The Hospital Infrastructure Projects in the Kingdom of Saudi Arabia - Research Proposal Example

Research Proposal s Submitted by s: Research Factors that contribute to the hospital infrastructure projects in the Kingdom of Saudi Arabia running over the budget and being delivered late in the last decade. Introduction Saudi Arabia’s Healthcare system is categorized as a national healthcare system whereby the government provides the services that are associated with healthcare through various government agencies (Mufti, 2000, p. 3). Although this is the case, there is an increasing role and an escalating participation from the private sector in providing healthcare services in Saudi Arabia (Shoult, 2006, p. 420). The Ministry of Health is the chief government agency mandated with providing preventive, curative and rehabilitative healthcare to the people of the Kingdom through a network of health centres that are located all over the Kingdom (Saltman, 1988, p. 259). It also assumes the referral system which provides curative care to all the members of the society from the general practitioners level that operate at the local health centres to the advanced technology specialist curative services through a wide foundation of general and specialist hospitals (Knapp, Madden and Fowler-Kerry, 2012, p. 162). The Ministry of health is the chief agency as far as planning, financing and controlling the healthcare centres is concerned (Kimberly, Pouvourville and Daunno, 2008, p. 128). It is also mandated with conducting overall supervision and the follow up of activities that are related to healthcare which are implemented by the private sector, which makes it a national health service that serves that whole population of the Kingdom of Saudi Arabia (Chai, 2005, p. 178). The healthcare industry in the Gulf is an industry that is growing very fast as the government in this region continually seek to make improvements to what has been a low standard of service which forced many nationals to go overseas when they need specialized medical attention (Kloep, 2012, p. 107). This industry has also attracted foreign investors who are keen on taking advantage of the rapid expansion that it is experiencing. Investment that is directed at the health sector in the United Arab Emirates has increased considerably, tripling in the last five years and ii is expected that it will rise from USD3.2billion to USD11.9billion in 2015, which will be a contribution of more than 6 percent of gross domestic product that will not be associated with oil. Saudi Arabia also started a countrywide healthcare plan intended to give services to the whole kingdom. This includes more than 420 health projects and over 127 health facilities that are worth more than USD3.2billion. The projects include 19 medical complexes and hospitals intended to have a capacity of more than seven thousand beds that will be an addition to the three centres intended for treating children. Two 200-bed and five hundred bed-bed hospitals in Makkah, 500-bed treatment centres in Qatif, al-Hassa, Khamees Mushayt and Dammam as well as 100-bed health centres in Jeddah as well as Riyadh are among the facilities under development. Statement of the problem There have been many changes taking place in Saudi Arabia in terms of growth in population and the lifestyle that the people have adopted (Selvik, Stenslie and Meyrick, 2011, p. 225). This means that the demand for healthcare services that are essential has escalated making the healthcare that is in existence experience strains and stresses. Consequently, the investments that are being placed on the new healthcare capacity are increasingly burdening public finances yet the policy makers in the region appreciate that better access to healthcare is important in making sure that the people of the kingdom are healthy and protect its economic stability. This rising demand for healthcare that is better places a significant burden on the finances that Saudi Arabia has. The population growth of Saudi Arabia is reported to be 2.7 percent and the cases of the population being affected by chronic diseases such as diabetes and heart disease are rising making the need for better healthcare an issue that should be addressed immediately. To come up with a better healthcare system for the people that live in this region, the government must be able to overcome a number of challenges and obstacles. Among these challenges was increasing the physical healthcare capacity across the entire region, which include the border areas and the areas that are remote. It also has to provide staff and workers that are qualified to work in the new facilities that it aims to build. The policy makers also have the obligation to make sure that the standard of quality of the healthcare offered remains the same or gets better as it implements the expansion. The Kingdom decided to widen its tertiary care hospital infrastructure to enable it to provide sufficient care across all its provinces and as a result, the budget of the Kingdom includes funds meant to develop 19 new hospitals to add to the 102 that are already under construction. The Kingdom’s government has been able to get knowledge that the healthcare system, which is prevailing, is not sustainable. This paper based on desk research and interviews that are in-depth with experts that will include policy makers and contractors will aim to find