Building for a better hospital

Value-adding management & design of healthcare real estate

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Recent deregulation of laws on hospital real estate in the Netherlands implies that healthcare institutions have more opportunities to make independent accommodation choices, but at the same time have themselves become responsible for the risks associated with the investment. In addition, accommodation costs have become an integral part of the costs of healthcare. This sheds new light on the alignment between the organisation of healthcare and accommodation: care institutions themselves bear the risk of recouping their investment in real estate and high accommodation costs lead to higher rates for healthcare compared to competing institutions. In this thesis, the ideas and concepts of Corporate Real Estate Management (CREM) are examined in terms of the contribution they could make to the process of accommodation decision by using recent cases in Dutch hospitals. CREM can be defined as the management of the real estate portfolio of a corporation by aligning the portfolio and services with the needs of the core business in order to obtain maximum added value for the business and an optimal contribution to the overall performance of the organisation. This definition assumes that accommodation can add value to the organisation and contribute to its overall achievement. Elaborating on the added value of real estate in addition to quantifying these added values and making them applicable to hospital real estate management is therefore central to this study. The added values determine the transition between the different phases in the cycle of the initiation, design, construction and occupancy of the accommodation. In addition, the added value of real estate functions as a common language between the disciplines involved in the design and construction of hospital accommodation, such as the healthcare institution, healthcare manager, real estate manager and architect. In four sub-studies (1) Context, (2) Management, (3) Value and, (4) Design several concepts that contribute to a more informed decision-making on accommodation aligned with the organisation of healthcare are made applicable by elaborating on, and connecting, existing conceptual frameworks. Conceptual models from different disciplines are aligned in order to achieve an integral approach by both organisation and accommodation management. In addition to the conclusions and recommendations of the separate studies (1-4), the final result is a toolbox (PART 5) that can be used to support a decision-making process that results in a better informed real estate strategy. The instruments are tested by an assessment of recently completed hospital construction projects.