It just got harder...

There is something a little sad about a huge project which is almost finished, almost fully occupied. Camaraderie departed, teams splintered, tension gone. Project director Bob Anderson tries to sum up the atmosphere at the end of the job: "The overall feeling was great, everybody was over the moon. My feeling was not quite as excited as the rest, though, because I thought 'That's what we came here to do'."

It's easy at this point in a project to look back with rose-tinted glasses, to remember a project which ran like clockwork. Anderson cannot recall his darkest day because, he says, he always knew he was going to get the job done

But it has not all been plain sailing. There's been the incredibly drawn-out bid process. And the constant bitching by the press, sniffing for any bad news story to pull down PFI. It's not altogether easy designing and building a hospital as practices and technology change from year to year - sometimes even from month to month.

Anderson is no stranger to monster projects. His two favourites are a £400m petrochemical plant in Moss Morram and the £2.5bn Devonport dock yard. But hospitals are another matter altogether. Before Edinburgh Royal Infirmary, he was Balfour Beatty's regional director for the west of Scotland; they had jobs in the health sector but they were small fry: £3.5m hospital extensions and the like.

So Anderson has learnt a thing or two over the past six years. He's been around the project from the very start, even involved since the bidding stage. And although he cannot take the collective power of the project team when he moves on to the next job, he has to take with him the knowledge they gained.

As the infirmary finishes, Anderson takes on his new role. It's so new that it doesn't even have a name yet. He will be managing Balfour Beatty's design and construction operations for healthcare. His brief is to take the things that worked and make sure they are done better on subsequent jobs.

Balfour Beatty's PFI hospital experience is gradually mounting up. The £96m Durham hospital, whose tender process started after Edinburgh's, is now up and running. That team have now moved south to work on the £90m Blackburn hospital, which is nearing financial closure. There is also University College London, a joint venture with Amec.

As for the future, Balfour Beatty is one of only two bidders bidding for the £420m Birmingham PFI hospital. It is bidding for St Helen's and Wakefield, both worth Around £200m. The make up of the joint ventures vary from project to project

Now it is up to Anderson. He will be trying to use the following lessons to make each Balfour Beatty PFI hospital job better than the previous one:

1. redefinE the standard
Hospital guidance is out of date. There is no list of what the standard ward, operating theatre, or morgue should comprise. On the Edinburgh project, this meant that the bid had to be reiterated 44 times until the desires of the end-users, the clinical staff, met the affordability limits that the Trust and the Lothian Health Board had established. Sometimes this might mean reducing floor space. And sometimes this meant reconsidering what fixtures and fittings were necessary.

"I think there should not really be any discussion about what goes into an operating theatre, for example, because the key bits are the same. The choice that the end user should be involved in is the bits you see, the finishes: flooring, colours, landscaping," says Anderson.

Andrew Smith, who was project manager for the service providers Consort, has some problems with this approach however: "There is no point at all in the design team saying 'this is what we did in the last hospital'." Powerful consultants at the forefront of their profession, like those in Edinburgh, will not want to be governed by architects, he says.

However the Clinical Standard Board and other bodies are working to try and set up standards, so that the way care is delivered is more comparable at whatever hospital.

2. communicate
Imagine a group of architects, M&E designers and healthcare professionals sitting down to have a 'clear the air' conversation about what a new hospital could involve. A wealth of unfamiliar jargon on both sides.

"You have got to work hard with people to explain what design and construction is all about," says Anderson. "That's been hard for us but I have to say that the Trust has always been enthusiastic."

There were regular meetings between the designers and people from the trust project team who were representing the end-users, that is the doctors, nurses and other workers. Consort's Smith thinks that the lines of communication between end user and designer should have been shorter, and even suggests that the service company (in this case Consort) should have control of the design team.

But for Anderson, there had to be a balance between involving clinical staff and allowing them the time and space to keep doing their job. That is, caring for people.

3. pool your expertise
At the same time that Anderson's team was working up the design for Edinburgh, colleagues at Durham were doing the same thing, although a couple of months ahead having completed earlier.

Value engineering exercises showed that there were savings to be had which could apply beyond Edinburgh.

you can use people to change each other

Bob Anderson

"We recognised that we should start to share that with the Balfour Beatty team at Durham."

Perhaps the biggest shared innovation was the switch from concrete to steel frame. Specialist contractor Severfield Rowen allayed fire protection fears by backing up its factory-applied spray coating with independent research, which gave ERJV the confidence to go with steel frame. The programme benefited: "It allowed us to advance the construction work, to smooth out the peaks in the workforce over the period of the project and pull forward some of the works."

Severfield's reward for this was that the Durham hospital team also decided to switch from concrete to steel, despite being further down the design road than Edinburgh.

4. be 'peoplesmart'
Getting the right team together when you are going to be working together for four-and-a-half years is pretty important. Anderson's request to the parent companies of the joint venture - Balfour Beatty, Morrison, Haden Young - was to send him top grade team-players with a few years under the belt. "You go for older people with a bit more experience.

"Sometimes the mix was not quite right and they went back to the parent companies."

Anderson says that there were lots of women on his team. "We should have females in the construction industry. Sometimes they approach things from a different angle. You can use people to change each other, in a constructive way." He mixed people up to help generate ideas.

When asked about the highlights of the project, Anderson talks about the satisfaction of seeing individuals progress. In particular he picks out Andrew McGill, a planning manager who was seconded from Morrison. Psychometric testing revealed he was a gem: "Andrew McGill came up as the most innovative and lateral thinking of the lot. We used him a lot."

McGill's wide range of roles included making a video of the whole building process and leading training sessions for staff. He is now working with Anderson on the bid for Birmingham Hospital.

5. clerks of works work
The clerk of works is considered an old-fashioned concept. On most design and build jobs, the quality management system demands that the contractor is self-checking. But Anderson found that using one on this job kept standards up.

"Our responsibility was not just to construct but to the design team as well. It would be relatively easy to allow the quality to drop. I wanted the clerk of works almost as a rod for our own backs."

And, yes, the role is as hated now as it ever has been. One wall had to be demolished because the clerk of works did not consider it to be up to scratch.

6. adapt or fail
Perhaps the biggest lesson for Anderson is the rate at which healthcare - and the way it is delivered - moves on. The hospital was responsible for buying the technical kit, but that still means that the design of the building has to cope with changing working practices.

"One of the biggest challenges is to predict for the future for how your services might be, how they will evolve and change," says Jane Todd, who was operations manager for phase one of the hospital.

"We have got it right in some places, but in other areas we have got it wrong," she admits.

The challenge now for Consort, says general manager Stephen Gordon, is for them to provide the flexibility the hospital needs: "We have to ensure that we keep up with clinical technology and the way it is delivered."

7. play the media game
Anderson was unprepared for the intensity of press scrutiny for his project. He says that both he, a local lad with family links to the infirmary, and the men were sometimes frustrated by the stream of negative articles which appeared in the papers. "We had comments from the workforce saying 'Here we are grafting long hours in all weather, doing our best, and all they can do is criticise'."

PFI is a political hot potato and therefore always makes good copy.

To tackle the situation Anderson, Balfour Beatty's press officer Marjorie Hooper and the Trust's Rosie Hewitt handled queries together, passing them to the relevant person and keeping each other informed.

Anderson offers his advice to others: "The first thing I would do would be to ask the press to tell you what it is they want to know. It's very easy to enter immediately into a dialogue without understanding what the topic really is.