Introduction
This document is a decision document whose aim is to carry out analysis of the possible sites and come up with a decision on the location to build a hospital for the Mid South Hospitals NHS trust. The project will be financed by several companies which include banks, building firms, developers and service providers.
The hospital once completed will be run by the Private Finance Initiative (PFI). Large scale buildings such as this hospital would in the past be financed by the treasury but under the private finance initiative they are put out to tender. The private consortia is given the opportunity to build the new facility and then lease it back to the NHS along with non clinical support such as maintenance, catering, cleaning and laundry.
The consortium is then paid an annual unitary payment by the NHS trust. These payments are higher than those that the treasury would have paid if it had financed the project. The payments also flow back to the coffers of the private companies that make up the consortium instead of circulating back to the NHS. This results in an increase in the return to investment. The returns that will come up after winning the contract are enormous and therefore this document provides in depth analysis of the locations to ensure that the contract is won.
The current hospitals in the region are old and cannot cope with the current medical demands of the residents. The facilities in these hospitals are also not updated to the current technology and therefore the need to develop a state of the art facility for this region cannot be overlooked.
Another problem that faces the area is whether to construct one large hospital at a centralized location or many hospitals at different locations in the area. The construction of one large hospital is favored by the consortia since it will result in the hospital being able to provide excellent special treatment centers across a wide range of specialties. The hospital will be able to attract more medical specialists.
This option however faces some drawbacks since the area does not have a good bus transport system and getting a specific location where its accessibility will not be affected to a great deal become problematic. Before making a decision on the preferred site, it is important to examine in detail the potential sites which may act as the location for the hospital. These are examined below.
Sites
Potential site A: Old Colliery
This site is a disused mining site and needs a considerable amount of investment to clean it up and sterilize it before it can be built upon. The landscaping of the area is currently being done and also the infrastructure is being improved. On the other hand, the transport network for the area is poor and the quality of housing for the area is also poor.
There are no green areas around the place meaning that the environment is not well conserved. The advantages of this area is that there is availability of unskilled and semi skilled workers who may prove an advantage if the project is initiated in this region. The locals and the politicians will also not be opposed to the construction of the hospital in this region.
Potential site B: Dams Nature Reserve
This site is close to a railway station and the bus services in the area are good. The quality of housing in the area is also good. It has a large number of golf sites and also a good green space. The reserve however has been declared a site of special scientific interest. This is due to the presence of Great Crested Newts in some ponds and westlands. There is also a species of some rare water insects present in this area.
The place may give a good return to investment but at the expense of the scientific research being carried out. The activists for environment oppose the choice of this site and if chosen, their opposition may result in delays before the ground breaking activities to build the hospital start.
Potential site C: Derelict Woolen Mill Complex
This site has a good motorway access. The place also has quality housing units and the cost of these houses in this region is low. This has resulted in more young workers opting to flee from other areas to come and live in this area. It is also a busy area, built up and has many residential houses. It is also the second most populated in the district.
After careful analysis of the three possible sites that have been listed above and some of their advantages and disadvantages mentioned, it was decided that the Derelict Woolen Mill complex served as a better location to build the hospital. This is based on the factors that are discussed below. The location is has an already established transport network that needs only a few adjustments once the hospital is built.
This is advantageous since the accessibility of a hospital facility is one of the most important aspects before deciding on its location. This is advantageous to it since a look at the Old Colliery shows that the area does not have a proper transport network. The patients and also the health workers will therefore have a hard time to access the hospital.
The transport infrastructure for this area needs to be built from scratch and this will affect the returns to investment if the hospital is built in this area. The shareholders would demand a return of 15%-20% per year and this value would be reduced if the cost of building infrastructure is also included. The Dams Nature Reserve also has a good transport network but the delay that will be caused by the problems of the environment will delay the construction of the hospital.
The site also experiences an influx in the number of young workers. This is advantageous since it would result in the availability of low cost labor. The workers fleeing into the area are young and may be unskilled, semi skilled and also skilled. This will ensure that the availability of labor is not a problem for this region.
The presence of housing units in the area also acts as an advantage. This is because the workers will be leaving within the environs of the construction and therefore there will be no delays in terms of the time of arrival for commencement of duty. The workers will not be opposed to working overtime when the need arises since they live in the nearby areas. Under these circumstances, the consortia will not be subjected to extra costs such as those of offering transport to these workers in case they work overtime.
