Frequently asked questions
Danish Regions' answers to a number of frequently asked questions about investment in new hospital construction are provided below.
Why aren't the regions sharing knowledge and experience about hospital construction?
The regions regularly share knowledge and experience about hospital construction in different ways and at several levels:
- Via formal and informal forums and networks where managers and employees from the construction organisations exchange experience and share knowledge about relevant elements of hospital construction.
- Via 10 guidelines for joint initiatives in hospital construction, where the regions work together on areas such as joint procurement for the projects, equipment traceability and new IT solutions to optimise cooperation with patients and family members.
- Via eight focus areas for the development of content in the new hospitals, where the regions are jointly gathering knowledge, exchanging experience and developing ideas for how the content of the new hospitals can be developed to ensure a dramatic improvement in quality and efficiency.
Where are the regions drawing their knowledge and inspiration about modern, future-proof hospital buildings from?
- A number of countries have invested heavily in hospital buildings over the last 10 years. The regions are therefore constantly seeking inspiration and drawing on experience from hospital construction projects in other countries and using this knowledge actively in their own hospital projects. The Danish hospital construction projects are not starting from 'scratch', but are building on the experiences and knowledge gained from new hospital buildings in other countries.
Why don't the regions build one hospital at a time?
- The construction project timetables are staggered to a certain extent. The simultaneity of the hospital construction projects is an advantage because it leads to a number of positive synergy effects in the form of ongoing knowledge sharing and optimal resource utilisation, for example through joint procurement and tendering.
- If the regions were to build one hospital at a time, the projects would stretch over a period of approx. 75 years, taking only the major construction projects into account.
- Constructing the hospitals at different times would lead to inequality among citizens in the various regions due to the varying quality throughout the health system.
- Delaying some hospital construction projects would also mean that the given regions were unable to make improvements to the acute structure and group specialised functions. The regions would be prevented from enjoying the derived quality and efficiency improvements resulting from the new hospital structure.
Why don't the regions build standardised hospitals based on a national model?
- It is not appropriate to build standardised hospitals across all five regions. There is great variation in the starting point for construction among the regions. Some of the construction projects involve renovations/extensions to be integrated with existing buildings, while others involve new construction on a vacant site. These variations require solutions adapted to the local setting and cannot be accommodated by standardised modular construction.
- There is a long Danish tradition of employee involvement in matters of significance to the employees' workplace, and there are provisions in various legislation and agreements regarding co-determination which support employee involvement. Within the hospital construction projects, it is vitally important for realising the efficiency gains that employees assume ownership of the changes. Standardised modular construction cannot necessarily accommodate the needs and input of employees, and makes employee involvement difficult.
- The regions do plan to use prefabricated and standardised elements in the hospital construction projects, such as prefabricated bathrooms and laboratories.
Why don't the regions build flexible hospitals, as has been done in the Netherlands?
- Flexibility is at the very top of the regions' agenda in relation to building modern, future-proof hospitals.
- The principles the regions are using in their construction planning are basically the same as the principles being used in the Netherlands.
- The regions plan to build with a high degree of generality, making it possible to quickly and easily change the size and functionality of the rooms, such that wards can be converted to outpatient clinics, for example.
Why aren't the regions integrating world-class energy and environmental initiatives into the new hospital construction projects?
- In the buildings being financed by Kvalitetsfonden, the regions are building as energy efficiently as possible within the available budget framework.
- The challenge is that the same total budget has to finance the energy efficient solutions as well as wards, operating equipment, etc. It is not possible to increase the scope of the investment, and the option the regions have of financing energy saving initiatives in existing buildings through loans does not apply to new construction. However, the Government and Danish Regions have begun discussing options for making loans available for energy investments which go beyond low-energy class 2015 of the Danish building regulations.
- The fixed budget and criteria for the Kvalitetsfonden construction projects may mean the regions have to abandon the goal of building according to the highest energy standards – despite the fact that this is less cost-effective from a lifetime economics and social perspective.
Why don't the regions enter into partnerships with private companies in relation to elements of the new hospital construction projects?
- Cooperation with private companies in the form of PPP projects, for example in relation to operation of particular functions associated with the hospitals (such as car parks, central sterilisation departments, patient hotels, kitchens and laundries) does present certain advantages to the regions.
- There are several barriers to entering into public-private cooperation. To date the Government has stated that any PPP projects must be kept within the total budget allocated for each hospital project.
- The regions would be obliged to provide security in connection with PPP projects. Under this obligation, the public party has to provide security corresponding to the private party's investment sum for a period of 25 years, and this money only begins to be released after 10 years, at a rate of 1/15th per year.
- The inability to keep the PPP projects within the total budget along with the obligation to provide security limits the opportunity for PPP cooperation in relation to the new hospital construction.
How have the regions equipped themselves for the task of managing the finances of the hospital construction projects?
- The regions are responsible for implementing the hospital construction projects using the most suitable solutions for the local situation and within the set investment framework. There is therefore a strong focus in the regions on managing the finances of the hospital construction projects.
- Financial management is based on the principles in the KPMG report the regions commissioned in order to equip themselves for managing the large construction projects.
- The regional councils are closely monitoring the projects, for example by following up on the management manuals the regions have prepared.
- The regions are focusing on a secure organisation and careful risk management, so that they can adjust the projects in a timely manner if the conditions for any given project change.
What challenges are associated with the frameworks that exists for the Kvalitetsfonden construction projects?
- When the Kvalitetsfonden funding was allocated, the expert panel stipulated a number of dimensioning principles for the hospital construction projects. These dimensioning principles reflect the applicable legislation and price level at the time the process governing the investments was defined.
- This means that construction must be based over a period of 10-15 years on a static framework reflecting the legislative and economic conditions that applied in 2008, under restrictions that prevent reductions in the number of square metres, etc.
- All the construction projects have been scaled back as a result of the criteria the expert panel has stipulated as a basis for the projects in terms of need projection, capacity utilisation, space requirements and finances.
- In general this means the regions are unable to accommodate any legislative changes which could make the construction projects more expensive.
- However, for each specific construction project, the region may decide which solutions are appropriate in the local situation – taking into account the general principles for better capacity utilisation, etc., as long as this happens within the specified budget framework.