1

Healthcare Planners: “What can they bring to the

briefing table in Healthcare projects?”

Summary of questionnaire results.

Abstract.

This paper contains a short summary of a questionnaire undertaken as part of the

dissertation component of “MSc Planning Buildings for Health” at London South

Bank University. The rationale and methodology for the questionnaire are briefly

explained. The results are presented in tables and figures, each of which are

followed by a brief summary of the findings. The results are followed by conclusions

drawn from the primary data and recommendations for further development and

research of the Healthcare Planner’s role.

Key words: Healthcare Planner, Project briefing, Healthcare Construction.

(Author: Delly Dickson, RGN, MSc, July 2015.)

2

Contents List of Tables ............................................................................................... 3

List of Figures .............................................................................................. 3

Introduction. ................................................................................................. 4

Questionnaire Development. ...................................................................... 4

Questionnaire Content. ............................................................................... 5

Questionnaire Analysis. .............................................................................. 7

Questionnaire Results. ............................................................................... 8

Conclusions............................................................................................... 32

Recommendations. .................................................................................. 33

References. ............................................................................................... 34

3

List of Tables Table 1. Response rate - actual response numbers and percentages by modified grouping.

(Dickson. March 2015) .......................................................................................................... 8

Table 2. HCP declared professional qualifications. (Dickson. March 2015) ......................... 10

Table 3. Comparison table - Perception of the frequency that HCP's are involved in the

briefing process. (Dickson. March 2015) ............................................................................. 14

Table 4. Comparison Table - The top three activities undertaken by HCP's. (Dickson. March

2015) .................................................................................................................................. 20

Table 5. Recognition of HCP skills by Healthcare Construction Industry – perception of

HCP’s. (Dickson. March 2015) ............................................................................................ 21

Table 6. Recognition of HCP skills by Healthcare Construction Industry - perception of

Construction. (Dickson. March 2015) .................................................................................. 22

Table 7. Recognition of HCP skills by Healthcare Construction Industry - perception of

Client. (Dickson. March 2015) ............................................................................................. 23

List of Figures Figure 1. Four groups that are involved in the briefing stages of healthcare projects.

(Dickson. March 2015) .......................................................................................................... 6

Figure 2. HCP declared professions. (Dickson. March 2015) ................................................ 9

Figure 3. Demographics of where all respondents live. (Dickson. March 2015) ................... 11

Figure 4. Demographics of where all respondents have worked. (Dickson. March 2015) .... 12

Figure 5. HCP type of employment. (Dickson. March 2015) ................................................ 13

Figure 6. HCP opinion of the questionnaire statement. Question 11. (Dickson. March 2015)

........................................................................................................................................... 15

Figure 7. Construction Industry and Client opinion of questionnaire statement. Questions 31,

50 and 71. (Dickson. March 2015) ...................................................................................... 16

Figure 8. HCP declared activities from list provided. (Dickson. March 2015) ....................... 17

Figure 9. Construction Industry expectation of HCP activities from list provided. (Dickson.

March 2015) ........................................................................................................................ 18

Figure 10. Client expectation in briefing activities from HCP and substantive staff. (Dickson.

March 2015) ........................................................................................................................ 19

Figure 11. HCP responses - "How do you keep yourself updated?" (Dickson. March 2015) 25

Figure 12. All respondents - "Do you consider that the HCP role requires further

development, with more formal recognition in the healthcare sector?" (Dickson. March 2015)

........................................................................................................................................... 28

Figure 13. All respondents - "How do you think HCP skills or competencies should or could

be measured?" (Dickson. March 2015) ............................................................................... 30

4

Introduction.

During the spring of 2015, an electronic questionnaire was developed for the

dissertation component of the “MSc Planning Buildings for Health” course at the

London South Bank University. Curiosity had been piqued by the role of “Healthcare

Planners” (HCP’s) within the Healthcare Construction Industry in Great Britain. The

purpose of the questionnaire was to explore how Healthcare Planner’s (HCP’s)

contributed to Healthcare Construction Projects. Focus was placed on the briefing

stages of Healthcare Construction Projects. This paper presents a summary of the

questionnaire methodology and the questionnaire results, followed by conclusions

drawn from the data and recommendations for further development and research.

Questionnaire Development.

The preferred method for primary data collection was identified as an electronic

questionnaire, which utilised the strengths of quantitative and qualitative research

methods.

Due to the diversity and complexity of activities undertaken, plus the subjective nature

of the HCP’s role, a combination of descriptive and analytical questions (Neville. 2014,

p.7) facilitated inclusion of the less tangible aspects of the research hypothesis. To

create depth and richness within the research findings (Carr, 1994, p.721) the

responses were initially triangulated across four groups of participants, to enable

comparison of attitudes and values.

A pathway for individual participants to choose was identified at question five. The

decision of which pathway to take was chosen by the participant according to their

own interpretation of their employment status, within the headings offered. Definition

or explanation of the headings was not provided. This intentional omission allowed

participants some flexibility on how to define themselves, along with the opportunity to

probe individual’s perceptions of their role in the subsequent analysis. This meant that

each grouping was self-defined and therefore included a mixture of professions.

5

The questionnaire included both closed and open questions which related to the

findings from a literature review and the hypothesis being investigated. (Robinson.

