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Improving Healthcare through Built Environment Infrastructure

Improving Healthcare through Built Environment Infrastructure

Michail Kagioglou (Editor), Patricia Tzortzopoulos (Editor)

ISBN: 978-1-444-31968-2

Jan 2010, Wiley-Blackwell

296 pages



From the Foreword by Rob Smith, Director of Estates and Facilities (NHS England), Department of Health

‘The built environment for the delivery of Healthcare will continue to change as it responds to new technologies and modalities of care, different expectations and requirements of providers and consumers of care. It is vital that built environment students and practitioners alike avail themselves of the best possible information to guide them in their studies, continuing professional development and the delivery of their tasks. The range is enormous from the assessment of need, planning the service delivery to design, construction, commissioning, maintenance and operation of the healthcare environment.

The book that follows addresses these areas from a blend of contributions of experienced practitioners to the descriptions of the output from recent research that moves forward the frontiers of knowledge and practice in the many areas of the healthcare built environment.

I happily commend this book to all engaged in the exciting fields of planning, delivering, maintaining and operating healthcare environments. When we get it right, we are able to do immeasurable good.’

This book helps academic researchers as well as practitioners to understand how the healthcare infrastructure sector works by addressing the crucial issue of healthcare delivery from a built environment perspective.

It explains the trends in healthcare, models of healthcare delivery; healthcare planning; the NHS building and investment programmes; the procurement process; and facilities management; financial models – including PFI and LIFT; risk allocation and partnering.

Past investigations in the area of healthcare delivery have concentrated on either the medical aspects or the design issues of buildings but Improving Healthcare through Built Environment Infrastructure is unique in considering the ‘meeting space’ of built environment technologies and modern methods of procurement with the medical and operational needs of healthcare settings.

The authors have brought together key industrialists and academics, all heavily involved in the formulation and delivery of new practices. Case studies illustrate how policies and healthcare models are implemented in practice and help identify the key challenges for the future.

Note on Editors

Contributors Biographies

Forward (Rob Smith)

Chapter 1: Introduction: Improving healthcare through built environment infrastructure (Mike Kagioglou and Patricia Tzortzopoulos)

Session 1: Practitioner contributions

Chapter 2: Planning healthcare environments (Duane Passman, Brighton & Sussex University Hospitals NHS Trust Brighton, UK)

2.1. Introduction

2.2. Background and history

2.2.1. The Hospital Plan of the 1960’s

2.2.2. The Economic Crisis of the 1970’s

2.2.3. Change in the 1980’s

2.2.4. Further change in the 1990’s

2.3. The Planning Landscape

2.4. Policy Developments since 1997

2.4.1. The NHS Plan, 2000

2.4.2. Delivering the NHS Plan, 2002

2.4.3. The NHS Improvement Plan, 2004

2.4.4. Our health, our care, our say: a new direction for community services, 2006

2.4.5. Our health, our care, our community, 2006

2.4.6. Healthcare for London, 2007

2.4.7. High Quality Care for All, 2008

2.5. Capital Procurement Methodologies and NHS Organisations

2.5.1. Overall Capital Investment in the NHS

2.5.2. The Private Finance Initiative (PFI)

2.5.3. NHS LIFT

2.5.4. ProCure 21

2.5.5. NHS Foundation Trusts

2.5.6. NHS Trusts

2.5.7. PCTs

2.6. Settings for Healthcare

2.6.1. The Home

2.6.2. General Practitioner (GP) Surgery

2.6.3. Larger Health Centres

2.6.4. One stop shops/polyclinics

2.6.5. Community Hospitals

2.6.6. District General Hospitals (DGHs)

2.7. Supply-Side Considerations

2.7.1. Beds

2.7.2. A & E

2.7.3. Outpatients

2.7.4. Imaging

2.7.5. Other Factors

2.8. Demand side

2.9. Design and The Physical Environment

2.10. Conclusion

2.11. References

Chapter 3: Plan for uncertainty: design for change (Sue Francis, CABE - Commission for Architecture and the Built Environment London, UK)

3.1. Introduction

3.2. Context

3.3. Impact on the built environment

3.4. Optimising design

3.5. Futureproofing design

3.6. Design Matters

3.7. Measuring Design Quality

3.8. Final remarks: Making places

3.9. References

Chapter 4: Designed with care? The role of design in creating excellent community healthcare buildings (Kate Trant)

