The new 359-bed hospital will be the biggest public children’s hospital in Australia, and the central hub of an enhanced state-wide network of children’s health services.
The Lady Cilento Children’s Hospital merges staff and expertise of the Royal Children’s Hospital and the Mater Children’s Hospital
It is part of a $1.5 billion program of work, including an adjacent academic and research facility, the refurbished headquarters of the Children’s Hospital Foundation; land to accommodate families within the precinct; improved road access and a new Adolescent Drug and Alcohol Withdrawal Service building.
Developing Queensland Children’s Hospital has been no easy feat. The overarching challenge: bring together two old (but long-standing) children’s hospitals and win people’s hearts…
Ahead of their presentation at Australian Healthcare Week 2014 in March, I caught up with some of the people tasked with steering the project from concept to completion: Dr Peter Steer, Chief Executive, Children’s Hospital and Health Services, Bruce Wolfe, Project Director at the project’s architect, Conrad Gargett Lyons, and Tim Treby, Project Director for the managing contractor, Lend Lease.
Could you outline your involvement in the Lady Cilento Children’s Hospital and where your focus lies?
Peter Steer: I’m the Chief Executive of the Children’s Health Queensland Hospital and Health Service that will be running and managing the facility at the end of the day. I’ve been involved for five years now, and my focus is to ensure that we deliver a contemporary design that delivers against our vision and mission, which is a really patient- and family-focused healthcare service.
Bruce Wolfe: This was something of the ultimate architectural prize so, initially, my involvement was bidding on the project; then Master Planning and developing the building concept with the design team, health planners and client. In many ways my role involved managing the complex relationships on the project and that is my focus now as the building nears completion
Tim Treby: I have been involved in project for over 6 years, from commencement of the Master Planning phase as Building Consultant initially, and then as Managing Contractors representative. I am responsible for delivering the building to meet the expectations of the client and the many other project stakeholders.
The success of the project relies heavily on effective collaboration and communication. What would you say is key to getting this right?
Peter Steer: The relationship between the principals on the project. We were very fortunate with the appointed architectural team and the managing contractor as those relationships are critical. The other critical communication issue in health is the quality of stakeholder engagement and, in particular, user group engagement.
We learned through the project that you can’t over-communicate in the context of these complex designs. The healthcare professionals using the facility feel very strongly about their services. There’s a significant education element around that stakeholder and user group engagement. It was one of the things we got better at as the project progressed.
I’ve been involved in a number of significant projects before and am continually surprised at how difficult it is to bring people along. Some clinicians have strong opinions and their expectations are very high, and not always contextually appropriate for the capital build. There are real challenges in managing stakeholder user groups. We took the communication and listening process very seriously. We went back repeatedly to review and subsequently did some significant schematic re-design work because we were keen to ensure people felt listened to.
Bruce Wolfe: Time spent listening is always valuable; listening to both ideas and criticisms. It’s crucial to moving forward collectively.
Tim Treby: I agree that the success of any project relies heavily on effective collaboration and communication. The larger and more complex the project, the more challenging this becomes, and the more important it is. This project has been extremely challenging in virtually all aspects of the development process, and the toughest issues to overcome, in hindsight, have been those where communication and collaboration have been lacking in some form. We are fortunate to have a client who recognises the importance of this and we are able to communicate openly and resolve potential issues early.
What preconceptions did you bring to the project and were they reinforced or altered?
Peter Steer: My preconception was that it was going to be a very complex capital build and that there would be issues around our workforce merger, given that this was bringing two hospitals together. They’ve been reinforced – it’s a very complex project that is now going well, I’m not sure there’s been anything like it in this country before.
Bruce Wolfe: At the interview for the project, we talked about a very different type of hospital, open and “permeable”. I actually wondered whether this may have been too big a move for Queensland Health but it the opposite was true, the client was keen to embrace innovation and bring new ideas to the planning including the concept of a more open and community connected hospital. The site was also challenging and involved a broad review and evaluation of the urban context. This was fundamental to the success of the project and in reality was every bit as complex as imagined.
Tim Treby: This was always going to be a technically challenging project; a heavily serviced hospital including an energy facility on brownfield site bounded by major arterial roads, bus tunnel, schools, hospitals, residences and a telephone exchange. Having been involved in many hospital developments before the LCCH this was understood, and has been reinforced many times over during the life of the project. The project has traversed several cycles, including economic, political, industrial, corporate and stakeholders which have all had to be negotiated. I knew that the project team would have to be tenacious to overcome the challenges that would and have come, and also that we would be all be justifiably proud of the end product. It is a fantastic result.
QCH was not a public-private partnership. Do you see any benefit of using this new PPP style?
Peter Steer: We benefited from not being a PPP, primarily because the site was complex and had some major design challenges, along with the organisational merger; engagement was critical. And certainly the procurement process and the choice of managing contractor versus a PPP allows a lot more user and stakeholder engagement. That was the advantage for us.
In terms of Public-Private Partnership, given the challenges for government finding injections of capital money, PPPs will become more attractive. PPPs will be a mechanism (and not an unreasonable one) to deliver these big projects that otherwise will simply not get off the ground. PPPs certainly have their place and their advantages, but I don’t think there’s a perfect methodology. The mechanism of procurement really does need to fit the purpose and context.
Bruce Wolfe: Shortly after the design of QCH, CGR won the commission to master plan and provide the design of the Reference Project of the Sunshine Coast University Hospital, a PPP project on a large scale. One of the difficulties in the PPP process is getting sufficient client and user-group contact with the competing design teams. I think that was well handled in that project but it remains a difficult aspect of PPPs. The benefits are in relation to the capital cost savings for government and allowing the health experts concentrate on delivering their core expertise.