2014, p.4) All open and most of the closed questions incorporated an opportunity to

include additional comments, either to clarify the response or to add additional

information, which the participant felt was pertinent to the hypothesis.(Oppenheim.

1992, p.112) This facilitated the opportunity to probe beneath the surface and access

data that was rich in personal comment and insight. (Neville. 2014, p.37) However,

acknowledged limitations of this type of research include difficulty in reproducing

results along with subjective findings which are open to differing interpretations,

(Brace. 2013, p.43). This meant that it would be difficult to generalise the results and

to replicate the findings.

To maximise the number of potential participants, invitations were extended via a

mixture of sampling strategies. This resulted in a variable sample size across the

groups as they were approached directly or in-directly for voluntary participation. It is

acknowledged that this sampling strategy provided little control regarding the number

of participants, however, absolute control over participant selection was not a critical

factor for this study. (Neville. 2014, p.31) Limited control was achieved by approaching

participants from within the construction and healthcare industries and the

questionnaire was available on-line for an imposed time limit of four weeks. It is

considered that there are no ethical concerns within this research as all required

permissions have been granted. (Carr. 1994, p.719).

Questionnaire Content.

To enable triangulation of results, a generic questionnaire was developed for

distribution to four main groups who had been identified from the literature as major

contributors to the development of a healthcare project brief. The four main groups

were identified as Health Clients, Principle Supply Chain Partners (PSCP’s), non-

PSCP’s and Healthcare Planners. The groups approached for this research are

identified in figure 1.

6

Figure 1. Four groups that are involved in the briefing stages of healthcare projects. (Dickson. March 2015)

The questionnaire contained a total of eighty six questions, distributed evenly across

the four groups. Following self-identification of their profession at question five, each

participant was funnelled to a specific pathway within the questionnaire. Each pathway

contained the same questions, with generic wording modified to reflect the group’s

perspective in relation to HCP’s. For example, the question “Do you currently work “as

a” Healthcare Planner?” on the HCP pathway, was modified to “Do you currently work

“with” Healthcare Planners?” on the other three pathways. This ensured that questions

were relevant to the participant’s chosen grouping and facilitated subsequent analysis.

A small pilot study distributed to HCP’s, healthcare clients and construction industry

professionals was completed to ensure the format and content was appropriate before

wider distribution. Minor adjustments were made to the questionnaire content following

feedback.

The questionnaire launched on 14th January 2015 for a period of four weeks, to an

initial distribution list of ninety two participants who had expressed an interest. The

questionnaire closed at midnight on 11th February 2015.

Willing participants were added to the distribution list as they expressed interest by

direct contact or via LinkedIn Group forums. This resulted in a total distribution list of

Health Clients

PSCP

Non-PSCP

Healthcare Planners

7

one hundred and forty one (141) people who had expressed an interest in

participating.

Questionnaire Analysis.

Primary data gathered from the questionnaire produced quantitative and qualitative

evidence. To maintain confidentiality, all results have been attributed and presented

according to respondent’s unique identification numbers, generated by the

questionnaire tool. Where responses have been quoted, these numbers have been

further defined by colour with blue denoting Healthcare Planner’s, green denoting

Construction and red denoting Clients.

In explanation of the three groups identified above, the original four groups were not

directly comparable due to low numbers from three of the groups. Therefore the four

responses from the PSCP group and the seven responses from the non-PSCP group

were combined and renamed as Construction giving a total of eleven responses. This

enabled the eleven construction responses to be directly compared with the eleven

client responses. However, it is recognised that the construction and client groups are

not directly comparable to the significantly larger number of HCP responses (fifty). The

questionnaire was subsequently analysed according to the themes emerging from the

questions, due to the large number of variables within the responses.

The data is subject to the respondent’s self-interpretation of the questions, in order to

explore the qualitative aspects of the hypothesis. It was recognised that this was a

weakness in the data, as it would be difficult to replicate the results.

Notably, sixty percent of HCP respondents were resident outside of the UK and were

not familiar with UK National Frameworks or PSCP’s which meant that they were not

always able to make a direct comparison. It is further acknowledged that the data may

be influenced by industry sensitive considerations and is based on subjective personal

experience.

One hundred and forty one email invitations were distributed over a period of five

weeks. Direct invitation by email proved effective, however the snowball method of

distribution had limitations as unique identification and subsequent confidentiality was

8

reliant upon a direct link to individual email addresses. The snowball method did not

allow for this requirement, resulting in an unidentified number of potential participants

being lost.

Questionnaire Results.

A total of eighty six responses were received, equating to a sixty one percent response

rate. However, fourteen entered their demographics only, equating to sixteen percent

who did not complete. In comparison to an expected response rate of thirty percent

(Neville. 2014, p.33) this questionnaire produced a usable sample of seventy two

responses, which equates to a fifty one percent response rate.

It is observed that the above average response rate may be attributable to the

participants having a “…high degree of interest…” in the research subject. (Sheehan.

2001, p.0) These results have been presented below as group numbers and

percentages in table 1.

Group Number of responses

Construction 11 (15%)

Client 11 (15%)

HCP 50 (70%)

Table 1. Response rate - actual response numbers and percentages by modified grouping. (Dickson. March 2015)

Questions one to five.

Questions one to four explored the demographics of all respondents and question five

funnelled the respondent to a particular pathway within the questionnaire. The decision

of which pathway to take was the personal choice of the respondent, according to their

interpretation of the headings offered and definitions were not provided.

