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Keyhole surgery

Project 5; Kingston; We want a 36 week project in 18 weeks, the client told bidders for Kingston Hospital's new surgical ward block. And at no extra cost. A meccano-like system was delivered, reports Andrew Mylius.

The project

A resources crisis at Queen Mary's Hospital, Roehampton, meant that in August this year it lost capacity to care for 132 patients. The news broke in March, leaving just months to find replacement beds.

Space for an interim surgical ward block was found at Kingston Hospital, on a car-park hemmed in on three sides by other hospital buildings.

Planning permission for the block was rushed through the local authority - the block is to remain for only five years. Kingston Hospital staff headed by estates manager Neal Deans drew up a brief and, with speed being of the essence, the project was tendered as design-build. Bidders were required to provide a facility that was up and fully functional within 20 weeks. It had to match or better levels of servicing and energy performance in existing, permanent hospital buildings. It could not be an assemblage of site accommodation units.

The structure delivered by design-build contractor Terrapin is a three storey pre-engineered modular design, composed of steel columns and beams with sheet steel wall and roof panels. Accommodation consists of five- bed and single-bed 'bays', each with an en-suite bathroom. There are two assisted-use toilet/bathrooms on each floor. Every bed is serviced with medical gases and nurse call system.

Terrapin won the £3.4M contract for a surgical ward block at Kingston Hospital in west London on the promise that it could deliver the facility on time. Initial tenders from Terrapin and competing bidders estimated the job would take 36 weeks to complete. Under pressure from client Kingston Hospital NHS Trust Terrapin reassessed the ways it would manage and resource construction, halving the programme to 18 weeks. There was no change to tender price.

To push the project through on time client and contractor collaborated closely. Working relationships were open, arranged to remove bureaucracy, and much decision making was formalised with a handshake.

'We had to believe the contractor was selling us a quality product,' comments Deans. He and his colleagues built up their confidence in Terrapin by visiting other schemes by the contrractor and talking to users.

Once the vetting process was completed, though, the informal relationship worked well for Deans: 'The whole committee process you normally get on a construction project was cut out.' Terrapin chairman and managing director Nick Whitehouse agrees: 'Shortcircuiting the information route meant we were providing it directly to the people who actually have to do the job.'

An indicative design, specifying spatial requirements, servicing and giving outline floor plans had been drawn up in a hectic nine day period by a team of surgical staff and Kingston Hospital's estates department. However, modifications were made as construction progressed.

'It was unusual to have to make quick decisions,' observes Deans. 'As the client you'd normally confer with your own team of architects, services engineers and cost consultants. But we didn't have time to look at drawings and then think about them. We were making design decisions on site.'

Dovetailing Terrapin's system-built structure with the hospital's requirements for specialist services led to knowledge exchange with medical subcontractors. 'Terrapin wasn't conversant with our piped medical gases and nurse calls,' Deans says. 'We recommended our own specialist contractors and integrated them into the design and construction process. It was a novelty to have them working alongside one another and the contractor not complaining: 'Your subbies are causing us grief'.'

Different trades marshalled by Terrapin and its suppliers were required to liaise closely to ensure nobody strayed from the critical path, throwing construction off schedule.

The team

Kingston Hospital NHS Trust, Kingston Hospital Clinical Management Group, Terrapin

Lessons learned

Get everybody - users, builders and suppliers - involved in discussion about what needs to happen, how it should happen and when, but give decision- making powers to an autocrat.

Accept compromise when it helps overcome obstacles or deliver value to the project overall.

Manufacture and pre-assemble as much as possible off site to minimise on site damage and maximise speed.

Establish long term relationships with suppliers; if they know and trust you, they'll give support when you or your client most need it.

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