Navigating Uncertainties: A Comprehensive Review on Change Factors in Healthcare Construction Projects

  • Azzah Othman
  • Jasmine Ahmad
  • Mimi Fitriana Zaini


Healthcare construction projects are complex and considered as dynamic environment that are constantly changing, reinvented, and reworked. These occurrences continue throughout the entire project lifecycle. Each healthcare project aims to deliver high-quality of healthcare services. Yet uncertainties are inherent in these projects which significantly impact their outcomes. In a recent report published by the Public Work Department, more than 90% of hospital projects across Malaysia are categorized as underperforming. The report mentioned that the scenario was due to ineffective project management, which ultimately led to extreme delay considered futile. This study explores the multifaceted nature of uncertainties in healthcare construction projects that shape the trajectory of change within these projects, which ultimately determining their success. A systematic literature review was conducted on relevant previous research works in the field of change management in healthcare projects. The analysis of these studies leads to the identification of the factors affecting change in a project setting. The finding reveals that the five main factors affecting change order in healthcare projects are medical technology, design and scope, operational, external environmental, and contractor. In addition, several future-proofing approaches were adopted as a mitigating strategy towards improved change management. This study underscores the significance of recognizing and addressing uncertainties in healthcare construction projects. It provides insightful contributions for project professionals in navigating change management while balancing the force of project uncertainties and maintaining performance that meets the project’s intended functionality and success.  



