Lifecycle Coordination Mechanisms of Building Services Systems in Comprehensive Hospitals: A Grounded Theory-Based Case Study in Shenzhen
by
Shangyan Yan
1,2,3, 
Xiaoyu Li
1,2,3,*,
Jianmin Meng
1,2,3,
Hailin Chen
1,2,3 and
Zhenfeng Weng
4,5 1
School of Architecture and Urban Planning, Shenzhen University, Shenzhen 518000, China
2
BENYUAN Design Research Center, Shenzhen University, Shenzhen 518000, China
3
State Key Laboratory of Subtropical Building and Urban Science, Shenzhen 518000, China
4
School of Cyber Science and Engineering, Southeast University, Nanjing 210000, China
5
Shenzhen Second People’s Hospital, Shenzhen 518000, China
*
Author to whom correspondence should be addressed.
Buildings 2026, 16(10), 1985; https://doi.org/10.3390/buildings16101985
Submission received: 9 April 2026
/
Revised: 30 April 2026
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Accepted: 14 May 2026
/
Published: 18 May 2026
(This article belongs to the Collection Construction Management – Future Innovations, Methods, Techniques and Technologies)
Abstract
Building services systems in comprehensive hospitals must support safety-critical clinical workflows within dense spatial and technical interfaces. Coordination among owners, designers, contractors, operators, and clinical users is often fragmented across planning, design, construction, and operation. This study adopts an exploratory qualitative case-study design using grounded theory coding procedures. Semi-structured interviews and field observations were conducted with 44 stakeholders involved in 10 tertiary hospitals in Shenzhen, China. Through open, axial, and selective coding, the study identifies contextual conditions, recurrent coordination breakpoints, and four lifecycle coordination mechanisms: requirement stabilization, technical integration, verification and handover, and feedback optimization. The findings show that failures in hospital building services systems are not merely technical defects. They are cumulative socio-technical failures generated by unstable clinical requirements, discontinuous responsibilities, weak knowledge translation, and delayed decisions at stage interfaces. The proposed model reframes coordination as an iterative lifecycle process and provides an analytically grounded framework for diagnosing coordination risks and organizing stakeholder responsibilities in complex hospital projects. Its effects on project outcomes require further validation through future implementation and comparative studies.
1. Introduction
Building services systems are fundamental to the operational infrastructure of comprehensive hospitals and must accommodate highly specialized clinical requirements within limited and intensively used architectural space. Unlike those in many other public buildings, hospital building services systems are shaped by dense technical interfaces, strong dependencies on clinical workflows, and tightly coupled spatial and functional relationships. As a result, they constitute a distinct and highly interdependent socio-technical subsystem whose realization depends on coordination across management, design, construction, operation, and clinical use throughout the project lifecycle.
In practice, however, such coordination is often fragmented. Misalignments in objectives, responsibilities, knowledge translation, and decision-making can accumulate across project stages and eventually appear as system underperformance, spatial conflicts, and cost escalation. Table 1 presents representative cases documented through field investigation and on-site photographic records by the authors. More critically, deficiencies in hospital building services systems may continue to generate adverse effects after completion. In severe cases, they may compromise department functionality, delay clinical services, and even threaten hospital service continuity and the safety of medical staff and patients.
Architectural research has examined building services systems from multiple perspectives, including technical characteristics and spatial performance requirements, material composition and spatial configuration logic, and the relationship between resource input and spatial benefit [1,2,3,4,5]. Although previous studies have repeatedly pointed to coordination bottlenecks involving multiple stakeholders, they have largely remained at the level of technical implementation and have paid insufficient attention to cross-stakeholder coordination across the project chain. Without effective lifecycle coordination, isolated technical improvements are difficult to translate into overall system reliability and spatial effectiveness. This study, therefore, investigates the lifecycle coordination of building services systems in comprehensive hospitals. It focuses on key coordination processes such as goal alignment, role and responsibility mapping, knowledge translation, and decision synchronization [6,7,8], and examines how coordination breakpoints emerge, accumulate, and affect the realization and operation of hospital building services systems. By doing so, the study aims to explain how stage-interface coordination breakpoints are formed under the specific conditions of comprehensive hospitals and to develop an analytically grounded framework for diagnosing coordination risks and organizing lifecycle responsibilities. The framework is not presented as an empirically validated tool for improving project outcomes; its implementation effects require further project-based validation.
Existing studies on hospital building services systems have mainly focused on technical and managerial issues within individual project phases, including system performance optimization and performance enhancement [9,10,11], integrated building–services design [12,13], construction and assembly technologies [14,15], and operation and cost management [16,17]. Meanwhile, research on hospital project management has advanced in broader areas such as organizational models [18,19,20], procedural control [21,22], investment management [23,24], and digital collaboration [25,26,27]. The former tends to address phase-specific technical objectives, whereas the latter focuses on project-wide governance and management efficiency. However, little attention has been paid to how these two strands can be connected at the level of hospital building services systems as a distinct and highly interdependent subsystem of comprehensive hospitals (see Table 2). This disconnect helps explain why technical problems in hospital building services systems are often reproduced through cross-stage coordination failures, and it defines the central gap addressed in this study.
In response to this gap, this study addresses three questions: how coordination failures in hospital building services systems are manifested across the project lifecycle, how these failures are produced through multi-stakeholder misalignments, and what lifecycle mechanisms can diagnose and mitigate such coordination breakpoints. Drawing on the experiential accounts of multiple stakeholders, the study identifies four recurrent coordination breakpoints: clinical-service objective divergence, cross-stage responsibility discontinuity, operational knowledge translation gap, and stage-interface decision suspension. These terms are used as second-order analytical labels derived from coding rather than as pre-existing theoretical constructs borrowed from other fields. The study further traces how these breakpoints generate cumulative consequences across planning, design, construction, and operation. On this basis, the study develops a hospital-specific lifecycle coordination model for diagnosing coordination risks and organizing lifecycle responsibilities in comprehensive hospital building services systems.
The contribution of this study does not lie in proposing another generic lifecycle checklist. Rather, it lies in explaining why building services systems in comprehensive hospitals repeatedly fail at stage interfaces. Compared with ordinary public buildings, comprehensive hospitals are characterized by safety-critical service continuity, intensive clinical dependence, rapid functional adjustment, dense ceiling and shaft interfaces, and complex operator–user relationships. These conditions make coordination failures cumulative: unstable clinical requirements in the planning stage may later appear as insufficient capacity; unclear responsibility during construction may become maintenance inaccessibility; and incomplete handover may lead to delayed fault diagnosis during operation. Therefore, this study conceptualizes coordination breakpoints as stage-interface disruptions through which socio-organizational misalignments are transformed into technical, spatial, and operational failures.
2. Materials and Methods
2.1. Research Design
This study adopts an exploratory qualitative case-study design using grounded theory coding procedures. The purpose is not to claim a universally generalizable theory, but to construct an explanatory framework grounded in multi-stakeholder accounts and field observations from hospital building services projects. Grounded theory coding procedures were used because they enable analytical categories to be developed from fragmented but experience-rich accounts provided by different stakeholders [28,29].