The cost that is involved when this site is chosen is also mainly due to the construction of the hospital. The additional costs that the consortia may be subjected to are not so much as compared to the other potential sites. This is an important parameter since these additional costs will affect the consortia’s return to investment. For the case of Old Colliery, the site may be subjected to additional costs due to the need to clean the site up before the construction commences.
The site will also need to be sterilized and these costs may prove to be enormous. Other costs that the consortia may incur include those to improve the landscaping and infrastructure of the area. The Dams Nature Reserve will also have additional costs in case it is chosen. This is because the environment conservationists will not allow them to do away with the species that are currently under research.
The option that the consortia will have is to relocate these species. This is not an easy task and may require a lot of funding to be able to provide the same conditions for the species in a different location. The location of the hospital at the Derelict Woolen Mill Complex will ensure that these additional costs are avoided.
The site also provides attractive housing units that may serve the professional staff at the hospital. The area has been developed to be a residential area and the housing is also cheap. This has resulted in the young people moving to occupy the houses in this region. The location of the hospital in this region will therefore ensure that the health professionals are able to be comfortable living in this area as the quality of the houses is high and they are also cheap.
Compared to the other sites, this is the most viable location. For instance, the housing in Old Colliery is poor and the health professionals may not find it attractive to work in this region since the accommodation will not be readily available. They may opt to work in other health facilities where there accommodation will not be problematic.
The importance of having accommodation near the health facility is to enable the health workers to respond quickly to situations such as emergencies. The cost of transport to and from the working environment is also minimized.
The district also faces health deprivation and since this problem is evenly distributed throughout the district it is best to choose a location in the district that will have a large population. This will ensure that a large number of the district’s residents get access to the health facilities and this may intern help to reduce the deprivation of health in the district.
Since woolen town is the second most populated town in the district, the location of the hospital in this area may prove to be an important factor in ensuring that this is achieved. This town is also easily accessible from other areas and this may also prove to be an added advantage since it may not act as a barrier to the people living in other towns.
Political issues may also serve to affect the location and how the hospital construction is carried out. This is primarily because the district has two parliamentary constituencies within it. This will prove to be a hindrance since the representatives of these constituencies will want the hospital to be in their constituency. The eastern part of the district is represented in parliament by Jerry Bourne while the western part is represented by Hillary Thompson.
The latter still wants to vie for the seat and will do anything to ensure that he gains support from the members of her constituency. Another problem that arises is that her constituency’s boundary will be altered before the next general election if this project is initiated. This will make her seat marginal and she is not for this. She wants the hospital to be built on the western side.
To solve these political issues on boundaries, it is necessary to hold a meeting between the leaders of these two constituencies together with some members from these two areas. Discussion on the overall impact of the location of the hospital and how it may improve the communities well being should then be conducted. The economic problems in the east are by far more than those on the west. The employment opportunities in the west are also more compared to those in the east.
The politicians should be able to curb their needs for the benefit of the entire society and during this meeting; this should be passed to the two politicians. The building of the hospital in the west will serve to improve the living standards of those living in this area.
Those in the west should support this measure since it will also help to reduce the increase in the population in their area as more people will not be moving to this area in such of employment. Therefore, the main way in which these political issues should be solved is by ensuring that the politicians do not put their needs before those of the people who they represent in parliament.
Other factors that affect the location of the hospital include health and education deprivation. The choice of the Derelict Woolen Mill Complex will ensure that the standards of living in woolen town are improved. This is important as the measures of poor health such as low birth weight and increased hospital admissions are seen in this town. The construction of the hospital in this area will ensure that the health workers promote good medical practices in the communities that live around and also away from the hospital.
The hospital will also attract more residents settling in the area and this may result in education centers coming up to serve the new and increased population. These education centers will also serve to improve illiteracy in the area and consequently reduce the level of education deprivation in the area. The hospital will also help in improving the skill level of the people living in the area it is built. The choice woolen town also serves to ensure that the skill level of its inhabitants, which is low, is considerably improved.