out why the development of the new hospitals have run over budget and are also delivered late during the last decade. The research will evaluate the issues that are associated with the construction of the new hospital infrastructure that might be causing the delays and why they are more expensive than the initial figure budgeted. Background of the study The health care sector is experiencing some changes that are dramatic in terms of the behaviour of customers, market dynamics as well as regulatory framework which have affected the ways in which healthcare is delivered and made it become even more intricate. Health that is consumer driven where the individual that seek the services want greater choices and control in the way that they spend for healthcare combined with the pressure to deliver the highest possible quality of care at costs that are affordable, is making shifts necessary in the industry. Health care providers have to re-evaluate the products they have so that they can be in a position to meet the demands that are escalating as well as new business models to enable them to remain competitive in the industry. The facilities associated with healthcare are assorted ranging from hospitals, clinics and nursing homes, to technological diagnostic and research centres. Through the adopting, the new landscapes that provide a competitive platform, the funders of healthcare as well as the providers will be able to identify new opportunities in both existing markets and those that are coming up. Demand for the provision of quality health care is rising all over the world where in the developed world, the demand is influenced by evolving demographics as well as epidemiological trends which entail an aging population as well as diseases that are chronic (Bardram, Mihailidis and Wan, 2007, p. 276). In a majority of the developing countries, the growing demand for healthcare services can be attributed the rise in the populations and income growth as well as the prevalence of diseases that include obesity and diabetes. Reforms that are linked to regulations and funding combined with an increased demand for healthcare services due to the growth in population, and increase in income as well as an increase with diseases linked to lifestyle requires that the healthcare market in the Middle East should go through major changes and significant development. The government of the Kingdom of Saudi Arabia is implementing an expansion of the infrastructure in this sector while seeking to increase the participation of the private sector so that it can fill the gaps that exist in the provision of quality services. The governments that are in the Gulf Cooperation Council, which include the Kingdom of Saudi Arabia, are supported by large budget surpluses that has allowed them to make investments that are directed at supporting healthcare provision and improving the industry to make it meet equal international standards. The global standards that it aims to meet are in respect of the number of beds and the excellence of the medical services offered to their citizens. In the year 2002, the Saudi Health system was established by a royal declaration, which mandated it to insure the provision of healthcare that was whole and all-inclusive to all the people that live in Saudi Arabia in a manner that is fair minded, comprehensive and affordable to all. By 2004, 1848 medical centres were categorized as major and the total number of hospitals stood at two hundred. There was a significant increase in the Ministry of Health’s budget from 2.8 percent of the total national budget in 1970 to 6.4 percent in 2004 and in 2006; there were 20.4 doctors for every 10,000 people. By 2008, the number of primary health care centres had increased to 1925 in the entire Kingdom and 220 hospitals, which took up the referral system that provides care for members of the society in at all the levels. This include the level of the general practitioners who are located at the health centres to the antecedent technology specialist curative services that are provided through the widely founded general and specialist hospitals. Presently, the health services in Riyadh have been through a number of stages, which have enabled it to reach the position that that it is in today, and this entailed the development of work force, creation of hospital primary healthcare centres, emergency services, ambulance as well as the development of the private sector. The Ministry of Health in Saudi Arabia has the second highest budget in the Saudi government as far as budgetary allocations are concerned. This budget is of USD26.6billion as at 2013. A fraction of this budget was allocated to projects that were meant to develop and improve hospital infrastructure in the Kingdom (Al-Rasheed, 2010, p. 219). The Ministry of Health has been able to implement nineteen new hospitals and five medical centres are under construction are intended to have a combined capacity of twenty three thousand beds once they are completed. From the data that is found at the Ministry of Health, it can be established that the government and the Ministry depended on construction companies that were not from Saudi Arabia to implement the hospital projects in the period between 1970 and 1990. These companies were rates highly and the standards of the work that they carried out could be seen in the finished product that they delivered. These