Refurbishment
the space is left in a useable condition, and in a healthcare setting this means achieving a high level of cleanliness.
Daily ‘clean-up’ operations Where this is required, it is important to build in the time required for daily clean-up operations into the projection of what will be achievable in a given amount of time. Where it is impossible for work to be carried out outside operational hours – where a facility operates 24-hours-a-day, for example – operational staff should be consulted to identify the best timing for the works, avoiding particularly busy or critical periods. Visual, sound-attenuating, and dust-proof barriers should be maintained between patients, staff, and the work site wherever possible. In a setting such as a 24-hour accident and emergency facility – which clearly cannot be temporarily re- located for the duration of the project – this may be achievable by temporarily screening off one section of the facility at a time in order to complete the works. Naturally, this will reduce capacity, so ideally this kind of work should be planned around quieter periods.
Maintaining patient privacy A further aspect of disruption which may be easy for a project manager to overlook is patient privacy, since even the presence of a non-clinical worker in the care space might be considered a disruption in some care facilities. Perhaps surprisingly, this can be more of a challenge in NHS healthcare facilities than in private care, since, although patient expectations may not be quite as high, flexibility and availability of private patient spaces can be more limited. The project manager must be sensitive
to these concerns, and should consult with clinical staff to ascertain what level of presence is acceptable in any given area at operational times. This leads into another essential consideration – communication.
Communication Communicating to all stakeholders – and particularly vulnerable patients, their families, and key employees – over exactly how long a job will take, and what level of disruption will be involved, and then sticking rigidly to these plans, is critical. This will minimise the potential for negative feeling towards the project, and help to reduce its overall impact on patient wellbeing. Clear initial communications help set
expectations at the right level from the outset, and these should be followed up by frequent updates throughout the project. Where there is potential for members of the delivery team to come into contact with patients and staff, it is important that they are briefed so that their manner is friendly and appropriate.What is also important is that they provide stakeholders with the
36 Health Estate Journal September 2013
Training at the beginning of the project may not
be enough, as standards may slip if regular
refreshers are not given throughout the duration
right information, or that, if they cannot easily provide it themselves, they are able to refer any questions to the right authority, who will then be able to provide answers. Selection and training of the delivery team will be touched on in more detail. It is difficult to underestimate the
importance of well-managed communications with those using facilities. Done well, good communication can win support for the project, and help it to run smoothly. However, undertaken incorrectly, or left neglected, it can create opposition to the works, and lead to dissatisfaction among both patients and staff.
Team training It is difficult to think of two working environments more different from one another than a construction site and a clinical setting, and, for those used to working in the former, a drastic change of mindset is required when entering the latter. Of course, the project manager is the most important link in the chain, and healthcare projects require a specific skill-set in order to work around all of the aforementioned concerns. It is therefore a major advantage if the person leading the project has experience of managing a team in live medical environments. Equally important, however, are the
conduct and discipline of every other member of the team that will be working on site. Ensuring that the necessary procedures are always followed by each team member requires a combination of training and close supervision. Training at the beginning of the project may not be enough, as standards may slip if regular refreshers are not given throughout the duration. Monitoring operatives to ensure that procedures are followed will then guarantee that any non-conformance is kept to an absolute minimum. This can make the team manager’s role extremely demanding, but it is essential, since the behaviour of contractors is one of the most important factors that can determine the success of a project in a healthcare setting.
Importance of the contract From an estate manager’s perspective, it is very wise, if not essential, to include full details of what is expected of the delivery team within the terms of the contract
under which the works are carried out. This should include the times of day when access to, and work on site will be allowed, as well as detailing any precautions that must be taken during the works, such as those outlined above. Such an approach not only ensures that the client and contractor teams are ‘on the same page’ from the outset, but also provides recourse if work is not being delivered to the agreed standard, or in line with the agreed working arrangements. It may be a good idea to consult a third- party contract administrator to draw up and enforce the terms of the contract, as this can be beneficial for relations between key client representatives and contractor operatives.
Going forward As pressure mounts on the NHS to deliver services to an increasing volume of patients, while maintaining low levels of capital spending, hospital refurbishments and extensions are going to become an ever more popular option. It is crucial that both estates managers and the construction industry build the skillset needed to deliver these projects efficiently, and without adverse effects on staff or patients. Only through comprehensive pre-planning, regular, well-managed communication with all stakeholder groups, and constant attention to maintaining clinical standards, can this be achieved. The stakes are high, and corners cannot
afford to be cut. For estates managers, working with a project team that can demonstrate experience in successfully delivering healthcare projects is not only advantageous, but indeed essential.
Richard Hall
Richard Hall is a director at integrated property services and project delivery specialist, Styles&Wood, where he heads up the company’s Public Sector Division. His 20 years’ experience includes overseeing a range of high value engineering, construction, and multi-discipline fit-out projects, including healthcare schemes.
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