Design For Healthcare
CAN SALUTOGENIC OUTCOMES
BE ACHIEVED THROUGH PPP?
Global Examples Reveal a Way Forward
Design & Health 10th World Congress and Exhibition
Toronto, July 2014 | Kenneth Schwarz
PPP Process
Range of Experience
Market
development
curve
Healthcare PPP
High Sophistication








Use of PPP in other sectors
other than transport
Develop other partnership
models
Leverage new sources of
funds from capital markets
Establish dedicated
PPP unit in agencies
Establish policy & legislative
framework
Initiate central PPP policy unit
to guide implementation
Develop deal structures
Begin to build the
marketplace
UK
Canada
Stage 3

Australia
Northern Ireland
Greece
Netherlands
New Zealand
Italy
Germany
Stage 2

Sophisticated infrastructure
market with pension funds &
private equity funds
More creative flexible
partnerships models
e.g BSF, LIFT
Sophisticated risk
models and LCC
Slovakia
Latvia
Russia
Mexico
Brazil
Stage 1

Low
Chile
Spain
Portugal
France
Japan
Hong Kong
Belgium
USA
Denmark
Hungary
Czech Republic
Maturity
Singapore
South Africa
Bulgaria
Croatia
Poland
Albania
High
Traditional Procurement
Public Sector
(End user)
Public Sector
(End user)
Define
Assets & Services
Design
Direct Payment
Build
* Payment * Payment * Payment
1 234
Define
Design
Build
Finance
Operate
Operate
(FM)
PPP Procurement
Public Sector
(End user)
Define
Assets & Services
Contract
Unitary Payment
Private Sector
(SPV)
Design
Build
* PPP Contract * Unitary Payment
1 234
Define
Procure
Build
(Competition)
Operate
Finance
Operate
(FM)
Matched Teams
Public
Sector
Private
Sector
COMPARATIVE
STRATEGIES.
Southmead, Bristol
Southmead Hospital / Carillion plc/ BDP architects
Level 1
Southmead Hospital / Carillion plc/ BDP architects
Level 2
Southmead Hospital / Carillion plc/ BDP architects
Thirteen Pocket Gardens
Southmead Hospital / Carillion plc/ BDP architects
Rehab Therapy Garden
Southmead Hospital / Carillion plc/ BDP architects
Atrium Greenery
Southmead Hospital / Carillion plc/ BDP architects
Wayfinding and Art
Southmead Hospital / Carillion plc/ BDP architects
Public Lift and Stair Core
Southmead Hospital / Carillion plc/ BDP architects
Inpatient Reception
Southmead Hospital / Carillion plc/ BDP architects
Inpatient Rooms Cluster
Southmead Hospital / Carillion plc/ BDP architects
Inpatient Room
Southmead Hospital / Carillion plc/ BDP architects
Residential Details
Neighborhood Face, Lower
Neighborhood Face, Center
Main Entrance
Favorable Outcomes
Salutogenic
1
2
Commitment
Public sector team committed to
achieving salutogenic outcomes
Definition
Comprehensive brief includes
salutogenic agenda
Competitive
Dialogue
Public/Private interaction energised
by competitive environment
Documentation
RDD
Realization that if it’s not
documented, it’s not in the proposal
Selection
Selection team recognises value
of salutogenic aspects
3
Vigilance
Public sector team kept intact for
construction phase reviews
Favorable Outcomes
Salutogenic
1
2
Commitment
Public sector team committed to
achieving salutogenic outcomes
Definition
Comprehensive brief includes
salutogenic agenda
Competitive
Dialogue
Public/Private interaction energised
by competitive environment
Documentation
RDD
Realization that if it’s not
documented, it’s not in the proposal
Selection
Selection team recognises value
of salutogenic aspects
3
Vigilance
Public sector team kept intact for
construction phase reviews
Favorable Outcomes
Salutogenic
1
2
Commitment
Public sector team committed to
achieving salutogenic outcomes
Definition
Comprehensive brief includes
salutogenic agenda
Competitive
Dialogue
Public/Private interaction energised
by competitive environment
Documentation
RDD
Realization that if it’s not
documented, it’s not in the proposal
Selection
Selection team recognises value
of salutogenic aspects
3
Vigilance
Public sector team kept intact for
construction phase reviews
