Mitigating Hospital Design and Delivery Failure: A Retrospective Auto-Ethnography Study

There is an urgent need for further research in hospital design and delivery to understand the integrative, nuanced and intricate nature of healthcare project delivery and design management. Historically, each new hospital programme develops a new delivery model that takes a different approach to the management of design. However, this approach is not sustainable. Hospitals have a significant complexity, which may be impacted by role changes and procurement methods which can result in significant errors, costly delays and lack of ability to learn from failure. A retrospective abductive, auto-ethnographic case study approach was taken in the examination of five major hospital projects of similar size and complexity reflecting five temporal periods was carried out by a project architect who subsequently became a construction design manager spanning a career of over 30 years. This variant of action research involved a retrospective mode of abductive reasoning applied retrospectively. An approach to hypothesis testing (using literature) is used to explain and theoretically frame historical practices. It was found that National delivery models (and their change over time) have had a significant influence on hospital project delivery and particularly on design and engineering systems integration. The role standards have played in design have also played a significant role, and in part may have constrained innovation and unduly increased cost. Recommendations are made for a new integrated healthcare delivery model that supports an approach to innovative design and construction of new hospitals responding to advanced clinical and technology approaches.