Accelerated design for new hospital – check out how it’s done.

In the run-up to Health Facilities Design and Development conference, I wanted to explore some of the new case studies on the agenda.

One topic that really stood out is Jeffrey Williams’ presentation in his role as Director of Nursing at St John of God Midland Public and Private Hospitals, in particular the short time it took to get the project off the ground.

I caught up with Jeffrey recently when he gave me a sneak preview on some of the features of the new hospitals, key design innovations and a breakdown of the user group consultation process:

Project overview

Construction of the new 367-bed co-located public and private hospitals has reached 70 per cent, and is on target for a November 2015 opening.

With 307 beds, the public hospital will offer a wide range of services to the communities of Perth’s northern and eastern suburbs and the inner Wheatbelt, while the 60-bed integrated private hospital will offer the choice of private health care.

State and Commonwealth Governments have jointly invested $360 million in the public hospital project that will be operated by St John of God Health Care under a public private partnership agreement. The WA-based private health care operator is investing $70 million in the private hospital.

Fast facts

  • First major hospital facilities to be built in the Midland area in more than 50 years.
  • HASSELL architects and Brookfield Multiplex are the design and construction partners.
  • The public hospital will treat approximately 29,000 inpatients, 55,000 emergency patients and 89,000 outpatients in its first full year of operation.
  • The public hospital will provide an expanded range of services from those provided by Swan District Hospital free of charge to public patients.
  • There will be 367 beds in total – 307 public beds and 60 private beds.
  • The public hospital will have 50 per cent more beds than the Swan District Hospital.
  • More than 1,000 staff will be employed at the hospitals.
  • Easy access will be provided for pedestrians, vehicles, and public transport.
  • On-site parking will include 725 staff bays and 221 visitor bays.
  • Easy drop off and access to the emergency department will be provided.
  • Patients, visitors and the community will enjoy landscaped gardens, courtyards, public art and plazas.
  • The hospitals are being built on an eight-hectare site, four times the size of the Midland Oval.

Accelerated design

The State Government released its expression of interest in September 2010 seeking responses within five weeks.

Post EOI submission, St John of God Health Care continued to work closely with its partners Brookfield Multiplex and HASSELL to develop a design within the allocated budget while awaiting confirmation of our selection to tender for the request for proposal.

Thankfully St John of God Health Care was selected and had a short 20-week window in which to prepare and submit a response.

On 1 December 2011, St John of God Health Care was announced as the preferred tenderer and, following negotiations, signed a contract with the Western Australian Government on 14 June 2012.

During the negotiation phase, St John of God Health Care, Brookfield Multiplex and HASSELL worked closely with the State Government’s consultants to ensure that any major design issues were dealt with at a high level so that construction could start as soon as possible after contractual completion.

This preparation allowed St John of God Health Care to achieve the State Government’s goal of starting work within one month of satisfying the conditions precedent, in August 2012

User group design

While we completed the design very quickly, we could only establish the design user groups after the contract was signed. This led to a concurrent construction and user consultation process that meant we had to focus on those areas where we needed to finalise the design and start building first.

We began a four-step user group process, with each group running between 16 and 20 weeks.

At the first meeting, we presented the users with a schematic design. The architects and builders then took the users’ advice and presented the modified design at the second meeting. The third stage was detailed design when we presented drawings showing room elevations and the position of furniture and equipment. The fourth meeting was a presentation of the final detailed design and allowing the users a last opportunity to highlight any remaining issues.  The detailed design was then signed off ready for construction drawings to begin.

Taking the Emergency Department User Group as an example, the users told us that the waiting room was too small and so we adapted the design accordingly. This process allowed us to drill down into the operational detail by asking them their opinion on matters such as the number of cubicles and the department’s layout.

Accelerated construction

While the user group consultations were taking place, preparatory construction work, such as piling and pouring concrete for the floors got underway. We also made decisions such as the location of wet areas to enable holes to be drilled for the later installation of pipes and drainage.

In those early days, we included around 130 square metres of expansion space on each floor. This built-in flexibility meant that we were well prepared for short-and long term expansion and design changes.

Managing expectations

From the word go, we made it clear to the user groups that the construction budgets were fixed.

The WA Health Clinical Services Planning Framework was a useful tool as some things were a given and did not need to be included in the design discussion.

For example, we had already made sure that we had the right number of beds and could explain to the users that we were working with a 30-bed medical ward, a 24-bed short stay surgical unit, or a 12-bed intensive care unit.  We also knew that St John of God Midland Public Hospital was a Level 4 hospital for cardiology and a Level 1 hospital for intensive care.

