Abbotsford Regional Hospital & Cancer Centre

Breaking new ground┬áA new health facility in British Columbia has raised the bar for quality and speed of service as well as maximum value for money, as Alan T Swaby learns. Bringing any major construction project in on time and on budget is something of a feat and should be applauded. But when the contractual arrangement is something entirely new, then the achievement is even more noteworthy.ThatÔÇÖs whatÔÇÖs happened at the Abbotsford Regional Hospital & Cancer Centre, 60 miles east of Vancouver in the rapidly expanding region of the Fraser Valley. While public-private partnerships have been in use in the United Kingdom and other parts of Europe for a good number of years, the British Columbia authorities had only limited experience with a single, much smaller PPP project prior to the Abbotsford job.Nevertheless, right on schedule the 300-bed, $355 million health center opened its doors in August last year, three and a half years after construction began. It has been built by PCL Constructors Westcoast Inc. to replace AbbotsfordÔÇÖs aging acute-care hospital with a state-of-the-art facility capable of servicing the 330,000-strong population in the Fraser Valley catchment area. Another first for the province is that a dedicated cancer center has been integrated with a hospital from the ground up. The design and construction of the building has been led by chief project officer Walter Hiller. ÔÇ£Prior to the release of the RFP [request for proposals],ÔÇØ he says, ÔÇ£members of the team spent time in the UK studying similar projects over there. We also enlisted the help of some very capable consultants who contributed to the tender and contract details. In addition, there was considerable widespread consultation with 200 healthcare professionals who would eventually have to deliver the care services. It was time-consuming but paid dividends. We managed to meet schedule and budget with change netted to zero cost, which is virtually unheard of for an acute hospital. Now that we have three monthsÔÇÖ actual experience of running the hospital to look back on, nothing untoward has turned up. Staff and patients alike thoroughly endorse the new facility.ÔÇØFrom the clientÔÇÖs point of view, PPP projects provide a known financial outlay that transfers selected risks from the public sector to the private. This particular contract encompassed every aspect of finance, design and build, followed by operations and ongoing maintenance. The contract will run for a period of 33 years, encompassing the three and a half years taken up with construction and then covering the day-to-day operations of the site for the next 30 years. Before the first sod was turned, health authorities knew exactly what costs to budget for over the next generation. Even the hard and soft FM costs can only fluctuate within narrow and well-defined amounts. ÔÇ£Rather than splitting up operational tasks,ÔÇØ says Hiller, ÔÇ£such as parking, security, catering and so on, and then procuring them as separate service contracts, all non-clinical functions have been bundled together and are the responsibility of our private-sector partner. The agreement specifies performance-based payments estimated to be $39 million less than those associated with a traditional procurement model.ÔÇØThe bureaucracy of day-to-day maintenance has also been streamlined. Any member of the caregiving staff who identifies a needÔÇöwhether itÔÇÖs as simple as changing a light bulb or finding some food for a patient outside of normal meal timesÔÇösimply has to contact one number, regardless of the issue. Requests are then logged, and the contractor is obliged to carry them out within a prescribed period of time. Any deviation from these standards renders the contractor liable for deductions from the monthly operational fee.The one element not the responsibility of the contractor is clinical services. The site is shared by the Fraser Health Authority, which runs the hospital services, and the British Columbia Cancer Agency, which administers specialist oncology services.A considerable amount of effort has been expended in making caregiving as efficient and productive as possible. The facility is divided into six pods, each performing a different roleÔÇöovernight stays, outpatients, diagnostics etc.ÔÇöbut closely grouped around a central 80-foot-high atrium designed to provide a distinctive non-institutional feel. Moving from one pod to another is simplicity itself, not only reducing fatigue for those moving around but also ensuring that care, diagnostics and treatment are delivered as productively as possible.The hospital has been built to provide a calm, healing atmosphere. The normal standard for Canadian hospitals is to have four-bed wards, but at the Abbotsford Regional Hospital there are only one- or two-bed rooms that are designed to give patients maximum control over their own environment and privacy while minimizing the physical exertion of healthcare workers and satisfying the latest ideas in infection control. To lift patientsÔÇÖ spirits, rooms have large picture windows allowing streams of natural light while providing pleasant courtyard or scenic views, including the nearby range of snow-capped mountains.Making life easier for staff, particularly nurses, is also a high priority. Nursing units have at most 40 beds monitored by nurses at four alternative locations, maximizing speed of response while minimizing the number of steps nurses need to take. To avoid bedside visits just to collect information, patients have the latest nurse-call systems enabling two-way conversations about their needs. LetÔÇÖs say the patient wants an extra blanket: the nurse can be made aware of this and make just one bedside trip to deliver it rather than two.Over $80 million has been invested in new equipment and technology for the hospital and cancer center, including a $30 million contract with GE Healthcare for state-of-the-art medical imaging equipment, patient monitoring systems and digital picture archiving communications system. The package includes a raft of teaching and operational systems to streamline hospital administration and help healthcare professionals keep critical decision-making information right at the patientÔÇÖs bedside.Not only has the Abbotsford Regional Hospital & Cancer Centre become a valuable community resource in one of the fastest-growing parts of Canada, it will no doubt act as a model for other similar public construction projects for years to come.┬á