The analysis followed open, axial, and selective coding. Initial labels were generated as closely as possible from participants’ original expressions. These labels were then compared, grouped, and abstracted into sub-concepts and categories. Existing lifecycle coordination and project management literature was used only as a sensitizing background during interpretation, rather than as a deductive coding framework. Therefore, the study follows an iterative qualitative logic: empirical coding first identifies recurrent phenomena, and subsequent interpretation relates these phenomena to the lifecycle coordination of hospital building services systems, as illustrated in Figure 1.
2.2. Sample Selection and Study Context
To conduct an in-depth investigation into the current state of architectural and building services systems development in comprehensive hospitals, this study selected ten representative tertiary hospitals in Shenzhen as research subjects. Shenzhen’s recent intensive hospital construction efforts have provided samples of newly built comprehensive hospitals that are large in scale and equipped with advanced systems. Moreover, under conditions of high urban density, Shenzhen has actively explored innovative architectural models for hospitals, focusing on intelligent, green, and vertical configurations, which increases the complexity of coordinating intricate building services systems within constrained spaces. Additionally, Shenzhen exhibits particularities in its hospital construction regime. The Shenzhen Municipal Bureau of Public Works, as an institutional carrier under a centralized government construction management system, assumes the responsibility of controlling the entire lifecycle of hospital construction, facilitating the optimization of multi-stakeholder collaboration.
At the same time, the Shenzhen context also shapes the transferability of the findings. High urban density and vertical hospital development intensify conflicts among ceiling layers, shafts, equipment rooms, and maintenance access. Rapid public hospital construction increases schedule pressure and may amplify late-stage coordination failures. Moreover, the centralized public works management model makes mechanisms such as joint approval and cross-stakeholder coordination institutionally feasible. In decentralized, privately funded, or slower-paced hospital projects, these mechanisms may need to be supported by different contractual arrangements, owner-led governance structures, or integrated delivery models. Therefore, Shenzhen is treated not only as a source of representative high-complexity hospital cases, but also as a specific institutional and spatial context that conditions the proposed model.
Thus, selecting tertiary hospitals in Shenzhen as samples for this study holds significant referential value for optimizing mechanisms of multi-stakeholder collaboration in the building services systems of comprehensive hospitals in the region. Furthermore, the research group’s local presence in Shenzhen facilitates the collection of data from hospitals in the area. The selected samples encompass hospitals from various districts of Shenzhen, including Futian, Luohu, Nanshan, and Bao’an, providing a comprehensive reflection of the overall state of comprehensive hospital construction and their building services systems in Shenzhen. All selected hospitals are classified as tertiary level, with the majority being top-ranked Grade A hospitals, ensuring a certain level of advancement and complexity in the construction of the samples. The samples also include public hospitals led by local government construction and collaborative medical practices co-established with universities, representing diverse operational models typical of Shenzhen’s medical architectural construction. The specific parameters of the sample hospitals are listed in Table 3, which includes hospitals with newly constructed areas.
2.3. Interview Participants and Data Collection
Data collection was conducted using semi-structured interviews and field research to acquire comprehensive and authentic primary data. A total of 44 individuals participated in the interviews, comprising 7 hospital construction management staff, 8 professional designers, 5 construction management personnel, 19 hospital operations management staff, and 5 medical personnel. To improve the transparency of the qualitative sample, the demographic profile of the 44 interview participants is summarized in Table 4. To protect institutional and personal confidentiality, the hospitals are coded as H1–H10 and the participants are coded as P01–P44. For participants who were involved in multiple hospital projects, the hospital code indicates the main project from which the interview evidence was derived.
To ensure the breadth and representativeness of the interview data, this study employed a combined approach of purposive sampling and theoretical sampling for the research. In the initial phase, purposive sampling was utilized, prioritizing interviews with experienced personnel involved in hospital construction and building services systems maintenance. The first round of interviews included 3 individuals from the construction aspect and 6 from operations, covering topics such as policy orientation, construction management challenges, operational issues, and maintenance pain points. Preliminary analysis indicated that the construction stakeholders were focused on compliance, cost-effectiveness, and schedule control, while the operational stakeholders concentrated on the adaptability and maintenance convenience of building services systems, reflecting significant perceptual differences between the different entities regarding building services systems. To gain deeper insights into the cognitive and behavioral differences between these groups, theoretical sampling was used to supplement the interview sample. This included an additional 4 construction management personnel, 8 professional designers (in architecture, HVAC, plumbing and drainage, electrical, and automation), 5 construction management staff, 13 operations management staff, and 5 clinical frontline medical personnel. This approach systematically collected authentic feedback on the construction and use of building services systems from various stages, specialties, and roles. Concurrently, field research was conducted, involving on-site inspections of building services systems rooms, ceiling layers, shafts, and rooftop spaces, supplemented by photographic records and observational data. All interviews were recorded and transcribed verbatim to form a systematic and detailed foundational dataset, supporting the subsequent application of grounded theory through progressive coding and theoretical development.
2.4. Grounded Theory Coding Procedure
2.4.1. Open Coding
This study uses grounded theory to identify recurrent coordination breakpoints in hospital building services systems and to explain how they emerge across the project lifecycle. Grounded theory was considered appropriate because it enables explanatory categories to be developed from fragmented yet experience-rich accounts provided by multiple stakeholders. The first stage of analysis was open coding, in which the interview texts were examined line by line and labeled according to the phenomena described by the participants. These initial labels served to condense raw statements into analytically meaningful units and provided the basis for subsequent concept aggregation. In this study, the interview accounts of 44 participants constituted the primary data source. Initial labels were generated as closely as possible to the participants’ original expressions. For example, the statement, “The number of air changes in the HVAC system strictly adheres to standards, yet often results in disputes with the design institute. I argue that these standards represent the minimum threshold, which severely limits our adjustment capability. Some people feel overheated, and others feel stuffy, thus the cooling capacity and ventilation rates are significant issues,” was coded as “aa3—design strictly adheres to minimum standards” and “insufficient cooling capacity and ventilation rates” (see Table 5). Through constant comparison, these labels were further consolidated and conceptualized, resulting in 42 sub-concepts such as “frequent functional changes in spaces”.
2.4.2. Axial Coding
The second stage of analysis was axial coding, which aimed to identify the intrinsic logical relationships among the sub-concepts generated through open coding. The core task of this stage was to integrate dispersed concepts and distill higher-level abstract categories, thereby laying the foundation for subsequent theoretical construction. In this study, three complementary analytical strategies—causal analysis, contextual analysis, and hierarchical categorization—were adopted to support the continuous comparison, clustering, and integration of concepts [30,31,32,33]. Through this process, three primary categories with clear logical progression were identified.
Contextual Conditions refer to the background conditions and constraints surrounding hospital building services systems, mainly including construction context, renovation context, and normative context.
Coordination Breakpoints refer to recurrent disruptions in cross-stakeholder coordination during the lifecycle of hospital building services systems in comprehensive hospitals.
Outcome-Based Feedback refers to the performance, efficiency, spatial, and experiential consequences generated by these coordination breakpoints under specific contextual conditions.
Together, these three primary categories form a causal framework for understanding multi-stakeholder coordination problems in hospital building services systems and provide a clear basis for the subsequent stage of selective coding (see Table 6).
