El pensamiento económico cubano y la política de empleo

This section presents the findings about design quality stakeholders and the matrix exercise. Together with aiding stakeholder identification, the use of the matrix especially helped the participants to convey their perspectives about the position of stakeholders in comparison with each other. As mentioned in section 4.3.2, the analysis of the matrices was performed in two manners, i.e., in-case and cross-case. To avoid repetition, the findings are presented here based on the latter and for seven stakeholder groups as sub-themes (table 4-4).

Sub-Themes for Theme Three

Patients &

visitors/families Clinicians & non-clinical staff Facilities managers Architects Builder contractor Client body Government/Regulators

Table 4-4: sub-themes under the Theme Three

Design quality in healthcare buildings represents a large number of stakeholder groups: ‘we may have 15 to 20 different stakeholders’ [P1-6], ‘there are too many stakeholders usually’ [P1-8].Figure 4-3 shows how the participants mapped the stakeholders they identified for healthcare settings. Photograph of one of the filled matrices is given in appendix A. 17 stakeholders of healthcare environments were collectively identified on the matrices and positioned based on how much they could affect or were affected by design quality, in the participants’ perceptions. In the followings, the results are discussed for the different stakeholder groups.

4.4.2.1 Patients and visitors/families

The position of the ‘patients’ on the matrices clearly implies that they are highly affected by design quality but left with limited influence on related decisions in the participants’ viewpoint (figure 4-4). They are repeatedly located at the lower right corner. The built environment can affect the patients in different ways from medically related aspects to general wellbeing way-finding and reduced infection (Ulrich et al., 2010; Huisman et al., 2012). On the other hand, their input, if any, according to P1-1 and P1-10, is mostly on aesthetics and are relayed by a liaison. Lawson (2010) similarly indicated that many stakeholders in healthcare projects have little or no voice in the briefing process. Mat6 (matrix 6) shows a relatively moderate impact of the building on the patients. According to P1-11, who was referring to primary healthcare centres, this is because the patients stay a short time in these spaces so the environment does not affect them that much. This suggests that the design quality impact upon patients and other stakeholders likewise, can vary by building type.

Figure 4-4: Matrix results for stakeholder ‘Patients’

Visitors and patients’ families are affected less than patients according to the participants but still there is a marked discrepancy between how much they can affect design quality and how much they are affected by them (figure 4-5). With the exception of the Mat2, this group is located at the lower centre of the matrix space. In Mat2, the interviewees considered the visitors/families to be highly affected by design quality especially in children hospitals

where parents or siblings often stay and sleep with the children. Huisman et al. (2012) mentioned that visitors may play an important role in patient’s recovery.

Figure 4-5: Matrix results for stakeholder ‘Visitors/Families’

4.4.2.2 Clinicians and non-clinical staff

The next major stakeholder group are the people working as the staff in healthcare buildings. These include doctors, surgeons, nurses, GPs, Physiotherapist, receptionists, cleaners, hospital managers etc. The clinicians, among these, were considered by all the participants to be affected highly by the design quality and also with high influence on related decisions (figure 4-6). They are located on the top right corner of all the matrices. Compared with the patients, these are considered to be equally or sometimes even more affected. Unlike the patients, the participants found them to be involved in design quality decision-makings and more regularly present in the stakeholder workshops. Even P1-2 believed this high power is ‘at the expense of other people’.

Unlike the clinicians, the non-clinical staff, e.g., receptionists, cannot affect the decisions proportionate to the level they are affected by from the viewpoint of the participants (Figure 4-7). Similar to the ‘patients’ and ‘visitors/families’, they are not very much involved in the decisions. However, as P1-2 said, they should be more engaged.

Figure 4-7: Matrix results for stakeholder ‘Non-clinical staff’

4.4.2.3 Facilities Managers

Facilities Managers (FMs) are another stakeholder group responsible for right operation of the building when in use. The results from the matrices show that design quality impacts highly upon FMs despite somewhat less than that on patients and clinicians. However, how much they can affect varies across the matrices. Although P1-2 believed they, in general, ought to be much more important than they are, in some projects their presence in decisions is required contractually.

4.4.2.4 Architects

Architects or the design team from architecture firms are a key stakeholder group of design quality. The participants considered a fairy high power for this group in influencing design decisions (figure 4-9). P1-6 stated that the way the architects usually affect the design is not by making the final decisions but by providing alternative solutions; ‘People make choices and select options but we influence the options’. While the influence of clinicians is mostly on the specialist equipment and services and the influence of patients on the aesthetics side, P1-2 believed the architects can influence all aspects of design.

In terms of how the architects are affected is on a different level to the way users are affected, that is ‘in a commercial sense’, according to P1-11. Whether the architects deliver a high quality design or not can affect their reputation to become engaged by the client again and also in terms of the lessons they learn for future projects.

Figure 4-9: Matrix results for stakeholder ‘Architects’

4.4.2.5 Builder Contractors

The results from the matrices for builder contractors show inconsistency in opinions, similar to the FMs. The Mat5 and Mat6 indicate that this group is affected modestly by the design quality, whereas the other matrices tell a different story. The variance can be seen for both the extent to which they are affected as well as their ability to affect the design quality. ‘It varies enormously depending on the project, P1-2 said. For large projects they have more power and are more affected compared to small extensions or refurbishments,

according to P1-6. In more recent procurements systems - referring to the PFIs - P1-8 believed ‘they now have a far more influence, they become the client’. In contrast, P1-2, P1-11 and P1- 12 perceived moderately low influence from contractors on design decisions, based on their experience. ‘They don’t get a huge amount of input in the decisions’, said P1-11. Some showed dissatisfaction with contractors’ high influence. P1-8 referred to the ‘intense conversation’ they have with contractors sometimes. P1-11 went further by saying:

‘They will build whatever is on a piece of paper and it doesn’t matter if it doesn’t work because it is not their responsibility, this is our responsibility. They benefit from the success of our scheme.’ [P1-11]

Figure 4-10: Matrix results for stakeholder ‘Builder Contractor’

4.4.2.6 Client Body

The client could denote different groups or individuals in different projects. They could themselves be users or a hospital board. In our matrix exercise, groups like the NHS Trust, NHS Estate Team, and developer are categorised as the client body. This point was also reflective in some of the comments like ‘it's not just a person in a hospital’ [P1-1] or ‘the client in a healthcare building is not one person it is always maybe about 15 people’ [P1-6]. This point has been also raised by the Sengonzi et al. (2009) that especially for organisations like the NHS, the client is not a single point of contact but comprised of several interest groups. The client was considered as the ‘ultimate decision makers’ [P1-4] with very high

influence on design quality and similarly with high responsibility in terms of what it becomes in the building.

‘They just dictate the whole of the project, rather than really one of the separate attributes, they influence lot of the attributes. They make decisions about the overall project’ [P1-6].

4.4.2.7 Government/Regulators

The ‘department of health’ was identified in all matrices and was consistently positioned in the top left quartile. P1-10 described them with ‘high and considerable influence on design decisions’. Setting programs of investment and commissioning design guides are examples of how they affect design quality in projects, as brought up by P1-2 and P1-8. Although this group is not equivalently affected according to the matrices, the quality of buildings also affects them, as they are ‘responsible for the nation’s health’ [P1-2].

Figure 4-11: Matrix results for stakeholder: Department of Health

Politicians and the treasury were identified in two matrices with high influence yet considered to be increasingly remote by the others. Local authorities, unlike the politicians, were seen to have more influence on design quality decisions recently especially for community health centres. In most matrices, they are considered to be fairly equal in terms of both axes. Par1-11 pointed out that it is literally us going to meet them.