Tender Process for Hospital Development

Modified: 15th Mar 2021
Wordcount: 4556 words

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1.1 Project by BDP

Project: Grange University Hospital

Location: Llanfrechfa Grange, Cwmbran, South Wales

Client: Aneurin Bevan Health Board

Cost: £350m

Size: 55,000m2

Completion: Spring 2021               Grange University Hospital (BBC News, 2019)

Grange University Hospital will serve a population of approximately 600,000 people in the South East of Wales. Boasting state of the art facilities to cope with all major emergencies, complex emergencies and critical care. The 471 beds and 40 specialist services on offer will be easier to access due to the semi-rural location. A fully functional helipad will allow the admission of severe emergencies.

Built on Greenfield land the hospital will provide 360° views to open countryside to provide patients with a therapeutic recovery. The design of the building will provide every patient room with unobscured access to natural light to promote wellness. Staff working and resting spaces will be highly connected to attract and retain the best workforce possible.

Level 2 BIM plays a large part in the design stage of the project, maximising the use of digital technology through the whole supply chain. These digital tools will be used during the offsite manufacture of many components of the build, maximising quality control, enabling build efficiency and improving health and safety.

Laing O’Rourke will provide the focus of this report as the principle contractor on the site working alongside, cost and management company Gleeds.

1.2 Context

During the tender process the customer made it mandatory that any consultancies or contractors were to be certified to ISO 9001:15 to ensure the project would successfully meet its quality requirements. Laing O’Rourke hold their certification to ISO 9001:15 as part of one of their core values due to the positive impact that its implementation has on:

  • Health and Safety
  • Technical Quality
  • Human Resources
  • Financial and Commercial
  • Document Control

Using an ISO 9001:15 Quality Management Systems (QMS) enables the prevention of non-conformities ensuring the overall quality on the project. A QMS may also provide “assurances on quality within the supply chain” (Counter, 2018). This system will determine the success of the overall project as it will intervene if materials do not meet the quality required for the project, overall providing the customer a quality product.

Using ISO 9001:15 as a QMS has many benefits that can be achieved by following the 7 key principles of Total Quality Management (TQM) identified in the International Organisation for Standardisation publication, Quality Management Principles (2015)

  • Customer Focus
  • Leadership
  • Engagement of People
  • Process Approach
  • Improvement
  • Evidence Based Decision Making
  • Relation Management

The latest ISO 9000 QMS suite that was released in 2015 has a continuous cycle of Plan, Do, Check, Act (PDCA) employed to create a more seemless and efficient operation. The four parts of PDCA can be further summarised to provide a clear understanding of their role in ISO 9001:15.

  • PLAN - Leadership, Planning, Support, and Context
  • DO - Operation
  • CHECK - Performance Evaluation
  • ACT - Improvement

With an excellent attitude to quality assurance Laing O’Rourke are using a cutting edge technique during construction called Design for Manufacture and Assembly (DfMA). This process uses an offsite manufacturing site in Worksop owned by Laing O’Rourke to manufacture parts for the project. Apart from the obvious impacts on defects and quality, a by-product of DfMA is reductions in site build time, labour and processes that lead directly to reductions in safety and cost risks. Always at the forefront of innovation in offsite capabilities and excellent standards of construction Laing O’Rourke Project Director, Mike Lewis, said: “The Grange will leave a lasting legacy for the South East Wales region and the local community in Cwmbran and once again highlights how our engineering expertise and DfMA (Design for Manufacture and Assembly) is delivering a high quality building for the Aneurin Bevan University Health Board and will result in the second half of the construction programme finishing on or before schedule.” (Laingorourke.com, 2019). It is with these bold moves in innovation that Laing O’Rourke remain one of the companies that produce whole projects with QMS at the core, leading to increased customer satisfaction and profits.

The benefits of being ISO 9001:15 certified range depending on an organisations current market strategy. Current benefits associated with both BDP and Laing O’Rourke holding ISO 9001:15 certification have been highlighted from the QMS international website. (Norwich, 2019)

  • Marketing Ability

The ability to gain advantage during the tender process over a non-certified organisation and compete for tender where ISO 900:15 certification is mandatory.