To clarify how the four coordination breakpoint categories were derived from empirical coding rather than imposed as pre-existing concepts, Table 7 traces each category to its domain-specific definition, typical empirical basis, and related lifecycle mechanism.
2.4.3. Selective Coding
The third stage of analysis was selective coding, which aimed to identify a core category capable of integrating the main categories and providing a coherent explanation of the research phenomenon, based on the preceding stages of open and axial coding [34,35]. In this study, coordination breakpoints were identified as the core category because they provided the strongest explanatory and integrative power for understanding multi-stakeholder coordination problems in hospital building services systems. As the central category of the analysis, coordination breakpoints link contextual conditions with outcome-based feedback: they are shaped by specific contextual conditions and, in turn, generate performance, efficiency, spatial, and experiential consequences. This positioning established coordination breakpoints as the analytical core of the grounded theory model.
2.4.4. Analytical Credibility
To strengthen analytical credibility, three procedures were adopted. First, stakeholder triangulation was used. The interview sample covered hospital construction managers, professional designers, construction managers, hospital operations and maintenance staff, and clinical users, allowing the same coordination problems to be compared across different stakeholder perspectives. Second, data triangulation was used. Interview data were supplemented by field observations of equipment rooms, ceiling layers, shafts, rooftop spaces, and photographic records. Third, constant comparison was used throughout open, axial, and selective coding. Labels, sub-concepts, and categories were repeatedly compared across stakeholder groups and project stages to avoid relying on isolated statements.
These procedures enhance the credibility of the explanatory model. However, they do not constitute outcome validation. The model should therefore be understood as a diagnostic and explanatory framework derived from qualitative evidence. Its effectiveness in improving project cost, operational performance, or system reliability requires further longitudinal and comparative validation.
2.5. Analytical Framework and Model Development
To translate the grounded theory findings into an explanatory model, this study mapped interview-derived concepts concerning multi-stakeholder coordination behaviors onto key lifecycle interfaces and re-examined them in relation to hospital-specific project processes. Through this process, four recurrent coordination breakpoints were identified: clinical-service objective divergence, cross-stage responsibility discontinuity, operational knowledge translation gap, and stage-interface decision suspension. These breakpoints are shaped by contextual conditions and, in turn, generate performance, efficiency, spatial, and experiential consequences.
Based on these coordination breakpoints and the feasible suggestions provided by the respondents, four lifecycle coordination mechanisms were identified: requirement stabilization between the planning and design stages, technical integration between the design and construction stages, verification and handover between the construction and operation stages, and feedback optimization between operation and future planning. These mechanisms should be understood as breakpoint-control mechanisms rather than as generic project phases. Figure 2 presents the multi-stakeholder practice analysis of coordination breakpoints in hospital building services systems.
3. Results
3.1. Lifecycle Coordination Model
Following the phased coding of the interview data, the lifecycle coordination model was developed to explain how hospital building services systems can control recurrent coordination breakpoints at key stage interfaces. The model should not be read as a simple sequence of generic project phases. Rather, each mechanism corresponds to a specific type of coordination breakpoint identified from the interview and field data. Although the model is grounded in the empirical data of this study, its stage-interface logic is also consistent with collaborative project delivery research, which emphasizes early stakeholder involvement, transparent responsibility allocation, and continuous information exchange across project phases.
Requirement stabilization responds to clinical-service objective divergence by converting clinical and operational expectations into confirmed performance, capacity, and spatial boundaries. Technical integration responds to cross-stage responsibility discontinuity and operational knowledge translation gaps by turning design intent into executable and accountable construction information. Verification and handover respond to stage-interface decision suspension by shifting acceptance from formal technical completion to operational readiness. Feedback optimization responds to the loss of operational learning by transforming post-occupancy experience into future planning and design inputs. In this sense, the model explains coordination as an iterative socio-technical process rather than a set of isolated project tasks.
Table 8 further clarifies how the proposed lifecycle coordination model differs from conventional coordination practices in requirement definition, stakeholder participation, technical integration, completion acceptance, handover information, and post-occupancy learning.
3.2. Requirement Stabilization Mechanism
The Requirement Stabilization Mechanism operates at the early stages of the project lifecycle and focuses on systematically translating user needs into design inputs, thereby defining the functional objectives and boundary conditions of hospital building services systems. It comprises four key tasks: requirement translation, task clarification, anticipation and reservation, and joint approval. Together, these tasks support the early alignment of construction objectives, design parameters, and stakeholder expectations, helping reduce clinical-service objective divergence in subsequent stages (see Figure 3).
3.2.1. Requirement Translation
Requirement translation is the first task of the requirement stabilization mechanism. It aims to convert clinical, operational, and departmental needs into technical requirements for hospital building services systems. In the early phases of hospital projects, different stakeholders often describe building services systems from different knowledge backgrounds: clinical departments focus on medical workflows and functional needs, operators focus on maintainability and system reliability, while designers need clear performance targets, capacity parameters, spatial boundaries, and interface conditions. This difference often causes operational pain points to be poorly translated into design briefs and drawings.
Therefore, requirement translation should include benchmarking, on-site reference research, and requirement analysis. Through visits to exemplary projects and discussions with relevant departments, stakeholders can clarify construction objectives, identify future functional changes, and translate user needs into explicit technical terms. In this sense, reference research is not an independent mechanism, but a supporting method for requirement translation.
3.2.2. Task Clarification
Task clarification, grounded in the shared understanding and construction objectives formed through requirement translation, involves multiple stakeholders—including hospital construction and operational managers and designers—collaboratively participating to clearly define and formally solidify the core requirements, performance metrics, capacity parameters, and boundary conditions of building services systems. This process further refines the construction tasks and organizes all parties to confirm the specifications, reducing the likelihood of later changes due to unclear tasks.
3.2.3. Anticipation and Reservation
The anticipation and reservation mechanism emphasizes proactive construction of flexibility within the building services systems during the design expression phase to accommodate functional adjustments and building services systems evolution. Most hospital operation leaders highlight issues such as insufficient capacity, difficulty in expansion, and backup failures in various electromechanical building services systems. The current design approaches for these systems often lack consideration for the hospital’s planning and development trends. Therefore, at the design onset, it is imperative to conduct comprehensive calculations based on the total capacity of the hospital’s building services systems, integrating evolving medical practices and future development plans of the hospital precinct. Key locations such as building services systems rooms, vertical ducts, and suspended building services systems layers must have provisions for expansion conduits to ensure that the building services systems can dynamically respond to future technological loads and building services systems replacements, thereby establishing a foundational infrastructure and spatial framework.
3.2.4. Joint Approval
Joint approval, as a converging process node within the mechanism of requirement stabilization, primarily entails the confirmation of design intentions and expressions for building services systems that emerge from preceding phases of requirement translation, anticipation, and reservation. This stage involves the coordination and decision-making regarding contradictory issues that arise during the design process to ensure that the subsequent construction of building services systems is aligned around a unified objective. Many hospital operations managers report minimal involvement in the early stages of a project, yet they are accountable for addressing usage issues that emerge later. Therefore, it is imperative to include multi-party confirmation stages during the design phase. Additionally, they, along with the mechanical and electrical design leads, have highlighted the need for decision-making to resolve conflicts such as those between system redundancy and cost-effectiveness or between energy-saving targets and cleanliness requirements. If such conflicts are ambiguously handled in the early stages, designers may resort to minimum regulatory requirements, ultimately compromising the effectiveness of the building services systems in later use.
