shifted the WBS process from a top-down mandate to a cross-functional negotiation. BIM models functioned as a shared visual platform that enabled engineering and design teams to collectively validate structural components, thereby increasing active technical engagement. Simultaneously, ERP integration synchronized the physical WBS work packages with real-time cost breakdown structures (CBS), which restricted budgetary modifications to authorized managers while requiring quantity surveyors to provide empirical data inputs before structure updates were approved. (see Table 5)

Identification and Description of Objective Factors

The findings indicate that stakeholder participation in WBS development is influenced by four primary objective factors: (1) project organizational structure, (2) communication and coordination systems, (3) utilization of information technology, and (4) formal support and project culture.

Project Organizational Structure

The matrix-based project organizational structure enables cross-functional interaction during the WBS development process. This arrangement encourages the involvement of multiple parties in comprehensively defining the project work structure. One informant stated: “Our organizational structure is matrix-based, so the WBS cannot be determined by only one function; cross-divisional coordination is essential.” This finding demonstrates that the organizational structure functions as a

Table 5. Key Informants and Their Roles in Participatory WBS Development No. Position Role in Participatory WBS Development Interview Method 1 Senior Vice President of Building Operations Division Establishing strategic policies and approving the WBS structure Face-to-face 2 Project Manager Coordinating cross-functional integration in WBS development Face-to-face 3 Site Operation Manager Implementing the WBS in field operational activities Online 4 Site Engineering Manager Developing technical deliverables within the WBS structure Online 5 Site Administration Manager Supporting WBS documentation and updates Online 6 Quantity Surveyor Manager Integrating the WBS with the project cost structure Online 7 BIM Manager Integrating BIM models with the WBS structure Face-to-face 8 Claim & Contract Manager Ensuring contractual aspects are accommodated within the WBS Face-to-face 9 Project Owner Representative Providing approval and strategic direction for the WBS Face-to-face Source: Primary data processed by the researcher (2025) Table 6. Objective Factors Influencing Participation in WBS Development No. Objective Factor Main Indicators Data Sources 1 Organizational Structure Matrix structure, crossfunctional coordination Interviews, organizationa l documents 2 Communicatio n & Coordination Routine meetings, BIM sessions, digital communicatio n Observations, meeting minutes 3 Information Technology BIM and ERP integration, work visualization System documents, interviews 4 Formal Support & Culture SOPs, WBS templates, collaborative culture Internal documents, interviews Source: Primary data processed by the researcher (2025) mechanism facilitating stakeholder participation in project planning processes.

Communication and Coordination Systems

A structured communication system constitutes a significant factor supporting stakeholder participation. The project utilizes routine coordination meetings, BIM coordination sessions, and digital communication media. One informant explained: “Technical coordination is conducted through weekly meetings and BIM coordination sessions. All changes to the work structure are discussed across functions.” This finding suggests that effective communication enhances the quality of WBS development through intensive information exchange.

Utilization of Information Technology (BIM and ERP)

The implementation of BIM and ERP contributes to improving the accuracy and integration of the WBS. These technologies enable work visualization and synchronization among work structures, costs, and schedules. One informant stated: “The WBS structure is directly linked to the BIM model, particularly for structural and MEP work packages. ERP is also synchronized for cost control.” Thus, information technology serves as a primary enabler supporting data-driven participatory processes.

Formal Support and Project Culture

Internal policy support and a collaborative organizational culture strengthen stakeholder participation. The existence of standard operating procedures (SOPs) and WBS template references provides guidance in developing work structures. One informant noted: “There are internal SOPs for work structuring and WBS template references from previous projects.” An organizational culture that is open to crossfunctional input also enhances the quality of the resulting WBS. These four objective factors interact in shaping a participatory ecosystem for WBS development (see Table 6). The organizational structure provides the coordination framework, communication systems ensure information flow, information technology enhances accuracy, and organizational culture reinforces collaboration. Consequently, stakeholder participation in WBS development within healthcare project management is determined not only by technical aspects but also by the simultaneous integration of structural, social, and technological factors. Analysis of Research Findings Based on the Research Questions The analysis was conducted using a qualitative approach through in-depth interviews, field observations, and project document reviews. This approach not only describes empirical phenomena but also interprets the relationships among objective factors, forms of stakeholder participation, and their implications for project management effectiveness. Accordingly, the analysis is thematically organized into four main sections: (1) objective factors in WBS development, (2) forms and levels of stakeholder participation, (3) the relationship between objective factors and stakeholder participation, and (4) managerial implications.

