REFURBISHMENT PROJECTS


Mitigating uncertainty and risk on a complex ‘refurb’


Healthcare architect and consultant, Efthimia Pantzartzis, and Nikolaos Pantzartzis, a mechanical engineer with extensive experience in complex public schemes, both of Studio di Ingegneria e Architettura Pantzartzis in Bari in Italy, discuss a recent project to comprehensively refurbish the Surgical Block at San Paolo Hospital in Puglia. They also set out some of the lessons learned on how to successfully undertake such a project amid the constraints and challenges posed by an unexpected event – in this case the COVID-19 pandemic.


Ageing of hospital estate assets is a growing concern for many European countries, and indeed in any country in which care has been largely provided in buildings that are at least 30 years’ old. Against this backdrop, with physical constraints, a lack of decanting facilities, shortage of funding, and socio-political choices, refurbishment of existing buildings is often seen as more viable than building new healthcare facilities. Since January 2020, the COVID-19 pandemic has piled further pressure on the healthcare system, including built assets and their operability. In this context, the refurbishment of the Surgical Block at San Paolo Hospital in Puglia, Italy, provides some useful real-world strategies to mitigate uncertainty and risk in project design and construction – from stakeholder consultation and needs, to final commissioning and operation.


Healthcare delivery in Italy In Italy, 82% of the existing hospital building stock was built before 1990, and 58% before 1970. In Liguria and Marche 59% and 47% of the provinces’ hospital buildings respectively pre-date 1946.1 Puglia is no different – 31% of its hospital building stock was built pre-1946; 12% between 1947 and 1969; 46% between 1970 and 1989, and just 11% constructed post-1990.1 The healthcare system in Puglia is mainly public, with some private providers contributing to the delivery of care together alongside the public system. Delivery of healthcare services is via 45 Health & Social Care (H&SC) Districts, gathered together in six Local Health Authorities (LHAs). Facilities include 31 Integrated Community Care Centres; five second-level hospitals (with an average 825 beds), 16 first-level hospitals (average of 299 beds), and 12 basic hospitals (average 127 beds). The aforementioned public hospitals include two hospital Trusts and two research hospitals.


68 Health Estate Journal October 2022


A side view of the San Paolo Hospital in Bari.


The San Paolo Hospital The San Paolo Hospital in Bari opened to the public in the 1990s. The mono- block hospital has a linear design with a single corridor layout, eight floors, and two underground floors. It is structured in three separate towers, aligned in parallel, and joined together on the shortest side, to form one single building block. There is also a lower block, with two above-ground and two subterranean floors – housing the hospital’s Emergency Department and Surgical Block, with a dedicated route and accesses. Over the years, regular maintenance and partial refurbishments have ensured that the hospital remains compliant with regulations, as well as able to accommodate new clinical practices and


technologies, variations in the population catchment, and new patient needs. Technological advancement and changes across the healthcare arena have continuously put pressure on the existing built assets in which care is delivered, meaning that maintenance and refurbishment play a key role, alongside new design. The definition of maintenance implies two processes: retaining to avoid failure, and restoring post-failure.2


The


definition of refurbishment, meanwhile brings up six dimensions: social, ecological, economic, cultural, architectural, and technical.3


Both definitions encompass


the underlying concept of sustainability, which has acquired particular significance during the recent pandemic – with the resulting social, economic, and political


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70  |  Page 71  |  Page 72  |  Page 73  |  Page 74  |  Page 75  |  Page 76  |  Page 77  |  Page 78  |  Page 79  |  Page 80  |  Page 81  |  Page 82  |  Page 83  |  Page 84  |  Page 85  |  Page 86  |  Page 87  |  Page 88  |  Page 89  |  Page 90  |  Page 91  |  Page 92  |  Page 93  |  Page 94  |  Page 95  |  Page 96  |  Page 97  |  Page 98  |  Page 99  |  Page 100  |  Page 101  |  Page 102  |  Page 103  |  Page 104  |  Page 105  |  Page 106  |  Page 107  |  Page 108  |  Page 109  |  Page 110  |  Page 111  |  Page 112  |  Page 113  |  Page 114  |  Page 115  |  Page 116  |  Page 117  |  Page 118  |  Page 119  |  Page 120  |  Page 121  |  Page 122  |  Page 123  |  Page 124