EMERGENCY HOSPITALS Conclusions Some of the project team on site at the NHS Louisa Jordan.
as a team, to reflect on the unique circumstances which enabled the delivery of this facility in such a short amount of time. What can we learn, and how, as M&E engineers, can we drive more efficient and focused project delivery? Some of these lessons aren’t about game-changing innovations, but they are about a refocus and reprioritisation of the value we bring to projects.
The first ‘take-away’ is a renewed focus on first principles. Lying on the floor of the SEC and looking up the lights, and imagining how a patient would feel if they were in that place for three weeks, is fundamental to what we do. Codes and standards are clear as to how you should design, but as engineers we should never forget why we are designing or constructing a clinical facility. We should always put ourselves in the shoes of clinicians and patients to make sure that our solutions are not only compliant, but that they also work from a clinical delivery and patient comfort perspective. The way that we divide up the mechanical and electrical engineering is one of the elements which I think should be considered on healthcare projects in the future. Architects often collaborate and manage risk, but you tend not to see that in M&E, where firms often work in competition. Much has already been discussed about the huge amount of collaboration on COVID-19 hospitals, and from an M&E perspective, where appropriate, could we collaborate more to enable quicker delivery?
More efficient project delivery? The rapid delivery of COVID-19 hospitals UK-wide has led both NHS clients, and, to some extent, politicians, to consider whether standard healthcare facilities can be delivered more efficiently. From our NHS Louisa Jordan experience, the use of standardisation to free up design time and clinicians’ time to focus on more complex space was invaluable. Does it matter if a plug socket is 100 mm either side, particularly if it is the right type of room and bed layout? We need to question
52 Health Estate Journal September 2020
whether, as a profession, we are spending our time on work that allows the clinicians to get back to designing the care model, and the engineers and architects to design the infrastructure to support that care model.
Adaptability and flexibility of space will be another key consideration going forward – not just when addressing future pandemics, but also to design facilities that can flex to demand triggered by more regular events such as norovirus, and winter bed requirements etc. This also comes back to standardisation, and the design of simple hospital infrastructure which can be adapted to other needs relatively easily – for example to convert from low to high dependency through adaptable primary infrastructure
Early engagement
Early engagement and continuous dialogue with key stakeholders – including clinicians, peer reviewers, authorising engineers, and FM teams – was perhaps the most important factor in NHS Louisa Jordan’s success. Of course, we expect collaboration on every project, but peeling back the events of those first 48 hours, it produced some powerful outcomes. One of these was an extremely high level of design transparency. Often there will be reviews at set milestones, such as a RIBA or financial stage, but on most projects there is a lot of work that goes on between those stages. Mistakes can cost time and money, compromise quality, and lead to rework – all of which were unthinkable on this project; we had to get every step right. This meant authorising engineers, operational FM teams, contractors, clinicians, and estate managers, taking an active part in early decision making with daily calls, including with the head of Engineering at Health Facilities Scotland. When it came to the acceptance of derogations from standards, there was full visibility and a full audit trail. We didn’t over-engineer, but provided safe solutions with justified design decisions.
As a team we were incredibly proud to help deliver NHS Louisa Jordan, and that we had the expertise to do the best job possible. However, we didn’t work in a silo, and that early and proactive and collaborative engagement between all parties is something we need to repeat on future healthcare projects. Many of the lessons learned feed into each other. Input of clinicians and architects enables standardisation, which in turn enables design and construction of healthcare facilities which are flexible and adaptable. Standardisation also helps on cost, time, and the work of a contractor. It is largely around the early stage building blocks of a project where, after working on NHS Louisa Jordan, I can see room for redefinition. It may require more effort upfront, but in the long run it can save a lot of wasted time and money. Delivering care facilities takes complex engineering, and NHS Louisa Jordan was no exception, but by putting NHS staff, patients, and the care model at the forefront of our work, combined with the ability to take big and complex early decisions as a team, we have the building blocks for delivering better healthcare in the future.
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Thomas Rodger
Thomas Rodger joined AECOM (Faber Maunsell) in 2005, initially working in the St Albans Healthcare team, before moving to the Glasgow office in 2006. He now leads the MEP team in Glasgow, and acts as the Scottish Healthcare Engineering lead for AECOM. He has a wealth of experience in the healthcare sector, having designed hospitals in the UK and globally, including in Bermuda and the United Arab Emirates. In recent years, he has heavily focused on quality standards within healthcare facilities, working closely with Boards across Scotland to improve approaches to design and construction.
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