Objective Factors in WBS Development

The findings indicate that the development of the Work Breakdown Structure (WBS) in hospital construction projects is influenced by four main objective factors: project organizational structure, communication systems, utilization of information technology, and standard operating procedures (SOPs) (see Table 7). These factors form an integrated managerial system that supports the project planning process. The matrix-based organizational structure facilitates cross-functional collaboration among engineering, quantity surveying, and project administration teams. This finding is supported by the following statement: “WBS development cannot be carried out by only one party; all functions must sit together, especially during the initial stage.” (Site Operation Manager, interview, 2024) Furthermore, open communication systems and the utilization of technologies such as Building Information Modeling (BIM) and Enterprise Resource Planning (ERP) play significant roles in aligning stakeholder understanding. Another informant stated:

Table 7. Objective Factors Influencing WBS Development in the Dharmais Cancer Hospital Construction Project No. Objective Factor Empirical Findings from the Field Main Informant 1 Organizational Structure The matrix organizational structure facilitated cross-functional coordination and enabled technical personnel from different disciplines to contribute to WBS development. Site Operation Manager 2 CommunicationSystem Regular coordination meetings and BIM meetings served as the main forums for information exchange and decision-making during WBS preparation. Engineering Manager 3 Technology (BIM and ERP) BIM and ERP systems supported the integration of WBS with scheduling and project control activities. BIM Manager 4 Standard Operating Procedures and Templates Standardized WBS templates provided an initial framework that facilitated consistency in work package definition. Quantity Surveyor Manager Table 8. Managerial Implications of Participatory WBS Development Managerial Aspect Field Findings Implications Planning WBS as the basis for budgeting and scheduling Integration with cost and time systems Coordination Cross-functional collaboration Reduction of miscommunication DecisionMaking Work structures agreed upon collectively Faster responses to changes Risk Control High stakeholder ownership Reduction of delays and additional costs Project Adaptation Flexible structures toward changes Increased project agility

Forms and Levels of Stakeholder Participation

The findings reveal that stakeholder participation in WBS development was highly stratified across different project organizations, showing prominent variations rather than a uniform pattern of active engagement. Active and intensive involvement was concentrated primarily within core technical stakeholder groups such as the project manager, engineering leaders, and BIM specialists during collaborative forums like workshops and synchronization sessions. Conversely, owner representatives and supervisory consultants exhibited moderate, transactional involvement limited to formal checkpoints, while hospital end-users and supporting stakeholders demonstrated constrained participation, restricted primarily to post-hoc functional validation and reactive feedback rather than active structure co-creation. The findings indicate that stakeholder participation in Work Breakdown Structure (WBS) development varied across stakeholder groups rather than being uniformly active. The levels of participation were classified based on the intensity of involvement in discussions, frequency of attendance in coordination activities, and influence on WBS-related decisions. Stakeholders were categorized as having active participation when they consistently attended meetings and directly influenced work package definitions and planning decisions. Moderate participation referred to stakeholders who regularly provided input but had limited authority in decisionmaking. Limited participation referred to stakeholders whose involvement was mainly consultative or focused on validation activities. Evidence from interviews, observations, and project documents showed that the Project Manager, Engineering Manager, Quantity Surveyor, Project Control team, and BIM personnel demonstrated active participation during WBS preparation. These stakeholders were involved in work package identification, coordination meetings, and revisions to the WBS structure. In contrast, owner representatives and supervisory consultants exhibited moderate participation, mainly through review and approval processes. Hospital end users showed relatively limited participation because their involvement was concentrated on providing operational requirements and validating functional needs rather than participating in detailed technical discussions. The Project Manager explained: “We encourage the involvement of all functions so that the WBS becomes not merely an administrative document, but truly reflects field operations.” (Interview, 2024) Similarly, the Engineering Manager stated: “Coordination through BIM meetings allowed each discipline to align technical requirements and avoid inconsistencies in work package definitions.” (Interview, 2024) A member of the Project Control team noted: “Most revisions to the WBS originated from coordination among engineering, quantity surveying, and project control teams because these units were directly responsible for scheduling and monitoring project progress.” (Interview, 2024) Field observations of coordination meetings and documentary evidence from WBS revision records confirmed that technical stakeholders were more actively involved in decision-making processes than owner representatives and end users. Consequently, participation within the project cannot be characterized as uniformly active and intensive.

