Australia looks set to experience sustained investment in its healthcare infrastructure. Delivering the Federal Government’s health reform agenda will require significant expenditure on bricks and mortar, not just by the Federal government but its State government counterparts.
But the Federal Government’s reform agenda also acknowledges that – as far as users of healthcare are concerned – high-quality infrastructure does not necessarily deliver high-quality healthcare. Successful delivery of physical infrastructure should not be seen as an end in itself. Instead, the success or failure of a healthcare facility has to be judged on its capacity to enhance rather than impede the delivery of health services. Ultimately, achieving this objective is in the hands of those who playa role in the service planning process: health service professionals, clinicians and planners.
Looking at healthcare infrastructure from this perspective provides real challenges to those of us who are involved in its delivery. But it also provides us with real opportunities to maximise the return on infrastructure investment, and the key to this is focusing on how a healthcare facility can best perform in the long-term.
So how can we ensure a healthcare facility will still be performing optimally 25 years into the future? It pays to remember that the healthcare system is always changing due to:
- Emergence of new models of care, changing the scope and approach to care provision;
- Pursuit of improved throughputs;
- Changes in workforce skillsets and numbers; and
- Emergence of technological innovations.
Delivering a facility that achieves long-term excellence requires us to address all of these factors. While it’s vital to take a long-term view, doing so also involves tackling some complex issues and decisions regarding physical facility provisioning through the health infrastructure development process.
Anyone involved in delivering healthcare infrastructure will point out that it’s vital to get the close involvement – and commitment – of key stakeholder groups. But successfully engaging stakeholders with a view to defining a project is a complex task, and there are a number of potential issues that can arise:
- The reference points for key stakeholders and user groups can be limited by their exposure to other models of care;
- Undue weight can be attributed to the ‘loudest voice’ in the user tha group consultation process, detracting from other important elements of service delivery;
- User group bias in the provision of acute clinical services can also come from internal politics, conflict of interest or a desire for power and status;
- The new thinking in Models of Care requires a whole of system view which may contrast with a more traditional ‘silo’ mind-set;
- Stakeholders’ principsl skill-set is in service delivery, not process analysis so the responsibility to challenge and analyse sits with the health planners and architects; and
- Consultant engagament with user groups may be more about guiding and educating them around the planning process, as well as with new possibilities and ways of working in the future so they are able to better contribute to the definition process.
PERSPECTIVES OF HEALTHCARE PROVIDERS
There are also some additional complexities associated with effectively engaging healthcare employees. Given that these stakeholders work under extremely stressful conditions, there are a number of things that hospital executives can turn their minds to in order to improve the stakeholder consultation process:
- Ensure that hospital resources are able to create the ‘head space’ necessary to ‘future cast’ the required forward looking Models of Care;
- Allow sufficient time for users to ‘get up to speed’ and engage in the consultation process;
- Reduce the fear of change from concerns around clinical risks associated with taking on new or less well-tested Models of Care;
- Inadequate budget allocations to allow step changes in service delivery; and
- Tirneframes being set to meet political imperatives, rather than being aligned to the delivery of complex health infrastructure developments.
TAKING THE LONG-TERM PERSPECTIVE: STEPS TO GETTING IT RIGHT
Despite these complexities, we do know how to deliver healthcare infrastructure that provides operational excellence. The key is effective planning. Research undertaken by the Property Council of Australia (PCA) identified the top 10 drivers for excellence in healthcare facilities. They are:
- Client leadership
- Trusting relationship
- Adequate budget
- Stakeholder involvement
- Team establishment
- Understanding client business
- Value management
- Project initiation
- Team pride
What this study makes very clear is that behavioural drivers are the key to excellence. It found that ‘delighting the end user’ – clinicians, patients and the community – is the first prerequisite to achieving excellence. Further, a focus on price, liability and risk actually inhibits excellence.
Crucially, there is a specific window of opportunity that has to be taken when planning healthcare infrastructure, and this is during the start-up phase. The optimal time to begin planning large projects is 2.5 years before the first sod is turned. Figure 1 shows best potential to set a project up for excellence in the start-up phase, where perspective on what needs to be achieved can be attained with low cost in exploring options.
Figure 1: Level of influence and opportunity to deliver Operational Excellence over Time for new facility developments
As a rule of thumb, over a 25 year period, the ratio of key project expenditures is said to be:
Proportionately, this means the cost of capital infrastructure is an extremely low contributor to the overall cost of healthcare services, and the cost of a robust project definition study even less so. By contrast, the returns the community gets from a good decision making process will be felt for say 25 years.
Thinc Health steps to success: a summary
- Get going early – at least 2 Y2 years before construction starts to allow the lead time for robust health planning;
- Identify your Internal project team which is committed to being the ‘best client it can be’ to represent key stakeholders and achieve long-term operational excellence;
- Ensure that the decision-making priority is appropriate to the project stage. Quality may take precedence during definition, whereas cost or time may take precedence during implementation; and
- Once you’ve clearly defined the strategic direction and project environment that you want, you’re ready to brief and appoint your health Infrastructure project team.
By taking these steps, an opportunity exists to define a healthcare facility up-front for long-term operational excellence. It also ensures a facility that minimises staff activity, stress and fatigue while also improving patient safety.
The pay-off for taking this approach to healthcare infrastructure is huge. By bringing the right team together at the right time, you can create an environment which encourages innovation and maximises opportunity. Only by focusing up-front on the long-term benefits of operational excellence can you seize that once-in-a-lifetime opportunity to get things right, not for one year, but for a generation.
Thinc Health is currently providing health advisory (planning), as well as project strategy and management services on a number of large and complex health infrastructure projects around Australia to a total value of around $4Bn in capital spend.
If you would like to discuss this article or your forthcoming project, contact Brad Richardson at Thinc Health on 073221 8425 or firstname.lastname@example.org.