Tim Treby: They appear to be desirable from a public funding point of view, however I think that the cost to industry to bid for PPP tenders is excessive and unsustainable. There must be a more equitable procurement methodology that can be developed. I would question whether they are sufficiently client focussed for particularly complex projects.
How is the project responding to a change in customer demands?
Peter Steer: Things have changed enormously over the last seven years. To be both accurate and give praise where it’s due, the architects in their design have designed a facility that maximises flexibility.
As our understanding of service models has matured, we have had to make changes. We’ve obviously had to draw a line in the sand, but we were fortunate with a flexible design in the first place that has allowed us to survive well with adaptation over that long period of time between design and delivery.
Bruce Wolfe: Our customer for QCH was Queensland Health. In the long delivery of such a project there are inevitably changes in their demands that impact on planning. The versatility and flexibility of the design was tested during that six year period from master planning to completion.
Tim Treby: I think that when the Hospital opens people will be impressed with this building. It is a facility that has the welfare of its young patients and their families firmly in mind, as well as the needs of staff and visitors. There has been future flexibility built in, and much work done by the client, design and contractors teams to ensure the latest technology is provided in the facility, considering the lead times which have had to be managed.
What have been some of the biggest challenges you faced throughout the development of the project? Are there any lessons learnt?
Peter Steer: It’s critical in any healthcare design, particularly given the context of our merger and bringing two organisations into one, to get that engagement right. The other opportunity is getting stakeholders to understand there may be design solutions and technology solutions to some of our service delivery challenges at the moment.
A classic example of such an opportunity was in our outpatient design – we had our clinicians absolutely horrified that there was very little waiting space within this hospital for clinics etc. When you think about it, at first, a patient might think, why don’t we have larger waiting areas? But, the principle about being patient- and family-centric with this children’s health service is not to have people wait, and to design a facility that would enable waiting makes no sense.
You can create tension by your design, your intent and your vision for the organisation, and through technology, make a real difference to a design solution. There’s a major change agenda, a service change opportunity, with these big design projects, it’s difficult to grab them.
The other challenge is that on a really big, long project, the team changes. You have changes in personnel, particularly in the public sector, in the bureaucracy with whom you’re interfacing, and often have government changes. Managing that change can be a challenge.
Bruce Wolfe: This was a complex and testing project and there were really no areas that were not a challenge. A difficult brown-field site, two separate and very different organisations coming together, a highly visible project politically and a turnover of client project directors during the course of the project. The challenge was to stay focussed on the architecture and the building and the problems that were in a domain where we could be most effective.
Tim Treby: As I have already mentioned there has been no shortage of challenges on the project. The site location provided many technical and logistic challenges, and the form of the building required a lot of planning to develop methodologies to safely construct it, and it did drive innovation.
The clarity and alignment of expectations for the user group approval of the developed design was challenging, and exacerbated by external criticism and lack of continuity of some participants. The importance of external stakeholder engagement was recognised and managed well.
There has already been a lot of interest in this project from a design perspective. What has been your impression from that commentary?
Peter Steer: This project (and certainly the design that’s put on the table) is centred on creating a green and healing environment.
This vision has permeated everything with extraordinary attention in design, designing to minimise use of electricity, having our atria and major thoroughfares in the hospital, open to the environment.
There’s also a community vision where the intent of the architects has lived true, they’ve ensured the hospital is open to the community. There are major ‘windows’ that allow people both to see in and see out from this facility, which not only helps with finding context about time of day and place, space and time, but also builds community connections. For a children’s hospital, this is critical.
Bruce Wolfe: The building occupies the site quite powerfully which has generated discussion both for and against. As the building is revealed, the gestures of opening the building façade and connecting the inside spaces to the outside is more apparent and helps in the scale of what is a very large building. There is more of the ground plane also given to the public.
We have been pleased with the comments as the scaffolding has come down and surrounding buildings removed to reveal the civic domain.
It was also pleasing to be the first Australian hospital to win the Academy of Design and Health Award for Best Future Hospital
Once it’s open and people get to experience it, as opposed to looking at pictures, I am sure the impact will be much, much more significant.
Tim Treby: The external appearance tends to be polarising, and it certainly has people talking. The finished product being delivered is true to the brief and design intent, and will provide fantastic facilities.
The project has clearly seen lots of innovation. Have you any examples of how it’s acted as a catalyst for change for other hospitals?
Peter Steer: There’s little doubt that our emphasis on service planning and patient flow as a result of this process is influencing ambulatory care delivery across Queensland. We’ve been innovative in terms of our ambulatory clinic not just design, but service. We’ve got some great feedback and interest from health services across the State. It’s that interface between service design informing building design that has been the advantage.
Bruce Wolfe: I think it is probably too soon to tell but I think that since the design of this building was revealed in early 2008, there is a renewed emphasis in hospitals on intuitive way finding and creating public spaces in the building that link to form a network of volumes rather than of corridors and passageways. There have been planning innovations as well but these would be tested in practice before being adopted more broadly.
Tim Treby: The have been many innovations implemented during the construction phase, which will no doubt be used on future projects.
Hear more from Peter Steer, Bruce Wolfe and Tim Treby during their exclusive presentation at Australian Healthcare Week: ‘Queensland Children’s Hospital: The New Look PPP’s: Powerful Precinct Partnerships’ This project case will focus on the new Children’s Hospital Project, demonstrating a strong collaborative process adopted by the client, architect and contractor which has ultimately acted as a catalyst for change