Question one contained multiple sections relating to professional and academic

qualifications. As the focus of this research, the results for HCP’s are presented in

figure 2.

9

Figure 2. HCP declared professions. (Dickson. March 2015)

Figure 2 indicates that forty two percent of HCP’s identified their primary profession as

an architect and twenty six percent of respondents identified their primary profession

as a HCP. It is evident from this result that thirteen individual HCP’s perceived

themselves as a profession. An unexpected result was the number of equipment

managers who defined themselves as HCP’s and the lower than expected number of

HCP’s who defined their profession as a nurse.

0

5

10

15

20

2521

1

5

1

13

1 1 1 13 2

HCP declared professions.

Healthcare Planner (50)

10

Question one also explored the professional qualifications of respondents to determine

the range of recognised qualifications achieved. Respondents could enter more than

one qualification. As the research focus was on Healthcare Planners, responses from

this group have been presented in table 2.

Declared Qualifications. HCP.

ACHA 2

ACHE 1

AIA 4

ARB 2

BD+C 1

CBET 1

CEng 1

Chartered marketer 1

CIAT 1

CSBA 1

Dip Arch 1

EDAC 3

FACHE 2

FAIA 2

FCIBSE 1

FiMechEn 1

GGP 1

IHEEM 3

LEED 4

LRCP 1

MAPM 1

MBA 1

MBFIM 2

MCIPS 2

Medical Architecture 1

Midwife 1

MIET 1

MRCS 1

MRIAI 1

MSc Construction Project Management 1

MSc Health and Social Care Management 1

MSc Healthcare Facilities Planning and

Design

1

MSc Planning Buildings for Health 1

NHS Management 1

None 7

NCARB 1

NRAC 1

NSHE 1

PGD Construction Management 1

Prince 2 1

Registered General Nurse 9

RIBA 5

Total number of qualifications identified. Total number of qualifications declared.

42 76

Table 2. HCP declared professional qualifications. (Dickson. March 2015)

11

The results in table 2 reveal a wide variety of qualifications, with many HCP’s having

more than one industry recognised qualification. An unexpected result was that

seven respondents identified that they held no professional or academic

qualification.

Question two explored the demographics of where all respondents live in order to

make a comparison of their resident country with the countries where they have

worked. Countries of residence are presented in figure 3.

Figure 3. Demographics of where all respondents live. (Dickson. March 2015)

Of the respondents who indicated that they lived outside of the UK, the two from

construction both lived in the USA. Of the HCP participants, sixty percent were

resident outside of the UK. Predominantly from the USA (13) and Australia (6) HCP

respondents were resident in a total of twelve different countries.

This result indicated that the majority of the HCP group were not resident in the UK

and were therefore unlikely to be familiar with the UK National Frameworks or PSCP

ways of working. However, it was observed that such a high percentage of

international respondents contributed an unexpected international perspective. These

responses were considered to be a pertinent contribution to this research and have

been included.

0

5

10

15

20

25

30

CONSTRUCTION (11) CLIENT (11) HEALTHCARE PLANNER (50)

810

19

1 1 00 0 120

30

"Where do you live?"(All participants.)

England Scotland Wales Outside UK

12

As explained at Question two, Question three explored the demographics of where

all respondents have worked in order to make a comparison with their country of

residence. The demographics of where all respondents have worked are presented

in figure 4.

Figure 4. Demographics of where all respondents have worked. (Dickson. March 2015)

Of the respondents who indicated that they have worked outside of the UK, one

member of the construction industry had worked in seven different countries. Client

responses indicated that they had worked in four different countries. In comparison,

HCP’s identified that they worked predominantly in the USA (15) and Australia (10)

with a further forty-eight countries identified. All but two HCP’s were actively working

in this role, declaring between one and forty five plus years’ experience.

This finding supports the perception that HCP’s have usually worked on a large

number of healthcare projects and therefore the experienced HCP can bring a wide

range of experiential learning to the briefing table. This result also demonstrates that

HCP’s are a highly mobile, international resource.

0

5

10

15

20

25

30

35

40

45

CONSTRUCTION (11) CLIENT (11) HEALTHCARE PLANNER (50)

9 10

18

42

8

2 1

9

20

74 3

44

"In which countries have you worked?"(All participants.)

England Scotland Wales Northern Ireland Outside of UK

13

Question 9 asked the HCP group about their type of employment to explore the

anecdotal perception across all groups, that HCP’s were predominantly independent

consultants. These results are presented in figure 5.

Figure 5. HCP type of employment. (Dickson. March 2015)

As expected, the majority of responses from HCP’s (forty seven percent) indicated that

they considered themselves independent consultants. In comparison, thirty four

percent of HCP’s indicated that they were not able to identify themselves within any of

the available responses. This finding was unexpected and presents an area for

potential future research to explore alternative employment scenarios where the HCP

role may be embedded. It could be argued that the high percentage of responses from

outside of the UK, would explain the low response rate to the “PSCP affiliated” and

“NHS substantive post” categories.

The intent of Question 10 was to investigate how often HCP’s were engaged in the

briefing stage of a Healthcare project. This question was replicated in the other three

groups at Questions 31, 50 and 70 and the results for all groups are presented in

table 3.

0

5

10

15

20

25

IndependentConsultant

PSCPaffiliated

NHSsubstantive

post

None ofthese

No answer

22

2

6

17

3

HCP type of employment.