companies also have a good reputation and their comprehensive project schemes are outstanding. This means that in most of the cases these companies will deliver projects that are of the quality ordered, in the period that they promised and within the budget intended. Delay in construction projects is a situation that involves the project taking a longer time to reach completion than the time allocated (Bramble and Callahan, 2011, p. 1-14). It occurs often in the construction industry and there are instances of this all over the world especially in the developing countries. An estimated 70 percent of all the community development projects in the Kingdom of Saudi Arabia have been overdue in the past ten years. These has made the projects that are being delayed face huge financial losses, a compromise in quality and waiting times that are long in terms of operation of the project for public services. A key challenge that construction companies face is completing the projects given to them in the time that has been allocated and within the budget estimated (Colville, Amde and National Science Foundation (U.S.) 1995, p. 272). This is because any delays that linked to construction will typically lead to an amplification of the costs of the project (De Marco, 2011, p. 49). The construction industry made a contribution of between thirty and forty percent to the economy of the Kingdom of Saudi Arabia and the government is presently investing huge amounts in the construction industry including the construction of healthcare facilities. The kingdom spent nearly USD 234 billion on infrastructural projects between 1990 and 2000. Despite this huge figures, the companies that are in the construction industry still experience huge delays as a result of a variety of factors that have major effects on the construction projects. Ultimately, this delays lead to higher costs of construction than the original estimates (McCarthy, 2010, p. 338). Nonetheless, there have been attempts directed at identifying the major causes of the delays in building healthcare infrastructure projects in Saudi Arabia, as perceived by the construction parties that take part in the construction activities. The main causes of delays in the infrastructural projects in the world include a shortage in managerial skills, large volume of temporary workers, health and safety, insolvency as well as litigation (Keane and Caletka, 2008, p. 99). In the United Arab Emirates the factors that cause delays include drawings on preparation and approval, insufficient planning, delayed decision making, shortage of manpower, lack of proper supervision and management, insufficient labour productivity and lack of skills as well as difficulties in acquiring approvals from the government authorities and municipal committees (Al-Kharashi and Skitmore, 2009, pp. 3--23). There have been many researches in different countries aimed at identifying the reasons for infrastructure project delays. These have identified different issues such as finance issues and changes natural and material related factors, inadequate contractor experience, payment delays, inefficient and improper planning among others. Research question Based on previous studies that have been conducted and the literature review, there were factors that contribute to the delays that are experienced in the healthcare infrastructure projects in the Kingdom of Saudi Arabia and will be included I this research. The factors that cause delays that are identified will be divided into a number of categories that will include owner/client related factors, contactor related issues, consultant related factors, as well as external factors. The delay factors that encompass all the sectors of the development of the hospital infrastructure projects will all be incorporated in this identification. This will include the areas such as equipment and material, workforce, the environment and order changes, financing, regulations by the government, scheduling and controlling techniques, and the contractual relationships involved. Methodology The scope of the research will be restricted to hospital infrastructure projects and the blend of primary and secondary data will be used to identify the important factors that cause delays as well as running over budget in this projects. The target population will be the participants of the infrastructure projects that will include contractors and consultants as well as the department of projects in the ministry of health. The contractors and consultants that will be a part of the study research will be chose from four cities in the Kingdom of Saudi Arabia that will include Dammam, Jeddah, Riyadh and Tabuk so that bias because of location can be reduced. These participants on the research will be preferred since they represent the main entities in the hospital infrastructure projects construction and are in a position to provide information that is accurate about the delays according to the experiences that they have. The cities that will be included will be those that have hospital projects underway. Riyadh and Jeddah were selected since they are large cities (Kent, 1979, p. 314) while the other two were picked since they are relatively smaller and in different geographical areas. This will be done to ensure that the information and outcome that will come out of the research will be as accurate as possible. The