  • Development of Leadership Teams

Following the guidelines for ISO 9001:15 set out in ISO 9000:15 an organisation can work toward the goal of TQM. Creating effective leaders and partners.

  • Compliance

The ability to prove to a customer that you achieve the quality that they stipulate in the contract.

  • International Opportunities

International companies looking to expand or trade overseas can view the ISO 9001:15 certification as an assurance of a quality product or project. Currently recognised in approximately 188 countries.

  • Increased Efficiency

Implement processes and procedures which are based on a quality focus.

  • Greater Employee Morale

Ensuring that all employees are working to one agenda you can reduce errors and increase productivity.

  • Improved Record Keeping

As with any management system, ISO 9001 ensures you document your processes from start to finish. Helping you to handle customer complaints and improve process efficiency.

  • Improved Customer Satisfaction

Ensure you have a feedback system in place which will help you to understand your customers’ needs, identify areas for improvement and reduce wasted resources.

  • Continuous Improvement

Using non-conformity reporting and trend analysis, you can spot areas for improvement and stay ahead of the competition.

Being certified to ISO 9001:15 will also benefit an organisations customers indirectly further enhancing the appeal of using a company with ISO 9001:15 certification. Some of these benefits are,

  • Improved Quality of Service

This also comes with the benefit of increased on time delivery

  • Reduced Need for Returns

Issues are identified and resolved quicker, often without the customer knowing

  • Assurance of Service

Certification acts as proof that the organisation provide consistent, reliable and fit for purpose solutions

  • Improved Experience

Improving the relationship between customers/stakeholders and the organisation will create a better customer experience and increase the chances of the customer returning again in future.

As with any QMS there are both benefits and negatives. Ensuring that the negatives do not outweigh the benefits often comes down to the short sighted view of cost. The perception is that the larger the organisation the greater the ability to absorb the cost. This may be accurate but even small companies would benefit from the implementation of a QMS if adopted. (Constructionmanagermagazine.com, 2019) discusses in an article relating to Cross Rail that the opinion of construction managers is that 20% put recent increases in profit directly down to the implementation of a QMS.

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Choosing the correct QMS or TQM for any given project can prove a difficult task. The comparison of such systems is beyond the scope of this report. However it is clear to see that any type of quality system is better than the absence of one and that the recipe for success is in the level of commitment during and after implementation.

1.    Health and Safety

2.1 Context

For too long the construction industry has been marred for its attitude to Health and Safety and its “it won’t happen to me” attitude. Recent years have seen a drastic improvement in the overall ethos and statistics surrounding Health and Safety. Diagram 2.1.1 show the downward trend in the rate of fatal injuries across all sectors since the early 1980’s. Importantly construction is following the same trend showing a plateau over the past few years. 2018/19 recorded the lowest amount of fatal injury whilst at work of 30, still 30 too many. BDP and Laing O’Rourke take pride in their attitude to Health, Safety and Environmental Management and have vigorous systems in place to ensure that every one of their employees get home at night as the “Effective management of work activities and competent site supervision are essential in maintaining healthy and safe conditions” (Health and safety in construction, 2001). This is a core part of their excellent safety culture.

Diagram 2.1.1 Figure 12 (Workplace fatal injuries in Great Britain, 2019, 2019)

There is legislation in place that Employers and Employee’s must adhere to regarding Health and Safety and Laing O’Rourke also have their own policies and procedures that further reinforce Health and Safety. Laing O’Rourke has a safety culture that reflects its commitment to compliance with all Health and Safety legislation with its anonymous reporting procedure of non-compliance.

