What we have learned from PPP hospital engagements
Public Private Partnership (PPP) hospitals are a trend seen in other parts of the world that can provide lessons learned for large healthcare projects in the United States. Skanska currently has over $4 billion in hospital projects underway through this form of delivery in the United Kingdom alone. This delivery method encompasses the financing, developing, designing, building, and complete furnishing of hospital projects for public entities. It also includes maintaining and operating all of the facilities services (except for clinical operations) of the hospitals over a concession period of 25 to 35 years. This process has put us in the unique position of having interests in every aspect of the value chain for creating a building that delivers effective healthcare. It is this perspective that has taught us the most and changed our way of approaching traditional delivery methods for hospital building projects in the United States.
Under the PPP model our company has a significant financial stake in the operational performance and availability of the hospital facility. In other words, we have to think beyond the first cost of the design and construction of the buildings and walk a few years in the shoes of our clients. One of the obvious lessons learned is the value and importance of a well-thought–out, efficient, and highly functional design. Without this, even the best financed, built, and maintained hospital will still struggle to be successful if it does not function efficiently and well over time.
Another key learning point is that many times we have to slow down and spend more money up front to be able to save more and perform better over the life of a given system. By taking the time to evaluate more options and the complete life cycle costs for the critical building systems, we are able to achieve better value for our total expenditures. For this analysis we use a process called Whole Life Cycle Costing. It not only evaluates the initial capital, maintenance, and replacement costs over a given period of time, but also the cost implications for clinical operations, hospital revenue, patient outcomes, and environmental concerns for the life of a system.
We are not always able to influence all of these decisions in our traditional world of U.S. healthcare project delivery. However, if we can share this perspective and achieve improvements in the projects on which we are engaged, we can provide better value for our clients and healthcare systems.