REFURBISHMENT PROJECTS The Control Room within the new Surgical Block.
instability at international level. In this context, strategies to mitigate uncertainty and risk in project design and construction of hospital buildings acquire pivotal importance – even more so when we are taking about the refurbishment of specific spaces, such as operating theatre blocks, that are essential to the continuity of service delivery.
Identifying strategies to mitigate uncertainty
In this article I will set out to identify some useful strategies to mitigate uncertainty and risk which were deployed during the refurbishment – during the COVID-19 pandemic – of a surgical block, at a time when, with considerable pressures on the healthcare system, keeping the hospital in question fully operational became critical. This paper describes the refurbishment project, from design to construction and delivery. I will look at the key issues in the old surgical block, and the local clinical needs, which jointly informed the design of the new layout, which was discussed with the hospital’s clinical staff to ensure that the outcome would not only meet legal requirements, but also support the operational processes. Also examined will be the key strategies we followed to deliver the construction on time and on budget, which have been critical to the project’s success, and indeed to the operation of the entire hospital at a very challenging time.
Uncertainty and risk in construction projects Project management success depends on how complex the project requirements are, and how precisely they are met: time, cost, and quality, are the fundamental criteria against which it is commonly measured. A construction project is a dynamic project, in which the three criteria above can, and are likely to, be subject to change. Accurate information and high levels of detail are two elements that can support change without putting
at risk successful project completion. Nonetheless, unexpected events can result in deviations from the project delivery plan at any time: the further into the delivery these happen, the greater the impact on the project. Uncertainty and risk are extremely different aspects to deal with, and acknowledging the difference can become key, especially in complex construction projects, in which complexity is often associated with the project size, cost, time, or constraints. Uncertainty is a result of factors that
are both internal and external to the organisation. Human factors rely on levels of experience, and the expertise of the stakeholders involved.4
The more complex the project, the more people involved The more complex a project is, the more stakeholders will be involved, increasing the degree of uncertainty. Non-human factors are linked to the environment in which the project is being developed, including, for example, the supply of
construction materials and transport. Meanwhile, risk is defined as a combination of the probability that an accidental phenomenon will occur in any given period, and how serious a potential impact this would have. Risk can be identified; uncertainty cannot. Within a specific context, one can identify the key risks by determining the likely impact of a specific event on a specific project aspect. Risk management techniques include re-structuring the risk (i.e. breaking down the issue in order to put in place an appropriate response); transferring the risk (i.e. transferring it to another party at a cost), and sharing the risk (i.e. sharing the gains, and insuring and retaining the risk). When assessing uncertainty, the impact on the project is far more difficult to identify. The likelihood that an uncertain event may occur, and the effect of this event, are extremely difficult to predict and measure, leading to the definition of unpredictable uncertainty. In some circumstances, it may be more sensible to simply accept uncertainty as a component of the project, and adapt the way one might respond.
Key issues in the old Surgical Block The Surgical Block is located on the first floor of the San Paolo Hospital, and is connected to two separate parts of the hospital, both parallel to it. Neither the block’s eight operating theatres or the annexe support spaces have been refurbished since the hospital’s opening – for a number of reasons, key being maintaining the continuity of services. The original layout of the space, during the years, has been under evaluation and monitoring, as new procedures and new technologies emerged. The construction and finishing materials dated back to the 1980s, and needed upgrading to meet statutory requirements. The hospital Trust applied for funding
to carry out a complete refurbishment of the Surgical Block, and also the implementation of the Haemodynamic Service on the same floor, with the ambition to create a safe, efficient, and effective service delivery to address increased local needs (i.e. catchment area), but also capable of meeting future needs.
Project design The main purpose of the refurbishment project was to achieve fire safety compliance with new statutory requirements, but the project also provided the opportunity to redesign the layout of the Haemodynamic Service, with the addition of the new Lounge Room to complement the service and increase patient comfort, safety, and privacy. In the Surgical Block and all the annexe
One of the corridors in the Surgical Block.
spaces, the project included: n the installation of fire compartmentation between different departments and
October 2022 Health Estate Journal 69
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