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Crossing the design divide

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Nursing Times speaks to Elizabeth Smith, a nurse who, frustrated with a lack of nurses’ input into hospital redesigns, used a career change to redress the balance.

Working in a hospital isn’t easy, no matter what your role. Being a nurse, usually kept from the decision-making, is arguably the hardest role of all. You spend what at times seems most of your life walking the hospital corridors, doing your utmost for a diverse array of patients, working around the flaws in the system and the healthcare facility itself. And if you hear that your hospital is due a redesign, a refurbishment, a new wing or even a new building entirely, you often wish nurses had more input.

Tell us a little about your background

My early career was as a cardiology nurse. I spent ten years working in NHS hospitals before deciding to go to Africa to teach nursing.

After two years I returned to the UK and spent four years as project manager for Healthlink Worldwide looking after health projects in Africa, Asia, Latin America and the Middle East. After that, I became head of business relationships for NHS Professionals; and then acted as project manager for Capula Healthcare on NHS IT projects.

I’ve seen the day-to-day challenges faced by the NHS, the contrasts in approach to healthcare projects across the developing world, and I’ve been involved in the implementation of large-scale IT in an NHS environment. The lessons from all these projects were the same - success came when there was partnership and stakeholder involvement in the project. The impact of this was delivery of the project with added value of flexibility, sustainability and improved working practices, those that had been involved felt a sense of ownership and pride in the project and its results.

And is this the lesson you’ve taken to your new role?

Absolutely. Health facilities actually perform a number of functions - they’re a place to work, a place to heal, a place to learn and a place to die. Only by understanding this can you adequately deliver on all levels. When I was nursing, I heard the complaints and the appreciation; dealt with the consequences of poor design; experienced grand entrances that looked bright and beautiful in summer but which became cold and dark in winter; saw doors which couldn’t accommodate a standard bed; and, perhaps most tellingly, witnessed the operating relationships between private and public sectors, being privy to the real opinions that emerged when the ‘partner’ had left the building. I breathed the hospital environment on a daily basis, which is why I saw an opportunity to make a real difference to the provision of healthcare buildings by joining Medicinq Osborne as health framework manager.

How does your role make use of your nursing background?

Of course. The company wanted genuine insight into the client side of a construction relationship. No matter how much you empathise with your clients, no matter how much you try to put yourself in their shoes, it’s never quite the same as when you’ve BEEN the client; and what’s more, been the end-user with no say in the client/contractor relationship. The private sector wants to please its clients, to develop the buildings that meets with their expectations, but by and large in the past this has meant pleasing the client’s decision-makers. Now, more than ever, our clients are realising there are great benefit when they  involve their own staff, not just in specifying the design and function they’re looking for, but throughout the entire construction process.

And this is the way it should be. As a health professional I know the impact buildings have on the ability to do the job well. Medicinq Osborne has not just a contractual duty, but a moral duty to deliver on every level, and to every user. That means patients, doctors and nurses. And our obligation means not just engaging with a client, but creating a close and equal working relationship; if possible with an NHS client team which comprises a rounded mix of representatives from all levels of the hospital hierarchy. My job is to enable this eclectic group of people to become active participants in the development process by bridging the gap between construction and Medicine.

So what’s the key to successful hospital design?

The growth in framework agreements, and the building and property development consortiums assembled to take on those projects, has given the opportunity for construction to work side by side with competitors and clients, rather than across the desk from them. We are no longer responsible for just delivering a design, a third party has developed but are now involved at the early planning stages and we can be proactively contribute to the innovative development of the scheme through the ability to challenge ideas and concepts to ensure that the best solution is developed. This is a big step in the right direction, but the truth is that while framework agreements have encouraged the principle of partnership, we all have vested interests. The success stories come from those projects where each side stops thinking of itself as a separate entity, and genuinely forges a union – something that my new role allows me to facilitate.

“You don’t go into nursing for the money, you do it for the good you know you can do”

As a healthcare professional I was drawn to Osborne as they had a real desire to learn more about how healthcare delivery depended upon and could be enhanced by construction projects. I knew I could bring invaluable user experience to the company, and therefore to the client. You don’t go into nursing for the money, you do it for the good you know you can do, and one thing I’ve learnt throughout my rather diverse career is the enormous impact building design has. Not just on NHS managers, doctors or even nurses, but the patients the whole system revolves, or should revolve, around. So that moral and social duty to create the best environment for treating patients guides what I do now when putting together healthcare bids and project managing ProCure21 (P21) schemes.

Do you think that ProCure21 (P21) is the best means of delivering better hospital facilities?

P21 has had some bad press but I believe it is proof that as an industry we’re getting better at understanding our clients. Traditional construction is like painting by numbers, where as ProCure 21 Allows construction companies much more creative licence, by its very nature encouraging innovative thinking. Again I should stress these benefits are only achieved where Trusts trust the process and do not impose there own restrictions which limits creativity and frustrates those used to delivering P21 projects. What matters is that the end project allows the Trust to function efficiently and there is a practical approach to design. 

At Medicinq Osborne we’ve got a 100% record on handing over our P21 schemes on or before time, and on or below budget. We’re slightly ahead of an already outstanding statistic, and perhaps that’s because we don’t approach partnering as something special for the project, but the way in which all business should be conducted. Of course, I’m not naive. There are always constraints in any project, be it time, space or financial, but everyone working together breeds honesty and compromise in an atmosphere of conciliation, which can provide better solutions than originally planned.

That said, regardless of the framework for delivery, the real secrets are early involvement, understanding and communication. It would benefit more ‘ordinary users’ of buildings to understand how healthcare delivery is dependent on and enhanced by these projects.  Allowing more time at the outset of any healthcare project brings participants together and allows creativity and exploration.

Closing the communication gap also means providers truly understand the needs of the client and, in the case of P21 and healthcare projects in general, gain a real insight into what staff and patients require and expect. My various roles have always had a very strong emphasis on communication. I have first-hand experience of the impact that language and terminology can have on good understanding between different cultures. I use my skills and experience to close that communication gap between the construction industry and the health service. The fact is that our differing viewpoints as constructor and client are a good thing when brought together early.

NHS and private sector partners alike need to understand that everyone’s view is valid, and not just appreciate but fully utilise all the skills around the table. If we do that, there’s little room for failure.

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