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B+H+STH; A Case Study of Evidence-Based Design Influencing IPU Design Under a Public Private Partnership Process Ontario, Canada

January 2010
EDAC Advocate Firm Project
A Case Study of Evidence-Based Design Influencing IPU Design Under a Public Private Partnership Process Ontario, Canada


Firm's role on the project: Design, build and maintain. 

EBD Goal

A 960,000-square foot greenfield site regional hospital is being designed, built, financed and maintained (DBFM) for 30 years in Ontario, Canada under an AFP (Alternative Finance Procurement) process, a form of public private partnership delivery, which is now the norm in most of Canada, Europe and Australia.


B+H Architects (B+H) in joint venture with Silver Thomas Hanley (STH) are part of the successful DBFM consortium team. In response to a prequalified RFP, we had to deliver full schematic design to comply with a nearly 10,000 page Project Specific Output Specifications (PSOS) document which included an Illustrative Design (ID) outlining both operational and facility requirements.


We chose to empirically challenge the typical medical/surgical inpatient unit layout and program provided in the PSOS and ID. Following our successful selection for the project, we worked with the client group, the project development consultants, and the Health Ministry in a collaborative atmosphere to develop a solution based on evidence based principles as applied to this new facility. Our goal was to develop an alternative plan for the typical Inpatient Unit (IPU) reflecting more efficient operational principles whilst maintaining the requirements of the PSOS and the client vision of patient and family-centred care.


We utilized generally accepted nursing and clinical metrics for a hospital in this Canadian province and compared our design against the Illustrative Design. We, with the Client, the project development consultant and the provincial Ministry of Health, took this analytical information to create our review process to determine how, justified based on agreed outcomes, we would arrive at required changes to the PSOS. Specific testing included the construction of full-size mockup inpatient rooms as part of our assessment of our hypothesis.


A monitoring process for this project has been implemented as prescribed by the provincial government for the AFP public private partnership process to review the quality and conformance of the design to the PSOS. Implementation of the post–occupancy performance process is currently under consideration with the client, the Health Ministry, the provincial government’s project management agency, and our team within the confines of the AFP process. 

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