Favorable Outcomes
Salutogenic
1
2
Commitment
Public sector team committed to
achieving salutogenic outcomes
Definition
Comprehensive brief includes
salutogenic agenda
Competitive
Dialogue
Public/Private interaction energised
by competitive environment
Documentation
RDD
Realization that if it’s not
documented, it’s not in the proposal
Selection
Selection team recognises value
of salutogenic aspects
3
Vigilance
Public sector team kept intact for
construction phase reviews
Favorable Outcomes
Salutogenic
1
2
Commitment
Public sector team committed to
achieving salutogenic outcomes
Definition
Comprehensive brief includes
salutogenic agenda
Competitive
Dialogue
Public/Private interaction energised
by competitive environment
Documentation
RDD
Realization that if it’s not
documented, it’s not in the proposal
Selection
Selection team recognises value
of salutogenic aspects
3
Vigilance
Public sector team kept intact for
construction phase reviews
Favorable Outcomes
Salutogenic
1
2
Commitment
Public sector team committed to
achieving salutogenic outcomes
Definition
Comprehensive brief includes
salutogenic agenda
Competitive
Dialogue
Public/Private interaction energised
by competitive environment
Documentation
RDD
Realization that if it’s not
documented, it’s not in the proposal
Selection
Selection team recognises value
of salutogenic aspects
3
Vigilance
Public sector team kept intact for
construction phase reviews
South West Acute, Enniskillen
Northern Ireland Health Group/
Stantec Anshen+Allen architects
Children's Hospital, Melbourne
Children’s Health Partnership/ Billiard Leece Partnership and Bates Smart architects
Bridgepoint, Toronto
Bridgepoint Health / Infrastructure Ontario; Compliance: Stantec – KPMB Architects; Plenary Bridgepoint / HDR – Diamond Schmitt Architects
Less Favorable Outcomes
Lacks Aspiration
1
2
Commitment
Commitment in words, but not
deeds, to salutogenic outcomes
Definition
Highly prescriptive requirements
focused on core issues: functional
standards and costs
Competitive
Dialogue
Limited, highly-structured interaction
Documentation
RDD
Limited references to non-core
issues in documentation
Selection
Evaluation heavily weighted to
core issues
3
Vigilance
Poor public sector presence
allows unfavorable substitutions
and RDD interpretations
Less Favorable Outcomes
Lacks Organization
1
2
Commitment
Not committed to achieving
salutogenic outcomes
Definition
Poorly defined requirements; little or
no acknowledgment of salutogenic
aspects
Competitive
Dialogue
Inexperienced public sector team;
erratic interaction with bidders
Documentation
RDD
Unrealistic time-frames result in
incomplete proposals that require
completion, post selection
Selection
Highly cost-based; sometimes
politically influenced
3
Vigilance
Poor public sector presence allows
unfavorable substitutions and RDD
interpretations
LESSONS LEARNED
AND THE WAY FORWARD.
The Case For PPP
 Access to private capital
 Integrates design, construction,
maintenance & operation
 Engages private sector design,
construction and delivery expertise
 Builds long-term contractual
relationships for service delivery
 Has achieved high-quality product
and services
 Hand-over of asset to public sector
at end of concession period
The Case Against PPP
 Poor Value for Money:
higher borrowing rates and
profits for shareholders
 Now, “ on-balance-sheet”,
registering as public sector debt
 Slow and expensive to procure
 Long-term inflexibility
 Emphasis on the deal, rather
than on the product
 Partnership of rivals
Salutogenic Outcomes
Promoting wellness
Public Sector Commitment
 Design Champion
 Project Management Team
Private Sector Commitment
 SPV Design Manager and Contractor
 Architect and Supporting Team
Process
 Project definition
 Interactive competition
 Documentation/RDD
 Selection
 Vigilance
Alder Hey Children’s Hospital, Liverpool UK, Laing O’Rourke/ BDP Architects
1.5