Mitigating uncertainty and risk on a complex ‘refurb

Ageing of hospital estate assets is a growing concern for many European countries, and indeed in any country in which care has been largely provided in buildings that are at least 30 years’ old. Against this backdrop, with physical constraints, a lack of decanting facilities, shortage of funding, and socio-political choices, refurbishment of existing buildings is often seen as more viable than building new healthcare facilities. Since January 2020, the COVID-19 pandemic has piled further pressure on the healthcare system, including built assets and their operability. In this context, the refurbishment of the Surgical Block at San Paolo Hospital in Puglia, Italy, provides some useful real-world strategies to mitigate uncertainty and risk in project design and construction – from stakeholder consultation and needs, to final commissioning and operation.

Healthcare delivery in Italy

In Italy, 82% of the existing hospital building stock was built before 1990, and 58% before 1970. In Liguria and Marche 59% and 47% of the provinces’ hospital buildings respectively pre-date 1946.1 Puglia is no different – 31% of its hospital building stock was built pre-1946; 12% between 1947 and 1969; 46% between 1970 and 1989, and just 11% constructed post-1990.¹