Reinventing the Hospital – A Study of Lost Synergies in Danish Healthcare

The purpose of this study is to identify the effects of inter organizational relationships in construction projects by investigating how complexities are manifested in variance and repetitions across projects. The case is a set of 27 hospital projects in Denmark including new buildings as well as extensions of existing hospitals. The key empirical material consists of detailed drawings of each of the projects along with information of the participating organizations. The implications of the interorganizational relationships is studied thorough a theoretical framework of modularity by looking for variance and repetition. The analysis shows that the projects are designed for each specific location (region) with unsystematic and limited use of processual, organizational and technical repetitions. Overall, the projects are executed in parallel and follow the same phases with a high degree of user involvement in each of the projects; here inputs are gathered for the specific project that subsequently is designed by a unique team of architects and consultants. Although some of the participating companies are involved in several projects (especially as the client consultant), there is a high degree of variance in the project teams. Despite the variance of the project teams the overall and detailed design of the hospitals look remarkably the same. However, a detailed analysis of the patient rooms reveals that although 70% of the projects use the same architype (the L-type) they are different from each project. This lead us to the conclusion that the hospital is reinvented in each project leaving behind unrealized potential for leveraging similarity across the projects. This could have been achieved by a stronger central coordination, thinking of super hospitals as programs and portfolios rather than individual projects.