HCP (50)

14

The construction and client responses are directly comparable to each other.

However, the reader is respectfully cautioned that due to the disproportionate

number of HCP responses, the HCP numbers and percentages are not directly

comparable to the other two groups within this table.

Comparison Table.

Perceptions of the frequency that HCP’s are involved in the briefing process.

(All respondents)

Always. Frequently.

(4 out of 5)

Often.

(2-3 out of 5)

Infrequently.

(1 out of 5)

Never. No

response

HCP

(50)

28%

(14)

32%

(16)

22%

(11)

12%

(6)

2%

(1)

4%

(2)

Construction

(11)

9%

(1)

55%

(6)

18%

(2)

0 18%

(2)

0

Client

(11)

45%

(5)

27%

(3)

18%

(2)

0 9%

(1)

0

Table 3. Comparison table - Perception of the frequency that HCP's are involved in the briefing process. (Dickson. March 2015)

The results indicated that eighty two percent of HCP’s considered that HCP’s were

involved often or more in the briefing stages of a healthcare project. The results also

indicate that eighty two percent of construction and ninety one percent of client’s would

expect the HCP to be involved often or more in healthcare projects.

This finding provides conclusive evidence that the HCP role is considered to be

embedded within healthcare projects across all the groups, particularly by the client.

However, as previously cautioned, the resultant percentages are not directly

comparable across all the groups due to the higher number of HCP participants.

The purpose of Question 11 was to investigate if the HCP group would identify any

healthcare projects that could be completed without their input. HCP’s were asked for

their opinion of the statement:

“Involvement of a Healthcare Planner at the pre-briefing and briefing stages of a

healthcare project is essential to successful briefing outcomes.”

15

Figure 6. HCP opinion of the questionnaire statement. Question 11. (Dickson. March 2015)

As expected, ninety six percent of HCP’s agree or strongly agree with the statement

“Involvement of a Healthcare Planner at the pre-briefing and briefing stages of a

healthcare project is essential to successful briefing outcomes.” However, one

respondent disagreed stating that “Architects are typically more in tune to health

codes...” (10987313) and one submitted a neutral response indicating that it depended

on the project. (10985409)

0

5

10

15

20

25

30

35

40

45

StronglyAgree

Agree Neutral Disagree Stronglydisagree

41

7

1 1 0

HCP opinion of the statement:"Involvement of a HCP at the pre-briefing and briefing stages of a healthcare project is essential to successful briefing outcomes."

HCP (50)

16

The statement: “Involvement of a Healthcare Planner at the pre-briefing and briefing

stages of a healthcare project is essential to successful briefing outcomes.” was also

posed to construction and clients at Questions 31, 50 and 71. These results are

presented in figure 7.

Figure 7. Construction Industry and Client opinion of questionnaire statement. Questions 31, 50 and 71. (Dickson. March 2015)

An unexpected result was that one hundred percent of construction respondents

agreed or strongly agreed with the statement presented. This result was not supported

by the literature and does not align with responses in Table 3. Seventy three percent

of clients agreed or strongly agreed. However, twenty seven percent of clients entered

a neutral response which may indicate a lack of commitment to inclusion of the HCP

role in all project briefs. 10995793 responded “We have delivered successfully briefed

projects without them…” and 11000564 responded “I agree, but not essential to every

project...”

0

2

4

6

8

10

StronglyAgree

Agree Neutral Disagree StronglyDisagree

9

2

0 0 0

3

5

3

0 0

Construction industry and Client opinion of the statement:

"Involvement of a HCP at the pre-briefing and briefing stages of a healthcare project is essential to successful briefing outcomes."

Construction (11)

Client (11)

17

Within Questions 12, 42, 51 and 72 a list of activities undertaken by HCP’s was

provided. These activities were selected from the most frequently identified activities

of briefing in the literature. The responses from HCP’s, construction and the client have

been presented in figures 8, 9 and 10 below. A short summary of individual group

results follows each figure. The findings from all the groups are presented after figure

10.

At Question 12, the HCP was asked to identify all of the listed activities that they had

engaged in during the briefing stages of a healthcare project and were able to select

multiple activities. The intention of this question was to identify the activities most

frequently undertaken by HCP’s within the briefing process.

Figure 8. HCP declared activities from list provided. (Dickson. March 2015)

Two HCP respondents did not answer this question.

As expected the main briefing activities undertaken by HCP’s were related to

Adjacency Planning, Design Review, Functional Briefing and Presentations to

clients. The results indicate that the activity undertaken the least by HCP’s was the

Estates Strategy, although twenty one respondents (thirty six percent) had been

involved in this activity.

28

41

23

35

2327

31

42

18

37

21

43

3431

25

3642

23

3135

3226

36

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HCP (50) Declared Activities. (From list provided in questionnaire)

18

Within Questions 32and 51 the construction industry was asked for their perception

of which activities in briefing were undertaken by HCP’s, from the same list of

activities identified in Question 12.

Figure 9. Construction Industry expectation of HCP activities from list provided. (Dickson. March 2015)

The results indicate that one hundred percent of respondents expected the HCP to be

involved in the Clinical Strategy. Eighty two percent expected HCP involvement in the

Outline Business Case and presentations to clients. Seventy two percent expected the

HCP to be involved in the Full Business Case and Design review.

