Saudi Arabia’s Health Ministry is currently evaluating bids from contractors for the $2.7bn King Khaled Medical City (KKMC) in Dammam. With a tender that consists of 50,000 documents, and a new health minister, Ahmed bin Aqeel al-Khatib, appointed on 29 January, it is not surprising the process is taking some time.

“The Health Ministry is still evaluating and it has not made a decision at this point in time,” says Jarvis Hoult, CEO officer consultant at King Fahd Specialist Hospital in Dammam. He says part of the evaluation concerns the delivery schedule for the huge 1,500-bed medical complex. “We are looking at several options, largely to do with how much we build now, and do we go down the route of phased construction?”

Project completion

The tender for KKMC was published in September 2014, and in October MEED reported that four consortiums had bid for the project. “Once the contract is awarded to a construction company, we are looking realistically at about five years for completion, which includes six to 12 months for the contractor to mobilise and prepare the site,” says Hoult.

Like the other four medical cities in the kingdom, KKMC is designed to provide specialist tertiary care such as cardiac services, oncology, genetic and metabolic disease treatment, and ophthalmology. In addition, some of the cities will also deliver super-specialist treatment such as neurosciences, transplants and photon beam therapy.

If you see the drawings now, some of the things these [medical] cities are doing is really cutting-edge

“Each city is designed to serve populations within a huge radius,” says Osama Abu Sitta, regional vice-president at US consultancy Hill International, which is the project manager for two of the medical city schemes: King Faisal Medical City in Abha in the southern Asir Province and Prince Mohammed bin Abdulaziz Medical City in Al-Jouf in the north. “The wait time for operations will be reduced dramatically,” he adds. “People will no longer have to fly to Riyadh or Jeddah.”

Announced by royal decree in March 2011, the cities are part of a larger 10-year national investment strategy designed to bridge the gap between rural and urban care. It will also create a tiered, more organised system where patients are referred to hospitals and specialist centres in the medical cities by doctors in primary health centres, rather than the current system, which sees patients turning up at the nearest local facility.

To achieve this, the kingdom plans to build about 138 new hospitals by 2019, resulting in a total of 73,000 hospital beds, double the 36,886 that existed at the end of 2013. At the clinic level, it wants to have 2,750 primary health centres, up from 2,109 in 2013.

As well as KKMC and the northern and southern cities, King Fahd Medical City (KFMC) in Riyadh is being expanded to better serve the Central Region, and a new King Abdullah Medical City is being built in Mecca to serve the Western Region. The creation of new specialist medical cities means existing hospitals such as the King Fahd Specialist Hospital (KFSH) in Dammam will be able to revert back to their initial purposes.

“The original building was a 600-bed community hospital, which we then upgraded to become a specialist hospital, but there are only so many renovations we could effect,” says Hoult, adding that there was limited scope to enhance the facilities within the existing footprint.

Specialist treatments that are currently offered at KFSH will move to the new medical city, and the hospital is already working on the additional services it will offer. “We are trying to get those off the ground now before we move in to the new building,” says Hoult. “The more training that we can do and the more we can prepare it, the easier the transition will be.”

Advanced design

Although construction has yet to start on KKMC, the scheme has been recognised for its advanced design, which was done with the support of US consultancy Aecom. “We purposely went in with evidence-based design,” says Hoult “Form follows function, so we developed the processes and technologies, then designed the hospital to be more efficient than the King Fahd Specialist Hospital facility.”

Sensible as this sounds, such an approach is a new way of thinking and has meant taking a detailed look at how processes in the hospital work and then creating infrastructure to support them.

Traditionally, a more top-down approach would be used and standardised buildings created without detailed consideration of operational needs.

“We looked at how we treat our patients, how we deliver food, how we bring in supplies, where are the offices, and all sorts of things,” says Hoult. “Ultimately, we will have 1,500 beds and 4.2 million square feet, so the last thing you want to do is add unnecessary distance to our staff’s daily walk because of inefficient design. We are very pleased with what we have.”

Using BIM

Saudi Arabia will have a digitally designed and technically sophisticated new medical complex with automated delivery systems and a building that works with the needs of both the care team and its patients. One of the tools used to create the design, building information modelling (BIM), is becoming global best practice as a way of coordinating the vast quantities of data generated during design.

“We are one of the first to use BIM in the Middle East, and certainly one of the first to use evidence-based design and planning,” says Hoult. “BIM hasn’t been used a whole lot because it is a highly sophisticated software package and comes with significant cost. It is not cheap.

Fortunately for KKMC, the contract with Aecom included the use of BIM as part of the total design package.

“The nice thing about BIM is that it really does speed up the design process and eliminates literally thousands of mistakes that typically get made and add to cost and time,” says Hoult. “There is therefore a trade-off between using expensive software and getting design right the first time and not holding up construction. We are very pleased that we have it.”

Meanwhile, construction has begun on the medical cities in the northern and southern parts of the kingdom, with phase one of the infrastructure works for both complexes between 40 and 50 per cent complete, having been undertaken by local contractor Al-Fouzan Trading & General Construction Company. New 500-bed hospitals have long been planned in these regions, where people had previously been forced to travel to Jeddah or Riyadh for treatment, but the royal decree meant the original plans were reviewed and the designs reconfigured to create the 1,350-bed medical cities.

After the design changes, the Health Ministry opted to take the same approach on each of the cities, and in October 2012, Hill International was brought in to project manage the new complexes as well as 10 other hospitals around the kingdom.

“The medical cities are iconic, so the government wanted them to be more sustainable and efficient,” says Andre Tufenkjian, project director for the medical city projects at Hill International. “If you see the drawings now, some of the things these cities are doing is really cutting-edge. New technologies, new medical equipment, and products that are really high-end.”

Abu Sitta says the decision to use a project management office (PMO) consultancy was not made without discussion. “The Health Ministry had to convince the Finance Ministry that this was necessary, as it was seen as another layer of consultants,” he says. “But I think after two and a half years on the medical cities, the ministry is realising the role of the PMO is not a luxury; it is essential.” One of the key reasons for this is that project life cycles are so long that maintaining continuity is challenging without having a management office working with the client, says Abu Sitta.

Awaiting awards

As with KKMC, the team on the cities is also awaiting contract awards from the Health Ministry, but in this case it is the phase two deals that are expected to be signed within days. “According to the current schedule, we should complete phase one in February 2016 and phase two by 2019,” says Tufenkjian.

This summer, contract awards are also expected for the construction of the new King Abdullah Medical City in Mecca. Work on Riyadh’s medical city is already under way and includes plans for a national neurosciences institute, a cancer centre, a cardiac centre and a proton therapy centre.

With designs complete and construction having begun on three of the cities, it seems good progress is being made, which is positive news for the Saudi healthcare sector. Reducing the need for citizens to travel either internally or overseas for the treatment of serious medical conditions is a welcome step forward.