research will be completed in two phases where a comprehensive literature review will be reviewed with the aim of pointing out the prevailing trends and the approaches that are used in the identifying, evaluating and reacting to the delays that are linked with the delays that are experienced in the completion of the hospital infrastructure projects. The results that will come out of this stage will be the identification and categorization of the factors that lead to the delays in the hospital infrastructure projects in the Kingdom of Saudi Arabia. The number of project that have been delayed and those that have run over the budget will also be identified in this section so that the prevalence of this phenomenon can be established. The second phase will consist of coming up with a questionnaire and conducting detailed interviews the entities that are involved with the hospital infrastructure projects in the Kingdom of Saudi Arabia. The interviews will be conducted after the respondents have been issued with a rationale that will be aimed at seeking their consent to be interviewed (Smith, 2002, p. 132). The rationale will include the set of questions that will be asked and the amount of time needed for that interview so that the respondents can be able to prepare adequately for the interview. Ministry of Health interview Two interviews will be conducted at the ministry of Healthy at the department of projects and the respondents will be the head of this department and the manager of projects. It is intended that after a request has been sent the interview will take place at the office of the head of department so that he can be in a position to get evidence for some of the issues that will be addressed by the interview. The aim of the first interview that will involve the head of department will be to understand how the contractors that are awarded the tenders to develop the hospital infrastructure projects are chosen and the types of bidding systems that are in place. It will also aim to find out the standards and classification of the companies that the ministry of health considers when it wants to award the tenders to develop the hospital infrastructure. The interview will also seek to find out how the ministry responds to the cases where the projects have been delayed and how they transfer the same projects to new contractors in the case that the initial contractors withdraw from the contracts they have. The head of department will be asked if the ministry can be in a position to identify the factors in play that cause the delays as far as the completion of projects that it has commissioned are concerned and any measures that it is taking to improve the situation. The interview that will have the Manager of projects as the respondent will seek to understand how the ministry conducts its monitoring and tracking of projects that it is conducting and whether the ministry receives regular reports and have meetings with the construction company stakeholders to discuss the progress of the projects. The interview will also seek to establish the mode of communication that exists between the contractors and the ministry and how it can be improved. Interviews with the construction companies The next set of interviews will target the construction companies that are contacted by the ministry of health in the cities that were identified. All the interviews that will conducted with the construction companies will use a predetermined set of questions to make sure that there is uniformity in the responses that will come out of the interviews. One company will be identified in each of the small cities while two companies will be interviewed in each of the larger cities. The interviews will seek to know how many of the companies that will be involved in the research experience issues related to delay in the projects that they have been commissioned to deal with by the ministry of health. The interviews will also aim to find out the issues that the construction companies go through that make the projects that they are working on delay and run over the budgets that had been estimated. During the interviews, the mechanisms that are in place that are supposed to counter the factors that may cause delays in the completion of the projects that the companies are working on will be identified. The interviews will also seek to find out whether the factors that cause these delays are unique to particular companies and cities or if they are common throughout the Kingdom of Saudi Arabia. The construction companies will also be asked through the interviews to identify the issues that make the projects, which have been delayed to run over the budget. Analysis of results The responses that given by the respondents in the interview will be read through to identify any patterns and themes that will exist among the data that will be collected. It is predicted that several themes and possible categories will be discovered that will provide the foundation of analysis of the results of the interviews. Data reduction will employed to enable the revealing of the findings that will be in the interview transcripts and the observation notes (Reinartz, 1999, p. 5). These transcripts will require this reduction so that they can be able to represent the major themes and categories that will describe the factors that necessitate the delay of projects in the Kingdom of Saudi