Evaluation of the decision making process
The decisions that were made on the location of the hospital were made after careful and thorough analysis of all the available options. The conclusion to which site would be most suitable was therefore reached without many thoughts that were contrary to what was decided.
This decision making process was involving and several models of decision making were considered throughout the process to ensure that the optimum decision was made. These models together with the evaluation of the process are explained in this section of the document.
The first model that was considered during this process is the rational decision making model. This is a model where all the constituents are analyzed qualitatively before the decision is made (Savage, 2003, p. 87). It also involves the evaluation of the advantages and disadvantages of the areas in question. It is also mandatory to carry out strengths, weaknesses, opportunities and threats (SWOT) analysis to be able to make the most appropriate decision. For the case of the location, the three potential locations were analyzed to a great extent.
Their advantages and disadvantages were compared to be able to establish what the most viable option is. For instance additional costs that will be incurred when constructing the hospital at all these sites was analyzed. From this analysis, it became clear that the construction of the hospital in either Old Colliery or Dams Nature Reserve would be costly as opposed to constructing it in Derelict Woolen Mill Complex.
Through this cost analysis and the fact that the investors would want a high return once the construction was completed, it was important to ensure that the construction costs are minimum and any additional costs that can be avoided are avoided.
The number of workers that are present in Woolen town was also compared to those available to the other areas. By conducting a decision matrix analysis, it was established that Woolen town had a competitive advantage compared to these other towns.
The population of the town was increasing and most of the people coming in were in the different areas of the labor field. These included the unskilled, semi skilled and those that were skilled. The addition of these people to the labor market acted as advantageous to this area as it would ensure that the labor needs of building the hospital are met without any problems.
Comparison of the housing units that are available in all these regions also serves as an element of the rational decision making model. These units together with their costs were examined and the standards and the cost of the units in Woolen town were chosen. This is because they were competitive enough to serve both the health professionals once the hospital’s construction is completed and also the workers during the construction period.
This is because both these sets of people are important to ensure that the hospital is developed and once it starts its operation, it is not affected by factors such as the lack of health personnel. The quality of the apartments is high. They are built from the large old stone built mills. This were abandoned in the 1970s and 80s and their renovation results in the development of these apartments.
These apartments are also cheap and as a result the young employees are fleeing to occupy them from the expensive apartments and houses in other towns. Comparison between these prices of accommodation and the impact it has on the labor market was therefore conducted. Therefore, the application of the rational decision making model was used to its maximum efficiency and the decision made out of its use was the best possible.
The intuitive decision making model was also used during the decision making process (Duane, 2004, p. 237). This model is based on evaluating the available options and coming up with a projection based on your own thoughts about the situations. This process is normally not used as it mainly involves a person’s perspective of the entire situation (Jae, Hartman, & Siegel, 1997, p. 345).
For the choice of the location of the hospital, the intuitive model was used to predict which location will be chosen when considering the scientific interests in Dams Nature Reserve. While comparing this location with the other locations, it was decided that the cost of moving the species under research found in this area to other areas will be costly and the movement will affect the return to investment.
This conclusion was based on the fact that finding a new area to place the species and providing them with the natural conditions that they were experiencing would prove to be difficult and costly. By intuition it was also established that the environmentalists will delay the start of the construction of the hospital if this location was chosen. This is because they were opposed to this location being subjected to the changes that would have ensured that the hospital is built without any problems being encountered.
These changes include the relocation of the species and clearing of the area to facilitate construction. It was also viewed that the environmentalists would even consider going to court and delay any activities from taking place in case this location was chosen to host the hospital. A combination of all these factors ensured that this location was not chosen leaving only Old Colliery and Derelict Woolen Mill Complex as the viable options.
These two options were then examined and the model also applied to them. While comparing these two options, cost also came up as a factor to be considered. The projected cost of ensuring that the infrastructure was well laid in Old Colliery was also perceived to be high compared to those that would be used to renovate the transport network in Derelict Woolen Mill Complex. This resulted in the choice of the latter since entirely the cost of the project plays an important role in the choice of the location.
The intuitive model is mainly based on guesses. These however have to be guided with facts and figures to support it and ensure that it results in the coming up with a decision that is analytic and does not favor any party. It therefore should ensure that all the factors are put into perspective before the decision is made.