The clients were also asked for their perception of which activities in briefing were

undertaken by HCP’s at Question 72 and were provided with the same list of activities

identified in Question 12. The client was also asked an additional question at Question

73. “Did they engage NHS substantive staff in the same set of activities?” Figure 10

shows the combined client responses to Questions 72 and 73.

0

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8

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Construction Industry (11). Expected actitivies of HCP.

(From list provided in questionnaire)

19

Figure 10. Client expectation in briefing activities from HCP and substantive staff. (Dickson. March 2015)

The results indicate that seventy three percent of clients expected the HCP to be

involved in Activity Modelling and Demand and Capacity Modelling. Sixty four percent

expected the HCP to be involved in Care Pathway Modelling, Client Workshops,

Design Review, Functional Briefing, introducing new ways of working, Outline

Business Case, Patient pathway redesign and Presentations to clients.

In comparison, figure 10 also identified where clients are utilising their substantive staff

to undertake activities in healthcare projects. Ninety six percent of clients identified

that they used substantive staff, to variable degree, across all the activities presented.

The results show that eighty two percent of clients engage their own staff for Outline

Business Cases (OBC), Stakeholder Engagement and Strategic Business Cases

(SBC). Seventy two percent of clients also use their own staff for Adjacency Planning,

Care Pathway Modelling, Client Workshops, Full Business Cases and Presentations

to clients. However, two clients indicated that they do not use substantive staff in any

of the activities presented in the questionnaire.

8

67 7

5 5

87

4

6 67 7

67 7 7

1

65

6 6

3

78 8 8

56

7 76 6

87

6 6

9

78

7

5 5

9 9

7

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Client perception (11). Expected Activities undertaken by HCP (blue) and

substantive staff (orange). (From list provided in questionnaire)

20

It is evident from the results in figures 8, 9 and 10 that there is a lack of consensus

regarding the priority of activities undertaken by HCP’s in the briefing process.

Identification of the top two activities do not correlate across the groups with the third

top activity identified by all groups as “Presentations to clients.” These results have

been compared in table 4.

The top three activities undertaken by HCP’s.

HCP Design Review Functional Briefing Presentations to clients

Construction Clinical Strategy Outline Business Case

Presentations to clients

Client Activity Modelling Demand and Capacity Modelling

Presentations to clients (plus 7 other activities)

Table 4. Comparison Table - The top three activities undertaken by HCP's. (Dickson. March 2015)

In summary, the results indicate that some elements of the HCP role are being

completed in-house rather than being out-sourced and that there is a lack of

consensus on the priority of activities undertaken by the HCP. This finding provides

evidence that the HCP role remains ambiguous and fragmented across the

construction and healthcare industries.

An open question to HCP’s (Question 13), explored the additional activities undertaken

by HCP’s, which had not been included in the list provided at Question 12.

The HCP group identified that they also undertake the following activities:

Benchmarking, Catering, Change management, Community engagement, Current

best practice research, Derogation schedules, Equipment and technology modelling,

Financial analysis, Functional description, Future proofing, Health needs analysis,

Maintenance strategy, Market analysis, Master-planning, Mock-up’s of room layouts,

Observational studies, Operational requirements, Policy review, Post project

evaluation, Public relations and meetings, Room data sheets, Site appraisal and

constraints, Speciality mix, Standards compliance, Transfer of skills, Value

management studies, Workforce planning.

This result provides evidence of the diverse range of activities undertaken by HCP’s

which is supported in the literature. However not all activities are undertaken by all

HCP’s, which indicates that HCP’s specialise in their areas of expertise and

21

experience. It can be argued that this further fragments the role of the HCP within the

construction and healthcare industries.

The next three tables (tables 5, 6 and 7) investigated the three group’s perceptions of

where the HCP role is recognised within the project team. They have been presented

sequentially by grouping, with a summary of the results following table 7.

Question 15 asked HCP’s if their skills were recognised within the construction and

healthcare industries. Table 5 presents the HCP responses.

Always Frequently Sometimes Rarely Never Total

responses

No

response

Architects 15 (31%)

19 (39%)

14 (28%)

1 (2%)

49 1

Designers 12 (25%)

19 (39%)

14 (29%)

1 (2%)

2 (4%)

48 2

Healthcare Clients (End users)

15 (31%)

26 (53%)

6 (12%)

1 (2%)

1 (2%)

49 1

Healthcare Clients (Project

Lead)

12 (24%)

24 (49%)

12 (24%)

1 (2%)

49 1

National

Frameworks

5 (12%)

5 (12%)

15 (35%)

14 (32%)

4 (9%)

43 7

Principle

Supply

Chain

Partners

5 (11%)

19 (40%)

16 (34%)

3 (6%)

4 (8%)

47 3

Project

Managers

11 (23%)

23 (48%)

10 (21%)

4 (8%)

48 2

Table 5. Recognition of HCP skills by Healthcare Construction Industry – perception of HCP’s. (Dickson. March 2015)

There were twenty nine additional comments to this question, with forty eight percent

indicating that the client is not aware of, or clear about, the HCP role. Confusion

between the role of architects and HCP’s was identified in twenty percent of the

additional comments. Comments indicate that engagement of HCP’s was considered

22

to be dependent upon the client or project team having previous experience of the

HCP role in seventeen percent of responses.