2.2 Health and Safety and the Law

The Health and Safety at Work Act 1974 (HASWA) is an umbrella Act that encompasses a plethora of regulations that relate to specific types of work carried out. As an Act of parliament HASWA constitutes law and employers can be held to accountable in court if negligence or a lack of due diligence is found. During the construction of the Grange University Hospital Laing O’Rourke will adhere to the regulations below in all cases. (Counter, 2018)

  • The Construction (Design and Management) Regulations (CDM) 2015
  • The Work at Height Regulations 2005
  • The Control of Noise at Work Regulations 2005
  • The Management of Health and Safety at Work and PPE Regulations 1999
  • The Control of Substances Hazardous to Health Regulations (CoSHH) 1999
  • The Lifting Operations and Lifting Equipment Regulations (LOLER)1998
  • The Provision and Use of Work Equipment Regulations (PUWER) 1998
  • The Confined Spaces Regulation 1997
  • The Reporting of Injuries Diseases and Dangerous Occurrences Regulations (RIDDOR) 2013
  • The Manual Handling Operations Regulations 1992

The interpretation of these regulations has historically been an influencer in any type of legal case regarding breaches of HASWA. The courts take a firm view that ignorance is no excuse and that the law around Health and Safety is very much black and white. Due to this approach the industry has seen the creation of approved codes of practice on the regulations of HASWA since the early 90’s. Whilst they are not regulatory and do not have to be followed any deviation from the codes must be justified showing compliance using evidence to prove the compliance to HASWA. Some of the approved codes of practice that are relevant to the Grange University Hospital found on the HSE website (Hse.gov.uk, 2019) are:

  • L5 – Control of substances hazardous to health (6th edition)
  • L21 – Management of health and safety at work, Management of health and safety at work regulations 1999. Approved code of practice and guidance
  • L153 – Managing health and safety in construction, Construction (design and management) regulations 2015. Guidance on regulations
  • L22 – Safe use of work equipment, Provision and use of work equipment regulations 1998. Approved code of practice and guidance
  • L113 – Lifting operations and lifting equipment regulations 1998. Approved code of practice
  • BS 18004 2008 - Guide to achieving effective occupational health and safety performance

Best practice in construction dictates that when following health and safety guidance a company can show that it is competently a safely completing all of its works tasks. The Management of Health and Safety at Work and PPE Regulations 1999 is an integral piece of guidance that Laing O’Rourke follow to enable themselves to reduce the likelihood of breaches in health and safety during construction and continue to show best practice.

2.3 The Management of Health and Safety at Work and PPE Regulations 1999

Following an accident at the Worksop DfMA plant where there was a fatality, Laing O’Rourke have tightened up their already stringent Health and Safety policies and procedures to further guard the safety of all of their employees and assets. Using BS 18004 2008 Guide to achieving effective occupational health and safety performance and L21 – Management of health and safety at work, Management of health and safety at work regulations 1999. Approved code of practice and guidance, Laing O’Rourke are striving to go above and beyond the remit of the regulations set out in the Management of Health and Safety at Work Act 1999.

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To ensure compliance with this regulation all works carried out must be covered by risk assessments and method statements carried out by trained personnel. RAMS as they are commonly known will identify any risk to employees, public and assets and allow barriers and control measures to be put in place to reduce or remove the risk. The RAMS should eliminate, reduce, isolate or remove any risks identified. The risk assessment must contain a risk matrix where the probability of an outcome can be crossed with the potential severity of an outcome giving a matrix score that if undesirable can be adjusted by introducing factors in the method statement. Appendix 1 Diagram 1, 2 and 3 show sample copies of a Health and Safety Policy, Risk Assessment Form and Method Statement.

To provide best practice Laing O’Rourke have a training, development and monitoring system in place to ensure that all employees are competent and safe in the carrying out of their daily tasks. Some of this system is mandatory like the need for an up to date CSCS card or a license to operate certain types of equipment but on the whole most of the system is deemed as essential to ensure best practice is achieved. Laing O’Rourke uses a 4C and CI method that is highlighted below to maintain their safety culture. (Counter, 2018)

  • Establish and maintain CONTROL of the Safety arrangements.
  • Promote CO-OPERATION (safety needs to be a collaborative effort)
  • Ensure good COMMUNICATION of relevant information throughout the organisation.
  • Secure the COMPETENCEof your workers and contractors.
  • Provide clear and visible leadership and ensure CONTINUAL IMPROVEMENT

2.4 The Construction (Design and Management) Regulations (CDM) 2015

CDM 2015 applies to virtually all constructions works, to fully give them the recognition they deserve as a game changer in the Health and Safety sector is beyond this report. However a brief overview of what they provide is essential in a smooth construction. The regulation legally requires those involved to consider health and safety issues throughout the whole lifecycle of a project from design to demolition. Duties are placed on clients, designers and contractors and “the objectives of the regulation are to ensure better planning and design of construction projects, which, in turn will lead to a reduction in accidents and incidents of ill health within the industry” (Perry, n.d.). CDM 2015 has highlighted the responsibility hierarchy and abolished the blame culture of the past where duty holders would try and deflect any responsibility if problems occurred.

