Choosing the right procurement route is one of the most important decisions in any healthcare construction project. The method selected influences risk allocation, programme certainty, cost control, and how effectively clinical requirements are delivered.
This article compares design & build and traditional procurement specifically in the context of healthcare projects. It explains how each approach works, where risks typically sit, and how procurement choices affect clinics, hospitals, laboratories, and other healthcare facilities.
Why Does Procurement Choice Matter in Healthcare Projects?
Healthcare environments are inherently complex. Projects must balance clinical workflows, regulatory compliance, patient safety, and operational continuity, often within constrained buildings or live environments.
The procurement route determines:
- Who carries design and delivery risk.
- How early contractors engage with clinical requirements.
- The level of cost certainty at different stages.
- How changes are managed once works are underway.
In healthcare, these factors can directly affect patient care and service continuity.
What Does Traditional Procurement Look Like in Healthcare Construction?
Under traditional procurement, the design is completed first, typically by consultants appointed directly by the client. Once the design is finalised, a contractor is appointed to construct the works.
Key characteristics of traditional procurement
- Design and construction are separate contracts.
- Greater upfront design detail before construction begins.
- Contractor involvement comes later in the process.
- Changes during construction can lead to variations.
This route has historically been common in public sector healthcare projects and larger hospital schemes.
How Does Design & Build Work for Healthcare Projects?
Design & build brings design and construction responsibility under a single contract. The contractor is engaged earlier and works alongside designers to develop and deliver the project.
Key characteristics of design & build
- Single point of responsibility
- Early coordination of design, cost, and construction
- Greater programme certainty
- Integrated approach to compliance and delivery
This model is increasingly used across private healthcare, clinics, laboratories, and refurbishment-led projects.
Read More: Design & Build Process
How Is Risk Shared Under Each Procurement Approach?
| Area | Traditional Procurement | Design & Build |
| Design responsibility | Client-appointed consultants | Single design & build contractor |
| Construction risk | Contractor (against fixed design) | Contractor (design and construction) |
| Change management | Variations often required | Changes managed within one team |
| Programme impact | Higher risk of delay | Greater programme certainty |
How Do Procurement Routes Affect Healthcare Compliance?
Healthcare projects must meet strict regulatory standards regardless of procurement route. These include fire safety, accessibility, infection control, and mechanical and electrical performance.
Under traditional procurement, compliance coordination relies heavily on accurate design information being passed through multiple parties.
Design & build allows compliance considerations to be resolved alongside construction planning.
Which Route Offers Better Cost and Programme Certainty?
Traditional procurement
- Greater design certainty before tender.
- Final cost often fixed later in the process.
- Variations can arise if site conditions differ from design assumptions.
Design & build
- Earlier cost certainty aligned with developed design.
- Programme overlaps between design and construction.
- Fewer cost surprises when constraints are identified early.
For healthcare clients operating within tight budgets or funding approvals, this distinction can be critical.
What Happens When Healthcare Projects Must Stay Operational?
Procurement choice becomes especially important when works are carried out in live healthcare environments.
Traditional procurement can struggle to adapt once construction begins, particularly if phasing or sequencing needs to change.
Design & build offers greater flexibility when working in operational settings, such as clinics or hospitals that must remain open. This approach is often used for designing healthcare facilities in live environments, where patient safety and continuity of care are paramount.
When Might Traditional Procurement Still Make Sense?
Traditional procurement can still be suitable where:
- The project is large-scale and new-build.
- Clinical requirements are unlikely to change.
- Design control is prioritised over programme speed.
- Public sector governance requires separation of roles.
Understanding these conditions helps clients make informed decisions rather than defaulting to a single model.
Final Thoughts
There is no universal procurement model that suits every healthcare project. The right choice depends on risk appetite, programme constraints, regulatory complexity, and whether facilities must remain operational.
Understanding the differences between design & build and traditional procurement allows healthcare providers to align delivery strategy with clinical and operational priorities from the outset.
If you are assessing procurement options for a healthcare project, early evaluation of risk, compliance, and operational constraints can prevent costly changes later.
FAQs
Is design & build always faster for healthcare projects?
Not always, but it often provides greater programme certainty by overlapping design and construction activities.
Can traditional procurement work for healthcare refurbishments?
Yes, but it can be less flexible if conditions change during construction, particularly in live environments.
Which procurement route offers better cost control?
Design & build typically offers earlier cost certainty, while traditional procurement may involve more post-tender variations.
Does procurement choice affect regulatory compliance?
Both routes must meet the same standards, but design & build can simplify coordination by integrating compliance into delivery planning.
Can procurement strategy be adapted mid-project?
Changing procurement routes mid-project is complex and rarely recommended. Early decision-making is key.
