CAPITAL EQUIPMENT SELECTION
or late consideration in the process once a design is well established and progressed, and is then often forgotten until developments approach the operationalisation stages mid-way through construction. The failure to consider and continuously develop a robust Equipment Strategy as an integral part of the design, build, and construction process with key principles established early within the design process linked – for example – to the establishment of 1:50 designs, can have significant impact on the ability and process to operationalise and manage a new hospital, and even lead to delays in operationalisation and additional costs.
Figure 1: Considerations for equipping.
Medical Incubators X-Ray / MRI Monitors
Patient Safety Experience Productivity Efficiency
Non Medical Desks Chairs Bins
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Quantities
Considers Digital
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Decisions Collaborative Clinical
Trust experts Contractor
Regular updating It would be easy to overlook key items of equipment if the Equipment Strategy and its plans are not sufficiently considered early in the process, and the plans and equipment schedules are not continuously updated as the design is developed. Something as basic as oxygen flowmeters can result in the need for expensive temporary solutions or delays to opening. For large, complex healthcare schemes the impact will be significant, as the timescales for medical equipment procurement, supply, installation, and commissioning, are typically in excess of six weeks, and if the equipment choice is subject to clinical evaluation, this may take much longer. The financial impact of such delays to opening new healthcare facilities can also be much wider and more significant. The absence of a well-defined Equipment Strategy and robust set of plans that are continuously developed through the design and build process, when scaled up for a large complex project, could have serious consequences for its success. Similarly, not having the correct
infrastructure – such as a specialist mains outlet in an operating theatre for laser equipment, or appropriate stud work in the walls for equipment mounting arms – can result in additional costs, delays, and service interruptions. It is equally important that the design of new healthcare facilities not only considers the equipment itself, but also its functional requirements – in terms of infrastructure design, power, medical gas supply, drainage, data, and environmental control etc. An early process of supplier engagement and horizon scanning will also support the development of a clear understanding as to the likely evolutionary changes to
48 Health Estate Journal September 2024
equipment. Furthermore, considering the future management, maintenance, and replacement of complex equipment is also an important component of developing the design, equipping, operational, and maintenance strategies in parallel from the outset.
What has Leeds Teaching Hospitals done differently? At Leeds Teaching Hospitals NHS Trust we’ve placed an equal importance on the progressive development of our Equipment Strategy and Equipment Plans to ensure that our proposals are integrated and comprehensive. Our approach has been to develop a strategy which not only considers what equipment we may need for our new facilities, but also the digital and Net Zero impacts of our equipment choices and future ambitions. So, what approaches have we taken? Combining the knowledge and
experience of the Trust’s internal BtLW Programme Delivery Team, with its clinical knowledge/visioning and internal specialist resources such as Infection Protection Control (IPC), alongside the specialist knowledge of external equipment consultants, has many benefits. External consultants are familiar with, and will be able to draw upon, a variety of equipping solutions developed and implemented across many projects – providing valuable experience to be combined within internal specialist clinical, operational, and equipment experience to develop equipping design strategies and solutions. The Trust’s internal BtLW Programme Delivery Team brings to the table the specialist knowledge of equipment models, preferred procurement strategies, clinical
Innovation Green
Aligned to Room by room
schedule
requirements, IPC and maintenance strategies, and financial solutions, while the external equipment consultants are fully conversant with different equipping solutions, and have the expertise to develop equipping lists based around equipment dimensions and weights. Together, this combined expertise and knowledge results in a successful solution. Finally, while local knowledge is important, the combined input and experience ensures effective and informed decision making and successful project delivery. The BtLW Programme
Team at Leeds has ensured that it embeds this resourcing approach
– bringing together internal and external specialist expertise from an early stage in the project delivery – to support successful delivery, the goal being to minimise future delivery risk.
Use of equipment consultants The Trust has been working with established specialist equipment consultant, MJ Medical, which has supported it in the preparation of its Equipment Strategy, Bill of Quantities (BofQ), Equipment Responsibility Matrices, and generic equipment specifications, and in the development of early design and operational strategies from an equipment perspective. Together, this information has proven valuable in informing the early design and business case processes. The initial Bill of Quantities was
produced using the NHS Activity DataBase (ADB) to identify the typical equipment needs of each planned space in the hospital. This is a useful baseline for developing the final equipment schedule in collaboration with clinical stakeholders as the design progresses. The BofQ in our project includes electrical outlets, gas fixtures, luminaires, chairs, tables, desks, storage, medical equipment, and mounting hardware etc. Figure 1 highlights the key considerations
for equipment selection, namely: n Considerations should start with a focus on the patient, taking account of their experience, along with how particular technology can improve service efficiency and productivity.
n There needs to be alignment between the BofQ and the schedule of accommodation on a room-by-room basis to develop accurate equipment costs for the project.
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