We were therefore clear about what we were trying to achieve and this allowed the users to understand the clinical scope so they could focus on how the unit might work and how we could make workflow more efficient.

Innovation in design

We standardised all of the rooms that are common across multiple areas of the hospital. For example, a dirty utility and a clean utility have the same layout in all areas.

We will be using swipe access widely throughout the hospitals for security, including to high traffic areas such as emergency department and restricted areas such as drug rooms.

All patient bedroom ensuite rooms were manufactured offsite as ‘pods’ to a standard, including a standard bedroom pod and a mental health pod, and installed within a short timeframe. While this was cost neutral from a construction perspective, cost and time savings were achieved in the installation.

We decentralised our staff stations, meaning that most ward areas have two or three staff stations instead of one centralised staff station and so clinicians will be closer to their patients.

Finally, we designed to accommodate future expansion. When the State Government issued its proposal for a 307-bed public hospital, they said that the hospital must have the capability to expand to 464-beds by 2021.

The design accommodates expansion in several ways:

1. Intensive Care Unit and Coronary Care Unit

This 12-bed shared unit has six rooms configured for intensive care patients and six rooms configured for coronary care patients. The six coronary care rooms can quickly be converted to intensive care rooms as the required services are already in place and space exists in the adjacent area for 12 coronary care beds to be installed with minimal disruption.

2. Operating theatres suite

The operating theatres suite is designed to cater for the maximum 464-bed capacity with nine theatres and three procedure rooms. These are all of equal size and configuration meaning that the three procedure rooms can easily be converted into theatres, while the procedure rooms can be re-located to a nearby area of the hospital.

3. Private beds

The two 30-bed private wards have been integrated in such a way that when the State Government wants to expand the public hospital from 307 to 367 beds, these can easily be converted into public hospital beds and St John of God Health Care will build a stand-alone private hospital on a nearby site.

4. Additional wing

The expansion to 464-beds can be achieved by adding a new wing extending out from the existing ward block on the northern side of the hospital. Again, this is designed to be achieved with minimal disruption to existing hospital operations.

Lessons learnt

I have two roles and two sets of responsibilities on this project: the first is clinical design and the second is transition and operational readiness. I have learnt lessons across both of these areas.

It was challenging in terms of the limitations on which people within WA Health that we and the other tenderers were allowed not access during the bid preparations. If we were to go through the same process in the future, we would request earlier and wider access to key players in the public sector.

Secondly, we would focus on operational preparedness earlier. While we had a firm view of how we would run the hospital, we did not start working through this in earnest until after the building program started. If we had begun earlier, we would have benefited from additional preparation time.

However, all aspects of the project, including the partnership with WA Health and the North Metropolitan Health Service, in particular, have worked really well. In terms of construction and commissioning, everything is on budget and on track for opening in November 2015

Working in partnership

The traditional public private partnership means the State saves on design, construction and facility management, but continues to deliver the service. As our model also includes clinical services delivery, the State Government can achieve further efficiencies.

Overall, it has been a very positive process, with the focus now firmly on completing construction, operationalising our commissioning program and finalising the details of the patient transfer from the existing Swan District Hospital that will close when the new hospital opens.

Hear more from Jeffrey during his presentation at Health Facilities Design and Development Victoria.

Old Aussie buildings… Don’t write them off just yet

The spotlight is well and truly on retro & refurb as Australia is poised to reduce energy emissions, operational costs and get smarter with space. But why is it so important now? How can technology help? Where do we keep making mistakes? And what can be done to make sure our older buildings stand out? We sought the expert’s insight from Caimin McCabe, Director, Cundall Australia ahead of his presentation at Retrfit & Refurb 2014

What would you say are the key drivers prompting property owners and investors to start thinking about retrofitting their own buildings?

There are a few key areas here:

  • In the building owner’s mind is asset repositioning or increasing asset value. They want to create a better asset and establish a point of difference from the competition.
  • The asset valuation might be done as a direct result of current operational costs to try and reduce the running costs of those buildings.
  • Retention is an increasing driver for retrofitting. Particularly in Grade B, C and D buildings where there’s a lot more competition for tenants. When their leases come up for renewal, they start to reflect upon whether they want to stay or if they’ll get a better deal elsewhere.
  • Flexibility is another area we’re seeing as a driver. There are increasing numbers of smaller entities who want smaller space in good locations, leading to a need to accommodate multiple (small) tenancies on each floor – particularly within Grade B, C & D buildings.
  • In the back of people’s mind whilst doing this are issues like NABERS Energy performance to see if it can be improved.

How are technologies and new approaches being used to improve environmental and operational performance of existing buildings?