CABE - Commission for Architecture and the Built Environment London, UK

4.1. Introduction

4.2. Why does design matter?

4.3. Building healthy neighbourhoods

4.4. Access to health

4.5. Surprise and delight

4.6. Designed with care

4.7. Open all hours

4.8. Better isn’t good enough

4.9. Must try harder

4.10. What makes a good healthcare building?

4.10.1. Good integrated design

4.10.2. Public open space

4.10.3. A clear accessible plan with one main reception

4.10.4. An environmentally sensitive approach to building design, materials, construction and management

4.10.5. Circulation and waiting areas

4.10.6. Materials, finishes and furnishings

4.10.7. Natural light and ventilation

4.10.8. Storage

4.10.9. Adapting to future changes

4.10.10. Out of hours community use

4.11. Final remarks

4.12 References

Chapter 5: The stages of LIFT - Local Finance Improvement Trust - for the development and delivery of primary healthcare facilities (Richard Groome)

John Laing plc Manchester, UK

5.1. Introduction

5.2. The LIFT Process

2.1. Project Inception

2.2. Project Set up

2.3. Feasibility

2.4. Stage 1 Approval

2.5. Outline Design

2.6. Final Scheme Design

2.7. Financial Close

2.8. Construction Management Set Up

2.9. Facilities Maintenance (FM)

5.3. Cultural Differences

5.4. Conclusions

5.5. References

Chapter 6: The Integrated Agreement for Lean Project Delivery (William A. Lichtig,  McDonough, Holland & Allen California, USA)

6.1. Introduction to Sutter Health

6.2. Integrated form of agreement

6.3. Traditional Responses to Owner Dissatisfaction with the Status Quo

6.4. What is Lean?

6.5. The Application of TPS Principles to Design and Construction

6.6. Sutter Health’s Formulation of a Lean Project Delivery Strategy

6.7. Development of the Integrated Agreement for Lean Project Delivery

6.7.1. Relationship of the Parties

1.7.1. Creating a Collaborative Design and Construction Environment

1.7.2. Articulating and Activating the Network of Commitments

1.7.3. Optimizing the Project, not the Pieces

1.7.4. Tightly Couple Learning With Action

6.8. Conclusion

6.9. References

Chapter 7: The Sutter Health Prototype Hospital Initiative (Dave Chambers, Sutter Health California, USA)

7.1. Getting Started

7.2. Goals and Metrics

7.3. Design

7.4. Results and conclusion

7.5. References

Session 2: Academic contributions

Chapter 8: The Strategic Service Development Plan: An Integrated Tool for Planning Built Environment Solutions for Primary Health Care Services (Ged Deveraux Manchester Joint Health Unit Manchester City Council, UK)

8. Introduction

9. Background

10. The Development of Primary Care

11. The Role of the built environment in delivering primary health care

12. The Origins of the Strategic Service Development Plan

13. A Comparative Case Study of the MAST LIFT SSDP

13.1. Partnership Working

13.2. Planning Process

13.3. Benefits Realisation

13.4. What was learnt?

13.5. Common Themes of the Document Analysis

13.5.1. Partnership Working

13.5.2. Planning Process

13.5.3. Benefits Realisation

13.6. Common Themes from the Interviews

13.6.1. Partnership Working

13.6.2. Planning Process

13.6.3. Benefits Realisation

13.7. Discussion

13.7.1. Partnership Working

13.7.2. Planning Process

13.7.3. Benefits Realisation

14. Conclusion

15. Recommendations

16. References

Chapter 9: From care closer to home to care in the home. The potential impact of telecare (James Barlow, Steffen Bayer, Richard Curry, Jane Hendy and Laurie McMahon Imperial College London and Loop2 London, UK)

9.1. Introduction

9.2. Key trends

9.3. What is telecare?

9.4. The impact of telecare on care services

9.5. Implications for the healthcare built infrastructure

9.6. Conclusion

9.7. Acknowledgments

9.8. References

Chapter 10: Risk Management and Procurement (Nigel Smith, Denise Bower, Bernard Aritua School of Civil Engineering, University of Leeds Leeds, UK)

10.1. Introduction

10.2. General Principles of Risk Management in Infrastructure Procurement

10.2.1. Risk Planning

10.2.2. Risk Identification

10.2.3. Risk Assessment

10.2.4. Risk Response

10.3. Risk and Procurement routes

10.4. Risk in NHS Procurement

10.5. Multi-project procurement

10.6. Sustainable NHS procurement options

10.7. References

Chapter 11: Supporting evidence-based design (Ricardo Codinhoto, Bronwyn Platten, Patricia Tzortzopoulos, Mike Kagioglou University of Salford Salford, UK)

11.1. Definitions

11.2. the built environment and health Outcomes: considerations about evidence-based Design

