Glitches, snags and crises: a study of change in hospital adaptation projects

Design and programme changes during refurbishment projects remain a considerable cause of concern for UK National Health Service (NHS) Estates managers, due to their potential to disrupt or delay projects and increase cost uncertainty. Similar concerns also impact on the engineering sector, especially in the production of complex, highly engineered products. The techniques developed to study and manage engineering change may have positive benefits for construction. This research looks at the mechanisms of change that operate in refurbishment projects with the aim of identifying commonalities with engineering change. Hence, the research adopts an engineering approach to change and evaluates three very different NHS refurbishment projects, to explore change events and identify options for limiting the consequences of change. The projects chosen for this study were markedly different, with specific drivers, procurement methods, contracts and building systems. One project concerned the construction of a factory-fabricated, modular extension to a UK hospital, whilst a second entailed a "state of the art" refurbishment of an existing neo-natal unit. A third project involved a heavily constrained ward refurbishment. Factors which influenced the level and complexity of change frequently resulted from the lack of accurate information at crucial stages, particularly related to the existing building structure and condition. However, the necessary changes followed very different trajectories. This study forms part of a much larger investigation which aims to develop sustainable adaptations for hospital buildings in response to the changing climate