I’d say the best bang for buck is actually looking at control upgrades and getting the building management system to actually do what it should be doing. Look at sub-metering to actually monitor where energy is being used; target reduction rather than assumptions.

The market is obviously seeing a lot of new technologies emerge, as well as enhancements to existing buildings including classic co-generation and tri-generation. In reality though, existing buildings can often find this difficult to accommodate as they don’t tend to have plant rooms available…

What’s quite important to us is it’s not just doing it for the environmental sake; the economics of decision making is equally important. Greater equipment efficiency and operation need to be considered..

Engaging the ‘right’ technical advisor or engineer to work alongside building or facility management in terms of the operational tuning is also key. The trick is to ensure this happens on an on-going basis in lieu of a one-off assessment.

We’re also seeing consultants and facility managers use big data analytics software to assess controls and trend log profiles in real-time to identify ‘rogue’ systems and control issues.

We’ve also found (and this is probably part of the whole-of-life approach) that there’s a tendency to ignore the façade. We’ve had some really good success on buildings where we’ve taken a step back and looked at the building as a whole and said: ‘Rather than just going in there and doing the engineering, we’ll check the whole façade.

We recently took this approach in a project that was focused on the chiller, in which we made many changes to the façade. This resulted in no need for a replacement chiller.

We re-commissioned and put in some new technology components, like diffusers to improve the air quality – we moved the pot of money around. In the end we got the building from its one star NABERS to a four star NABERS. We also significantly improved the indoor environmental quality of the building, so now the building is actually liked, not hated.

You might have an efficient building, but if you don’t want to work there, it doesn’t really matter.

Property owners of B, C and D grade buildings are under pressure to evaluate cost benefits. What are the key areas that need to be addressed during business case development to ensure ROI?

The interesting thing is, embarrassingly to some of the newer buildings, some of the older buildings actually have better performance. Just because they’re old doesn’t mean they’re bad. There is a trend in industry generally that new is good and actually sometimes old is better.

A lot of the old buildings are designed more with passive design in mind. The level of glazing, for example, in an existing building is generally a lot lower than on a new building. Our own office here has only 25 per cent glass, but we’ve got more daylight in our office than we would have if we were actually in a new building. This is because of how it’s introduced and how it’s used. The are a lot of advantages to those buildings which are not traditionally marketed or sold, which is why I talk about the whole building approach. It’s stepping back and asking: ‘What are the attributes? What are the benefits? How do I enhance them and connect the tenant to those benefits relative to other buildings?’

It’s important to realise there’s no silver bullet – if somebody’s trying to tell you that there is, don’t believe them. Every building is unique – there isn’t one size fits all. You have to judge each building on its own in terms of what’s there, but the approach needs to reflect the energy efficiency, indoor environmental quality and the attributes that the building actually has.

Depending on the asset location and target market, the argument isn’t about ROI, but more towards differentiation from competing Grade B, C & D buildings.

Building owners are typically looking only at rent; they’re not considering the quality of the environment they’re in. That’s where I suppose our role is, along with other colleagues, to try and highlight what the building could be for them.

The real risk is what happens if the landlord decides on doing nothing. The danger for the landlord is that they are then left with looking at costly incentives for tenant’s attraction or attention. They’ve potentially got higher vacancy and operating costs weighing down the asset value. They could even be breaching bank covenants as they’re not actually getting the returns. In our mind, doing nothing for an asset owner of a B, C or D grade building in the marketplace is not really an option any more – they just need to sit back and determine how they want to do this and how to reposition the asset.

A major retrofitting and refurbishment project will encounter many challenges across the design and delivery phases. From your experience, what would you say are the main barriers that prevent people from achieving their aspirations on a re-lifting project?

A few areas here also:

  • Existing site or services infrastructure might not be sufficient to achieve required outcomes – there could be limitations inherent within the building.
  • Working around existing tenants can also be problematic and might limit the extent or timing of works that can be done to retain a ‘live’ building.
  • Availability of financing will always be an issue. There’s also a lack of understanding on the alternative funding mechanisms, such as an Environmental Upgrades Agreement (EUA).
  • The return on investment could also be perceived to be too low to actually do the work. In terms of guaranteeing better rents, it’s impossible to do that. We find there’s a tendency to jump in legs first without spending enough time doing the upfront assessment and design stated. When you start to do the actual work, you expose issues you weren’t aware of because the due diligence wasn’t done at the beginning. This in turn might result in costly mistakes (affecting overall budget) and subsequent cut backs or reduction in scope as part of a value engineering response.