3.3. Technical Integration Mechanism
The Technical Integration Mechanism operates between the design and construction stages and focuses on maintaining continuity between design intent and construction execution. It addresses the challenge that hospital building services systems often undergo repeated adjustments when technical decisions, procurement conditions, and site realities are not effectively coordinated. This mechanism comprises four key tasks: specialized technical briefings, joint detailing, procurement confirmation, and process mock-ups. Together, these tasks strengthen interprofessional coordination, improve constructability, and reduce cross-stage responsibility discontinuity and operational knowledge translation gaps during implementation (see Figure 4).
3.3.1. Specialized Technical Briefings
Specialized technical briefings involve a systematic exposition and clarification of the design intent and key technical solutions by the designing entity prior to construction, specifically for hospital building services systems. This process is essential to ensure that the construction team accurately understands the design specifications. Within the context of hospital building services systems, it is critical to conduct detailed disclosures concerning medical process requirements and performance benchmarks. A hospital infrastructure manager noted that during the design briefing, only the floor plan for the purified air conditioning was provided, marking only the quantity and location of high-efficiency filters. However, the sealing level required for installation was not specified, leading to the use of standard rubber strips for sealing by the construction crew, which ultimately resulted in an exceedance of microbial contamination standards upon inspection.
3.3.2. Joint Detailing
Joint detailing is a crucial mechanism that builds upon specialized technical briefings. It involves the collaborative refinement of building services systems, key interface connections, and construction drawing revisions by the design team, construction team, and building services systems suppliers. This process ensures the formation of a coherent system logic and spatial integration among different specialties within the building services systems. Architectural designers and electromechanical engineers have pointed out that due to insufficient detailing, the sequence of professional entry and installation often results in issues such as insufficient clear height and maintenance space upon completion. Establishing a joint detailing system, with clearly defined responsibilities for detailing, can significantly enhance the collaborative effectiveness and implementation ability of building services systems.
3.3.3. Procurement Confirmation
Procurement confirmation addresses the frequent discrepancies between the design and implementation of building services systems through a matching review process, focusing primarily on the confirmation of technical specifications and installation conditions. Several construction managers have highlighted that hospital building services systems are complex, often facing issues such as insufficient installation space, transportation difficulties, and interface mismatches, typically originating from gaps in information between design and procurement phases.
3.3.4. Process Mock-Ups
The process mock-ups mechanism involves selecting segments of building services systems installation in advance to conduct virtual process simulations and on-site physical prototype testing, particularly for systems with stringent construction process requirements, such as medical gas systems, clean air conditioning, and main electrical systems. Some hospital construction managers and operational managers believe that the process mock-ups mechanism can effectively prevent issues of inoperability post-construction, exposing conflicts early and allowing for timely adjustments.
3.4. Verification and Handover Mechanism
The Verification and Handover Mechanism operates at the transition from construction to operation and focuses on ensuring that hospital building services systems can reliably support real clinical use after completion. In hospital projects, technical compliance at the construction stage does not necessarily guarantee operational suitability. This mechanism, therefore, emphasizes the verification of system functionality, the transfer of operational information, and the alignment of system interfaces before the building enters routine use. It comprises three key tasks: system integration, performance verification, and information handover. Together, these tasks help reduce stage-interface decision suspension at the commissioning stage and improve the operational readiness of hospital building services systems (see Figure 5).
3.4.1. System Integration
System integration refers to the comprehensive linkage and data integration between building services systems and the hospital’s smart operational management platform. This integration ensures that, prior to the formal completion and delivery of the building services systems, communication linkage, protocol configuration, and joint testing with the smart platform have been established. Several hospital logistics managers have noted that although systems are constructed, their delivery often lacks comprehensive review and testing of the smart system interfaces. This deficiency frequently results in operational systems failing to upload data or losing control, ultimately rendering the smart platform ineffective.
3.4.2. Performance Verification
Performance verification mandates that prior to system handover, the functional performance of the building services systems should be assessed through operational simulations and empirical testing. Technical directors from various hospitals have pointed out that some projects are currently handed over based merely on conditions such as “building services systems electrification” or “system ventilation,” without verifying the performance of building services systems under peak loads and diverse operating conditions. This oversight leads to immediate problems upon system use. A structural engineering staff member recounted an incident during the commissioning of a purification air conditioning system, where the system was tested with only one air volume. Subsequently, when multiple devices in the department were activated, the entire pressure differential failed. Therefore, it is imperative that the systems undergo multidimensional performance testing under full load and continuous operation contexts, and that a detailed third-party assessment report is provided as the basis for handover.
3.4.3. Information Handover
Information handover emphasizes that upon completion of building services systems installations, there must be a synchronous transfer of comprehensive operational parameters, installation blueprints, maintenance manuals, and building services systems historical data, especially information pertaining to concealed installations. Information handover is regarded as a critical component of the project completion and acceptance process. The findings from verification activities should be formally documented to confirm and synchronize the acknowledgment of delivery responsibilities and the status of the building services systems. This approach aims to prevent superficial acceptance procedures that merely follow formalities without substantive verification. Several hospital operations and maintenance departments report that in the initial stages of assuming control, they often encounter significant difficulties, such as “inability to locate diagrams, unavailability of knowledgeable personnel, and unclear system logic,” which severely impacts their ability to perform debugging and maintenance efficiently. Furthermore, hospital management often indicates that hospitals are not always involved as stakeholders in the completion and acceptance process, leading to a situation where issues are passively accepted. Therefore, it is necessary to implement an information handover mechanism that ensures the complete transfer of building services systems information, enabling the operations and maintenance team to have a comprehensive, traceable, and retrievable understanding of the building services systems.
Based on the verification and handover mechanism, Table 9 summarizes a practical checklist for on-site verification, system integration, information handover, responsibility confirmation, and operational readiness.
Because some hospital building services systems are safety-critical, Table 10 further translates the lifecycle coordination mechanisms into risk-sensitive coordination gates for medical gas, clean HVAC, emergency power, logistics, and fire protection systems.
3.5. Feedback Optimization Mechanism
The Feedback Optimization Mechanism operates after occupation and extends toward future planning, focusing on transforming operational experience into iterative learning for subsequent projects and system adjustments. Because hospital building services systems are highly dependent on evolving clinical workflows, user demands, and technological change, many coordination problems only become fully visible during operation. This mechanism comprises three key tasks: operational evaluation, retrofit decision-making, and iterative foresight. Together, these tasks establish a post-occupancy learning loop through which outcome-based feedback can inform future planning, design, and optimization of hospital building services systems (see Figure 6).
3.5.1. Operational Evaluation
Operational evaluation focuses on systematically documenting the performance status, maintenance information, and user experiences of hospital building services systems. Several heads of hospital electromechanical departments indicate that assessments of building services systems are often one-sided. Assessments should not only consider energy consumption but also maintainability and medical staff experiences. In some areas, maintenance personnel are unable to access systems, and issues such as the howling of HVAC vents, leakage problems, and mold issues are frequently reported complaints.