Table 10. Summary of Research Findings Based on the Research Questions No. Research Question Key Findings Triangulation Evidence 1 How does the project context influence stakeholder participation in WBS development? Project context, such as organizational structure, tender time pressure, and technical complexity, influences stakeholder participation patterns in WBS development. Interviews with the Project Manager, analysis of project baseline documents, and observations of WBS workshops. 2 What is the level of stakeholder participation in the WBS development process? Variations in participation levels were identified, including active participation (BIM and Quantity Surveyor teams), moderate participation (operational teams), and limited participation (project owner representatives). Interviews with the Site Manager and BIM Manager, workshop minutes, and observations of project team discussions. 3 How do stakeholder interactions occur in WBS development? Stakeholder interactions were cross-functional and collaborative, although under certain conditions they became more formalistic due to time pressure and project complexity. In-depth interviews, workshop minute analysis, and observations of work package development processes. 4 What are the implications of stakeholder participation for the effectiveness of WBS development? Stakeholder participation improved the clarity of responsibility allocation and work structures, although its effectiveness was highly dependent on top management support. Statements from the Senior Vice President of Building Operations Division, workshop documents, and standard operating procedures. Instead, the findings suggest differentiated levels of participation, with varying degrees of influence on WBSrelated decisions depending on stakeholder roles and responsibilities. Relationship Between Objective Factors and Stakeholder Participation The analysis demonstrates that objective factors are closely related to the level and quality of stakeholder participation. A collaborative organizational structure, open communication systems, and technological support constitute essential prerequisites for effective participation. In practice, coordination forums such as BIM meetings became the primary interaction spaces among stakeholders. Observational findings indicated that each functional division participated in decision-making processes related to the WBS structure. Nevertheless, participation was also influenced by situational factors such as time constraints and design changes. Under certain conditions, decisions had to be made by the core team, although they remained supported by technology-based coordination systems.

Managerial Implications for Project Effectiveness

The qualitative findings indicate that participatory WBS development carries important implications for project management effectiveness, particularly across planning and control workflows. Interview accounts from the QS Manager highlight that collective work package definitions directly supported early budgeting accuracy. Furthermore, field observations of BIM coordination sessions showed that collaborative adjustments helped resolve multidisciplinary design clashes proactively. Document reviews of the project's revised RACI matrix and meeting minutes further indicate that early alignment among technical units reduced subsequent miscommunication regarding task ownership, although these outcomes remained highly conditional upon active top management endorsement (see Table 8). Moreover, stakeholder involvement enhanced decisionmaking speed and adaptability to project changes.

