Literature Review On Construction Of Healthcare For Aged

Discuss about the Literature Review on Construction of Healthcare for Aged.

 

The literature review is based on a risk management plan in the construction of healthcare for aged people. The identification of risks in construction project follows a systematic way to analyze the risks and then respond to the risks in order to achieve the objectives of the project. The benefit of this risk management plan is to identify the risks and analyze it using quantitative risk analysis technique to make improvement in the construction of healthcare project (McNeil, Frey & Embrechts, 2015). Contingency plan and funding are required to plan for the improvement of risks and mitigates it using best possible techniques.

The healthcare sector is always under aggressive pressure to upgrade as well as enlarge their infrastructure as per the current and advanced technologies. Bromiley et al., (2015) stated that as new technology increases the demand of the aged people and patient, therefore it requires building and constructing a healthcare for them. Banerjee (2016) opined that when there is a high probability of risk in constructing of healthcare, then the risk management team should plan for managing the risk with keep in mind the health and protection of the patients.

Each of the construction projects within the healthcare sector needs risk assessment plan to give a better environment to the aged people. Therefore, pre-construction planning is required to start the project plan. Driver and Bernard (2012) discussed the healthcare construction plan should ensure people that they are following renovations of their healthcare based on rules and regulations of the healthcare sector, federal as well as local laws. Paape and Spekle (2012) pointed that during the planning process of the healthcare; firstly, the design engineers should develop high detailed design drawings of the healthcare infrastructure and then planned for further innovations. The planning process should take entire infrastructure, which supplies the construction area.

Grotsch, Blome and Schleper (2013) stated that there are three various viewpoints of risk tolerance in the construction project such as project manager, stakeholder as well as the organization. The risk tolerance of the organization is based on the financial stability of the organization as well as diversification (Christoffersen, 2012). The risk tolerance of the project manager reflected security of a job as well as organizational culture. Finally, stakeholder’s is based on objectives of the project plan. Sometimes, there is a failure in an interaction between project stakeholder as well as a manager. Thamhain (2013) argued that the organization’s acceptance of the risk changes throughout the project duration. In the below curve, it is seen that from the week 1 to week 4, there is a constant rise in project risks. Therefore the risk management team takes proper step to reduce those risks. In week 5, week 6 and week 7, the risk decreases and finally in week 8, the risk tolerance reduces to 2.

Figure 1: Risk tolerance curve

(Source: Created by author)

Mansfield et al., (2015) opined that the financial, as well as industry status, affects the risk tolerance of the construction project. Mace et al., (2015) argued that due to limited resources of the healthcare sector the risk management team takes a decision to overcome the issues. The risks, which are raised in the construction project, are due to over budget, lack of communication, finish late, out of scope as well as improper project management plan. Most of the participants are not agreeing with risk tolerance levels; therefore, it influences levels of a project lifecycle. With time, this risk leads to costly to the organization. Hajdu (2013) concluded that most of the risks are related to negative outcomes due to lack of understanding of risk tolerance factors. Therefore, decision making under risk is required to construct the healthcare for aged people so that the healthcare infrastructure should be constructed within time and budget as an estimate (Lam, 2014). The organization should have best organization culture in order to support proper decision taking steps as well as innovation. Pre-construction plan is taken as better decision-making process for selected construction project.

Hwang, Zhao and Toh (2014) stated that in order to overcome with the risks of the construction project, at first a risk management plan is required to identify the risks in the project work. It is the responsibility of project manager to identify emerging risks. For controlling the risks, the project manager should plan for services; estimate the deadline of risks, quality assurance, and analysis of the construction contracts. Hwang and Ng (2013) discussed the risk management plan consists of three processes such as risk identification, risk response as well as risk control. These three processes are required for the construction project plan. Identification of both internal, as well as external factors, is required so that the management team should take possible steps to overcome with those risks for successfully constructs the healthcare infrastructure.

Figure 2: Risk management plan

(Source: Hwang & Ng, 2013, pp-277)

Kikwasi (2013) opined that risk identification determines which risks are affecting the construction project of healthcare. It should be performed on the daily basis throughout the entire project plan. Risk identification deals with both interiors as well as exterior risks of the project. Wirba, Tah and Howes (2012) concluded that the internal risks are a budget estimation and assignments of staff. The external risks are those, which are beyond the control of the project team. The tools and techniques, which are used to identify the risks, are brainstorming, survey, feedback from the employees, workshops as well as interviews (Kerzner, 2013). The risk management team identifies the following risks while constructing a healthcare for aged.

Error in the design of the healthcare infrastructure: The design manager should design a healthcare infrastructure, which should meet the project goals. Hwang, Zhao and Toh (2014) pointed that error in the design of the infrastructure while designing will result in poor planning. The design of the structure is vital for any construction project plan. 

Risk due to not using usual construction agreements: Each of the construction project plans should follow the construction agreements. Grotsch, Blome and Schleper (2013) argued that if the construction team does not follow the construction rules and regulations, then there is a chance of a breakdown of the healthcare building. This particular healthcare project should follow strict rules based on the project plan.