3.5.2. Retrofit Decision-Making
Retrofit decision-making within the context of hospital development refers to a reactive mechanism triggered by the results of operational evaluation. This process fundamentally involves systemic evaluations to determine the necessity of renovations, the methods to be employed, and the outcomes achieved thereby. Interviews with several heads of hospital engineering departments indicate that current building services systems renovations often occur as “reactive emergencies,” lacking a standardized decision-making process. Common issues identified include “replacing parts without adjusting the system” and “expenditures yielding poor outcomes.” One individual from the hospital’s general affairs office recounted a renovation of the medical gas system, which yielded minimal improvements due to an initial failure to diagnose the fundamental issues accurately. It is imperative that the insights gained from these renovation decisions be systematically reviewed and summarized. Such an approach would effectively provide valuable recommendations for subsequent projects, thereby preventing misguided renovations.
3.5.3. Iterative Foresight
Iterative foresight emphasizes the need for periodic analysis of the various technological trajectories and developmental trends of hospital building services systems. This analysis aims to inform future construction and expansion projects. For instance, regarding the logistics systems, several hospital operations managers have expressed diverse opinions and insights. Some highlight the high maintenance costs and poor timeliness, while others note the benefits of reduced workflow intersections and alleviated congestion. Some even predict a future trend towards robotics-dominated intelligent logistics systems. However, these analyses and forecasts largely remain confined to the level of hospital operations management and have not yet been incorporated into current project workflows. The feedback optimization mechanism can provide an initial reference for future hospital construction endeavors by transforming operational experience into planning and design inputs. However, its effect on subsequent project outcomes still requires validation through longitudinal project implementation.
4. Discussion
4.1. Theoretical Implications
This study repositions hospital building services systems as a hospital-specific socio-technical subsystem whose performance cannot be adequately understood through technical design alone. In comprehensive hospitals, building services systems are deeply entangled with clinical workflows, operational routines, spatial constraints, and institutional decision-making. This makes them fundamentally different from the building services systems of many other public buildings and helps explain why phase-specific technical optimization often fails to resolve recurring project problems. In this sense, the study extends existing research by shifting attention from isolated technical performance toward lifecycle coordination as a central explanatory dimension.
What emerges even more clearly from the grounded theory analysis is that many failures in hospital building services systems are not singular technical defects, but accumulated coordination failures. The identification of clinical-service objective divergence, cross-stage responsibility discontinuity, operational knowledge translation gap, and stage-interface decision suspension provides a more process-based explanation of how such failures are produced. These coordination breakpoints describe recurrent states of disruption through which stakeholder intentions, professional knowledge, and implementation actions become disconnected across the project lifecycle. By establishing coordination breakpoints as the core category, the study provides an analytical structure that links contextual conditions with outcome-based feedback and offers a more coherent interpretation of why hospital building services systems repeatedly encounter performance, efficiency, spatial, and experiential problems.
The transition from grounded theory findings to a lifecycle coordination model further strengthens the contribution of the study. Rather than stopping at the identification of problems, the paper shows how recurrent coordination breakpoints can be translated into four interrelated mechanisms: requirement stabilization, technical integration, verification and handover, and feedback optimization. The significance of this move lies in reframing coordination as an adaptive, iterative, and system-wide socio-technical process, rather than as a set of isolated project tasks. This interpretation is consistent with socio-technical systems theory, which argues that technical performance is inseparable from the social organization of people, tasks, decision rights, and work routines. This helps bridge the gap between studies focused on technical optimization and those concerned with broader hospital project governance, offering a conceptual pathway through which hospital building services systems can be understood as both technical infrastructure and organizational process [36,37,38].
4.2. The Social Dimension of Socio-Technical Coordination
The social dimension of hospital building services systems is reflected in how stakeholders define problems, allocate responsibilities, translate knowledge, and make decisions across project stages. In this study, technical failures such as insufficient medical gas capacity, poor maintainability, weak smart-platform linkage, and inadequate handover information were repeatedly associated with social and organizational conditions. These include unstable clinical requirements, late involvement of O&M staff, fragmented responsibility between design and construction, weak communication between clinical users and technical teams, and delayed decisions about redundancy, cost, and operational readiness.
The four lifecycle mechanisms proposed in this study therefore address not only technical tasks, but also recurrent social coordination problems. Requirement stabilization creates a shared language between clinical departments, owners, operators, and designers before technical parameters are fixed. Technical integration makes design intent, procurement constraints, installation conditions, and maintenance requirements visible to all relevant actors. Verification and handover reintroduces hospital operators and clinical-use scenarios into project acceptance, reducing the risk that formal completion is mistaken for operational readiness. Feedback optimization institutionalizes post-occupancy learning so that operational experience does not remain isolated within the O&M department.
These stakeholder coordination problems are not unique to Shenzhen. Although the institutional setting of Shenzhen influences the feasibility of mechanisms such as joint approval, similar socio-technical challenges are likely to appear in complex healthcare projects in other regions: clinical needs are difficult to translate into engineering parameters, responsibility is often fragmented across project phases, and operational knowledge tends to enter too late. In other geographical or institutional contexts, the same mechanisms may be implemented through different governance tools, such as integrated project delivery, alliance contracting, owner-led clinical commissioning, BIM-based common data environments, or structured post-occupancy evaluation. Therefore, the model should be understood as a transferable coordination logic rather than a Shenzhen-specific administrative procedure.
4.3. Practical Implications
The practical significance of the findings lies in showing that the quality of hospital building services systems depends as much on coordination structure as on technical solutions. The field-documented cases presented in Table 1 make this particularly visible. Functional failure, spatial conflict, and cost overruns are not simply construction defects in a narrow sense; in hospital settings, they can continue to affect service continuity, departmental operation, and medical safety long after project completion. This makes coordination in hospital building services systems a matter of operational resilience rather than routine project management alone.
Many of the downstream problems identified in this study can already be traced back to the early project stages. When user needs are weakly translated, functional boundaries remain unclear, or future adjustment is not anticipated, later design and construction work are forced to operate on unstable assumptions. The Requirement Stabilization Mechanism, therefore, has direct practical relevance for hospital owners, design managers, and operational stakeholders. It suggests that requirement translation, task clarification, anticipation and reservation, and joint approval should be treated as essential project processes rather than optional coordination supplements. In complex hospital projects, stabilizing requirements early can help reduce clinical-service objective divergence and limit repeated redesign and retrofit.
The findings also highlight that continuity between design and construction cannot be assumed. In hospital projects, technical decisions often become distorted when procurement constraints, installation conditions, and on-site realities are not brought into the same coordination process. The Technical Integration Mechanism is valuable precisely because it addresses this gap. Specialized technical briefings, joint detailing, procurement confirmation, and process mock-ups help translate design intent into executable system integration. In practice, these processes can improve constructability, reduce interface mismatch, and preserve critical conditions such as clear height, maintenance access, and system compatibility.
What happens after construction is equally important. The Verification and Handover Mechanism and the Feedback Optimization Mechanism both show that technical completion does not automatically result in operational suitability. Hospital building services systems are exposed to real clinical loads, evolving management routines, and changing technological demands only after occupation. For that reason, system integration, performance verification, information handover, operational evaluation, retrofit decision-making, and iterative foresight should be understood as continuous lifecycle processes rather than postscript tasks. Seen from this perspective, the proposed lifecycle coordination model provides a diagnostic structure for identifying coordination risks and organizing stakeholder responsibilities. It should not be interpreted as evidence that implementation will automatically improve cost, reliability, or long-term performance; these effects require further project-based validation.
