Planning Capital Projects: Five strategic questions to ask
Capital projects involve a huge amount of logistical and planning resource in the short and medium term, but what can you think about now in order to ensure your long term strategic aims are being considered too?
Working across numerous large business cases projects related to building changes, we’ve seen the benefits of thinking early about how your building fits into the wider health economy; the opportunities it offers to transform care, data and IT; and the potential partnerships you can make. These are amongst the most valuable questions organisations ask themselves when thinking ahead:
How will my project align objectives for my Integrated Care System?
Rather than asking how to redesign your current space for your current caseload, rebuild projects present the opportunity to consider what you could provide more- or indeed less- of what the population around you could need in the future. All organisations need to consider their role in their Integrated Care System, and how new spaces could help to remove the barriers between different types of care. For instance, as one of the leading examples of an ICS, Frimley is using capital investment to build bespoke diagnostic units and transitional maternity units in a way that begins to move care a little further away from traditional inpatient set-ups.
What balance should I strike between ‘hubs’ and ‘spokes’?
In our recent work with High Intensity Users of emergency services, we’ve been thinking carefully about the benefits of co-located services vs. community-based services. High Intensity Users often have multiple complex mental and physical health needs, and so upon presentation to A&E, may benefit from some immediate mental health liaison services on site, for instance. However, moves towards more preventative models for High Intensity User Services would ideally work with service users in advance their peak, and co-location could create incentives for users to present at A&E more often than they need to in order to access mental health services. Accordingly, a future-oriented lens focused on at-scale preventative care should be applied to any temptation to create large ‘all-in-one’ services for more immediate needs. Moreover, the associated workforce implications should be considered, as ‘hubs’ experts and specialists remain important for collaboration and innovation.
What will our building project mean for data, information, and technology?
63% of NHS Providers’ Estates were built before 1995–a time when only 0.4% of the world’s population owned a computer! It is therefore unsurprising that the technologies we depend on in healthcare settings often represent compromise and ‘making do’. Re-build projects present opportunities to embrace technology to the full, from incorporating the live bed state trackers or wearable technologies, to simply ensuring that your staff will always have good connectivity for their devices. That said, associated costs of such projects are not negligible, and so need to be considered from the very beginning. Costs will be incurred from the integration between old and new systems, with the linking of patient records and new innovative apps a notable challenge.
What is the role of the hospital in supporting the wider wellbeing and lifestyle choices of the population?
Bringing in an estimated £2-3bn revenue each year, NHS retail is a non-negligible part of the daily operations. Further to the standard offering of coffee and magazines, some Trusts are considering local and visitor needs more broadly: Nottingham City Hospital, for instance, developed a 52-room hotel to serve travelling families, business delegates, and others wanting to stay close to the site. Partnerships with educational, residential, health and fitness, or care home providers could all present opportunities to fulfil civic functions whilst also unlocking alternative revenue streams. It will also be increasingly important to make these choices in the context of environmental impact, in terms of any new products or services being offered as well as the way in which those services are delivered. In some cases that might mean refurbishment could better mean ecological concerns than new builds.
How might we prime our system for research and innovation?
Working with clinical academic networks on service re-design for population health, we have learned that the importance of this question cannot be underestimated. What is possible in the future will be learned by whole systems working in partnership transferring innovations from the clinic to the lab and back. New technologies and availability of data make this more possible than ever and there is growing evidence of unmet possibility to significantly expand trials, and population level research to enable true learning health systems. This has been exemplified by the One London partnership, whose increasingly accessible and usable data not only helps frontline staff, but also researchers who can get a live picture of patient outcomes and the impact of interventions.
Authors: Jonathan Chappell and Katie Burns
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