As public and private sectors increasingly join forces to deliver essential infrastructure, the promise and pitfalls of Public-Private Partnerships (PPPs) in healthcare demand closer scrutiny. 

Global leading health Architect and health planner, Stanton Kroenert – Founder of SKAr, shares his insights into some of the pitfalls of PPP’s.  

“Hospitals are the backdrop for the most dramatic moments of our human existence. It is most likely where we are born and where we will die. Therefore, a patient bedroom should be designed with the same reverence as a church, but they are usually designed with the same disdain as a cheap motel; robust and easy to clean.” 

Exploring the Architectural Challenges in PPP Hospital Construction 

From an architectural perspective, Public-Private Partnership (PPP) contracts for hospital construction introduce challenges that impact functionality, adaptability, and the overall quality of healthcare environments. While PPPs aim to streamline financing and delivery, their structure often undermine the architectural integrity and long-term usability of hospital buildings, which ultimately can introduce inefficiencies into the design process. 

1.Prioritising cost over design

Private partners, driven by profit, tend to minimize construction costs, which can lead to compromises in materials, spatial planning, and overall functionality. Standardized or cost-driven designs often fail to consider essential elements such as patient flow, infection control, and natural lighting—all of which influence staff performance and patient outcomes. 

PPP contracts are frequently signed early in the design process, locking in specifications before thorough architectural planning or consultation with stakeholders. This early commitment limits the architect’s ability to incorporate feedback or respond to evolving clinical requirements. Hospitals are complex, user-centred environments that demand iterative and flexible design—an approach often restricted by the rigid timelines and risk-averse nature of PPP contracts. 

2. Hospitals need to adapt continuously 

PPP contracts tend to focus on short-term cost control and long-term maintenance predictability, which can prevent architects from incorporating adaptable features. Design elements like modular layouts or systems that support future retrofitting are often overlooked or underfunded.  Hospitals need to ensure they are adaptable to the future that has not yet been written; advances in medical technology, shifts in care delivery, and changing patient demographics. 

3.  Good Design can come second to financial decision-making 

In many PPP hospital projects, decision-making is led by financiers and project managers, with limited input from healthcare professionals and architects. As a result, design becomes a checklist of deliverables rather than a thoughtful, human-centred response to healthcare needs. 

4. Inefficiencies in the Bidding Process 

The PPP bidding process itself is inefficient and wasteful. Each bidding consortium produces its own architectural design based on a shared reference brief, engaging full design teams to develop proposals tailored more to commercial objectives than to healthcare priorities. The result? Dozens of thoughtful hospital designs are discarded when bids are unsuccessful—valuable intellectual work relegated to the shadow realm of “paper architecture.” 

Conclusion 

PPP hospital projects often constrain architectural creativity and compromise long-term usability. To ensure hospitals are not just delivered on time and within budget—but are truly fit for purpose—architectural voices must be heard early and often. Only then can we design spaces that help heal not just the body, but the mind and spirit as well. 

More to come in Part 2 when we explore solutions to designing hospitals where the Architects, patient and the PPP consortium stakeholders all win. 

Author: Stanton Kroenert  
Date: 08/09/2025