4.4. Contextual Transferability and Limitations
The Shenzhen context shaped both the observed coordination problems and the feasibility of the proposed mechanisms. High-density urban conditions and vertical hospital development increase spatial and technical interface conflicts. Rapid hospital construction intensifies schedule pressure and late-stage adjustments. The centralized public works management model makes joint approval and cross-stakeholder coordination more feasible than in decentralized or privately funded projects. Therefore, Shenzhen should be understood not only as an empirical setting, but also as an institutional and spatial condition that shapes the proposed model.
The model is most applicable to large-scale, high-density, technically complex hospital projects with strong owner coordination capacity. Its applicability to decentralized, privately funded, smaller-scale, or slower-paced healthcare projects requires further testing. In such contexts, the same mechanisms may need to be supported by different contractual arrangements, integrated delivery models, or stronger owner-led governance.
Another limitation is that the study focuses on model construction and explanation rather than quantitative outcome validation. The lifecycle coordination model has interpretive strength, but its effectiveness in improving project cost, operational reliability, user satisfaction, or long-term system performance still needs to be tested through longitudinal implementation and comparative case studies. In addition, while the present research identifies important implications for equipment rooms, shafts, suspended service layers, maintenance access, and other spatial nodes, it does not yet convert the coordination model into a detailed set of architectural design tools. This leaves a clear direction for subsequent research: to connect lifecycle coordination mechanisms with spatial node optimization and more directly executable design strategies.
5. Conclusions
This study examined the coordination problems of building services systems in comprehensive hospitals from a lifecycle perspective. Drawing on semi-structured interviews and field observations involving 44 participants across planning, design, construction, operation, and clinical use in ten tertiary hospitals in Shenzhen, the study used grounded theory coding procedures within an exploratory qualitative case-study design to identify contextual conditions, coordination breakpoints, and lifecycle coordination mechanisms.
The findings show that failures in hospital building services systems are not merely technical defects within isolated project phases. They are cumulative socio-technical failures generated by clinical-service objective divergence, cross-stage responsibility discontinuity, operational knowledge translation gaps, and stage-interface decision suspension. These breakpoints link contextual conditions with performance, efficiency, spatial, and experiential consequences.
On this basis, the study developed a lifecycle coordination model consisting of requirement stabilization, technical integration, verification and handover, and feedback optimization. The model provides an analytically grounded framework for diagnosing coordination risks and organizing stakeholder responsibilities in complex hospital projects. It also clarifies how safety-critical building services systems can be managed through risk-sensitive coordination gates and evidence-based handover procedures.
However, the model should not be understood as a universally validated implementation tool. Its effects on project cost, operational reliability, user satisfaction, and long-term system performance have not yet been quantitatively or longitudinally validated. Future research should test the model through comparative case studies, longitudinal project implementation, and the development of executable design tools for critical spatial nodes of hospital building services systems. Further studies should also examine whether the model can be adapted to decentralized, privately funded, smaller-scale, or non-Shenzhen healthcare projects.
Author Contributions
Conceptualization, S.Y., X.L., J.M. and H.C.; methodology, S.Y. and X.L.; investigation, S.Y.; formal analysis, S.Y.; data curation, S.Y.; resources, J.M. and Z.W.; writing—original draft preparation, S.Y.; writing—review and editing, S.Y., X.L., J.M., H.C. and Z.W.; supervision, X.L. and J.M.; project administration, X.L. and J.M.; funding acquisition, X.L. All authors have read and agreed to the published version of the manuscript.
Funding
This research was funded by the Natural Science Foundation of Guangdong, grant number 2023A1515011134.
Institutional Review Board Statement
All subjects gave their informed consent for inclusion before they participated in the study. The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Ethics Committee of the Health Science Center, Shenzhen University (Project identification code PN-202500178, approved on 9 October 2025).
Informed Consent Statement
Informed consent was obtained from all subjects involved in the study.
Data Availability Statement
The data presented in this study are available from the corresponding author upon reasonable request. The data are not publicly available due to interview confidentiality and privacy restrictions.
Conflicts of Interest
The authors declare no conflicts of interest.
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Figure 1.
Grounded theory coding and model-development procedure.
Figure 2.
Multi-stakeholder practice analysis of coordination breakpoints in hospital building services systems.
Figure 2.
Multi-stakeholder practice analysis of coordination breakpoints in hospital building services systems.
Figure 3.
Requirement Stabilization Mechanism.
Figure 4.
Technical Integration Mechanism.
Figure 5.
Verification and Handover Mechanism.
Figure 6.
Feedback Optimization Mechanism.
Table 1.
Representative Field-Documented Consequences of Coordination Failures.
| Functional Failure | ||
| Inoperability | Insufficient capacity | Low operational efficiency |
 |  |  |
| Case 1. Logistics system outdoor exposure Specimen damage due to light exposure. | Case 2. Emergency pandemic response Oxygen supply failure in pipelines. | Case 3. Logistics congestion Delayed delivery of medical boxes. |
| Spatial Conflicts | ||
| Installation failure | Maintenance difficulties | Compromised spatial quality |
 |  |  |
| Case 4. Inadequate space in utility rooms Insufficient air conditioning capacity External building services systems attachments. | Case 5. Overcrowded ceiling conduits Lack of maintenance space. | Case 6. Ducts causing reduced clearance. |
| Cost overruns | ||
| Construction cost | Operational cost | Renovation cost |
 |  |  |
| Case 7. Loss of control in professional coordination HVAC system installation failures Design changes and onsite modifications. | Case 8. Weak linkage between building services systems and platforms Challenges in building services systems management and energy efficiency optimization via smart platforms. | Case 9. High costs of multidisciplinary retrofitting Reluctant adoption of mobile building services system units. |
Table 2.
Overview of Relevant Studies.
| Type of Study | Research Themes | Specific Topics |
|---|---|---|
| Optimization of Hospital Building services systems | Technical optimization and performance enhancement of specialized building services systems | Air purification configurations in hospital architecture, energy evaluation of clean air conditioning systems in surgical units, design of hospital rail logistics transport systems |
| Integrated design of building and building services systems | Aesthetics of integrated architectural and building services systems design, vertical space efficiency evaluation in high-rise inpatient buildings, integrated design of structures and building services systems | |
| Construction and assembly technology integration of building services systems | Application of BIM technology in hospital Mechanical, Electrical, and Plumbing installation, optimization of hospital corridor pipelines and comprehensive bracket design | |
| Operational management and cost control of building services systems | Hospital logistics building services systems management models, hospital MEP management based on building automation technology | |
| Comprehensive Management of Hospital Construction | Construction organizational models | Governance of hospital project owners, integrated delivery models for hospital building projects, hospital construction project management methods |
| Construction procedural regimes | Standardization of hospital construction project processes | |
| Construction investment control | Comprehensive investment control in hospital construction projects, audit tracking of hospital construction engineering | |
| Digital collaboration | Collaborative application of hospital BIM technology, integrated BIM management design processes and methods |
Table 3.
