Any chain is only as strong as the weakest link. Whether you are building a new care home or refurbishing your existing care home, the entire chain of delivery needs to connect and maintain its strength to achieve a successful conclusion. The first (and last) link in the chain is understanding and anticipating CQC certification.
Three of the key principles implemented by CQC are making sure that residents are safe, treated with dignity and respect and live in a person- centric environment. That applies to all aspects of a care home, but in this case, we are applying it to the design and construction process. Achieving new certification or recertification is not a straightforward process but can be simplified to an extent if the care home is redeveloped in a way which is sympathetic to those requirements but also takes the opportunity to differentiate itself from the market and future proof itself for the next generation of residents and their families.
Engaging the stakeholders
The second link in the chain is thinking like a resident. Some care home operators employ estates managers. One of my clients has a Director of Innovation and Delivery. That person not only manages the building's day-to-day but also engages with all the stakeholders to bring on board everyone with an interest in successfully completing the project. With schools going back, I will use a triangle analogy. Some building contractors will try to balance time, cost and quality, with one of those factors missing out, creating an isosceles triangle, but ideally what you want is an equilateral triangle, with innovative care home operators looking at it from the perspective of equal strength of the design team, the delivery team and the operational team, or alternatively the equal needs of estate management, clinical management and operational commercial management. However you choose to describe it, supporting and promoting the residents’ experience leads to greater staff retention, greater commercial return and a successful business model.
The third link in the chain is project preparation. When the stakeholders have engaged with the process, expressed their views and highlighted various important factors, what is the overall design brief issued to the architect? Has risk been stripped out of the building to such an extent that it looks like an institution? The care home should be a living community with IT hubs, cinema, shops, cafes and restaurants, hairdressers, all bringing the outside in to create active lives for residents. The stakeholders should be creative at the beginning to avoid expensive changes later. Change management systems are not supposed to be a safety net to catch all the things that were forgotten in their preparatory stage. AGP once asked a builder and architect to increase the bed spacing by 30 cm to accommodate clinical equipment. The problem was that the power, medical gases, lighting and fire systems had all been installed, plasters and in some cases commissioned. A small change meant a large cost.
The next link in the chain is design team engagement. Think differently. Do all of the brainstorming at an early stage. Have you considered a collaboration agreement or two-stage partnering agreement, perhaps using a BIM protocol or “early contractor involvement” procurement structures? If the design is iterative, sharing information, looking not just at delivery costs but also the practicalities of running an operational care home, then you should have maximised the opportunity to develop a really strong asset. Are the spaces flexible inside the building? For example, one client identified that their internal medical room was a very rarely used because the local GP practice encouraged residents to attend surgery, that room has now been altered to become a flexible space for the GPs if necessary or for other health and welfare suppliers and also a staff room for internal use. What about innovative IT and communications equipment to help staff? Would new heating and power technology save money in the long run, even though they are slightly more expensive initially? Have you developed long dark corridors or “family” apartments? There is no right or wrong answer for any particular care home. Choice of the design consultancy team and ultimately choice of the building contractor could help in some circumstances. One care home client chose a building contractor with less direct experience in the care home sector because they were more enthusiastic to work in partnership with the care home operator to develop new ideas and implement new solutions, which was a very similar contract price to the long established building contractor who would roll out almost a standard product without thinking too hard or engaging in a collaborative manner with the operator.
Delivery of the project is the next link in the chain. You could demand that the product is delivered in phases or alternatively you could decant all residents. For the purposes of health and safety (CDM), one must consider the safest solution. Protecting residents’ privacy and dignity might mean a slightly longer build programme but will achieve a better return from residents and their families and staff members in the long run. One care home operator engaged the builder to deliver the care home in phases so the builder had to post people in the corridors (human traffic banksmen) to help the residents climb over planks on the floor covering trenches and holes. Contractors should be encouraged (in fact, obliged under the contract) to suggest cost savings, innovative design and also environmental impact minimisation measures. A balance must be struck between opening for business quickly and protecting the residents and the neighbouring landowners from the noise and mess that is inherent in any building contract. Simple contract structures such as regular review meetings and monitoring, KPI’s and early warning will reduce concerns about a disruptive process and focus everyone on the positive end result.
If the care hime operator has particular internal policies and procedures in place, then the design and construction must be sympathetic to those policies and procedures, putting the team on notice of the need to comply with them, therefore making the operational phase of the care home easier to run. Good design and construction can lead to a safe, practical, flexible low-risk environment that promotes an active, independent life for residents. Communication and preparation can bring that in on time and on budget (for example compare the normal JCT type approach and the more resource intensive but more proactive management involved in an NEC contract). Contracts can penalise but can also incentivise. If you have an enthusiastic builder who wants to use the new care home as a case study to develop his own business he will be more incentivised than constantly hitting him with penalties and claims, which are a necessary part of construction but not always the most effective delivery solution if you are trying to promote collaborative solutions.
A further link in the chain is the staff. A care home that is deliberately designed and built to make it easy to operate and maintain will encourage retention of staff who enjoy working there and spend more time with the residents, rather than sorting out a defective building. Although the defect might seem minor, sometimes small problems can become very irritating and reduce the morale in the care home. Think about the contractual method of engagement with the builders and the design consultancy team for ensuring the best possible cost effective construction quality and then minimising the impact of snagging latent and patent defects after practical completion. Every building has small defects but if the repair works are handled sensitively with good communication and appropriate planning, this should not interfere with the care home being "care ready" for complex conditions, encouraging families to place relatives in a care home and achieving high standards from the CQC.
If any one of those links in the chain breaks than the overall business model running forward will suffer, becoming reactive, not proactive. Think about how you appoint your team, create a strong chain and link up your new care homes.