A new hospital in nine days? Why can't all projects be like this?

The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of the University of Birmingham

“The simplicity and repetitive nature of Nightingale hospital design reveals another reason why these projects can be delivered so quickly. The projects contain very little risk. ”

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In response to the 2020 Coronavirus (Covid-19) pandemic, ‘pop-up’ Nightingale hospitals are taking shape around the UK. At the time of writing, one is housed in the ExCel Arena in East London, with a capacity of 5,000 beds, making it by far the largest hospital facility ever seen in the UK. On 3rd April, it was opened (via videolink) by Prince Charles. Other new facilities are being finalised across the UK in Birmingham, Bristol, Harrogate (in Yorkshire), Glasgow, Washington (near Sunderland), Exeter, Manchester and Belfast. Other faciltiies are planned for Cardiff and North Wales and in Cumbria.

The press are full of stories of the herculean effort to deliver these facilities in an incredibly short time period (reportedly, nine days to convert the Excel Arena). I have been asked several times by colleagues and students – why can’t all projects be like this? So, how is it possible to construct a 5,000-bed hospital within nine days?

Well, for a start, they are not construction projects in the normal understanding of that term. Essentially, they are existing spaces that are being repurposed to temporarily serve as hospitals. Secondly, there was a clear focus on the objectives. When most projects are conceived, the business case and a scope that delineate the parameters of the project are contested and ambiguous. In the case of the Nightingale projects, the business case was obvious and unambiguous – to save as many lives as possible. This meant that the priorities for the project could be established with ease and this will have led to speeding up the planning process.

All projects can be understood in terms of three priorities: time, budget or cost, and performance (sometimes abbreviated to quality). In most projects, planning is about seeking to deliver to the specification as efficiently as possible. This involves project planners continuously balancing different delivery options that meet the project scope against savings in costs and time – what can become a very protracted process. In the case of the Nightingale hospitals, the planners were able to focus their planning efforts to prioritise speed of delivery while ensuring they met the basic performance criteria. The budget was less important and, indeed, has not been mentioned in any of the press coverage.

An observation of the hospital constructed inside the ExCel is illuminating. In line with their namesake, Florence Nightingale’s plans for hospitals in the Crimean War, they are relatively simple, serried ranks of beds. While this overplays their simplicity, compared to a modern, general hospital, they lack complexity. The simplicity and repetitive nature of Nightingale hospital design reveals another reason why these projects can be delivered so quickly. The projects contain very little risk. With complexity comes a risk of project errors. With simplicity risk diminishes and this substantially reduces the likelihood of project delays and cost overruns.

Finally, we have the stakeholders. With most projects, while there will be some common ground, the stakeholders are frequently at odds with each other over what they want from the project. Aligning disparate stakeholder interests is a key concern for most project managers. In the case of the Nightingale hospitals, it seems that the planning and delivery has been undertaken by a coalition of the British Army and the National Health Service (NHS). General Sir Nick Carter, Chief of the UK Defence Staff was interviewed by the BBC on 7 April 2020. He explained how the Royal Engineers worked in close collaboration with the Department of Health on procurement, contract arrangements and design skills together with Chartered engineers. According to General Carter, the military provided logistical support in terms of planning, organizing and application of ‘foresight’ as well as a focus on delivery. He also explained how they drew on past expertise where the British Army had supported establishing a 600-bed facility in Oman. All this demonstrates a sense of purpose and direction, uniting the stakeholders in common objectives and goals.

What is also revealing is that the hospital will not immediately accommodate 5,000 patients. Initially, only 500 beds were provided. The reality of making this hospital operational reveals the connection between projects and their subsequent use. The hospital requires substantial amounts of medical equipment which is only being made available in tranches while, it is reported, the facility would need 16,000 staff who are not yet all available.

In summary, the reasons the first Nightingale hospital could be delivered so quickly were; a clear set of priorities where cost increases could be accepted, a relatively simple and repetitive design that eliminated much risk, a unity of purpose among the multiple stakeholders and the formidable planning and logistical capabilities of the UK armed forces, together with the medical expertise of the NHS. 

Image credit: Sludge G ‘Nightingale NHS hospital E16’ via Flicker.com.

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