Sample Parameters.
| Sample No. | Hospital Grade | Year(s) of Construction | Building Area (m2) | Number of Beds |
|---|---|---|---|---|
| 1 | Tertiary Grade A | 1999\2025 | Approx. 220,000/510,000 | 1800\2500 |
| 2 | Tertiary Grade A | 2012 | Approx. 370,000 | 2000 |
| 3 | Tertiary Grade A | 1980\2024 | Approx. 140,000/360,000 | 1000\1500 |
| 4 | Tertiary Grade A | 2024 | Approx. 600,000 | 2500 |
| 5 | Tertiary Grade A | 2017\Under Construction | Approx. 140,000/700,000 | 800\3200 |
| 6 | Tertiary Grade A | 2018\Under Construction | Approx. 140,000/130,000 | 800\600 |
| 7 | Tertiary Grade A | 1957 | Approx. 70,000 | 800 |
| 8 | Tertiary Grade A | 2019 | Approx. 210,000 | 1500 |
| 9 | Tertiary Grade A | 2015\Under Construction | Approx. 170,000/320,000 | 1000\1500 |
| 10 | Tertiary Grade A | 1984\Under Construction | Approx. 80,000/470,000 | 700\2000 |
Table 4.
Demographic profile of interview participants.
| Participant Code | Related Hospital Code | Years of Experience | Role | Stakeholder Group |
|---|---|---|---|---|
| P01 | Multiple | 32 | Director of the hospital | Hospital Construction Management |
| P02 | H1 | 12 | HVAC Engineer | Operation & Maintenance |
| P03 | H1 | 11 | MEP Engineer | Operation & Maintenance |
| P04 | H1 | 14 | Clinical Personnel | Medical Personnel |
| P05 | H1 | 14 | Hospital Construction Manager | Hospital Construction Management |
| P06 | H2 | 18 | Hospital Construction Manager | Hospital Construction Management |
| P07 | H2 | 13 | Facility Management | Operation & Maintenance |
| P08 | H2 | 11 | Water Supply & Drainage Engineer | Operation & Maintenance |
| P09 | H2 | 11 | MEP Engineer | Operation & Maintenance |
| P10 | H3 | 15 | Construction Manager | Construction Management |
| P11 | H3 | 14 | MEP Engineer | Operation & Maintenance |
| P12 | H3 | 9 | Facility Maintenance | Operation & Maintenance |
| P13 | H3 | 10 | Hospital Construction Manager | Hospital Construction Management |
| P14 | Multiple | 17 | Construction Manager | Construction Management |
| P15 | H4 | 13 | Electrical Engineer | Operation & Maintenance |
| P16 | H4 | 12 | Facility Maintenance | Operation & Maintenance |
| P17 | H4 | 13 | Facility Management | Operation & Maintenance |
| P18 | Multiple | 19 | Hospital Construction Manager | Hospital Construction Management |
| P19 | H5 | 14 | Facility Management | Operation & Maintenance |
| P20 | H5 | 11 | Clinical Personnel | Medical Personnel |
| P21 | H5 | 12 | Facility Maintenance | Operation & Maintenance |
| P22 | H6 | 16 | Construction Manager | Construction Management |
| P23 | H6 | 12 | Intelligent & BIM Engineer | Operation & Maintenance |
| P24 | H6 | 10 | Facility Management | Operation & Maintenance |
| P25 | H7 | 18 | Hospital Construction Manager | Hospital Construction Management |
| P26 | H7 | 13 | Facility Management | Operation & Maintenance |
| P27 | H7 | 12 | Clinical Personnel | Medical Personnel |
| P28 | H8 | 15 | Construction Manager | Construction Management |
| P29 | H8 | 14 | Electrical Engineer | Operation & Maintenance |
| P30 | H8 | 11 | Facility Maintenance | Operation & Maintenance |
| P31 | H9 | 17 | Hospital Construction Manager | Hospital Construction Management |
| P32 | H9 | 13 | Facility Management | Operation & Maintenance |
| P33 | H9 | 9 | Clinical Personnel | Medical Personnel |
| P34 | H10 | 18 | Construction Manager | Construction Management |
| P35 | H10 | 15 | Facility Management | Operation & Maintenance |
| P36 | H10 | 12 | Clinical Personnel | Medical Personnel |
| P37 | Multiple | 26 | Architect Designer | Professional Designer |
| P38 | Multiple | 16 | HVAC Engineer | Professional Designer |
| P39 | Multiple | 8 | Water Supply & Drainage Engineer | Professional Designer |
| P40 | Multiple | 21 | Electrical Engineer | Professional Designer |
| P41 | Multiple | 5 | Intelligent & BIM Engineer | Professional Designer |
| P42 | Multiple | 18 | Medical Process Designer | Professional Designer |
| P43 | Multiple | 7 | Architect Designer | Professional Designer |
| P44 | Multiple | 11 | Intelligent & BIM Engineer | Professional Designer |
Table 5.
Representative Example of Open Coding from Interview Text.
| Interview Text | Labeling | Conceptualization |
|---|---|---|
| “Adjustments to the location of the machine room are primarily driven by frequent changes in space usage, which usually involve minimal changes in area but can significantly impact the crossing of pipelines and the requirements for clear height.” “The number of air changes in the HVAC system strictly adheres to standards, yet often results in disputes with the design institute. I argue that these standards represent the minimum threshold, which severely limits our adjustment capability. Some people feel overheated, and others feel stuffy, thus the cooling capacity and ventilation rates are significant issues.” “There was a severe shortage of oxygen supply at the terminal points during the sudden onset of the pandemic, leading to numerous deaths due to the inability to access sufficient oxygen.” “The designer and construction personnel are unfamiliar with the electromechanical system configurations of the laboratory, necessitating extensive communication, multiple site visits, and coordination with departments to show the designer good examples on site and collaborate on the details in real time.” “The issue arises because what the department wants and what is ultimately represented in the architectural drawings differ. Their understanding does not align with that of the designers and our engineering staff. How do you achieve consensus? Is it through formal meetings?” “Although BIM is now used for integrated management, construction units often make adjustments on site for ease of installation and due to time constraints, leading to discrepancies between the final installation and the design. This results in many on-site modifications, suboptimal clear height outcomes, and very limited maintenance spaces. A multi-party joint detailing approach should be adopted early to clarify details and reduce on-site adjustments.” | aa1 Frequent functional changes in space usage prompt adjustments in the location of the machine room aa2 Challenges in meeting clear height requirements aa3 Design strictly adheres to minimum standards aa4 Insufficient cooling capacity and ventilation rates aa5 Insufficient oxygen supply at the terminal aa12 Departments and designers visit exemplary sites to synchronize requirements aa38 Need to solidify requirements through meetings and ensure accurate representation in drawings aa73 Discrepancies between installation and design aa74 Suboptimal outcomes in clear height aa75 Extremely limited maintenance space aa76 Multi-party joint detailing | A1 Frequent changes in space functionality A2 Impact on clear height A3 Reliance on minimum standards A4 Insufficient supply A8 Benchmark visits for requirement translation A11 Collaborative review A25 Multi-party joint detailing |
Table 6.