Alfredsen Larsen, A. S., Karlsen, A. T., & Andersen, B. (2020). Hospital project front-end planning: current practice and discovered challenges. Project Leadership and Society, 100004.
Arefazar, Y., Nazari, A., Hafezi, M. R., & Maghool, S. A. H. (2019). Prioritizing agile project management strategies as a change management tool in construction projects. International Journal of Construction Management, 22(4), 678–689.
Åsgård, T., Breistrand Bringsvor, H., & Jørgensen, L. (2023). ScienceDirect ScienceDirect Co-determination and participation in project management. Experiences from the construction of a hospital building in Norway. ScienceDirect Co-determination and participation in project management. Experiences from the construction of a hospital building in Norway. ScienceDirect Co-determination and participation in project management. Experiences from the construction of a hospital building in Norway. Procedia Computer Science, 219, 1744–1751.
Brambilla, A., Sun, T., Elshazly, W., Ghazy, A., Barach, P., Lindahl, G., & Capolongo, S. (2021). Flexibility during the COVID-19 Pandemic Response: Healthcare Facility Assessment Tools for Resilient Evaluation. International Journal of Environmental Research and Public Health, 18(21), 11478.
Burnham, R. (2020). An Overview of Complexity Theory for Project Management. In
Dartey-Baah, S. K. (2022, April 1). The relationship between project complexity and project success and the moderating and roles in the construction industry of an emerging economy.
Economic Planning Unit (EPU) (2021). Twelfth Malaysia Plan, 2021-2025.; Percetakan Nasional Malaysia Berhad.
Gumede, N. P., & Hattingh, T. (2020). Establishing a Selection Framework For a Lean And Value Engineering Hybrid Methodology. South African Journal of Industrial Engineering, 31(4).
Gunduz, M., & Almuajebh, M. (2020). Critical Success Factors for Sustainable Construction Project Management. Sustainability, 12(5), 1990.
Haleem, A., Javaid, M., Pratap Singh, R., & Suman, R. (2022). Medical 4.0 technologies for healthcare: Features, capabilities, and applications. Internet of Things and Cyber-Physical Systems, 2, 12–30.
Harit, M., & Judson, L. (2023). Mitigation Strategies for Delay Factors in Healthcare Projects. Journal of Building Construction, 5(1).
Harrison, R., Fischer, S., Walpola, R. L., Chauhan, A., Babalola, T., Mears, S., & Le-Dao, H. (2021). Where Do Models for Change Management, Improvement and Implementation Meet? A Systematic Review of the Applications of Change Management Models in Healthcare. Journal of Healthcare Leadership, Volume 13, 85–108.
Jalil, M. A. (2022, September 23). 13 projek KKM berstatus “sakit” [METROTV]. Harian Metro.
Karlsson, S., Lindahl, G., & Strid, M. (2019). Future-proofing in healthcare building design (pp. 220–226). 4th Conference on Architecture Research Care & Health (ARCH19).
Krystallis, I., Rickaby, B., & Murtagh, N. (2019). A sustainable built environment for healthcare: generative mechanisms for future-proofing. IOP Conference Series: Earth and Environmental Science, 297, 012039.
Kyrö, R., Peltokorpi, A., & Luoma-Halkola, L. (2019). Connecting adaptability strategies to building system lifecycles in hospital retrofits. Engineering, Construction and Architectural Management, 26(4), 633–647.
Lavikka, R. H., Kyrö, R., Peltokorpi, A., & Särkilahti, A. (2019). Revealing change dynamics in hospital construction projects. Engineering, Construction and Architectural Management, 26(9), 1946–1961.
Manap, H. A. (2023, May 29). 90 peratus projek KKM lewat kerana kontraktor tidak berpengalaman. Utusan Malaysia.
Memari, S., Kocaturk, T., Lozanovska, M., Andrews, F., & Tucker, R. (2023). Future proofing for hospital building design: from research to practice. Architectural Engineering and Design Management, 1–20.
Miceli, A., Hagen, B., Riccardi, M. P., Sotti, F., & Settembre-Blundo, D. (2021). Thriving, Not Just Surviving in Changing Times: How Sustainability, Agility and Digitalization Intertwine with Organizational Resilience. Sustainability, 13(4), 2052.
Moradi, S., & Kähkönen, K. (2022). Success in collaborative construction through the lens of project delivery elements. Built Environment Project and Asset Management, 12(6), 973–991.
Nilsen, P., Schildmeijer, K., Ericsson, C., Seing, I., & Birken, S. (2019). Implementation of change in health care in Sweden: a qualitative study of professionals’ change responses. Implementation Science, 14(1).
Okada, R. C., Simons, A. E., & Sattineni, A. (2017). Owner-requested Changes in the Design and Construction of Government Healthcare Facilities. Procedia Engineering, 196, 592–606.
Phillips, J., & Klein, J. D. (2022). Change Management: From Theory to Practice. TechTrends, 67(1), 189–197.
Project Management Institute. (2021). Guide to the project management body of knowledge. (7th ed.). Project Management Institute.
Rawson, J. V., & Davis, M. A. (2023). Change Management: A Framework for Adaptation of the Change Management Model. IISE Transactions on Healthcare Systems Engineering, 13(3), 1–12.
Rehman, O. U., & Ryan, M. J. (2018). A framework for design for sustainable future-proofing. Journal of Cleaner Production, 170, 715–726.
Saad, D. A., Gharib, F., & El-Said, M. (2021). Simulation of design changes impact in healthcare construction projects using system dynamics. Canadian Journal of Civil Engineering, 48(5), 554–569.
Schönbeck, P., Löfsjögård, M., & Ansell, A. (2020). Framework for change control in healthcare construction projects compared to current practice. International Journal of Construction Management, 22(12), 1–8.
Scialpi, G., & Declercq, J. (2023). Adaptability in healthcare buildings: a perspective through Joseph Bracops Hospital. Frontiers in Medical Technology, 5.
Shafique, M., Khan, M. Z., & Rahman, A. (2023). The Impact of Project Complexitu on Project Success With The Mediating Role of Team Performance. International Journal of Business and Management Sciences, 4(1), 181–202.
Sun, M., & Meng, X. (2009). Taxonomy for change causes and effects in construction projects. International Journal of Project Management, 27(6), 560–572.
Tampio, K.-P., Haapasalo, H., & Lehtinen, J. (2023). The client’s essential stakeholder collaboration activities at the front-end phase of a hospital construction project. International Journal of Managing Projects in Business, 16(8), 182–207.
Vazquez-Ingelmo, A., Garcia-Penalvo, F. J., & Theron, R. (2019). Information Dashboards and Tailoring Capabilities - A Systematic Literature Review. IEEE Access, 7, 109673–109688.
How to Cite
OTHMAN, Azzah; AHMAD, Jasmine; ZAINI, Mimi Fitriana. Navigating Uncertainties: A Comprehensive Review on Change Factors in Healthcare Construction Projects. International Journal of Business and Technology Management, [S.l.], v. 6, n. 2, p. 188-199, june 2024. ISSN 2682-7646. Available at: <>. Date accessed: 22 july 2024.
English Section