Schedule risk: Within estimated time, the construction of the project is not possible to do. It will influence the finish date of the plan, which gives an adverse effect on the budget (Kendrick, 2015). The time delay is due to lack of resources and improper planning.

Raw materials and equipment issue: In the case of a construction project, the raw materials as well as equipment used not of best quality. Therefore, there is a chance of a breakdown of the healthcare building (Rigby & Bilodeau, 2015). The management should review the quality of the raw materials before its usage.

Procurement risk: There is a risk of lack of specialized expertise for the project work. Sometimes, the experts and labors work for the project have a lack of skills to design the infrastructure. As this healthcare is constructed for aged people, therefore it uses many advanced technologies equipment to build the IT infrastructure (Driver & Bernard, 2012). If the labors have the lack of technical knowledge, then they are not able to construct the proper infrastructure for the project work. 

Security risk: The security of the blueprint of the healthcare infrastructure is required. The share of the blueprint with others as well as any third party should hamper the entire project work (Kendrick, 2015).

The risk of not putting project insurance: The risks arise when the construction team is not placing project insurance when the project is valued of $1 billion. They are required to put their plan under the construction insurance program. The insurance policies of the contractor are not covering the policies under the insurance rules and regulations.

Budget risk: A construction project requires a high value of cost to build the building. As it is healthcare construction plan, therefore high cost of equipment is required for the aged people to take care of their health (Pritchard & PMP, 2014). However, the plan requires enough funding.

Wirba, Tah and Howes (2012) opined that within the construction project, scheduling of the project plan is considered as mainly critical factors. In order to analyze the identified risks, PERT technique is used to identify the duration of the risks for the project work. This technique takes part of the uncertainties, which are recognized in the construction process. Due to the risks in the project, it takes more time to complete the plan as estimated. Grotsch, Blome and Schleper (2013) stated that the PERT technique is used to carry out the schedule risk assessment of the construction project. It will stimulate the time taken by each of the risks. Then, the actual time was taken and probability to complete the plan is estimated.  Hwang, Zhao and Toh (2014) stated that using the PERT technique; the construction team could identify the total duration of the identified risk in the project plan. In order to estimate the total time, at first optimistic, pessimistic and most likely time are estimated for the risks to occur. Mansfield et al., (2015) opined that optimistic time is the shortest time taken by the risk to be mitigated. Pessimistic time is the maximum time period to be taken to complete it. It has assumed that those risks can exceed the total time from the estimated time. Wirba, Tah and Howes (2012) argued that most likely is the time taken by the team to analyze it if it is repeated time by time.

The risk analysis is done using the risk register matrix; the identified risks are categorized as shown in the below table. The risks are identified based on its probability and impact on the healthcare construction project plan (Driver & Bernard, 2012). Each of the types of risks is ranked based on its consequences on the project plan.

Risk ranking	Risk types	Responses	Impact	Likelihood	Probability
1	Design error	Accept	Medium	High	Very high
2	Usual construction agreements	Mitigation	Medium	Medium	Moderate
3	Schedule risk	Accept	High	Low	Moderate
4	Raw materials and equipment risk	Accept	Medium	High	Very high
5	Procurement risk	Mitigation	Medium	Low	Moderate
6	Security risk	Accept	High	Medium	Moderate
7	Not putting insurance	Avoid	Low	Low	Low
8	Budget risk	Accept	Medium	Medium	Moderate

 

	Impact
Likelihood	Very low	Low	Medium	High	Very high
Very high
High			Design error, Raw materials and equipment risk,
Medium			Usual construction agreements, Budget risk	Security risk
Low		Not putting insurance	Procurement risk	Schedule risk
Very low

Figure 3: Risk register matrix

(Source: Driver & Bernard, 2012, pp-267)

The following table shows the possible time taken by the team to analyze each of the risks based on its effects on the project plan. For doing the quantitative risk analysis, PERT technique is used to identify the total time taken to complete the analysis of the risks (Hajdu, 2013). The formula used to calculate the total duration for the identified risks is:

t_e= (t_o + 4* t_m + t_p)/6

where, t_e= expected time

t_o= optimistic time

t_m= most likely time

t_p= pessimistic time

Risks analysis	Optimistic (to) in days	Most likely (tm) in days	Pessimistic (tp) in days	Total duration (te) in days
Design error	6	12	30	14
Usual construction agreements	3	6	15	7
Schedule risk	3	9	27	11
Raw materials and equipment risk	4	19	28	18
Procurement risk	3	9	27	11
Security risk	2	5	8	5
Not putting insurance	1	4	7	4
Budget risk	6	12	30	14

Risk type	Response	Comment
Design error	Accept	The Design Manager gives a response to this risk by proper designing of the blueprint of the healthcare building.
Usual construction agreements	Mitigation	It is mitigated by following the construction agreement while constructing the buildings (Wirba, Tah & Howes, 2012).
Schedule risk	Accept	Proper estimation of schedule
Raw materials and equipment risk	Accept	Proper collection of resources as per the construction requirements
Procurement risk	Mitigation	Recruitment of proper experts with accurate skills and knowledge of construction (Grotsch, Blome & Schleper, 2013).
Security risk	Accept	Authorization of the information is required.
Not putting insurance	Avoid	Insurance risks are avoided as it is based on company’s requirements. If it is not required, then it cannot give bad effect on the construction (Hajdu, 2013).
Budget risk	Accept	Proper estimation of budget

