Integrated design, design management and the delivery of major hospitals

There is a failure to fully achieve client expectations and to deliver integrated hospital building solutions that function to all spatial and equipment requirements. Often this is because the construction of hospitals is based on designs established several years before the start on site. A retrospective abductive, auto-ethnographic case study approach has been taken in the examination of four major hospital projects over a period of 30 years. The level of design integration and effect of design management and coordination issues relating to stakeholder engagement, roles and responsibilities, static and dynamic briefing and the integration of major medical equipment has been explored at a project level, then contextualised within a wider delivery model to understand the impacts of these on integrated delivery and systems integration. Five temporal periods were observed, four of them relating to the retrospective case studies these were: (1) prescriptive integration - where traditional procurement with Design, Bid, Build delivery was combined with standards and guidance; (2) dysfunctional integration - where the adoption of Private Finance Initiative (PFI) with Design and Build delivery transferred traditional roles and reduced standardisation; (3 and 4) adaptive integration 1 and 2 - which saw both a gradual deregulation of standards; and, an understanding for standards, and (5) the fifth temporal disintegration period - where guidance from the wider delivery model ceased to be updated due to top down policy reorganisation and lack of centralised control and includes a current case study. Throughout these temporal periods, it was found that the national delivery models have had a significant influence on hospital project delivery and particularly systems of systems integration. A new model based on layering principles that shows the impact of wider delivery models on systems integration is proposed to improve the provision of 'state of the art' facilities at project completion.