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Capital Planning and Delivery of Healthcare Projects

By Mark Michasiw, Director, Parkin Architects Limited

Canada’s institutional capital planning and project procurement have changed, forever. Although Canadian public/private procurement (P3) has moved faster and more adeptly than in the USA, there remain lessons to be learned  ̶  especially in regards to the long-term outcomes of P3s, when leases expire.

Current Challenges in Capital Planning

Capital planning  ̶  predicting the future of healthcare for a generation  ̶  is like long-range weather forecasting, when we can’t get the five-day weather forecast correct. It entails a higher order of complexity in planning, operation and variability model of care delivery than do schools and highways, which for some time have been delivered successfully under a P3 model.

Local demographics, cultural, catchment area and climate can all vastly influence the healthcare program and service delivery model.  This matrix of requirements and their projection over an extended period are essential to: establish scope, service delivery and cost of a proposed development; and to provide government and funding agencies the confidence to move forward.

Seeking New Solutions and Values

Early planning must consider site aspects, expansion of an existing operational facility, or a new site and its attendant necessary qualities.

A significant development in healthcare delivery in the past 15 years is the regional system for care. Where there once was a plethora of physicians’ offices, hospitals and some private contractors (X-ray, Ultrasound, Laboratory), now there is pressure to provide cost-effective care, which has spawned forms of managed-care approach, where diagnostic and in-hospital treatment procedures are increasingly switching to private contractors in clinic spaces.  Some jurisdictions are developing extensive ambulatory care programs that drive service, wherever possible, to be scheduled outside the acute care setting.  Nonetheless, the purpose is to streamline process, and increase patient satisfaction and throughput.

Where the P3 sector provides significant value is that a performance requirement can be addressed in a number of ways, encouraging creativity and insight of the design and construction team. Healthcare projects are measured against a stated performance; however, performance requirements must be principled thorough and bolstered by reasoning. This can produce compelling innovation and advancements in planning, space optimization and construction practices.

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