Sultan, Mohamed (2025) PPP contracts for healthcare facilities in Canada: Qualitative study to identify lessons learned. PhD thesis, Arizona State University, USA.
Abstract
This dissertation examines Public–Private Partnership (PPP) contracts for healthcare facilities in Canada, focusing on four interrelated areas: best practices, procurement processes, monitoring service performance, and contract renegotiations. International literature highlights several procurement practices critical for PPP success. These include establishing permanent PPP agencies with governance authority and diverse expertise, adopting predictable legal frameworks, expanding competition through open access to foreign bidders, and ensuring transparent and fair procurement with prequalification and output-based specifications. Canadian PPPs show strong alignment with these practices but exhibit room for improvement in broadening bidder participation and disclosing financial terms. Service performance monitoring in Canadian PPPs relies on mechanisms that strengthen accountability. Independent technical advisor ensures that quality assurance and service defaults are addressed through graduated responses with reasonable remediation time, and payment structures are tied to performance outcomes. Additional provisions permit dispute resolution, oversight of private monitoring systems, and rules for contract assignments to safeguard technical capacity. In terms of renegotiations, Canadian PPPs largely follow international recommendations but would benefit from refinements such as independent regulatory oversight, clearer thresholds on authority-driven variations, shared treatment of uncontrollable risks, and disclosure of renegotiation outcomes. To address observed gaps, a PPP model was developed and validated through a Delphi study with subject-matter experts. The model integrates governance, transparency, adaptive risk allocation, and lifecycle monitoring. Experts affirmed the importance of best practices as critical success factors, while noting uneven adoption across projects. The model was rated highly for alignment with international practices, though regulatory and institutional barriers constrain full implementation. This study hypothesizes that mature PPP programs can serve as testing grounds for internationally recommended practices. Canada's healthcare PPP portfolio—over 51 projects delivered in more than a decade—provides strong empirical evidence for such validation. Findings confirm substantial compliance with best practices in procurement, governance, and lifecycle monitoring, reinforcing their practicality and effectiveness in this environment. The study concludes that while Canada's PPPs conform to much of the global guidance, strengthening transparency, flexibility, and risk governance remains essential. The validated model consolidates fragmented approaches into a structured framework emphasizing accountability, outcome-based performance, and adaptability, offering significant potential for enhancing healthcare PPP outcomes.
| Item Type: | Thesis (Doctoral) |
|---|---|
| Thesis advisor: | Sullivan, Kenneth |
| Index terms: | resolution, dissertation, testing, implementation, transparency, monitoring, best practice, bidder, lifecycle, effectiveness, risk allocation, dispute, partnership, qualitative study, risk governance, Canada, Delphi method, governance, performance outcome, agency, international practice, critical success factor, lessons learned, program, variation, evidence, validation, strengthening, competition, adaptability, performance monitoring, accountability, quality assurance, compliance, specification, default, procurement process |
| Subjects: | contractual condition, professional development, software systems, performance management, partnership management, conflict resolution, sociology, dispute resolution, value management, control systems, data collection methods, business, research design and methodology, project delivery, health safety and environment, Geography, financial risk, structural engineering, monitoring and control systems, liability law, quality assurance, market analysis, research dissemination and communication, evaluation and assessment methods, strategic management, user focus, bidding, professional practice, contractual arrangements |
| Topics: | Stakeholder Management, Governance, Cost Management, Business Strategy, Information Management, Research Practice, Contract Administration, Site Management, Digital Applications, Design Practice, International Construction, Procurement, Health and Safety, Engineering Principles, Geographical Context, Project Management, Legal Issues, Quality Management |
| Descriptive scope: | 5 PCTEA |
N.B. Descriptive scope is a count of how many of the five facets of empirical research are indicated by the words used in title, abstract and keywords. It is not intended as a judgement on the research; merely a count of the kind of word we would expect to indicate Phenomenon, Concepts, Theoretical framing, Empirical techniques, Analytical techniques. If all five are present, then a code of “5 PCTEA” will indicate this. If you feel the coding for this record is questionable, we welcome discussion around the terms we matched or the way we categorized them. The facet you would expect may not be coded, or a facet may be coded inappropriately. This can also bear on a larger question, of which facets should be treated as defining in construction management research. Please get in touch, and we will look at it. More details here