Case Study: Design and Construction Challenges – Canberra Hospital Expansion (Critical Services Building)

Canberra Hospital Expansion (Critical Services Building)

Project Overview

The Canberra Hospital Expansion, known as the Critical Services Building (CSB), is one of the ACT’s largest health infrastructure projects. It represents a major redevelopment of the existing Woden campus, designed to improve emergency, surgical, and intensive-care capacity while ensuring flexibility for future models of care.

The project delivers approximately 40,000 m² of new clinical space, including new operating theatres, expanded ICU facilities, imaging, and emergency departments. It forms part of a 20-year master plan aimed at enhancing resilience, accessibility, and sustainability across the entire Canberra Hospital precinct.

1. Live Site Construction Challenges

The most significant challenge was constructing a major new facility within a fully operational hospital. Continuous patient services meant the project team had to manage noise, dust, and vibration while maintaining safe access for ambulances, staff, and visitors.

A detailed enabling works phase was required before main works could begin, involving temporary power and medical gas diversions, demolition of outdated buildings, and rerouting of key internal roads and utilities.

Tight staging, strong coordination, and effective stakeholder communication were essential to prevent disruptions to clinical operations. This required 24-hour coordination between the project delivery team, hospital management, and critical services departments.

Key lesson: In live environments such as schools or hospitals, sequencing and interface management must be planned early, and access maintained at all times.

2. Stakeholder and Consumer Consultation

The project placed strong emphasis on stakeholder engagement. Clinicians, nurses, consumer advocates, and patient groups were involved throughout the design process.

A dedicated Consumer Reference Group met regularly to provide feedback on ward layouts, patient rooms, lighting, and family-zone provisions. This level of consultation added time to the design process but significantly improved clinical and user functionality.

However, it also introduced challenges such as balancing architectural intent with operational efficiency, clinical compliance, and budget constraints. Frequent iteration required disciplined design governance to manage scope drift.

Key lesson: Structured stakeholder engagement adds value but must be time-boxed and aligned with decision gateways to avoid uncontrolled redesigns.

3. Services Integration and Technical Complexity

Hospitals are among the most complex building types, and integrating new systems into an existing campus presented major coordination challenges.

The new CSB required upgrades and extensions to power supply, chilled water, data, and medical gases, along with expanded vertical transport and redundancy systems. Existing infrastructure was at capacity, necessitating staged shutdowns and temporary connections.

Structural coordination with large-scale MEP systems demanded advanced BIM modelling and clash detection. Minor delays in one discipline had a domino effect on others due to the tight interfaces and limited access zones.

Key lesson: Early coordination between design and construction disciplines supported by robust digital modelling is essential for complex building services environments.

4. Site Logistics, Access, and Wayfinding

The hospital’s location in Woden meant limited space for laydown, parking, and delivery logistics. Construction traffic had to be fully segregated from public areas to ensure emergency access routes remained open.

Additionally, the design of new forecourts and entries had to comply with strict universal access requirements. Post-construction, some elements such as textured pavers at the Emergency Department entry were later criticised for accessibility issues, underscoring the importance of balancing aesthetic ambition with safety and usability.

Key lesson: Accessibility and functional design must take precedence over visual detailing in public-use health facilities.

5. Sustainability and Future-Proofing

The master plan for Canberra Hospital set ambitious sustainability and resilience objectives, aligned with ACT Government’s net-zero emissions by 2040 target.

The CSB incorporates high-performance building envelopes, energy-efficient HVAC, natural lighting, and adaptable modular layouts to accommodate evolving clinical models. Flexibility was designed into the building grid to allow future reconfiguration of wards and departments without structural alterations.

Key lesson: Future-proof design and adaptability should be prioritised over short-term cost savings, particularly for long-life infrastructure assets.

6. Procurement and Delivery Model

The project was delivered under a Managing Contractor model, allowing early contractor involvement (ECI) to mitigate delivery risk. This approach enabled early design input, supply-chain planning, and constructability reviews during the design phase.

However, the complexity of multiple stakeholders, late design changes, and tight cost targets led to significant program management demands. Maintaining alignment between government stakeholders, clinical representatives, and the contractor required strong governance and disciplined variation control.

Key lesson: For high-risk, public-sector projects, the Managing Contractor model works effectively when decision-making authority is clear and governance structures are firm.

7. Outcomes and Key Learnings

The project reached structural topping-out in 2023, marking a major milestone in the ACT’s largest health infrastructure investment. Despite pandemic disruptions and supply-chain pressures, delivery continued through proactive coordination and risk management.

Some minor post-completion issues such as accessibility and external paving highlight that even well-executed projects can face operational challenges once users interact with the final product.

Overall, the Canberra Hospital Expansion demonstrates how live-site delivery, stakeholder complexity, and service integration can be managed successfully through structured planning, early engagement, and technical precision.

Transferable Insights for Other Major Builds

For comparable education or institutional projects:

1. Prioritise early staging and services planning to prevent temporary diversions from becoming afterthoughts.

2. Use ECI or collaborative delivery models to align design, construction, and client expectations.

3. Leverage BIM and digital coordination tools to reduce clashes and rework.

4. Design for flexibility to anticipate how users’ needs will evolve.

5. Embed sustainability at concept stage to avoid expensive retrofits.

6. Engage users early but manage expectations with structured decision gates.

7. Apply strict interface management on operational sites for logistics, access, and safety.

Conclusion

The Canberra Hospital Expansion serves as a benchmark for delivering complex, high-risk health infrastructure in a live environment. It highlights the importance of balancing design quality, clinical functionality, and operational continuity, offering lessons directly applicable to large educational, modular, or public projects across Australia.