New airport funding revenue set to take off…

There are a lot of issues facing infrastructure funding at a national level. The simple truth is there’s less money in the government pot. As a result, it’s time for economic infrastructure projects to start thinking outside the box about how they’re going to get funding.

Economic infrastructure has a distinguishing characteristic – there is a third party revenue stream generated by people that want to use that piece of infrastructure.

If you want to use a road, or use an airport, then there’s a way in which airport charges are included into the overall financial structure.

Pre-GFC environment, people were ready and willing to take the risk on the third party revenue streams. But as times get tougher, it’s becoming harder to justify taking the risk on the revenue stream.

To get a bit of insight on exactly how we can start to green-light regional airport development projects, I caught up with Martin Locke, Partner at PwC.

Martin and I took a look at the different models government can use to facilitate new investment in infrastructure that is expressly going to have an impact on productivity, and have an impact on growing the economy, generating revenue streams over time:

  1. Government can still decide to build and finance a new piece of infrastructure in its entirety. As revenue streams begin to firm up, government can then choose to sell off that piece of infrastructure. That’s been done in the context of some of the road transactions recently in Queensland. That model is what can be referred to as ‘build now, future sell’ and could apply in relation a completely new piece of infrastructure, or a piece of infrastructure that is an expansion of an existing arrangement.
  2. Another model is to leverage existing assets. This is when the government identifies a particular brownfield asset that’s already generating a revenue stream, and looks at how to expand it. Stakeholders may be asked to step up and take a risk on a revenue stream before it’s been firmed up. Repayment is sometimes provided out of the existing asset, rather than the expansion.  There’s an example of this currently being developed in the roads area with the extension of the F3 to connect up with the M2 motorway. That’s been done as an extension of the original concession – it’s called Missing Link. In return for taking on the risk of constructing and generating this new revenue stream, shareholders ask for compensation in the form of extending the lease term on the existing concession.
  3. Revenue securitisation is another option. When social infrastructure is financed from substantial government investment, it’s because the private sector won’t take the revenue risk. For economic infrastructure projects, the government’s approach is to pay the private financier an availability payment once the infrastructure has been built, generating a return on the initial private capital. Separately, government will also look to generate a charge and revenue stream from that piece of infrastructure. That type of transaction is what’s currently being contemplated for th East West Link project in Victoria. It’s also an example of what was in relation to the subsequent leasing of the Sydney desalination plant.
  4. Contingent support: The fourth area is for government to provide some form of contingent support for a project.  For example, private financier funding might build an expansion, and the government agrees to provide funding support for that expansion. When the private sector financiers step up with their money, they’re told what the projected revenue stream is going to be, as it’s still a projection, and government provides a return guarantee (normally set at a lower level). There’s a cap and collar type arrangement that is adjusted depending on how much is earned. Once the level of the cap is reached, any excess revenue is paid back to government.
  5.  Finally, government can provide subordinated debt. The private sector will provide funding, but will only agree to fund around 50 per cent of the capital costs of the expansion. This will be because they can only see sufficient revenue to amortise 50 per cent of the capital. Government can then offer the remaining balance, in the form of a subordinated loan. Their subordinated loan is only serviced after the prior ranking loan for the banks has actually been repaid. It provides a mechanism where government is providing funding, designed to earn a return and ultimately be repaid.

The above models certainly offer some innovative funding methods, but without a solid business case to begin with, hopes of funding will be slim. Martin shared his key advice for building a successful business case:

Provide clear support for the future ability to generate third party revenue.  If you’re coming up with financial projections around how you’re going to repay your capital, and how are you going to come up with different forms of revenue stream, do your due diligence around that revenue stream to provide strong evidence.

People make a mistake of confusing economic analysis with financial analysis. People will be trying to justify a project by claiming it’s got a really good economic cost benefit ratio. A lot of indirect economic externalities might help generate a really decent economic cost benefit ratio, but unless they are related to financial benefits, the project will not be financially viable.

The government has become increasingly credit constrained. There’s very little money to deploy. They would far sooner see projects being privately funded rather than publicly funded. Ask yourself: How do I make sure that I’ve actually got a business case and a financial structure that is consistent with private funding being made available?

Hear more from Martin during Regional Airport Development 2014 where he’ll facilitate the workshop ‘Exploring Alternative Funding Models for Infrastructure and Commercial Developments’.

 This workshop will assist you with understanding the alternative infrastructure funding models; and aims to guide you through the processes and criteria for securing such funds. Now is the time to comprehensively explore your funding options to ensure you can turn your master plan into master actions.

[Exclusive interview] Building powerful partnerships at Queensland’s new Lady Cilento Children’s Hospital

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