There is an increased emphasis on the goals of sustainable development, especially in the construction sector. The increased emissions and waste production of the construction sector is something that has been brought to the forefront in many building conventions (Matthew, Ma, & Tan, 2012). As in this case study, the waste reduction should be highly emphasized in hospital B.
Hospital B deals with the demolition of the training building but the disposal techniques are yet to be defined. Therefore, prior to the actual demolition, waste disposal techniques should be identified and a proper framework for their disposal identified. Some of the techniques that may be used in the minimization of waste include recycling and reuse. The construction materials to be disposed of may be used in the refurbishment in the other sectors and as such, will minimize the impact of the development on the environment.

Hospitals A, B, and C

The internal stakeholders may be considered as the decision makers while the external ones may be considered as the consultants (lowe & Leiringer, 2008). Involving other independent external stakeholders, through communication and company reports, such as the World Bank may furthermore result in very desirable outcomes. External stakeholder such as the World Bank usually lends money that may be used for development purposes. This may be useful in the development of hospital B as it is capital intensive, having recorded the highest NPC per point score.
However, considering that the project is highly beneficial to the community, the major funding will come from government, the stakeholders and investors. In looking for funds from all these sources, the financial structure of the company should be well pronounced with the long-term as well as the long-term benefits identified (Liu & Wang, 2008).

Building fabric condition

Hospital A, Hospital B

The refurbishment and/or reconstruction of the three hospitals needs to consider the project initiation as well as the current state (Olander, 2007).It will specifically apply to hospitals A and B which require extensive refurbishment. Therefore, the University trust should consider all the stages of the project initiation and ensure that there is a proper framework that mitigates all the risks possible. Hospital A has significant refurbishment challenges due to constrain in the departmental footprint while hospital B requires the refurbishment of the single floor that is bridging the entrance, emergency assess and maternity. The state of the building will, therefore, be used to measure the types of works required.

Hospital C

To begin with, the government and the councils should provide standards for the plans (Aaltonen, 2011). However, the standards should meet the University’s trust approval and requirements for the hospital. Other groups involved in the analysis of the state of the building include the project manager, the contractors, and other stakeholders. Some of the risks to be considered include lack of proper refurbishment measures, wrong measure, and risks that pertains the cost of the new building.

Financial management techniques

Hospital B and Hospital C

There are two methods of recording the money flow within the hospital trust and this includes the accrual and cash based (Project management Institute, 2013). However, the technology to be used in the two hospital options is cash based. The decisions are centered on expenditure on new assets with little consideration of the assets available (Carroll & Buchholtz, 2014). The decision should be revised prior to the actual purchase of construction material.

Hospital A

The other system, accrual-based, is focused on the upgrade of the existing assets rather than the purchase of new ones (Hartney, 2016). The system may be observed in hospital A where there is an upgrade of the existing services.
Cost estimation is a risk that is encountered in refurbishment because the actual works may be more than those estimated. This will apply to the three hospital cases because each has a section that requires refurbishment. However, it will be very detailed in hospital A than in hospital B and C. Furthermore, considering the financial situation of the hospital trust, there is the need for extensive financial consultation and management throughout the whole process.

Proper Procurement strategies

Procurement is brought about by proper financial management. For the three hospitals, the systems used for the purchase of the commodities are accrual for hospital A while cash based for hospital B and C. However, this is as per the accounting whereby one system focuses on the purchase of new assets while the other system focuses on the refurbishment of the assets present.

Hospitals A and B

In the case of hospital A and B, the procurement officer should establish the status of the assets available prior to the purchase of the refurbishment material. This should be followed by the creation of a system that can continually monitor the state of these assets (Abdulla, Rahman, & Azis, 2010). Continuous monitoring ensures that the materials can be purchased when the need arises.

Hospital C

The accrual-based financial system has its major application in the procurement of the hospital’s assets. The option involves the construction of a new emergency department and the refurbishment of the current one. The refurbishment part may involve the cash-based system and there will be the purchase of new assets. Therefore, the procurement process will require an asset register which will enable effective asset management.
New build, reconfiguration, and refurbishment techniques

Hospital A, B, and C

The three hospitals are to be refurbished with t each method different from the other. In hospital A, the refurbishment will mainly cater for the existing blueprints while in hospital B and C there will be the refurbishment of single assessment and the emergency department respectively. In line with all the three building refurbishment requirements, the contractor should be well conversant with the existing blueprints to prevent any unwanted damage. Furthermore, the financial manager should ensure that a proper refurbishment schedule is set up, maintaining the timeline to a minimal. This will require the project manager to ensure that the project scheduling and the critical path methodology is applied prior to the actual works.

Hospital B and C

Hospitals B and C involve new buildings and this will require proper scheduling, costing as well as management. The critical path methodology has extensively been used to determine the time required for project completion (Turner, 2008) and it may be of significant importance to the two projects.

