The development or refurbishment of hospitals and healthcare facilities requires immense effort from many people over many years. Yet when a new facility opens, there are often evident weaknesses or missed opportunities in its design. 

How could those be avoided? Are the right people being involved at the right stage in the process?  

Missed opportunities

The UK’s Nuffield Institute gives some interesting examples of missed opportunities in its 2020 paper, ‘Lessons from the last hospital building programme, and recommendations for the next.’

They include new or renovated hospitals and care homes experiencing frustrations due to: 

  • Clinical areas with far too little space due to an early assumption that outpatient services would be decentralised. When the initial planners moved on, that key assumption was not passed on to their successors or shared with those in charge of operations, hiring staff or acquiring community facilities
  • Promised investments in at-home care never materialising, meaning additional inpatient beds had to be built later
  • Workarounds and inefficiencies that became necessary when carefully planned ideas were not implemented in the final phase. 

The paper also notes that COVID-19 has changed how health services are delivered, meaning we now need:

  • Reconfigurable spaces
  • Less clinic space for outpatient appointments and more private offices for telehealth consultations
  • Greater emphasis on infection control, which includes air circulation and capacity considerations and greater access to showers and changing space for staff
  • Critical care departments with negative pressure and spaces that can be segregated by infection status
  • Standalone elective-only sites that can also manage post-op critical care. 

Those are important considerations for anyone planning to commission capital works. 

The typical approach to capital works

As NSW Health describes it, the typical approach to capital works involves 3 key phases: planning, design and delivery. 

Planning Design Delivery
  • Clinical services plan
  • Master plan
  • Functional brief
  • Business case
  • Concept
  • Schematic design
  • Detailed design
  • Procurement
  • Construction
  • Completion
  • Evaluation.


Involve the right people earlier on

Stakeholder consultation is a key part of the process – but it’s vital to involve the right stakeholders. 

The Nuffield Institute warns against letting long debates on clinical strategy delay progress as the details will no doubt change by the time the building is commissioned. Instead, it is best to focus on methods that allow flexibility of approach. 

It is often middle managers and clinical leaders who are asked for their input to the design. Yet, what’s really needed are the insights of grassroots staff – ward nurses, scrub nurses, operating room technicians, for example. These people have much to offer in creating a genuinely user-friendly design with efficient workflows. 

And there’s another key group whose earlier input can benefit the outcome: the builders themselves. 

Involving builders earlier in the process

The traditional design-bid-build strategy involves several contracts with different specialists such as architects, designers and builders at different stages of the project. 

A different strategy is now gaining prominence, though: design-build. In this model, the design and build stages are intertwined, giving designers and builders a chance to benefit from one another’s expertise in decisions that affect budget and function, among other things. 

One builder at a recent roundtable hosted by Q-bital Healthcare Solutions expressed his frustration in being brought into hospital refurbishment projects at the final stage, simply to carry out agreed plans with no opportunity to influence the design despite possessing considerable experience – and despite often being on the receiving end of complaints from frustrated and disappointed end-users.

They’re getting something that they don’t need or can’t work with and unfortunately, we’re the last people that they’re seeing before they go and move in. They say, you guys could’ve done better. It’s like  – No, we know what needs to happen but we can’t do that.

Another builder expressed similar concerns: 

We always keep coming on the last stage so we don’t have an opportunity to help with the facility itself, to be able to make it more user-friendly… we come in the last stage a month before we start, procure everything and go and build it. 

But we’re the ones after we finish it, all the hell starts come back to me, why’d you do that? Why is that like that? What’s happening here? Why didn’t you do that like that? 

Some people say, you’re just a builder so go and build what we told you to do… We’re builders – we understand what needs to happen and what facilities need if they’re to be accommodating 30 end users…

Involving builders and grass-roots end users (not their overseers) throughout the design process may help to improve the usability of new or refurbished Healthcare Spaces. 

[These ideas were shared at a recent Q-bital roundtable as part of the Health Facilities & Development Summit – Building Hospitals of the Future conference in Sydney on 16 June 2022.]