Arabia. Discourse analysis will be the technique that will be employed to analyze and evaluate the data that will come from the interviews. This will involve identifying, coding and categorizing patterns and themes that will be present in the data where the applicability of the findings will be dependent on the analytic abilities that the people that are part of the research have (Grinnell and Unrau, 2008, p. 395). These analytic processes will be reported and documented fully and truthfully so that any other person that wishes to conduct a study that is of the same nature can be in a position to use them. The delay factor that has the highest impact will be established after all the delay factors that will be identified are listed. The one that will be mentioned the most number of times by the respondents to the interviews will be settled on as the most prevalent factor. Expected results The research will be conducted to identify the most vital factors that cause delays as far as completion of hospital infrastructure projects in the Kingdom of Saudi Arabia are concerned and the issues that make these projects run over the budgets that were estimated. It is expected that when analyzing the delay factors from the view of the construction companies it will be established that the highest delays occur due to the contractors that are mandated to deal with this projects. It is also expected that the results will show that there is also some contribution by the Ministry of Health towards these delays. From the literature review, the delay that are experienced in the hospital infrastructure projects and many other projects that are in the construction industry are responsible for the projects running over the budgets that had been intended (Bailey, 2011, 810). This is also expected to be replicated in the outcome of the results of the interviews with the ministry of health as well as the construction companies that are contracted. It is expected that the top ten factors that cause delays in the hospital infrastructure projects and consequently make the cost of the projects escalate past the estimates that were made would include: Low performance of the lowest bidder contractor in the tendering system Delays in sub-contractors work Poor qualifications, skills and experience in the contractors staff Poor planning and scheduling of the project Delays in progress payments Lack of engineers that are qualified Delay in preparation of shop drawings Cash flow problems on the part of the contractor Poor early planning of the project Non-utilization of the of professional construction contractual management Timeline The research will be conducted over a period of two months that will include that time that will be used to develop the literature review that will be used in the research. This time will also be used to come up with the interview questions as well as contacting the potential respondents to get their consents. The analysis of the results that will come out of this research will also be done in this period and conclusions drawn. Bibliography Al-Kharashi, A. and Skitmore, M. 2009. Causes of delays in Saudi Arabian public sector construction projects. Construction Management and Economics, 27 (1), pp. 3--23. Al-Rasheed, M. 2010. A history of Saudi Arabia. Cambridge University Press. New York. Bailey, J. 2011. Construction law. Informa Law. London. Bardram, J. E., Mihailidis, A., & Wan, D. 2007. Pervasive computing in healthcare. CRC Press. Boca Raton. Bramble, B. B., & Callahan, M. T. (2011). Construction delay claims. Aspen Publishers. Frederick, MD. Chai, W. 2005. Saudi Arabia. University of Indiana Press. Indianapolis, IN. Colville, J., Amde, A. M., & National Science Foundation (U.S.) (1995). Research transformed into practice: Implementation of NSF research : proceedings of the conference sponsored by the National Science Foundation, Arlington, Virginia, June 14-16, 1995. New York: American Society of Civil Engineers. De Marco, A. 2011. Project management for facility constructions. Springer. Berlin. Keane, P. J., & Caletka, A. F. 2008. Delay analysis in construction contracts. Wiley- Blackwell. Oxford, UK. Kent, A. 1979. Encyclopedia of library and information science. Dekker. New York [u.a. Kimberly, J. R., Pouvourville, G. D. and Daunno, T. A. 2008. The globalization of managerial innovation in health care. Cambridge University Press. Cambridge, UK. Kloep, M. J. 2012. Managed equipment services as a conceptual business opportunity model for the GCC with focus on UAE. Herz. Burgdorf. Knapp, C., Madden, V. and Fowler-Kerry, S. 2012. Pediatric palliative care. Springer. Dordrecht. McCarthy, J. F. 2010. Construction project management: A managerial approach. Pareto – Building Improvement. Westchester, Ill. Mufti, M. H. S. 2000. Healthcare development strategies in the Kingdom of Saudi Arabia. Kluwer. New York. Reinartz, T. 1999. Focusing solutions for data mining: Analytical studies and experimental results in real world domains.; Springer. London. Saltman, R. B. 1988. The International handbook of health-care systems. Greenwood Press. New York. Selvik, K., Stenslie, S., and Meyrick, J. 2011. Stability and change in the modern Middle East. I.B. Tauris & Co. Ltd. London. Smith, F. 2002. Research methods in pharmacy practice. Pharmaceutical Press. London. Shoult, A. 2006. Doing business with Saudi Arabia. Global Market Briefings. London. Read More