Identifying the Critical Factors Affecting the Operational Performance of Characteristic Healthcare Town PPP Projects: Evidence from China
Publication: Journal of Infrastructure Systems
Volume 29, Issue 4
Abstract
The need for healthcare facilities has increased with aging populations. Public–private partnerships (PPPs) have a proven record of accomplishment in supporting the financial viability of various types of infrastructure projects. Thus, globally, governments recently applied the PPP model to characteristic health town (CHCT) projects. However, previous studies focused primarily on the success factors of PPP projects, whereas studies of the factors in CHCT-PPP projects’ operational performance have been limited. This study identified the critical factors in a CHCT-PPP project’s operational performance. First, a literature review and expert interviews identified 24 factors in a CHCT-PPP project’s operational performance. Second, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed to determine the common factors in the CHCT-PPP project’s operational performance. To establish the final factor system, 264 effective questionnaires were collected to investigate stakeholders’ views on the relative importance of different factors. Finally, importance–performance analysis (IPA) was performed to identify the four key factors in the CHCT-PPP project’s operation performance: customer satisfaction, government satisfaction, value-for-money index, and healthcare-product development. This study can serve as a reference for identifying the key factors in a CHCT-PPP project’s operational performance and promoting the development of CHCT-PPP.
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Data Availability Statement
The data used to support the findings of this study are available from the corresponding author upon request.
Acknowledgments
This work presented in this paper is financially supported by grants from the Sichuan Soft Science Project (No. 21RKX0322).
References
Byrne, B. M. 1994. Structural equation modeling with EQS and EQS/Windows: Basic concepts, applications, and programming. Thousand Oaks, CA: SAGE.
Castelblanco, G., J. Guevara, and J. Salazar. 2022. “Remedies to the PPP crisis in the COVID-19 pandemic: Lessons from the 2008 global financial crisis.” J. Manage. Eng. 38 (3): 04022017. https://doi.org/10.1061/(ASCE)ME.1943-5479.0001036.
Chan, A. P. C., P. T. I. Lam, D. W. M. Chan, E. Cheung, and Y. Ke. 2010. “Critical success factors for PPPs in infrastructure developments: Chinese perspective.” J. Constr. Eng. Manage. 136 (5): 484–494. https://doi.org/10.1061/(ASCE)CO.1943-7862.0000152.
Chen, C., Y. Yu, R. Osei-Kyei, A. P. C. Chan, and J. Xu. 2019. “Developing a project sustainability index for sustainable development in transnational public–private partnership projects.” Sustainable Dev. 27 (6): 1034–1048. https://doi.org/10.1002/sd.1954.
Chen, Y. Q., Y. B. Zhang, J. Y. Liu, and P. Mo. 2012. “Interrelationships among critical success factors of construction projects based on the structural equation model.” J. Manage. Eng. 28 (3): 243–251. https://doi.org/10.1061/(ASCE)ME.1943-5479.0000104.
Cheung, E., A. P. C. Chan, and S. Kajewski. 2012. “Factors contributing to successful public private partnership projects: Comparing Hong Kong with Australia and the United Kingdom.” J. Facil. Manage. 10 (1): 45–58. https://doi.org/10.1108/14725961211200397.
Chileshe, N., C. W. Njau, B. K. Kibichii, L. N. Macharia, and N. Kavishe. 2020. “Critical success factors for Public-Private Partnership (PPP) infrastructure and housing projects in Kenya.” Int. J. Constr. Manage. 22 (9): 1606–1617. https://doi.org/10.1080/15623599.2020.1736835.
Chou, J., N. Irawan, and A.-D. Pham. 2013. “Project management knowledge of construction professionals: Cross-country study of effects on project success.” J. Constr. Eng. Manage. 139 (11): 04013015. https://doi.org/10.1061/(ASCE)CO.1943-7862.0000766.
