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The growth in framework agreements and development consortiums has forced construction firms to work side by side with competitors and clients, rather than across the desk from them.

But the truth is that, although frameworks have encouraged the principle of partnership, we all have vested interests. The success stories come from those projects where each side stops thinking of itself as a separate entity, and genuinely forges a union. I confess I鈥檓 at a slight advantage over many as I鈥檝e worked client and contractor-side.

My early career was as a cardiology nurse in the NHS. After a stint teaching nursing in Africa, I returned to the UK and worked in senior project management roles in the healthcare industry. I saw the day-to-day challenges faced by the NHS, and the contrasts in approach in Africa, Asia, Latin America and the Middle East, and I saw the implementation of large-scale IT in NHS hospitals. The lessons from these projects were the same: success came when there was partnership and stakeholder involvement. The benefit was flexibility, sustainability and improved working practices, as those that had been involved felt a sense of ownership.

Today, health facilities have to be so many things: a place to work, a place to heal, a place to learn and a place to die. Only by understanding this can you deliver on all levels. I have dealt with the consequences of designs that required patients to move up and down stairs for their treatment, installed grand entrances that look welcoming in summer but become cold and dark in winter, specified doors that didn鈥檛 fit a standard bed and witnessed the operating relationships between private and public sectors. I was privy to the real opinions that emerged when the 鈥減artner鈥� had left the building. I breathed the environment on a daily basis, which is why I saw an opportunity to make a difference to the provision of healthcare by joining Medicinq Osborne as health accounts manager.

So why did Osborne employ me? It鈥檚 simple 鈥� the company wanted an insight into the client side of a construction relationship. They wanted to get beneath the building鈥檚 shell and find out what it means to people who live near it and use it. No matter how much you empathise with your clients, it鈥檚 never the same as when you鈥檝e been the client; and, what鈥檚 more, been an end-user with no say in the client鈥揷ontractor relationship.

I have experienced grand entrances that look welcoming in summer but become cold and dark in winter, seen doors that didn鈥檛 fit a standard bed and heard the real opinions that emerged when the 鈥榩artner鈥� had left the building

We all want to please our clients, but by and large in the past this has meant pleasing the client鈥檚 decision-makers. Now, more than ever, our clients are involving their own staff and all the users of a building, not just in specifying the building, but throughout the entire design-and-build process.

This is the way it should be. We, as builders and designers, have not just a contractual duty, but a moral duty to deliver on every level. A fundamental change is that we no longer see ourselves as builders but people who help the professionals to work together to develop the project. Of course, I am not na茂ve. There are always constraints in any project, be it time, space or financial, but everyone working together breeds an atmosphere of conciliation, which can provide better solutions than originally planned.

Take, for example, Watford Acute Admissions Unit. The process of developing the project allowed the staff to re-examine the way they did their work. The new model resulted in faster assessment of patients, reducing waiting times and the accommodation of greater numbers of patients.

Procure 21 is proof that as an industry we鈥檙e getting better at understanding our clients; of the 200 ProCure21 schemes delivered to date, few have resulted in litigation and most have come in on time and on or below budget.

So what鈥檚 the secret to making client relationships work? Early involvement and understanding, and appreciating all the skills around the table.