The construction of the IKEM pavilions is guarded by an anti-corruption team, the sewers being drilled by miners
The Prague Institute of Clinical and Experimental Medicine (IKEM) has had a record year in the number of transplants.
“The number of treated patients is growing year by year and our building has also reached its maximum. In order to continue to treat and provide quality care to our patients, we must grow, “explains hospital director Michal Stiborek (MS), building two new pavilions, which will include 56 of the best equipped patients for transplant surgery and cardiology.
The costs exceed one billion crowns, of which more than 603 million crowns are paid by the state. This is one of the reasons why the construction has been supervised since its beginning by an independent third party – the Czech branch of the anti-corruption organization Transparency International (TI) within the so-called Integrity Pact. “We created the pact as a tool in the fight against corruption in public procurement,” says Petr Leyer (PL), director of the Czech Transparency International.
What do I mean by the Integrity Pact?
PL: This is a process that involves independent civic control in public procurement, brings greater transparency to the process of selection and implementation of public procurement and the possibility of supervision of the entire contractual process not only by stakeholders and the public. The first party is the contracting authority, in this case IKEM, ie the state, and the second supplier, ie the construction company, which is IMOS Brno. Among them is an independent monitor, which we as Transparency International. We have been with the project since the very beginning, when it was just an idea, and we have already helped with the preparation of the tender documentation. And we will monitor him until the complete handover.
MS: We approached Transparency to oversee this huge strategic project. The current IKEM was built after the Velvet Revolution, in the 1990s, the whole project was completed in 2005. For us, the current project is, without exaggeration, a building of the decade, an opportunity that can come once in a lifetime. Therefore, we wanted to do no efficient, effective and have no problem with the law.
So what exactly does Transparency International oversee?
PL: We want the building to be as transparent as possible to the public, which will then serve to. This will reduce the risk of corruption, for example. But integrity pacts are definitely not our exclusive domain. This model works to defend the public interest in other countries as well. In Italy, during the preparatory phases of a construction, a civic association was needed to monitor the archaeological survey and ensure that no cultural monument was damaged.
MS: We have already tried the cooperation in the construction of our energy center. It was a building worth approximately one hundred million crowns. And because it worked for us, we decided for it in pavilions G1, G2.
What has the model worked for?
MS: Especially in that we were able to save money on construction, which is not entirely customary. The assistance mainly includes legal know-how, experience in managing large projects. This makes project financing transparent.
PL: At the very beginning, we managed to set clear and fair conditions for the competition of suppliers, which reduces the price by 25 million crowns compared to the initial assumptions. This was important because it is a strategic government contract that is largely state-funded. As another example, I can mention, for example, change sheets, which come whenever something unexpected comes along during construction. Transparency looks at all the documents and asks what caused the change, whether there are any new risks and whether the change can be prevented. At the same time, it is a motto that we can inform the public in our case of a problem or disagreement. It’s actually such an ongoing audit. And the final benefit will be that no one will be able to come in two years and say that the construction was overpriced, that it was won by a pre-arranged company and the like.
Construction began about half a year ago. What stage is it in now?
MS: We are currently after the first construction milestone. In reality, this means that we have been building engineering networks for four months, during which we have discovered many uncharted networks of the past. We also have a excavated construction pit for both pavilions, from which the workers extracted over 48,000 tons of soil. There is really a lot of it. For example, we have built a retention tank that will capture rainwater. Among other things, we also made deep sewers, for which we even came here to Krč, real miners.
The completion seems to be just in time. I am encountering the expected influx of new patients related to coronavirus …
MS: I think so. The first year of coronavirus was a shock for the entire healthcare system and everything had to be completely overcome. However, we were already able to adapt that second year. The situation began to turn slowly but surely, and in 2021 we even performed the most transplants in the history of IKEM. We have increased the treatment of cooperation with other hospitals, which indicate to us both patients and organ donors. And we want to continue this cooperation even after the covid.
What do real new pavilions bring to patients?
MS: Our patients are people who need a transplant or major cardiac surgery. It is very complicated for them and from a health point of view it is impossible to transport them anywhere after the procedure. In addition, we expect them to come after the covid, simply because it will be necessary to catch up with the delayed care that has arisen in the last two years. The completion will create 56 new beds, a total of 83 beds in the new buildings will be thanks to the relocation of some current workplaces. Intensive care beds will predominate. The taller building will have seven floors, the lower four. The construction will also bring a new supply and expansion of the pharmacy. Another positive is that in the event of a prolonged interruption of heat supply, the new energy pilots and heat pumps will provide floor heating to the ICU, so that the hospital is not in danger of evacuating patients. The perimeter of the building will be fully glazed, the whole building will be barrier-free.
The building has many interesting elements and technologies, such as an oxygen evaporation station. What is it, what is it for?
MS: In the past, when a person had trouble breathing, he got an oxygen bomb. But such bombs were very difficult to handle. We have now created a completely new, larger central economy for the whole of IKEM, which supplies oxygen to all beds at once. And because we don’t have to use oxygen cylinders, we save not only money but also operation at IKEM. It’s easier to handle and stock.
Are patients currently limited by the construction? For example, has the number of parking spaces decreased?
MS: The restrictions mainly concern the area of comfort. Patient care has never been and will not be limited. You are right that it is extremely difficult for people today to get here. We are trying to rent as many parking spaces as possible, but it is still a comfort and we recommend everyone to come to our hospital by taxi or public transport.
PL: The construction contractor caters to the hospital and the patients as much as possible, they do noisy or dusty work at the agreed times, when the impacts are the least. We have not seen any major problems in this regard.
Given the current increase in energy and materials, will construction costs ultimately be higher than the estimated billion and fifty million?
MS: The supplier would like to increase the money for materials quite substantially. However, we may have to deal with the increase with the Ministries of Finance and Health, because it was these institutions that approved its budget. From the way it is now on, it seems that the amount we originally calculated will be final.
PL: IKEM had the CTU have a cost opposition to the construction. And even though building materials have become more expensive, the price cannot be increased without a fundamental change in the state’s position. Fortunately, we saved the mentioned 25 million crowns at the beginning, so the total price should not exceed the expected value thanks to this pillow.
When will the construction be completed?
MS: We plan to complete construction on January 2024. A trial run will follow to test the technology and all operations. It will be approved in December 2024 at the latest.