Questions 35 and 54 investigated how construction perceived HCP skills to be

recognised within the construction and healthcare industries and are presented in

Table 6.

Always Frequently Sometimes Rarely Never Total

responses

Architects 4 (36%)

4 (36%)

1 (9%)

2 (18%)

11

Designers 3 (27%)

5 (45%)

2 (18%)

1 (9%)

11

Healthcare Clients (End users)

2 (18%)

3 (27%)

5 (45%)

1 (9%)

11

Healthcare Clients (Project

Lead)

2 (18%)

4 (36%)

5 (45%)

11

National

Frameworks

1 (9%)

3 (27%)

6 (54%)

1 (9%)

11

Principle

Supply

Chain

Partners

2 (18%)

1 (9%)

6 (54%)

2 (18%)

11

Project

Managers

1 (9%)

4 (36%)

5 (45%)

1 (9%)

11

Table 6. Recognition of HCP skills by Healthcare Construction Industry - perception of Construction. (Dickson. March 2015)

There were six additional comments which included “…architects may feel they can

do this … but perhaps already switched on to the design of the built facility, not why it

is needed…” (11024808) and “I do not know of any consultants that employ a

healthcare planner.” (10993607)

Question 76 investigated how client’s perceived HCP skills to be recognised within the

construction and healthcare industries.

23

Always Frequently Sometimes Rarely Never Total

responses

Architects 2 (18%)

3 (27%)

4 (36%)

1 (9%)

1 (9%)

11

Designers 2 (18%)

3 (27%)

5 (45%)

1 (9%)

11

Healthcare Clients (End users)

1 (9%)

3 (27%)

2 (18%)

4 (36%)

1 (9%)

11

Healthcare Clients (Project

Lead)

2 (18%)

4 (36%)

4 (36%)

1 (9%)

11

National

Frameworks

5 (45%)

3 (27%)

1 (9%)

2 (18%)

11

Principle

Supply

Chain

Partners

1 (9%)

3 (27%)

4 (36%)

2 (18%)

1 (9%)

11

Project

Managers

6 (54%)

3 (27%)

2 (18%)

11

Table 7. Recognition of HCP skills by Healthcare Construction Industry - perception of Client. (Dickson. March 2015)

One respondent had not encountered the HCP role and therefore answered “Never”

to all the elements of this question. There were nine additional comments which

identified that forty four percent of clients were not clear what the HCP role entailed.

One interesting comment noted that “…National frameworks probably don’t pick this

up (and) link it to other roles within the project team.” (11063189)

As expected, the results from tables 5, 6 and 7, indicated that HCP skills are

recognised across the industries. However, an unexpected result was the thirty two

percent of HCP’s who considered their skills were rarely recognised by the National

Frameworks (table 9). This finding may be attributable to the sixty percent of HCP’s

resident outside of the UK. However, the construction industry clearly felt that the HCP

role was recognised, although they also indicated that the architect could do this role.

The results indicate that the client remains confused regarding the parameters of the

HCP role and the benefits it can bring to projects.

24

Question 16, 36, 55, 77 was an open question which asked all three groups “What do

you think could raise the profile of HCP’s to the client on healthcare projects?” It was

possible to enter up to five responses in this question.

There were one hundred and ten HCP comments to this question with the top themes

emerging as publishing and marketing (fifteen percent), evidence and demonstrate

skills (sixteen percent), establishment of a professional body or qualification (eleven

percent) and personal contact (ten percent). Thirty six construction comments were

received indicating that quantitative evidence was required (seventeen percent) and a

professional qualification would assist in raising the HCP profile (eleven percent). The

client group provided thirty additional responses which indicated the top themes for

this group to be a clear definition of the role (twenty three percent) followed by

evidence of benefits achieved (seventeen percent) and increased contact with the

client (seventeen percent).

It is observed from these comments that the client appears to be seeking clarity on the

role along with quantifiable evidence of the benefits to the project. The HCP and client

groups both identify that more direct contact would be beneficial to them. The

construction industry and HCP’s agree with the clients, that more quantitative evidence

is required, going on to say that this should be published and presented in various

forums. The construction and HCP groups indicate that some sort of professional

group or recognised qualification would assist in raising the profile of the HCP.

Question 17 asked the HCP “How do you keep yourself updated with

National/Regional/Local developments in healthcare projects?” to explore the

avenues and mediums most commonly used. Responses are presented in figure 11.

25

Figure 11. HCP responses - "How do you keep yourself updated?" (Dickson. March 2015)

Although there were forty one additional comments to this question, when analysed,

they all broadly fit within the categories presented. An unexpected result was the

number of HCP’s who used social network sites to keep updated. However, on closer

examination, social networks were used to access colleagues in the industry and to

identify related web-links. As one HCP respondent commented “No single source is

adequate, you need to continually be researching as many avenues as possible for

the latest success stories and failures.” (11056396)

Question 18 asked HCP’s “How do you prepare for a project where you have limited

experience?”

There were forty eight responses to this question which identified the same avenues

as Question 17. As expected the responses which featured most heavily were various

types of research (ninety eight percent) and consulting with others (ninety five

percent).

Questions 19, 38, 57, 79 asked all respondents to identify what they thought the key

skills of the HCP were.

05

1015202530354045

30

21

30

42

31

42 42 40

16

36

12

How HCP's keep themselves updated.(From list provided in questionnaire.)