In the quest to establish the location of the hospital, this model was used in situations where the projections beyond what was given were not available. It was used as explained above and its effects were found to conform to the conclusions that were established by the use of other models of decision making.
The recognition primed decision making model was also used. This model involves the checking of patterns and being able to analyze them and consequently make decisions based on the analysis of the patterns (Yoe, 2011, p. 102). These patterns are normally very important in any decision making process as they help in predicting the future outcomes of a particular process. Several patterns were checked in the quest to determine the best location for the hospital.
These included the health deprivation rates, the education deprivation rates and also the trends in the skill levels between the people living in the proposed locations where the hospital was to be located. New jobs were seen to bypass the older urban areas and therefore these areas suffered an economic decline.
The wages in these areas were also low and the economy was composed of people who had little or no skill. Improvement on the state of these regions needed to be done and this would be necessitated by the building of the hospital in this region. The hospital would attract more skilled labor and this will serve to teach the locals and therefore improve the level of skill in this economy. The trend on the population in the west was on the increase.
This is because the western side of the district had more employment opportunities which were more accessible. This increase in accessibility of jobs in this region resulted in people moving to this region in search of jobs. The east suffered due to this as most of its young population moved leaving behind only the elderly who cannot take part actively in the building of the economy in this region. These factors when put into perspective showed that the east would be the most viable option to build the hospital.
This is because it would limit the migration of the people to the west since job opportunities will also come up in this region. The public health in Woolen town is also of a higher. The heath deprivation is mostly suffered in this area and the availability of a large hospital in this region will serve as an advantage. This is because it will help increase the accessibility of medical care to the residents of this area and the district as a whole and therefore help in reducing the deprivation of health to the communities.
The analysis of the trends helps in ensuring that the trends that result in a negative impact are controlled and eventually eliminated and those that are positive are encouraged. The trend analysis provided a good base to ensure that an appropriate location is selected.
This location as a whole would therefore serve community and help in improving the standards of living of the members of the community. The analysis was also important as it ensured that the best location that will also be of economic importance to the consortia that builds the hospital is chosen (Munday, 2012, p. 76).
The political issues facing the consortia also proved to be a factor during the decision making process. This involved both parties that had political interests wanting the construction of the hospital to favor their political ambitions. The decision on ensuring that the needs of the people were put before the needs of these political aspirants was reached. This is because an analysis of the standards of living of the people living in the entire district was carried out and the results showed that these standards were fairly low.
The building of the hospital would in some way increase these standards and any attempts to slow down this process were eliminated. The argument that the Member of Parliament from the western part of the district, Hillary Thompson had that the hospital was to be build on the western part of the district was seen as being political. It would only serve to give him an upper hand in the political race in the forth coming elections.
On the other hand, the people on the east suffered and if the hospital was built in this region it would serve to increase their living standards. These options were weighed and it was decided that the well being of the majority which is the community should be considered first.
This therefore resulted in the conclusion that the hospital be built in the east so that it may improve the illiteracy level in this area since it will encourage the development of other social amenities such as schools. It would also increase the accessibility of health facilities to the people of this area who are subjected to health deprivation. Research that was conducted in this area also showed that the area suffers poor health.
This was evident due to the birth weight of the children being low. The number hospital admissions due to cardiovascular diseases and cancer were also high. The politicians were therefore encouraged to consider the well being of their constituents and also that of their neighbors and through this initiative, the decision to have the hospital built in Woolen town was reached.
The above explanations show that before the decision was made various models that are used to help in coming up with the most appropriate decision were analyzed. This ensured that the decision that was finally settled at will be the most viable one. It therefore has covered all the pros and cons of all the three locations that were being analyzed. All the possible decision making errors have therefore been eliminated and the decisions that have been made are considered fit to win the contract.
References
Duane, D. L. 2004, Business Research for Decision Making, South-Western Educational Publishing, Ohio.
Jae, S., Hartman, S., & Siegel, J. 1997, Schaum’s Quick Guide to Business Finance, McGraw Hill, New York.
Munday, J. 2012, Evaluation in Transition, McGraw Hill, New York.
Savage, S. L. 2003, Decision Making with Insight, South Western Educational Publishing, Ohio.
Yoe, C. 2011, Principles of Risk Analysis, Crc Press, London.