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Time, cost, quality – choose any two. Many of us will have heard this slightly flippant approach to setting project priorities over the years and any pragmatic project manager will understand that while our clients rightly require delivery against all three, there is often a pecking order related to the wider project context.

In healthcare, quality and cost almost always vie equally for first place, acknowledging that hospitals must be delivered to minimum technical standards to provide the right clinical environment, but that cash, especially in the public sector, is an exceptionally scarce resource at the moment.

By a process of elimination, this positions time in third place, with perhaps a tacit understanding that a project will take as long as it takes. This is often perpetuated with a somewhat cumbersome public sector delivery methodology linked to complex governance and decision-making processes - set up for all the right reasons – which frequently reduce progress to a snail’s pace.

This wider philosophy was certainly in the front of my mind whilst looking at two new projects earlier in the month and formed the basis for my early assumptions on delivery durations. The two projects were very different, but in both scenarios the clients balked at proposed go-live dates and challenged the teams to deliver the facilities more quickly. Although unusual, this wasn’t an unreasonable request, and certainly for project managers working in the commercial development world, this is frequently the norm.

Whilst you’re driving towards an aggressive deadline you must not rush ahead with a poorly considered design

So whilst reflecting that part of the issue might be my own overly cautious approach to scheduling, I set to work with each client to look at how to hit their timescales. Whilst some clever thinking on sequencing construction activities and working regimes does present potential opportunity, overall project durations on heavily-serviced hospital buildings tend to be fairly well-established and logically linked to size and massing. The real opportunity is therefore how quickly you can get a project to site, and how design, procurement and construction activities can be overlapped. And therein lies the real risk.

To design a complex healthcare facility successfully, the project team must engage extensively with the operational team that will be running and operating the building once it is built. They need to be involved fundamentally in the briefing, developing the operational strategies and continuing through an iterative design process to ensure that the winning contractor’s price accurately reflects their detailed requirements. Whilst most NHS Trusts have well-established estate development teams, clinical input must come from the user teams with the depth of understanding of how they will treat patients effectively in their department. Invariably, this will draw upon thinly stretched medical professionals for whom this is a distraction from the serious business of treating patients.

The key project management challenge is therefore getting the right level and volume of stakeholder engagement early on in the design process and accepting that whilst you’re driving towards an aggressive deadline you must not rush ahead with a poorly considered design. Gateways and end-stage sign off points are there for good reason – re-sizing a door to accommodate a hospital bed takes minutes on paper, but costs thousands if it’s not spotted until you’re into commissioning stages, weeks from going live.

Ultimately, like the majority of decisions in the imperfect world of project management, my scheduling challenges are one of pragmatic compromises. Increased pressure on clinical staff can be alleviated by perhaps using some of the budget allocation to backfill the day job and facilitate that vital early engagement. Looking at your procurement choices and how back-end design can overlap the early construction packages without compromising your commercial position is nothing particularly new but can pay dividends. And of course, implementing a decent change management process that isn’t just used to pick up the items that were missed out because the briefing stage was rushed should at least give a project a fighting chance of being successful.

Mark Halstead is director of programme & project management at Essentia, the consultancy arm of Guy’s and St Thomas’s NHS Foundation Trust