Chou, J.-S., H. P. Tserng, C. Lin, and C.-P. Yeh. 2012. “Critical factors and risk allocation for PPP policy: Comparison between HSR and general infrastructure projects.” Transp. Policy 22 (Jul): 36–48. https://doi.org/10.1016/j.tranpol.2012.05.009.
CPPPC (China Public Private Partnerships Center). 2022. “National PPP comprehensive information platform project management database.” [In Chinese.] Accessed July 1, 2022. https://www.cpppc.org:8082/inforpublic/homepage.html#/projectPublic.
Cruz, C. O., and R. C. Marques. 2013. “Integrating infrastructure and clinical management in PPPs for health care.” J. Manage. Eng. 29 (4): 471–481. https://doi.org/10.1061/(ASCE)ME.1943-5479.0000166.
Cui, C., Y. Liu, A. Hope, and J. Wang. 2018. “Review of studies on the public–private partnerships (PPP) for infrastructure projects.” Int. J. Project Manage. 36 (5): 773–794. https://doi.org/10.1016/j.ijproman.2018.03.004.
Dai, K., S. Li, J. I. Kim, and M. J. Suh. 2021. “Identifying characteristics of PPP Projects for healthcare facilities for the elderly based on payment mechanisms in China.” J. Manage. Eng. 37 (6): 05021009. https://doi.org/10.1061/(ASCE)ME.1943-5479.0000966.
Debela, G. Y. 2019. “Critical success factors (CSFs) of public–private partnership (PPP) road projects in Ethiopia.” Int. J. Constr. Manage. 22 (3): 489–500. https://doi.org/10.1080/15623599.2019.1634667.
Demirel, H. Ç., L. Volker, W. Leendertse, and M. Hertogh. 2019. “Dealing with contract variations in PPPs: Social mechanisms and contract management in infrastructure projects.” J. Constr. Eng. Manage. 145 (11): 04019073. https://doi.org/10.1061/(ASCE)CO.1943-7862.0001714.
Doll, W. J., W. Xia, and G. Torkzadeh. 1994. “A confirmatory factor analysis of the end-user computing satisfaction instrument.” MIS Q. 18 (4): 453–461. https://doi.org/10.2307/249524.
European PPP Expertise Center. 2019. “Market update: Review of the European PPP market 2018.” Accessed February 19, 2019. https://www.eib.org/attachments/epec/epec_market_update_2018_en.pdf.
Fan, Y., and L. Chen. 2020. “Research on the development of rehabilitation of endowment under the background of population aging.” [In Chinese.] J. Tech. Econ. Manage. 2020 (10): 112–117.
Hai, D. T., N. Q. Toan, and N. Van Tam. 2022. “Critical success factors for implementing PPP infrastructure projects in developing countries: The case of Vietnam.” Innovative Infrastruct. Solutions 7 (1): 1–13. https://doi.org/10.1007/s41062-021-00688-6.
Hair, J. F., W. C. Black, B. J. Babin, R. E. Anderson, and R. L. Tatham. 2009. Multivariate data analysis. London: Prentice Hall.
He, M., and K. Huang. 2021. Annual report on Kang-Yang industry of China (2020). [In Chinese.] Beijing: Social Sciences Academic Press.
Hsueh, C.-M., and L.-M. Chang. 2017. “Critical success factors for PPP infrastructure: Perspective from Taiwan.” J. Chin. Inst. Eng. 40 (5): 370–377. https://doi.org/10.1080/02533839.2017.1335619.
Hueskes, M., K. Verhoest, and T. Block. 2017. “Governing public–private partnerships for sustainability: An analysis of procurement and governance practices of PPP infrastructure projects.” Int. J. Project Manage. 35 (6): 1184–1195. https://doi.org/10.1016/j.ijproman.2017.02.020.
Kim, S., S. Hwang, and J. Son. 2022. “Safety management guidelines for precast concrete production plants using importance-performance analysis.” J. Constr. Eng. Manage. 148 (7): 04022038. https://doi.org/10.1061/(ASCE)CO.1943-7862.0002298.
