Arrives fluent in programme, cost plan and contract, and rarely with any experience of operating what was built.
Our own project · Meridian Hospital Group is a constructed operator; the instrument and its figures are real
Meridian Hospital Group · Group
Director of Development
Delivers the building, and leaves at handover, which is the exact moment its consequences begin.
Chapter 1 · Group
What they actually do
Owns the brief, the parcel, the design team and the construction contract. Answers for delivering a site to programme and to budget, and is measured on both.
Neither of those measures has anything to say about how the building will behave once it has patients in it. The role is judged complete at practical completion, and the sixty years start the following week.
- Answers for
- Delivering a new site to programme, budget and brief.
- Can actually move
- The brief, the parcel, the design team, the construction contract.
- Sees the cost of
- Capital cost daily. Operating consequence almost never, because involvement ends at handover, which is exactly when the sixty years begin.
Chapter 2 · From arriving to moving on
Growth in the role
Usually construction or property trained, which is why the instruments are capital instruments, and why operating consequence is so hard to get into the brief.
Clinical adjacency, infection control, statutory guidance, and the specialised plant a hospital needs and an office does not.
The best in this seat go and stand in an operating hospital and count how far a nurse walks. Very few do, because nothing in the role's measurement rewards it.
Some move into operating estates, which is the single most useful thing that can happen to a developer, because they finally inherit what they built.
Chapter 3 · And how it is usually settled
Where this role is in conflict
The distinctive feature here is that most of this role's conflicts are with people who have not been hired yet.
-
With The patient
Over Distance- Why it is structural
- Every metre between a bay and a store is a metre somebody walks for sixty years. Compact floor plates are cheaper to build and more expensive to run, and only the first appears in this role's measurement.
- How it is settled today
- By capital cost, because the operating consequence has no owner in the room at the moment it is decided.
-
With The Director of Nursing, years later
Over A layout that cannot be staffed efficiently- Why it is structural
- The person who will have to roster around the geometry is not appointed when the geometry is fixed.
- How it is settled today
- It is not settled. It is inherited, and the inheritor is measured on absorbing it.
-
With The Head of Estates and Facilities
Over Buildability against maintainability- Why it is structural
- Plant that is cheap to install can be expensive to reach, and the handover moves that cost from one budget to another.
- How it is settled today
- In favour of installation cost, unless estates is brought into the brief early, which is rare and cheap and mostly not done.
Chapter 4 · Actor one
How this reaches the patient
Enormous, entirely indirect, and almost wholly invisible to the person holding the role. Every distance a patient is wheeled, every corridor wait, every ward that cannot see its own bays was decided here.
The walking distance figure on the people page belongs to this seat. Six kilometres a shift is a floor plan, not a rota, and it was drawn by someone whose contract had ended long before anyone counted.
Chapter 5 · Actor two
How this reaches the rest of the provider
Hands the operator a fixed cost structure it cannot subsequently change. Layout determines staffing in a way no manager can undo; an operator can only decide who absorbs it.
This is the clearest accountability gap in the organisation, and it is the specific reason to run a configuration before committing to it: it is the only way to give this role feedback within its own tenure rather than a decade after it.
Every role, side by side
The full hierarchy, and where accountability and control come apart.
Back to people and hierarchy