Resilient Hospital Refurbishment

Garthwaite, Pam (2017). Resilient Hospital Refurbishment. PhD thesis The Open University.



Despite periodical refurbishments, hospital buildings appear to become less resilient over the long term. This thesis considers the underlying reasons for this loss of resilience and examines the implications for the wider hospital system. Decisions made during a project can radically alter its course, resulting in highly successful outcomes or alternatively, in projects facing budget overruns, delays, partially or wholly unfulfilled objectives, disappointed end-users, and inadequate buildings. Refurbishment change is examined through the lens of resilience at three levels of magnification; initially, the focus is on refurbishment projects in hospitals; this is followed by an examination of the wider refurbished hospital building; and finally, consideration is directed towards the NHS Estate.

Project changes may be particularly challenging when they relate to measures aimed at adapting buildings to future climate change. Specifically, there may be little enthusiasm for expenditure devoted to future needs, when funding is insufficient to meet today’s urgent priorities. Where Trusts have large portfolios of property, pre-emptive climate adaptation measures will take considerable time to realise, and accordingly, necessary measures must be in place before any climate-related risk to vulnerable patients becomes life-threatening.

Hospitals are extremely intricate buildings, both in terms of function and of the services that underpin the care process. Relatively small changes, either temporary or permanent, made during the course of a project can have significant repercussions for the hospital. A systems approach has been adopted to explore the relationships and connectivities that may be affected by the hospital refurbishment process. The research findings include the identification of change and resilience mechanisms in refurbishment projects. A framework for mapping change trajectories is presented, to assist in the analysis of propagating changes that affect refurbishment processes. The thesis also makes recommendations for what should be considered in hospital refurbishment projects to improve their overall resilience and reduce vulnerability to major impacts, particularly those that may arise as the UK climate changes.

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