Axial coding: context–breakpoint–outcome categories.
| Core Category | Main Concepts | Related Sub-Concepts |
|---|---|---|
| Contextual Conditions | Construction Context | High architectural complexity, large scale of hospital buildings, multi-type vertical development of building services systems, tight construction schedules, humid and hot climate, lengthy construction processes. |
| Renovation Context | Frequent changes in spatial functions, smart transformation upgrades, rapid technological iteration in medical building services systems, loss of old hospital building data. | |
| Normative Context | Ambiguous normative constraints, reliance on the lower limits of norms. | |
| Coordination Breakpoints | Clinical-service objective divergence | Unstable clinical requirements; inconsistent understanding between departments, designers, and engineering staff; insufficient translation of clinical needs into drawings; overreliance on minimum standards |
| Cross-stage responsibility discontinuity | Unclear accountability after design changes; fragmented responsibility among design, procurement, construction, and operation; passive acceptance of later operational problems | |
| Operational knowledge translation gap | Weak translation between clinical, design, construction, and maintenance knowledge; insufficient O&M participation; missing old-system data; unclear control logic | |
| Stage-interface decision suspension | Delayed or unresolved decisions about redundancy, cost, cleanliness, capacity, smart-system interfaces, and handover readiness | |
| Outcome-Based Feedback | Performance Issues | Insufficient supply, inadequate building services systems backup, inadequate control precision, unsuitable building services systems functionality |
| Efficiency Issues | High energy consumption, low maintenance efficiency, low transportation efficiency | |
| Spatial Issues | Insufficient installation space, difficulty in expansion, impact on clear height, insufficient maintenance space | |
| Experience Issues | Excessive building services systems noise, odor impact, poor lighting experience |
Table 7.
Traceability of Coordination Breakpoint Categories.
| Breakpoint Category | Domain-Specific Definition | Typical Empirical Basis from Coding | Related Mechanism |
|---|---|---|---|
| Clinical-service objective divergence | Divergence between clinical-service expectations and design or technical definitions of building services systems | Frequent changes in spatial functions; minimum-standard design; insufficient cooling capacity and ventilation rates; insufficient oxygen supply at terminal points; departments and designers needing site visits to synchronize requirements | Requirement stabilization |
| Cross-stage responsibility discontinuity | Discontinuity of accountability across planning, design, procurement, construction, and operation | Discrepancies between installation and design; on-site modifications caused by schedule pressure; suboptimal clear height; limited maintenance space; passive acceptance of problems by operators | Technical integration |
| Operational knowledge translation gap | Failure to translate clinical and O&M knowledge into design, construction, and handover information | Designers and construction personnel being unfamiliar with specialized system configurations; O&M problems not reflected in drawings; missing diagrams; unavailable knowledgeable personnel; unclear system logic | Verification and handover |
| Stage-interface decision suspension | Delayed or unresolved decisions at lifecycle interfaces that transfer risks to later stages | Unresolved conflicts between redundancy and cost; conflicts between energy-saving and cleanliness requirements; incomplete performance verification; reactive emergency retrofits | Feedback optimization |
Table 8.
Conventional coordination versus the proposed lifecycle coordination model.
| Dimension | Conventional Coordination | Lifecycle Coordination Model |
|---|---|---|
| Requirement definition | Mainly based on design briefs and code compliance | Clinical, operational, spatial, and capacity requirements are jointly confirmed |
| User participation | Clinical and O&M users often enter late | Clinical and O&M users participate in requirement stabilization and handover |
| Technical integration | Design, procurement, and construction are handled separately | Specialized technical briefings, joint detailing, procurement confirmation, and process mock-ups are coordinated before installation |
| Completion acceptance | Based mainly on formal completion and system activation | Based on full-load, scenario-based, and interface-based performance verification |
| Handover information | Drawings and manuals may be transferred incompletely | As-built data, concealed works, parameters, control logic, and maintenance records are transferred |
| Post-occupancy learning | Reactive repair and isolated retrofit | Operational evaluation and feedback inform future planning and design |
Table 9.
Verification and handover checklist for hospital building services systems.
| Checklist Dimension | Required Items |
|---|---|
| Performance verification | Full-load test; continuous operation test; peak clinical scenario test; emergency or failure-mode test; third-party testing report |
| System integration | Interface test between HVAC, medical gas, emergency power, logistics, fire protection, and intelligent operation platforms |
| Information handover | As-built drawings; concealed works records; equipment list; system parameters; control logic; platform interface protocol; maintenance manuals; commissioning history |
| Responsibility confirmation | Owner sign-off; hospital operator sign-off; unresolved issue list; rectification responsibility; warranty and emergency response contact |
| Operational readiness | O&M staff training; maintenance access route confirmation; maintenance space check; spare parts confirmation; emergency operation plan |
Table 10.
Risk-sensitive coordination gates for safety-critical hospital building services systems.
| Safety-Critical System | Potential Failure Consequence | Required Coordination Gate | Evidence Required Before Handover |
|---|---|---|---|
| Medical gas system | Insufficient terminal pressure; failure of ventilators or high-flow oxygen therapy | Capacity review; peak-load verification; redundancy decision record | Peak-load test report; terminal pressure test; O&M sign-off |
| Clean HVAC and infection-control system | Pressure differential failure; infection-control risk | Technical briefing; process mock-up; full-load performance verification | Pressure differential test; filter and sealing record; microbial inspection if required |
| Emergency power system | Operating room interruption; service suspension | Cross-system integration; emergency scenario test | Backup power switching test; UPS/generator interface test; emergency response record |
| Logistics and intelligent transport system | Delayed specimen or medical-box delivery; data upload failure | Operational scenario simulation; smart-platform interface test | Transport efficiency test; platform data interface record; fault response plan |
| Fire protection and smoke-control system | Life-safety risk; service interruption | Interface test; emergency linkage test | Fire linkage test; smoke-control test; emergency plan sign-off |
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MDPI and ACS Style
Yan, S.; Li, X.; Meng, J.; Chen, H.; Weng, Z. Lifecycle Coordination Mechanisms of Building Services Systems in Comprehensive Hospitals: A Grounded Theory-Based Case Study in Shenzhen. Buildings 2026, 16, 1985. https://doi.org/10.3390/buildings16101985
AMA Style
Yan S, Li X, Meng J, Chen H, Weng Z. Lifecycle Coordination Mechanisms of Building Services Systems in Comprehensive Hospitals: A Grounded Theory-Based Case Study in Shenzhen. Buildings. 2026; 16(10):1985. https://doi.org/10.3390/buildings16101985
Chicago/Turabian StyleYan, Shangyan, Xiaoyu Li, Jianmin Meng, Hailin Chen, and Zhenfeng Weng. 2026. "Lifecycle Coordination Mechanisms of Building Services Systems in Comprehensive Hospitals: A Grounded Theory-Based Case Study in Shenzhen" Buildings 16, no. 10: 1985. https://doi.org/10.3390/buildings16101985
APA StyleYan, S., Li, X., Meng, J., Chen, H., & Weng, Z. (2026). Lifecycle Coordination Mechanisms of Building Services Systems in Comprehensive Hospitals: A Grounded Theory-Based Case Study in Shenzhen. Buildings, 16(10), 1985. https://doi.org/10.3390/buildings16101985
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