REFURBISHMENT PROJECTS
Pantzartzis. Delivered via a traditional procurement scheme, the project included the installation of new furniture and equipment throughout the Surgical Block Lounge Room. The design phase lasted 90 days, as planned.
Delivery strategy, uncertainties, and risks The initial delivery plan took into account the need to keep both the Surgical Block and the Haemodynamic Service operational throughout construction. Phasing was the key strategy to ensure that the works could be carried out safely while the operating theatres and the haemodynamic service were in operation. The delivery plan for the Surgical Block
works initially comprised four phases, each interspersed by a two-month period to re-locate the construction site, and the temporary installation of the external cranes needed to undertake the external works and move the construction material, as described below. The first phase included the temporary set-up of theatres 7 and 8 (i.e. the operating rooms dedicated to the haemodynamic service), to allow the service to be delivered without interruption. The second phase entailed undertaking the works on theatres 1, 2, 3, and 4, the third phase involved the work on theatres 5, 6, 7, and 8, and the fourth and final phase saw the construction, fitting out, and furnishing, of the new Lounge Room.
Impact of COVID on construction The construction commenced in April 2019, as planned, but in December 2019 early news about COVID-19 started to be disseminated, and in January 2020 the outbreak arrived in Europe, including in Italy. At that time, the situation required extreme caution, both in terms of how hospitals were operated (e.g. maintaining separate routes for COVID-19 and non- COVID-19 patients), and as regards hospital capacity (with, for example, a heightened need for hospital beds and ICU beds for COVID patients). Having already begun, the works needed to be carried out and completed as quickly as possible. The likelihood of an unforeseen incident – with a potentially significant impact occurring – increased; the Surgical Block was working at only half capacity, with only four operating theatres
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The refurbishment at San Paolo Hospital provided the
opportunity both to address local health needs, and to plan for the future
The Recovery area.
in use due to the works having started. The planned phasing remained in place, but given the special circumstances, work had to be put on hold at some of the most challenging times, both to allow healthcare professionals to use all the available space, and so as not to put the construction staff at risk. The delivery schedule was adjusted, and the four phases reduced to two, with one already ongoing.
Revised construction schedule The first phase of the revised delivery plan included the work in theatres 5, 6, 7, and 8. Once these were completed, the area was tested and operated at full capacity, while the works commenced in the adjacent area. The second phase included the work in theatres 1, 2, 3, and 4, together with the work to build the Lounge Room. In alignment with this, the work on the Haemodynamic Services facilities in theatres 7 and 8 were divided into two phases. A new angiography system was installed and activated in theatre 8, with treatment undertaken in the old area. Treatment activity then commenced in the new theatre, with its new equipment, while the existing angiography system was removed from the old area, installed, and made operational, in theatre 7; the result being no interruption to delivery of haemodynamic services to patients. Uncertainty over both internal and
external factors which might affect the construction project also had an impact. As COVID-19 spread, a number of construction workers contracted the virus outside the project site, mostly from family members, resulting in a lack of personnel on site – a situation which required constant monitoring and scaling up to deliver the works on schedule. Another issue – which the Project manager had started to anticipate after the initial months of the pandemic – was
the supply of construction materials and raw materials, with staff shortages significantly impacting the supply chain, including production and transport. To avoid excessive delays, the materials and equipment were ordered at the earliest opportunity, and alternatives for material and equipment suppliers discussed and proposed to the stakeholders, with preference given to local suppliers. The adjustments and variations that were considered acceptable to the Trust and the stakeholders were put in place during the periods of non-activity, to make sure that all the materials and equipment arrived in time for the next stage. The construction works, and the
installation of the new equipment, were completed in June this year, as scheduled in the revised delivery plan, with the entire project finished in 18 months.
Conclusions Maintenance and refurbishment play a key role when new-build is not a viable option. The refurbishment of the Surgical Block at San Paolo Hospital provided the opportunity both to address local health needs, and to plan for the future, with the new Haemodynamic Service facilities and the new Lounge Room offering a safer and more efficient experience to patients and their relatives. Work included the refurbishment of the wallcoverings, floor coverings, and installation of new false ceilings – all aligned with specific clinical needs and relevant regulations, together with the new M&E technology and systems (i.e. air-conditioning, electrical, lighting, water, fire, alarm, and medical gases) for each specific functional space. The project included the installation of new doors and windows, and of equipment for the new theatres and the haemodynamic operating rooms, as well as the design of the new Lounge Room.
October 2022 Health Estate Journal 71
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