A&D professionals in Canada, the United Kingdom, or Europe who practice healthcare design have likely come across public private partnership projects, sometimes called PPP, 3P, or P3. This model is increasingly popular and presents endless opportunities.
Public Private Partnership 101
In Canada, a public private partnership is a project delivery model where a public project is “developed” as a comprehensive package by a consortium of private sector experts. This typically includes a developer or “consortium” lead, a fully balanced design team, a general contractor, mechanical and electrical sub grades, financial backers, bankers, and a team of lawyers. (Visit the Canadian Council for Public-Private Partnerships.)
Most of the existing healthcare building stock in this country is nearing expiry; our provincial government has limited funding and we desperately need public infrastructure. By reaching out to the private sector to Design, Build, Finance and Maintain (DBFM), the client (the government) is able to transfer risk and over 50 percent of the cost while retaining principle ownership of the building. Clinical operation remains in the hands of the government, but the Consortium maintains the facility for 20 to 30 years. After this period the building and operations will likely be returned to the client.
Who is our client?
There is a lot of fear in the design profession regarding public private partnerships as access to the client is different. As a design professional, your client becomes the consortium lead or the general contractor. It is similar to a design build, but with representation from finance and building maintenance and operations. The role of the design professional is the key differentiator between a typical P3 project organization (Figure 1, above) and a traditional project organization (Figure 2, below). By leveraging the range of expertise at the table, this structure can result in greater synergies.
The local climate
In British Columbia, only one to two major projects are released each year. (Visit Partnerships British Columbia.) Competition is fierce as up to 10 global consortiums may pursue a single project. Consortiums pair up with design firms from six months to over two years ahead of the RFQ/RFP release. Each shortlisted team (typically three in total) is strong and has the capacity and experience to do the work. The key is finding a strategic advantage which differentiates their expertise.
It’s important to note that scoring criteria are distinctly different in British Columbia, where a team can receive points for the competency of their design and construction solution versus just the lowest cost. The path to a winning scheme is often a balance of cost, construction methodology, and clinical effectiveness and efficiency. Equally important is the ability of the Consortium to facilitate a participatory design process by putting systems in place that limit the frequency of adversarial interactions. AP3 is a tough forum to foster design excellence and clinical effectiveness, especially for a complicated healthcare project, therefore a strong foundation of interaction with the user is essential.
Where do healthcare designers fit in?
The importance and power of our unique expertise as design professionals and the deep relationships that form are highly underestimated. Consortiums without experience participating in public private partnerships often aren’t shortlisted due to limited relationships and local expertise. Many consortiums feel that in order to control finances they need to employ a draconian management style as a way to limit exposure. Nothing could be further from the truth. The best design teams take advantage of the great body of expertise at the table. This creates a foundation of respect and camaraderie that begins in the early stages of design.
Healthcare design is not easy. It’s personal, especially in the public private partnership form where all parties assume financial risk. However, the process can result in a fun, educational, and rewarding experience.
Hal Collier, chief project officer for the Provincial Health Services Authority, says “The full integration of the knowledge and experience of the ultimate users of a building is critical to any design process, but especially so in healthcare design.” An additional benefit has been significant user ownership of the project, allowing for smooth transition and commissioning of the facilities. “When it comes to public private partnerships, as opposed to more traditional design processes, I've always felt that a project team must be very careful not to allow a design to progress too far without user participation. Public private partnerships require much more effort up front on the construction side of the design. This can overwhelm the architectural design efforts if it does not start from an understanding of the clinical purposes of the facility.”
User facilitation and engagement is the key differentiator, setting teams apart during the competition and design phases. We must demonstrate to the client and users how it can be a mutually beneficial and enjoyable partnership. Rather than limit the design team’s exposure to the users in an effort to mitigate risk, leveraging the architect’s ability to facilitate user integration and feedback creates a participatory experience for all parties. Another benefit is the ability to build strong relationships and an understanding of each other’s challenges and opportunities. This assists in being able to communicate and interact without the fear of engaging in a dispute over money. As design professionals we have a unique ability to effectively bring people together. We are accustomed to being prime consultants, facilitators, and leaders. We are proficient in gaining and maintaining consensus amongst distinct groups of people with different goals and ideas.
Each public private partnership project is unique and commands us to be nimble, open minded, cost conscious, egoless, visionary, strategic, and most importantly fearless leaders. It’s a tall order full of constraints but represents the opportunity to create exciting designs, strengthening our abilities and profession. Regardless of what side of the table we sit on, it comes down to building strong relationships. This foundation ensures a rewarding experience and end product.
Kirsten Reite joined Perkins+Will more than one year ago as a healthcare market sector leader for Vancouver and Western Canada. Kirsten is an architect with a focus in healthcare design for more than 15 years. Her project experience has ranged from $150,000 medical lab renovations to $400 million acute care hospital replacements. She has participated in three public private partnership projects to different levels of engagement over the last five years in British Columbia. Kirsten worked with Hal Collier while at her past firm, CEI Architecture Planning Interiors in Vancouver, British Columbia.
“Designing for Health” is a monthly, Web-exclusive series from the healthcare interior design leaders at Perkins+Will that focuses on the issues, trends, challenges, and research involved in crafting today's healing environments. Past installments of "Designing for Health" include (click on title to access the full article):
- Are Best Healthcare Design Practices Transferable to the Middle East?
- Best Strategies for the EDAC Exam
- Traditional Culture in a New World
- The Perils and Pearls of Field Research in Healthcare Facilities
- What's Your Problem? A Research Approach to Quantifying Design Solutions