A risk management system for construction procurement in NHS healthcare infrastructure projects

The last two centuries have witnessed great growth of investment in the procurement of healthcare infrastructure projects in the UK, which has brought about innovations in healthcare construction procurement methods. With such innovations, risk management for procuring NHS healthcare infrastructure projects has changed from risks mainly being undertaken by NHS client organisations to a shared risk management and cooperation mechanism between the NHS client organisations and construction suppliers. However, in these procurement methods, the division of responsibility between the public sector and construction suppliers has been deemed unclear and inefficient. This has led to high procurement costs, poor project performance, and low value for money. Therefore, the UK government and NHS is suggested to focus on managing risks more effectively when using construction procurement options with a shared risk mechanism. The aim of this PhD research is to develop an integrative and computer-based risk management system for construction procurement of NHS healthcare infrastructure projects in the UK to improve risk management associated with the currently used construction procurement options.

To construct the risk management system, 43 main risk factors and nine risk groups were identified from the literature and classified into macro-, meso-, and micro-level risks. The next step was to appraise the current practice of risk management in construction procurement of NHS infrastructure projects and investigate how the identified risk factors can be assessed. This was carried out through an online questionnaire survey which was developed to collect quantitative data from both the NHS client organisations and construction suppliers. These data were used to develop risk assessment and response frameworks, respectively. By employing fuzzy logic for risk assessment, the likelihood of occurrence, magnitude of impact and risk criticality were calculated for each risk factor and risk group as well as the overall risk. Covid-19 was found to be the top risk factor, and stakeholder risks were the most critical risk group. The overall risk criticality was rated medium to high, indicating that the decisions on procuring NHS healthcare infrastructure projects can be risky. A risk response framework was then developed according to the results of percentage analysis of the questionnaire data, which indicated that most of the risks should be shared by both parties or retained by NHS. The employment of fuzzy synthetic evaluation and percentage analysis provided a basis for developing a demo computer-based Risk Management System for NHS (RMS-NHS), which is a novel contribution of this research. Online semi-structured interviews were conducted with 12 questionnaire respondents from both the NHS client organisations and construction suppliers who agreed to have interviews to validate the demo RMS-NHS to seek advice on its potential improvements and what guidelines might help ensure that RMS-NHS can be used effectively.

The computer-based RMS-NHS includes all the key risk management stages and embeds risk management into the entire construction procurement lifecycle and Office of Government Commerce Gateway Review process. Guidelines on selection of proper procurement options, achieving better value for money, integrated project team, strategic risk response activities, communication management and stakeholder management were further developed to support the standardisation and effective use of RMS-NHS. The findings of this research, especially the RMS-NHS, could help NHS client organisations and construction suppliers better understand, assess, and implement integrated risk management in construction procurement of NHS healthcare infrastructure projects. RMS-NHS can prepare the public and private sectors for current and future health construction procurement scenarios to achieve better project performance and value for money.