Revealing change dynamics in hospital construction projects

Abstract

Purpose Hospital construction projects often suffer from relatively late changes in the project lifecycle, which disrupt the project execution and impact project productivity. The purpose of this paper is to explore the root causes of changes in hospital construction projects. The paper aims to propose ways to prepare for the changes. Design/methodology/approach The study focuses on changes during the construction of new hospital facilities. An explorative, case study research design is utilised. Five case projects from Finland, Sweden and the USA were selected for in-depth analysis. The primary data comprise semi-structured interviews, supported by secondary evidence such as change order documents. Findings The findings reveal eight categories for change sources: contracts, and equipment and systems are reflective of the fast-paced healthcare technology and changing user requirements, while external environment comprises changes caused by both regulatory and physical environment. Changes in operations are reflected in the continuous development of treatment methods and processes. The user, owner, designer and contractor initiated changes represent the stakeholder influence. The paper makes a connection between these change sources and project complexity dimension. A framework for change dynamics is introduced, and product and process flexibility is suggested as a suitable method to prepare for and manage changes. Originality/value The paper is the first to link construction changes to project complexity factors. The paper argues that changes, when managed appropriately, are not only necessary but also beneficial to large construction projects in a quickly changing environment. The findings guide project stakeholders in implementing project flexibility, in the product and process dimensions, which is a balancing force to project complexity.