HCP (50)

26

Within the HCP group, four percent identified quantitative skills which included: time,

evidence based design, knowledge of building limitations and opportunities,

knowledge of guidance and HBN’s and knowledge of clinical pathways. As expected,

ninety six percent of this group referred to qualitative aspects of their role, such as

understanding of various elements, experience of multiple projects, ability to achieve,

review or challenge, and an objective or independent view.

The construction group generally matched the HCP percentages of quantitative

compared to qualitative responses. This group also identified standardisation of design

as a quantitative skill.

As expected, thirty two percent of the client group were more focused on the

quantitative skills such as project management, legislation, demand and capacity

modelling, building knowledge and expertise in specialist design.

These results suggest that the client is seeking evidence that the HCP role brings

measureable benefits to the project and are perhaps not recognising the qualitative

aspects of the HCP role to the same extent as the other two groups.

Questions 20, 39, 58, 80 asked all groups what personal characteristics were required

by HCP’s.

As expected all groups placed communication and negotiation skills extremely high.

However, recurring characteristics identified by all groups also included patience and

tenacity, confidence and diplomacy, and the ability to listen.

Question 21, 40, 59, 81 asked all groups how they thought HCP’s could demonstrate

that their contribution had enhanced the project outcomes. Respondents were able to

enter up to five activities.

Surprisingly, the HCP group identified a relatively small number of quantifiable

outcomes, which included keeping to schedule, meeting budget and brief parameters,

reduced number of changes within the brief and flexible space. Construction appeared

to find this question easier to quantify, relating their responses to budget measures,

reduction and efficiency of space, compliance with guidance and early clinical sign-

27

off. The client groups related their responses to reductions in variations within the

scheme and reductions in time, which are also quantifiable measures.

Unexpectedly, the clients identified post-project evaluations and a reduction in whole

life costs as quantifiable measures, which had not been mentioned by the HCP’s or

construction. All of the groups mentioned patient or staff satisfaction as measurable

outcomes.

Question 22, 41, 60, 82 asked all groups how they thought HCP’s could demonstrate

that their contribution had enhanced the patient outcomes. Respondents were able to

enter up to five activities.

The HCP group were very focused on the patient and identified several measures to

indicate enhancements to patient outcomes. These included reductions in: falls,

complaints, waiting times, lengths of stay, mortality rates, costs, delays and

readmissions. The HCP group also identified right sized rooms, improved infection

control measures, patient centered care, sustainable development with future

expansion capability, increased use of rooms and evidence based design as other

measures for patient outcomes.

Patient outcome measures identified by the construction group included ease of

treatment, compliance with privacy and dignity, effective use of space, patient and staff

satisfaction surveys, improvement in patient statistics, reduced complaints, a

reduction in cost per admission, adaptable space and improved patient flows.

The client group identified improved attendance, patient and staff satisfaction surveys,

reduced length of stay, reduced falls, less congestion, improved patient safety and

facilitation of best practice as patient outcome measures.

As expected, the responses to this question provided evidence of a high patient focus,

particularly within the HCP group. These measurable patient outcomes were reflected

by all the groups with construction demonstrating a slight bias towards spaces, costs

and statistics.

28

At Questions 23, 42, 61 and 83 all respondent were asked:

“Do you consider that the Healthcare Planner role requires further development, with

more formal recognition in the Healthcare sector?”

The results are presented in figure 12.

Figure 12. All respondents - "Do you consider that the HCP role requires further development, with more formal recognition in the healthcare sector?" (Dickson. March 2015)

Two HCP’s did not answer this question, however, the results clearly demonstrate that

HCP’s agree or strongly agree further development is required. The one HCP who

disagreed resided and worked in Australia and indicated that the role was already well

established. (11050298).The neutral responses from construction included “Perhaps

up to a month’s training.”(10985409) and “…it is more about demonstrating the

value…” (11010574).The client neutral response was concerned about additional cost

to the Trust when there was “…potential for in-house skills to be developed…”

(10991171)

At Questions 24, 43, 62 and 84, all participants were asked:

“What skill set or core-competencies should an individual possess before they could

call themselves a Healthcare Planner?”

As expected, one hundred percent of the HCP group identified knowledge, experience

and understanding as their “skill-set” and “core-competencies.” These comments

0

5

10

15

20

Stronglyagree

Agree Neutral Disagree

20

16

11

13

6

20

5 5

10

All Respondents. "Do you consider that the HCP role requires further development, with more formal recognition in the

healthcare sector"

HCP (50)

Construction (11)

Client (11)

29

primarily related to the client business and inner-workings, but also included

references to the construction industry. Eighty seven percent of the HCP group also

identified analytical skills of some form, which included: various types of benchmarking

data, schedules of accommodation and capacity planning. However, HCP 11010563

commented “You know, I am not sure.” with 10926632 commenting “Tricky, much of

our role could be considered as pastoral!”

Within construction, the same observations were made regarding knowledge,

experience and understanding of the healthcare and construction industries. The

“pastoral” elements identified by 10926632 were also echoed across the construction

group.

“I don’t think it’s possible to define…” (10999232) was one comment from within the

client group, with 10991171 indicating that they were “not clear enough on the role” to

comment.

It can be observed from this result that the “skill-set” and “core-competencies” remain

difficult to define and quantify. However, they do reflect the findings within the

literature. (Haron et al. 2012, p.67)

30

Questions 25, 44, 63 and 85 asked all participants:

“How do you think HCP skills or competencies should or could be measured?”