2.    Quality

3.1 QA vs QC

Quality control alone is not a satisfactory way of meeting a customer’s quality demands. Inspection alone is not enough to sort out quality problems. A measurement of quality that took into account all of the customers’ needs was developed called quality assurance. Sometimes called quality management this new framework focuses on compliance with procedures to ensure the quality of a product or service. The British Standards Institution (BSI) developed a set of standards for the system of quality assurance rather than the product itself. This led to the creation of a framework where a management system can be implemented to ensure the customers’ needs are fully met.

The British Standard for Quality Assurance was BS5750 was introduced in 1979. The ISO 9000 series was based on the BS5750 and adopted by the EC and UK in 1987 as the BS EN ISO 9001, 9002 and 9003. Shortly after creation they were integrated to become the BS EN ISO 9001. (March, 2017)

The International Organisation of Standardisation (ISO) is concerned with the way an organisations quality management meets the customers’ needs and any regulatory requirement, with a view to enhancing customer satisfaction and continually improving the company’s performance in pursuit of these objectives. (March, 2017)

3.2 Quality Technical Essential Systems

There are a number of systems regarding quality management which supports the project

Essential Systems for Technical Quality

  • Inspection and Test Plans – Including site surveying equipment calibration so the
  • building and foundations can be set out at site. (Figure 3A,B)
  • Project management and project planning provides information for checks and what
  • needs to be checked and who needs to complete them. Project management will
  • highlight areas to check and manage the project so quality is achieved. Project
  • management will ensure that work complies with technical standards and that
  • operatives completing work comply with competency standards.
  • Material Testing e.g. Slump tests to determine concrete workability
  • Test Certificates for materials i.e. Steel being delivered to site (Figure 3C)
  • CARES Certification for steel being used in reinforced concrete
  • Work to comply with British Standards
  • Level 1, 2 and 3 Checks and audits must be completed checks ensures work meets
  • the quality required for the project

There are three levels of checks that BDP employ to ensure that the demand of a quality finished product is met. These QA/ audit checks are to ensure processes are standardised  

  • Level 1 – Internal, Local

Laing O’Rourke will carry out quality audits every 12 weeks to ensure that the demands of quality and compliance are being met. These internal auditors will inspect evidence and records to ensure that all work carried out to date is compliant with company procedure.

  • Level 2 – Internal, Company

BDP have employed a Construction Quality Assurance Officer (CQAO) whose sole responsibility is ensure that quality and compliance are being met. To ensure the consistency of quality over the whole project life the CQAO will carry out internal benchmarking. The CQAO will work alongside staff from Gleeds’s benchmarking and auditing department to facilitate this.

  • Level 3 - External

The client has written into the contract a provision for bi-annual checks to be carried out by an unidentified 3rd party with no notice period required to further ensure operational compliance in all areas.

Laing O’Rourke have used their extensive knowledge of DfMA and Level 2 BIM design to achieve a level 4 in six sigma at the Worksop site. 70% of the whole build will be manufactured at Worksop in controlled environments to achieve the minimal amount of defects and highest levels of quality. Once the parts are signed off and transported to the main site in South Wales they are fixed into place in a modular fashion.

3.3 Quality Technical Standards

3.    Human Resources

Although PDCA is concerned with “creating a more effective operation” (Counter, 2018) it also produces some excellent by-products that will benefit an organisation. PDCA will lead to the streamlining of operations and processes and the continual improvement of both. Along with these by-products training, mentoring and refresher courses provided for staff will raise employee awareness, moral, motivation and effectiveness. All of these benefits that PDCA creates will create a more effective operation from a personnel prospective as employees will feel valued when they can see the inward investments made, improving staff retention.