Data Triangulation and Validity of Findings

The validity of the research was strengthened through triangulation techniques involving source triangulation, methodological triangulation, and theoretical triangulation. Data were obtained from multiple key informants and verified through observations and project documents. For example, the following statement: “BIM model revisions are directly integrated with the WBS, forcing cross-functional coordination.” (BIM Manager, interview, 2024) was confirmed through observations of the attendance of all technical divisions during BIM coordination meetings. Overall, the findings suggest that participatory WBS development in the Dharmais Cancer Hospital construction project was shaped by the interaction between several enabling factors, including organizational structure, communication mechanisms, technological support, and established standard operating procedures, together with varying levels of stakeholder participation (see Table 9). Evidence obtained from interviews, field observations, and project documents indicates that active involvement of technical stakeholders facilitated cross-functional coordination and improved the alignment of work package definitions. Informants also perceived that collaborative planning processes helped minimize misunderstandings among project participants and reduced the need for repeated revisions to several components of the WBS. Although the present study does not provide direct quantitative evidence of project performance improvement, the findings suggest that participatory WBS practices appear to support better planning quality and coordination. Therefore, the effectiveness of WBS development should be understood as a context-dependent outcome influenced by both organizational conditions and the extent of stakeholder involvement rather than as a direct causal consequence of participation alone.

Summary of Key Findings

The research findings were obtained through data triangulation techniques involving in-depth interviews, project documentation studies, and direct observations of the WBS development process within the Dharmais Cancer Hospital construction project (see Table 10). Thematic Visualization: Relationship Between Stakeholder Participation and WBS Effectiveness The thematic visualization in this study illustrates the systemic relationship between project context, stakeholder participation, and the effectiveness of Work Breakdown Structure (WBS) development. The findings indicate several contextual factors influencing stakeholder participation patterns, namely: a. project organizational structure, b. team communication systems, c. cutilization of technologies such as Building Information Modeling (BIM) and Enterprise Resource Planning (ERP), and d. implementation of Standard Operating Procedures (SOPs). These factors function as the foundation determining the

quality of stakeholder involvement in the WBS development process. In practice, stakeholder participation was not homogeneous but was influenced by the roles, interests, and capacities of each stakeholder. One informant explained: “…the WBS development process involves many parties, but in practice only several teams are truly active due to time limitations and tender completion pressures…” This finding demonstrates that although a participatory approach has been implemented, its application still faces structural and situational constraints. Furthermore, effective stakeholder participation contributed to: a. improved clarity of work structures, b. strengthened cross-functional coordination, and c. increased accuracy in project cost, time, and quality planning. However, such effectiveness was highly dependent on commitment and support from top-level management. Without such support, participation tended to become administrative rather than substantive, thereby limiting the development of a comprehensive WBS. Therefore, the findings suggest that the effectiveness of WBS development in healthcare projects is determined not only by technical aspects but also by the quality of stakeholder participation shaped by organizational and managerial project contexts. This study extends the literature on Work Breakdown Structure (WBS) development and stakeholder participation by demonstrating that participation patterns are not uniform, but instead shaped by the interaction between organizational structure, communication systems, digital technologies, and institutional procedures. While prior studies have emphasized the importance of WBS standardization and stakeholder engagement in improving project outcomes (Arba, 2021; Mirajhusnita & Nisa, 2023), this study provides a more context-specific explanation of how these factors operate in a complex healthcare construction setting. Recent research also highlights the growing role of digital tools such as BIM and social network analysis in mapping stakeholder interactions in construction projects (Motahar et al., 2025), which aligns with the technological dimension identified in this study. Consistent with previous findings, structured WBS frameworks and early stakeholder involvement contribute to improved coordination and planning clarity (Schönbeck, 2022). However, the present study shows that such improvements are not determined solely by timing of involvement, but also by the distribution of authority and decision-making power among stakeholders. The findings indicate a stratified participation structure: technical actors (project managers, engineering teams, quantity surveyors, and project control units) were actively involved throughout WBS development, whereas owner representatives and end users participated mainly during consultation and validation stages. This stratification is influenced by role specialization, time constraints, and centralized decision authority within technical management structures. Studies on alternative WBS orientations similarly emphasize that decomposition structures must align with project governance to be effective (Odedairo, 2024). From a theoretical perspective, these findings refine stakeholder theory (Freeman, 1984; Mitchell et al., 1997) by showing that stakeholder salience does not automatically translate into equal participation in technical planning processes such as WBS development. Instead, participation is mediated by organizational arrangements (e.g., matrix structures), technological systems (BIM and ERP), and procedural formalization (SOPs and templates). This supports and extends coordination theory by demonstrating that coordination mechanisms not only improve efficiency but also shape participation distribution specifically, who participates, to what extent, and at which stage of planning. The dominance of technical stakeholders can also be explained by the operational characteristics of healthcare construction projects, which require high technical expertise and are subject to tight scheduling and regulatory constraints. Under these conditions, non-technical stakeholders tend to participate in a more formalistic manner, primarily through approval and validation rather than active design contribution. This partially contrasts with studies suggesting that BIMenabled environments enhance broad stakeholder integration (Li, 2025). The findings suggest that digital tools alone are insufficient to ensure equitable participation without accompanying governance and decision-right reforms. Similar evidence from hospital construction and BIM integration studies also indicates that stakeholder engagement often remains stratified despite technological advancement (CerezoNarváez et al., 2020; Motalebi et al., 2025). Based on these insights, this study proposes a conceptual interpretation in which WBS effectiveness emerges from the interaction between four elements: (1) organizational structure, (2) communication mechanisms, (3) digital integration tools, and (4) stakeholder participation intensity. Rather than a universal model, this configuration should be understood as context-dependent and shaped by project governance and stakeholder roles. In healthcare construction contexts, this interaction determines the consistency of coordination and the stability of WBS outputs. Practically, the findings suggest that healthcare construction projects may benefit from strengthening earlystage engagement mechanisms that go beyond technical coordination forums, ensuring that non-technical stakeholders are involved earlier in WBS structuring rather than only during validation phases. This is consistent with BIM-based stakeholder engagement literature emphasizing early involvement to improve project alignment. However, these implications should be interpreted cautiously given the singlecase design and the specific governance structure of the studied project. This study has several limitations. First, it is based on a single hospital construction project, which limits the generalizability of the findings. Second, stakeholder participation dynamics may be strongly influenced by projectspecific governance arrangements that are not present in other contexts. Third, the study focuses primarily on WBS development during the planning stage and does not examine its implications during project execution. Future research is encouraged to test and refine the proposed relationships across multiple healthcare infrastructure projects using comparative or mixed-method approaches, particularly to further validate how organizational and technological factors shape stakeholder participation patterns in WBS development.

