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The Nightingale hospitals
We assisted in the construction of these temporary hospitals in order to provide the NHS with additional beds.
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Rising to a challenge

As the UK government scrambled to prepare for an anticipated surge in COVID-19 infections in spring 2020, collaborative behaviours come to the fore. Odilon Serrano explores why.

Dealing with a crisis can bring out the best in people and organisations. A crisis provides clear purpose, requires collaboration, and demands action. And in the early stages of response, people and organisations are relatively selfless, focusing on bringing the situation under control and working with the expectation that recognition and compensation will be sorted out later. It’s in the early stages that collaborative behaviours are at their best.

This was illustrated as the coronavirus pandemic gathered pace in the UK in early 2020. Mott MacDonald wrote offering support to the Department of Health & Social Care on Friday 20 March 2020. This resulted in almost immediate requests for assistance, placing us at the centre of the response. Through late March to May, we took diverse roles in the delivery of four of the UK’s six Nightingale hospitals – healthcare facilities created in exhibition and sports venues to relieve pressure on NHS hospitals. In all we helped to deliver 7000 fully serviced hospital beds in less than two months.

  • London – 4000 beds: While the NHS and Army focused on converting London’s Excel exhibition centre into a hospital, we assessed the site-wide infrastructure needs. As well as providing the project management office service and technical helpline for the whole project, we designed and managed delivery of site access for ambulances, deliveries, staff and visitors; buildings for staff welfare, the ambulance station, storage and vehicle washdown; civils and drainage; clinical waste management; the site-wide fire strategy; perimeter fencing and security; power generation; and traffic management. We started on Monday 23 March. The facility opened on Wednesday 8 April.
  • Cardiff – 1500 beds: We started on site on Monday 30 March within 24 hours of receiving a request for help. We assembled the team and ran the build, handing the first 300 beds over on Saturday 11 April and handing the entire facility over to the NHS on 25 April.
  • Glasgow – 1000 beds: We ran the project management office for conversion of the Scottish Exhibition & Conference Centre on Monday 30 March and completed its conversion into the Louisa Jordan Hospital on Friday 17 April.
  • Manchester – 633 beds: We were asked to manage construction of Manchester’s Nightingale Hospital at the GEC on Saturday 28 March; our team was on site on Monday 30th with work completed on Sunday 12 April.

We worked in teams with other companies, and mobilised trusted partners and collaborators, to provide the required breadth and depth of expertise and capability, across the entire construction supply chain. The ultimate goal was simple and clear: to provide the necessary beds and supporting services so that the NHS could cope with the anticipated surge in coronavirus infections. Clinical performance specifications were set by NHS staff; experts across the supply chain pooled their knowledge and resources to solve other parts of the puzzle, including site access and security, temporary structures, ventilation, supply of medical gases, power and communication.

Crucible for collaborative leadership

To accomplish this, each project had a central co-ordinating and integrating function characterised by an open management structure that promoted:

Communication: Regular briefings using simple, clear tools helped to establish transparency, understanding and trust; robust processes for upward and downward communication promoted engagement and clarity of purpose for individuals and teams responsible for the overall project through to individual tasks.

Rapid and focused decision-making: To achieve rapid progress, decisions were based on best available information, underpinned by robust decision-making methodology; issues were swiftly addressed; all decisions were focused on clearly defined and agreed outcomes.

Gap analysis: Early action was taken to identify and close gaps in knowledge, services, capacity and resources.

Appropriate allocation of responsibility and risk: Individuals and organisations were appointed to roles based on knowledge, experience and skill set; they were empowered to take decisions and get things done, with the expectation that risks would be registered and addressed collaboratively; risk was shared.

Mutual support, accountability, trust and respect: A ‘one team’ culture was established, with all involved working collectively to enable personal, professional and project goals to be achieved; all undertook to keep commitments, own the consequences of their actions and supply information to manage expectations.

Challenge and innovation: Questions and alternative points of view were welcomed to improve understanding of issues and check assumptions; the team culture encouraged new ideas and enabled them to be put into practice without fear of failure.

Continuous improvement: Information and lessons learned were shared across all parts of the project team to achieve real time learning; challenges and failings as well as successes were communicated across teams responsible for different aspects of each project, and between the teams working at each of the different hospital sites.

Simplicity and flexibility: Standardisation and multiplication were embraced to meet the high-volume, repetitive demands of each project; shortfalls in equipment and unique solutions required by the project sites were overcome through rapid prototyping, approval and adoption.

Forward planning: The teams designed and constructed the Nightingale hospitals with a view to future decommissioning, enabling disassembly with minimal waste and the return of materials and equipment to suppliers.

Normalising collaboration

When the pressures of a crisis diminish, parties often revert to contractual relationships and ways of working – collaboration wanes and behaviours can become more self-interested. During the six weeks of intense activity to deliver the Nightingale hospitals, many participants were working at cost and procurement processes were truncated. All involved worked on trust.

Collaborative leadership is about cultivating and sustaining the behaviours that were seen during the crisis response when projects are being run under normal commercial conditions. How we collaborate in a crisis should be applicable at all times, on any complex project. The building blocks are:

  1. Collaborative leadership
    The leader must be clear on what needs to be done, and confident that the team has the necessary expertise. The leader requires the social and emotional intelligence to orchestrate many players, understanding their role in achieving the desired outcome. The leader must be able to make clear decisions under pressure, empowering the team to achieve progress.
  2. Technical competence
    The leader must be able to assign responsibilities to individuals and organisations who are competent. Boundaries, interfaces and interdependencies must be clear. All parties need to respect and value the capability and expertise of others in the team, and be willing to help each other, anticipating needs.
  3. Structured ways of working
    Structured working encompasses communication, managing interfaces, governance, identifying and resolving issues, checking objectives and activities are aligned, and managing risk. It doesn’t have to be complicated – indeed, the simpler the better. But all these requirements require continuous attention and improvement, with communication being especially important.
  4. Clear purpose
    Why we are here. What we are doing. Where we are going. These statements provide a team with common purpose: the collaborative leader must be able to articulate them with crystal clarity. It is important that people believe in the purpose.

This article was first published by the Institute for Collaborative Working in The Partner, May 2021.

View the story of Mott MacDonald’s involvement in the NHS coronavirus surge response:

Odilon Serrano

Collaboration director at Mott MacDonald

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