Optimising the project delivery from an operator’s perspective

By Isabel Cristina Arango, MSHA, Lead Healthcare Operations, Dar

The current healthcare arena in the Gulf States is undergoing changes. Financial sustainability is at the forefront, followed by procurement of services, emphasis on efficiency of delivery and diversification of specialty services.

As a consequence of the above and the newly developed governmental strategies which incentivise and promote private participation, investment opportunities have attracted the interest of the private sector thereby redefining the way healthcare delivery is procured.

New entrants and established investors are looking for development partners that are able to provide the necessary procurement advice and services in their investment decisions. Critical factors to the investors are: delivery of the project on time, on budget and to the proper specification. 

During the early stages of the project, when detailed user requirements are being established, it is imperative that the brief document defines and outlines the scope and aspirations of the project in functional time, cost, quality and scope terms. This brief should represent the mission statement of the project organisation which will need to be created and managed to attain these goals. It allows all parties involved to know and understand the expectations of the project from operational requirements to the aspiration and vision of the stakeholders. The discussions, considerations and decisions made within the briefing process will form the project team’s assessment of the built facility’s requirements. Therefore, operational input is critical during the initial stages of the project in order to clearly define the delivery parameters, functional aspects and specific needs of the end users and corresponding services. As the client’s demands become more advanced, the requirements’ interviews become more complex.

All too often, important aspects of the brief process are wholly or partially omitted or misinterpreted by those responsible for bringing the project to fruition. Research shows that a common link among all project participants is the lack of accurate information required, which many times results in fruitless and repetitive work, causing delays and diversion from the project’s objectives and desired outcomes. If not corrected, the end product is a facility unable to fulfill its desired purpose and goal, leaving stakeholders, end users and operators to provide services in a less than optimal matter with imposed work arounds that translate into financial and operational inefficiencies. In either situation, a decision is made to upfront the cost and correct the issues or incur the costs at a later stage.

Medical facilities are complex building typology requiring the expertise and services of experts in order to guide the successful execution of the project and best direct favourable outcomes. The Medical Architect’s role in the interpretation of the brief and input throughout the delivery of the project is crucial to the success of the project. 

The effects of the physical environment on the healing process have well been established and there is much that has been written on the topic of evidence-based design. The built environment can contribute to reducing errors, falls, infection and overall patient and staff safety. In addition, the built environment can also significantly impact other aspects of vital importance to the end users, operators and stakeholders such as right sizing of the facility, efficiency through which patients and staff move throughout the facility, provisions for current and the future technology, as well as the patient experience. As improvements in efficiency continue to evolve, so does the patient and staff expectations. High quality healthcare and best practices can only be achieved if the medical facility’s design is functional, economical and efficient. The ability to integrate new equipment and technology, new services and potential expansion are essential components in the design of a state-of-the-art medical facility and to continue to remain competitive in the healthcare market. A poorly designed facility which does not meet operational and end user requirements, cannot sustain itself in the long run, particularly, in the current and changing healthcare environment where expected clinical, financial and operational outcomes will determine the viability of the entity and its ability to compete in the world class healthcare arena.

As healthcare in the region continues to mature and develop, healthcare entities will face challenges that are both unique to the region and similar in nature to mature healthcare systems around the globe. By analysing historical data, challenges, lesson learned and patterns of world class healthcare and adding regional specific factors, stakeholders can make informed decisions on how best to strategically plan their healthcare facilities and protect their investments. Interestingly enough, when examining the top healthcare challenges faced by medical facilities throughout the western hemisphere, it is found to mirror many of the existing challenges pertaining to healthcare facilities in the Gulf region. Further examination of the cause and effect of these challenges lead to the determination that many, if not all of these challenges, can be mitigated to a certain extent by planning medical facilities in a manner that diminishes the impact of those challenges.

The following are the top current issues and challenges by category and examples confronting healthcare facilities across the globe that mirror the GCC states:

  • Financial Challenges – examples: reducing operating cost; emergency department over-use; increasing cost of staff; supplies etc.; energy intensive buildings; public funding strains and cuts.
  • Patient Safety and Quality - examples: redesigning care processes; redesigning work environment to reduce errors; compliance with accreditation bodies; reducing risk of infection.
  • Population Health Management – examples: providing services for underserved population; providing services for a specific patient population.
  • Technology – examples: infrastructure to accommodate new advances in technology and provide for future advances; interfacing of technology within the facility.
  • Patient Satisfaction – examples: patient experience and quality perceptions.
  • Reorganisation – examples: mergers; acquisitions; restructuring; partnerships.
  • Personnel Shortages – examples: lack of supply of key personnel; shortage of direct medical care personnel; shortage of personnel in specialised fields, shortage of medical school graduates.

Given the current and future challenges, as well as the complexity of healthcare facilities, it is no surprise that investors, stakeholders and operators turn to consultancy organisations to provide the necessary advice at the project inception to ensure the required outcome. The current climate in which healthcare facilities must operate within and produce financial and operational sustainability while providing world class healthcare and maintaining a competitive edge in the market, dictates the use of experienced resources to ensure the delivery of the project’s Key Performance Indicators.

The current competitive nature of healthcare delivery market has forced the consultancy services to seek differentiators raising the barriers of entry into the services they provide. Providing a wholly integrated service that would include healthcare operational consultancy, design, site supervision, equipment specification and project commissioning would differentiate such a service provider and ensure a successful, well integrated project.

Clients can benefit greatly from working with consultancies that retain medical operators and healthcare planners on their staff and integrate them within the teams that deliver the healthcare projects. Such experts will act as catalysts working closely with the client’s team to understand the main operational drivers and ensure integration into the development process. Frequently, healthcare operators are not brought in at the project inception. The presence of a hospital operator on the consultancy team would alleviate the potential risk of changes that might be very costly to the client if done at a later stage.

The healthcare delivery system will continue to evolve in the GCC as it develops towards a mature model. It is therefore certain that the healthcare facilities will need to be flexible and future proofed to protect the client’s investment.

Isabel Cristina Arango is a panelist at the Vision Session of the Building Healthcare Conference themed: ‘Who should be involved in the process and when’ scheduled to be held on Monday, 11th September 2017.