11.3. Searching for Evidence

11.4. healthcare environments and impacts on health

11.5. Organising information

11.5.1. Framework 1: Patient groups framework

11.5.2. Framework 2: Route cause and effects

11.5.3. Framework 3: Specific built environment characteristic framework – Colour

11.5.4. Framework 4: Built Environment and Health Outcomes – Overview

11.5. Organising Inforamtion

11.6. Conclusions

11.7. References

Chapter 12: Benefits Realisation: Planning and evaluating healthcare infrastructures and services (Stylianos Sapountzis, Kathryn Yates, Jose Barreiro Lima, Mike Kagioglou Uiversity of Salford Salford, UK)

12.1. Introduction

12.2. Benefits realisation

12.2.1. Benefits taxonomies

12.3. Research methodology

12.4. BeReal model overview

12.4.1. BeReal Usability and Controlling Structure

12.4.2. Investment Appraisal Approaches: General, Healthcare Specific and BeReal Mode

12.5. Case Studies

12.5.1. Brighton & Sussex University Hospitals (BSUH) Tertiary, Trauma and Teaching (3Ts), Case Study

12.5.2. Manchester, Salford and Trafford (MaST) Local Improvement Finance Trust (LIFT) Case study characterisation and discussion

12.6. Conclusions

12.7. References

Chapter 13: Towards the achievement of Continuous Improvement in the UK Local Improvement Finance Trust (LIFT) initiative (A.D. Ibrahim, A.D.F. Price and A.R.J. Dainty Dpartment of Quantity Surveying, Ahmadu Bello University, Zaria, Nigeria Department of Civil and Building Engineering, University of Loughborough, UK)





13.4.1 CI concept

13.4.2 Essential Requirements of Continuous Improvement in LIFT Preconditions and success factors for CI CI driving values CI enabling values CI infusing values Barriers to achieving CI in LIFT projects



13.5.1 Contextual analysis

13.5.2 CI strategy formation

13.5.3 CI implementation



Chapter 14:Performance Management in the Context of Healthcare Infrastructure (Therese Lawlor-Wright and Mike Kagioglou School of Mechanical, Aerospace and Civil Engineering, The University of Manchester, UK School of the Built Environment, University of Salford, UK)


14.1. Introduction

14. Organisational Performance Measurement Systems

14.3. Building Performance Assessment

14.3.1. Performance of Healthcare Facilities

14.3.2. Assessing Performance at the Design Stage

14.3.3. Assessing Performance at Operational Stage

14.4. Contribution of Infrastructure to Performance of Healthcare Organisation

14.5. Conclusions

14.6. References

Chapter 15: Hard FM and performance management in hospitals (Igal Sohet and Sarel Lavy Ben-Gurion University of the Negev, Israel College of Architecture, Texas A&M University, USA)

15.1. Components of Healthcare Facilities Management

15.1.1. Maintenance Management

15.1.2. Performance Management

15.1.3. Risk Management

15.1.4. Supply Services Management

15.1.5. Development

15.1.6. Information and Communications Technology (ICT)

15.1.7 Summary

15.2. Key Performance Indicators in Hospital Facilities

15.2.1. Asset Development

15.2.2. Performance management

15.2.3. Maintenance

15.2.4. Organization and Management

15.3. Research Methods

15.3.1. Structured Field Survey

15.3.2. Statistical Analysis

15.3.3. Model Development and Computing

15.3.4. Validation

15.4. Analysis of a Hospital Using the Indicators Developed – A Case Study

15.4.1. Profile of the Hospital

15.4.2. Data Analysis

15.4.3. Conclusions

15.5. Discussion

15.6. Toward a Maintenance Performance Toolkit

15.7. References

Chapter 16: Community Clinics -  Hard Facilities management and performance management (Igal Sohet Ben-Gurion University of the Negev, Israel)


16.1. Introduction

16.1.1. Healthcare Facilities Management

16.1.2. Alternative Architectures of Healthcare Service Provision

16.2. Clinic Facilities

16.2.1. Key Performance Indicators in Clinic Facilities


16.3.1. Case Study

16.4. Hospital Facilities vs. Clinic Facilities – Comparative Perspective

16.5. Concluding Remarks

16.6. References


"This book has a wide attraction across a range of interests in the delivery of better supporting infrastructure to the health sector. From a property management perspective it addresses the entire lifecycle of asset provision and draws the important link between good design, operation and the health outcomes that the facility underpins. The book has a good balance between industry and academic contributions and I recommend it to anyone with an interest in this specialised area of infrastructure provision and management." (Emerald Journal: Property Management, 2011)
· explains how the healthcare sector works

· triggers the questions to ask

· gives details of the key procurement methods

· details implications for designers and facilities mangers of changes in the NHS