The private finance initiative, project form and design innovation: The UK's hospitals programme

This paper discusses the role of public demand, in the form of a government procurement policy, in generating innovative solutions for healthcare infrastructure. It considers the effects of the project delivery system (planning, finance, construction and operation) for new hospitals on design innovation. It focuses on hospitals built under the UK's private finance initiative (PFI), which was partly introduced to inject increased innovation into hospital delivery. We use case studies of six early PFI hospitals to argue that the introduction of PFI has increased the complexity at the interface between project delivery and hospital operational functions. The result is a project delivery model which yields less innovative outcomes and produces facilities that might not be able to cope with future changes in demand. The paper suggests that new public procurement models do not automatically provide efficiency and innovation benefits.