Type of risk	Risk owner	Mitigation process
Error in the design of the healthcare infrastructure	Design Manager	The manager should design an accurate blueprint for their healthcare infrastructure.
Risk due to not using usual construction agreements	Project Manager	Proper follow and support of the construction rules and regulations should be done (Mansfield et al., 2015).
Schedule risk	Project Manager	The person should estimate the schedule of the project plan as per the requirements of the construction work.
Purchase order issue	Procurement Manager	The requirements equipment as well as raw materials are purchased on time otherwise, it delays the entire project duration (Hwang, Zhao & Toh, 2014).
Procurement risk	Procurement Manager	Recruitment of required skills experts is to be done.
Security risk	Risk Manager	The data such as blueprint, financial report should be kept secured from unauthorized use of third party person.
Risk of not putting project insurance	Project Manager	Insurance policies should be followed before starting the construction work (Thamhain, 2013).
Budget risk	Project Sponsor	The person should estimate the budget of the project plan as per the requirements of the construction work.

Mace et al., (2015) stated that the contingency plan for the construction project helps to mitigate the identified project risks during assessing the risks if there are chances of increasing the risk and gives an adverse effect on the healthcare project plan.

Risk event	Contingency plan	Trigger	Responsibility to make contingency plan
Non-delivery of the raw materials and equipment on time	Pre-ordered of the raw materials before appointment of contractors	Support from the top management team	Supply Manager
Lack of availability of resources	Recruitment of more resources is required with best skills and knowledge to work on a construction project (Kendrick, 2015).	It is not solved in 1 day.	Procurement Manager
Risk of getting approval	Early consultation with the government is required to get permission to construct the healthcare for aged people.	Support from the top management team	Project Manager
Failure in ICT	Establishment of back up procedures before failure of the ICT services (Mace et al., 2015).	Failure in the equipment	Project Manager
Lack of equipment	Required equipment should be ordered before starting the construction work.	Still, it is not solved in 7 hours.	Procurement Manager
Lack of funds	Pre-collection of a fund is to be done before a shortage of money for the project.	Support from the top management team	Project Sponsor

Bromiley et al., (2015) stated that funds are covering the risks of this construction project are the contingency funds. After preparing the contingency plan, the project manager estimates the total funds required to mitigate the risks. Hajdu (2013) concluded that there are two types of the fund for the project such as budget management reserve fund. The budget reserve fund is to be set up for those risks, which are identified, and management fund for those, which are still not identified. In order to make progress in the project, the budget reserve fund for the project decreases. Based on the assumption, the following contingency funding is categorized as follows:

Risk types	Budget baseline	Budget reserve	Project budget
Design error	$400	$15	$415
Risk due to not using usual construction agreements	$300	$16	$316
Schedule risk	$200	$18	$218
Purchase order risk	$200	$23	$223
Procurement risk	$340	$25	$365
Security risk	$450	$23	$473
Risk of not putting project insurance	$230	$21	$251
Budget risk	$380	$11	$391
Subtotal	$2500	$152	$2652
Management reserve	——-	——	$50
Total	$2500	$152	$2702

Driver and Bernard (2012) opined that change control is considered as the process which is mainly used to recognize, document as well as approve the changes to the construction project work. The change control process for this construction of healthcare project considers the following elements such as:

Documentation of the proposed changes: Bromiley et al., (2015) opined that in order to overcome with the construction risks, the change request is to be documented properly such that all the management team should be informed about the change request status.

Documentation of new construction rules and regulations: The new rules, as well as regulations of the construction project, should be documented such that the construction team should follow it at the time of building the healthcare infrastructure (Thamhain, 2013).

Testing of the quality of raw materials: Hajdu (2013) argued that the project manager properly checks the quality of the equipment as well as raw materials such that no quality assurance risks occur in the project.

Development of construction standard: Each of the construction standards is developed as per the business requirements. It should be constructed in such a way such that the place should be comfortable for the aged people.

It is concluded from the literature review is that use of new advanced technology for construction of healthcare for aged people increases their level of satisfaction. However, there is a high probability of occurrence of risks in the construction project. Therefore, the project should manage their risks by following a risk management plan. Their plan should make sure that the aged people and other people are satisfied with renovations of their healthcare based on rules and regulations, federal as well as local laws. The risk management plan consists of three processes such as risk identification, risk analysis and risk control to overcome with the risks. In order to analyze with identified risks, quantitative and qualitative risk analysis are to be done. Qualitative risk analysis is done using risk matrix, and quantitative risk analysis is done using PERT technique. It is used to carry out the schedule risk assessment of the construction project. It will stimulate the time taken by each of the risks. Finally, contingency planning and funding is done to mitigate the risks in the construction project.

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