Extensive Project appraisal

Hospitals A, B, and C

There are a number of appraisal techniques that may be used in selecting the best option from the three hospitals. Some of the techniques that may be used in assessing the economic feasibility as well as the payback period, accounting rate of return, the internal rate of return and the gross ratio among others (Beaume, Maniak, & Midler, 2009). The appraisal techniques that have been in the selection process are the net present cost, the net present cost per point score, the ranks, the weighted scores and the raw sources. These methods may give significant insight on the way forward but a thorough analysis is required prior to the actual selection. The three hospitals: A, B, and C have varying strengths and weaknesses and it may be wise to use a number of project appraisal techniques.

The stakeholders

Hospitals A, B, and C

Stakeholders have varying requirements on the methodology to be used for the development, the returns to be obtained, the funding among others. The project has a number of stakeholders who include staff, the Patients and visitors, volunteers, GPs, CCGs Service providers and other external stakeholders. Regardless, it is important for the project manager to pay attention to the requirements of each without comprising on the mission and vision statement of the organization (Eskerod & Huemann, 2013).
Decisions by the project manager are influenced by the stakeholders as well as other investors. In trying to ensure that there is efficiency in the methods used for management, he/she has to consider all the opinions and weigh them against all construction standards and requirements. Furthermore, the project manager should be in a position to source for funds from the investors as well as other stakeholders.balance sheets as well as company reports will ensure that there is adequate funding.

Provision of medical services

Hospitals A, B, and C

There are a number of issues that have led to the need for change in the three hospitals. These factors include patient flows, capacity, adjacencies, mortality and inefficiency of the staff. Refurbishment and reconstruction are just part of the plans for change. However, the number, as well as the skill of the staff, will determine the level of service to be provided to the patients.
The various rooms, as well as the adjacencies, should cater for the needs of the patients. A bigger resuscitation area with more beds, bigger spaces, an increase in the number of cubicles should be considered in the plans. However, all this will require a complete reshuffle of the current staff and the employment of the sufficient number of staff to cater for all the patients’ needs. All this is a requirement in the three hospitals.

Development control plans

The plans to be used for the development of each hospital will be different. The plan to be used in each case has to consider the condition of the building and the modifications required.

Hospital A

The hospital’s development plans are centered on refurbishment. Therefore, prior to project initiation, the project manager should consider various milestones that should be attained within each given period. Some of the milestones may be center on walling unit, ceilings, floor among others. By doing so and keeping the project works under check, he/she will be able to provide an alternative route whenever an unforeseen circumstance occurs.

Hospitals B and C

Hospital B involves the demolition of the training department and the construction of a new emergency department. On the other hand, hospital C is centered on a new emergency building and refurbishment of the current one. The works involved in the two hospitals are numerous as compared to A and as such, the project manager will have to develop proper control options. Most are centered on new building standards and some will be centered on the hospital standards.

Responsive nature of the asset management framework

There is the need for the asset management framework employed in the above scenario to be very responsive to the nature and demands of the stakeholders. The asset lifecycle is the major issue because it is influenced by numerous internal as well as external factors. In this, the asset lifecycle is to be profiled from the financial as well as the non-financial orientations with the need for an impromptu modification looked (Maheshwari, 2006).
The asset management lifecycle is very much prone to design and redesign concepts which generally affect the asset management framework (Ponnappa, 2014). Therefore, the management has to consider various long-term factors which may involve increased costs among other modifications. The various stakeholders may be faced with numerous challenges in the future which may drastically reduce the input to the decision-making process and as such, the framework should be flexible. In the hospital design and refurbishment, the asset refurbishment and construction has a maintenance routine of 4 years but this is subject to the decisions of the stakeholder and the funds available. Therefore a change in the stakeholder decisions has to be considered in implementing the framework.
The need for reinvestment is another factor that the framework should consider. This plays a major role in information disbursement within the organization .and is usually brought about by the changes that usually occur in the environment, the business and the operation of the asset (Eskerod & Jepsen, 2013.The investors and stakeholders present are influenced by all those factors and as such, there might be a change in their investment. This has to be considered in the framework.
The responsive nature of the framework determines the ability of the organization to adapt to the various stakeholder changes. Though the framework might be designed in such a way that it satisfies all these changes, the project manager may be the one in the most of unsuitable situations. This is because he has to manage the various changes without damaging the framework already in place while at the same time meeting the expectation of each stakeholder.
The initial design and implementations are usually overlooked by the project manager and in case of any change within the asset, he/she is responsible for the transition. Therefore, this might be a problem when the changes are big and cannot be easily implemented yet need to be met. Furthermore, the project manager is mandated with the responsibility of keeping the benefit-cost ratio at a desirable level and therefore, changes in the stakeholders’ expectations and investments might lead to a lower benefit-cost ratio which might put him/her in a precarious situation (Boxall & Purcell, 2011). Therefore, the decisions that are made by the stakeholders create uncertainty for the project manager especially when the decisions affect the overall structure of the project.


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