Practical Implications

For project management practice, several actionable recommendations emerge. First, early-stage stakeholder mapping should be systematically conducted to ensure clear identification of roles and expected contributions in WBS development. Second, mandatory WBS workshops should be implemented at the planning stage to strengthen crossfunctional alignment before formal approval. Third, BIM-based coordination and validation sessions should be institutionalized not only for technical integration but also as participatory platforms for broader stakeholder input. Fourth, structured checkpoints for owner representatives and end users should be integrated earlier in the planning cycle to reduce late-stage validation dependency and improve alignment with operational needs.

Limitations

This study is limited by its single-case design, focusing only

on the Dharmais Cancer Hospital construction project. As a result, the findings cannot be statistically generalized to other healthcare or infrastructure projects. In addition, the analysis is primarily based on planning-stage WBS development and does not fully capture participation dynamics during project execution phases. Beyond the single-case design, a primary limitation of this study stems from its reliance on a purposefully selected cohort of internal management informants and official project archives, which may introduce social desirability bias or overlook peripheral subcontracting viewpoints. Consequently, the localized participation framework developed here remains exploratory. Future studies are strongly encouraged to validate and expand this framework by employing multiple-case comparative designs across varying public-private healthcare sectors or utilizing mixed-method approaches. Integrating quantitative social network analysis (SNA) alongside qualitative insights would allow researchers to statistically measure participation intensity and mathematically model its direct association with WBS scope verification performance.

Future Research

Future research is recommended to conduct comparative studies across multiple hospital and infrastructure projects to examine variations in stakeholder participation patterns. Quantitative or mixed-method approaches may also be employed to measure participation intensity and its relationship with WBS effectiveness more rigorously. Furthermore, future studies could investigate the moderating roles of leadership support, project complexity, and digital maturity in shaping stakeholder engagement outcomes. Such research would provide stronger empirical grounding for developing more generalizable models of participatory WBS development.