It is important to note that as with any QMS, ISO 9001:15 is no different in the fact that certification does not guarantee a quality. Too much emphasis can be put on the need for certification rather than inherent pursuit of quality. Certification can be long winded and expensive if implemented incorrectly, staff that are trained will need refreshers costing time and money. People are people and by their nature quite often resistant to change, the average age of an organisations staff will affect the implementation process as the more mature amongst us demonstrate a stronger resistance to change. If implementation is not communicated well, throughout an organisation it can make people think that jobs may be at risk, causing people to jump ship, resulting in the added expense of re-recruitment. (Writiing, 2019)

4.    Financial and Commercial

Implementing ISO 9001:15 will not only lead to increased profits and customer satisfaction it will present benefits in other areas too. (Forsythe, 2015) suggests that an expectation of customer’s satisfaction about the benefits of improved quality and the cost association depends upon the experience of the past, and if the customer had a satisfying experience the customer’s enthusiasm and their probability of staying in the relationship will be increased. This will lead to a greater retention of customers and repeat custom.


  • Quality Management Principles (2015) International Organisation for Standardisation.
  • March, C. (2017). Construction management - theory and practice. 1st ed. London: Routeledge.
  • Brian, C. (2019). CECM-Quality Systems 1 [PowerPoint presentation] 6HX503: Civil Engineering Construction. 1st ed. Derby: derby.ac.uk.
  • Laingorourke.com. (2019). Significant milestone for The Grange University Hospital | Laing O'Rourke. [online] Available at: http://www.laingorourke.com/media/news-releases/2019/the-grange-uni-hospital-topping-out.aspx [Accessed 5 Nov. 2019].
  • Forsythe, P. (2015). Monitoring Customer Perceived Service Quality and Satisfaction during the Construction Process. Construction Economics and Building, 15(1), pp.19-42.
  • Norwich, Q. (2019). ISO 9001 Benefits. [online] QMS. Available at: https://www.qmsuk.com/iso-standards/iso-9001/iso-9001-benefits [Accessed 5 Nov. 2019].
  • Writiing, A. (2019). The Advantages & Disadvantages of TQM. [online] Bizfluent. Available at: https://bizfluent.com/info-8201247-advantages-disadvantages-tqm.html [Accessed 5 Nov. 2019].
  • Constructionmanagermagazine.com. (2019). CPD: Quality management | Home | Construction Manager Magazine. [online] Available at: http://www.constructionmanagermagazine.com/cpd-articles/cpd-quality-manag6ement-rou7te-bet4ter-profits/ [Accessed 5 Nov. 2019].
  • Health and safety in construction. (2001). 3rd ed. Norwich: HMSO.
  • Workplace fatal injuries in Great Britain, 2019. (2019). Published by the Health and Safety Executive.
  • Hse.gov.uk. (2019). Priced publications from the Health and Safety Executive. [online] Available at: http://www.hse.gov.uk/pubns/books [Accessed 5 Nov. 2019].
  • Perry, P. (n.d.). CDM 2015 questions and answers. 1st ed. London: ICE Publishing.
  • Hse.gov.uk. (2019). Risk management: Example risk assessments. [online] Available at: http://www.hse.gov.uk/risk/casestudies/index.htm [Accessed 5 Nov. 2019].
  • Ehs-singapore.blogspot.com. (2019). Risk Management. [online] Available at: http://ehs-singapore.blogspot.com/2011/12/risk-management.html [Accessed 5 Nov. 2019].
  • Dha.gov.au. (2019). Defence Housing Australia | Homepage. [online] Available at: https://www.dha.gov.au/ [Accessed 5 Nov. 2019].
  • BBC News. (2019). People 'don't understand' £350m hospital's impact. [online] Available at: https://www.bbc.co.uk/news/uk-wales-50209951 [Accessed 5 Nov. 2019].



Diagram 1, Example Health and Safety Policy taken from HSE (Hse.gov.uk, 2019)

Diagram 2, Example Risk Assessment and Matrix form taken from EHS Singapore

 (Ehs-singapore.blogspot.com, 2019)

Diagram 2, Example of a comprehensive Method Statement taken from DHA (Dha.gov.au, 2019)


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