Participants were able to enter more than one answer and these have been collated

in figure 13.

Figure 13. All respondents - "How do you think HCP skills or competencies should or could be measured?" (Dickson. March 2015)

Eighty two percent of HCP’s identified an experience matrix as their preferred

measuring tool, followed by sixty six percent for a competency matrix. This result was

expected. Fifty four percent of HCP’s advocated an academic qualification, which was

higher than expected, which may indicate that HCP’s are seeking to formalise their

skills. Additional comments recognised that academic qualifications do matter and

may indeed help (10988471, 11061097) but the consensus of opinion was that “…it

has to be a combination of these things, with the main factor being experience.”

(10986136)

Construction comments observed “Balance is required between academic, clinical and

experience.” (10991064) and that “…several measuring tools are applicable and valid,

depending on the detail requirements.” (11075130)

One member of the client group observed that “…a lot of it comes down to common

sense” (10985974) with another indicating “Membership of professional body”

(911043917) as a measurement of HCP skills and competencies.

05

1015202530354045

27

13

33

41

18

35 3 6 6 4 34 49 8 5

1

All Respondents."How do you think HCP skills or competencies should or

could be measured?"

HCP (50)

Construction (11)

Client (11)

31

The final question posed at Questions 26, 45, 64 and 86 asked all participants if they

would like to make any additional observations.

Notable comments from the HCP group included “…often the HCP raises the

questions or issues that are in the “too difficult to do” box…” (11003684) and that

“Quality planning…is paramount.” (11056396)

The construction group commented that “there appears to be no “entry level” for HCP’s

…they would benefit from the creation of a national body…” (10992953) and “…to

often the projections for the future are based on applying the models of the past.”

(11075130)

Two members of the client group (11000564, 10995793) identified that the

competency levels of HCP’s varied widely, adding that HCP’s had demonstrated

“…insufficient research based evidence to back-up their views…” (11000564) in their

interactions with clinicians.

It can be observed from these additional comments that HCP’s are primarily focused

on quality and dealing with the difficult issues. The client responses support findings

from the literature and the questionnaire, in that they are looking for research based

evidence. The construction group indicated that they are also looking for some level

of validation. An unexpected comment from construction suggests that some HCP’s

may not have updated their skills in line with more modern tools or methodologies.

32

Conclusions.

HCP’s are a highly mobile, international resource who can demonstrate a

wide range of experience across multiple healthcare construction projects.

The softer skills of negotiation, objectivity and critical challenge remain difficult

to quantify and continue to raise further questions on how to demonstrate the

value of the HCP’s expertise. The HCP role remains ambiguous and

fragmented across the healthcare and construction industries.

Clients are utilising substantive staff to undertake many of the HCP activities

within projects and are seeking clarity regarding the parameters and

additional benefits of using a HCP.

The HCP’s expertise is not yet substantiated within recognised academic or

industry parameters. HCP’s are not registered or monitored and have no

specific, industry recognised or academic qualification.

There is no central resource relating to Healthcare Planning as a profession,

therefore it is not yet able to call itself a profession. A defined skill set with

measurable competencies would further the HCP’s status by establishing

themselves as a recognised profession within the healthcare construction

industry.

Establishing themselves as an Institute or Association could promote

assurance and confidence in the expertise of the HCP.

33

Recommendations.

1. It is recommended that a robust format is developed that links the HCP’s

activities to the Key Performance Indicators and other measurement criteria

which are already embedded in the healthcare industry. This would begin to

provide irrefutable evidence of the HCP’s involvement, activities and outcomes

within briefing, in a format that the healthcare industry recognises.

2. It is recommended that HCP’s become more adept at promoting their role.

Improved marketing and publication of their quantifiable activities would raise

awareness of the benefits they can bring to healthcare construction projects.

3. It is recommended that the “Healthcare Planner Scope of Service and Duties.”

(Frameworks Scotland 2. 2014, pp.15-19) be adopted across the healthcare

construction industry in the UK, as the definitive base-line criteria for HCP

competencies.

4. It is recommended that established HCP’s work with the UK Government, the

healthcare construction industry and academic institutions, to define the

parameters of a potential qualification for Healthcare Planners.

5. It is recommended that registration as a Healthcare Planner within an Institute

or Association would facilitate monitoring of competencies and accountability

within the healthcare and construction industries.

6. Further research is required into this complex and diverse role within the

healthcare and construction industries.

34

References.

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Neville, C. (2014) Introduction to Research and Research Methods. [Online]. Available from: http://www.brad.ac.uk/management/media/management/els/20.-Introduction-to-Research-and-Research-Methods---20141021.pdf [Accessed 04 August 2014].

Oppenheim, A. N. (1992) Questionnaire Design, Interviewing and Attitude Measurement. London: Continuum.

Robinson, H. (2014) Approaches to Research (1). [Online]. Available from: ttps://blackboard.lsbu.ac.uk/webapps/portal/frameset.jsp?tab_group=courses&url=%2Fwebapps%2Fblackboard%2Fcontent%2FcontentWrapper.jsp%3Fattachment%3Dtrue%26navItem%3Dcontent%26content_id%3D_1221479_1%26course_id%3D_104325_1%26displayName%3DResearch%2BMeth [Accessed 17 March 2014].

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