Li, H., L. Lv, J. Zuo, K. Bartsch, L. Wang, and Q. Xia. 2020. “Determinants of public satisfaction with an urban water environment treatment PPP project in Xuchang, China.” Sustainable Cities Soc. 60 (Sep): 102244. https://doi.org/10.1016/j.scs.2020.102244.
Li, X., Y. Yuan, X. Liu, Y. Ke, and S. Jia. 2022. “Identifying critical influencing factors of the value creation of urban rail transit PPP projects in China.” Buildings 12 (8): 1080. https://doi.org/10.3390/buildings12081080.
Lietz, P. 2010. “Research into questionnaire design: A summary of the literature.” Int. J. Market Res. 52 (2): 249–272. https://doi.org/10.2501/S147078530920120X.
Liu, J., P. E. D. Love, M. C. P. Sing, J. Smith, and J. Matthews. 2017. “PPP social infrastructure procurement: Examining the feasibility of a lifecycle performance measurement framework.” J. Infrastruct. Syst. 23 (3): 04016041. https://doi.org/10.1061/(ASCE)IS.1943-555X.0000347.
Liu, J., P. E. D. Love, J. Smith, M. Regan, and P. R. Davis. 2015. “Life cycle critical success factors for public-private partnership infrastructure projects.” J. Manage. Eng. 31 (5): 04014073. https://doi.org/10.1061/(ASCE)ME.1943-5479.0000307.
Liyanage, C., and F. Villalba-Romero. 2015. “Measuring success of PPP transport projects: A cross-case analysis of toll roads.” Transp. Rev. 35 (2): 140–161. https://doi.org/10.1080/01441647.2014.994583.
Luo, Z., Y. Yang, H. Pan, and M. Zhong. 2018. “Research on performance evaluation system of shale gas PPP project based on matter element analysis.” Math. Probl. Eng. 2018: 4657383. https://doi.org/10.1155/2018/4657383.
Ma, H., S. Zeng, H. Lin, and R. Zeng. 2020. “Impact of public sector on sustainability of public–private partnership projects.” J. Constr. Eng. Manage. 146 (2): 04019104. https://doi.org/10.1061/(ASCE)CO.1943-7862.0001750.
Marques, R. C., F. S. Pinto, and J. Miranda. 2016. “Redrafting water governance: Guiding the way to improve the status quo.” Util. Policy 43 (Dec): 1–3. https://doi.org/10.1016/j.jup.2016.11.002.
Martilla, J. A., and J. C. James. 1977. “Importance-performance analysis.” J. Market. 41 (1): 77–79. https://doi.org/10.2307/1250495.
MCA of PRC (Minister of Civil Affairs of the People’s Republic of China). 2021. “Statistical Bulletin of Civil Affairs Development of 2020.” [In Chinese.] Accessed July 15, 2020. https://www.mca.gov.cn/n156/n188/c1662004999979993526/content.html.
Mei, T. 2020. “The application and development of PPP mode in hospital, medical and elderly care service industries.” In Annual report on the development of PPP in China, 145–156. New York: Springer. https://doi.org/10.1007/978-981-15-5724-8_8.
Mohamad, R., S. Ismail, and J. M. Said. 2018. “Performance indicators for public private partnership (PPP) projects in Malaysia.” J. Econ. Administrative Sci. 34 (2): 137–152. https://doi.org/10.1108/JEAS-04-2017-0018.
Moro Visconti, R., and D. Morea. 2020. “Healthcare digitalization and pay-for-performance incentives in smart hospital project financing.” Int. J. Environ. Res. Public Health 17 (7): 2318. https://doi.org/10.3390/ijerph17072318.
Ng, S. T., Y. M. W. Wong, and J. M. W. Wong. 2010. “A structural equation model of feasibility evaluation and project success for public–private partnerships in Hong Kong.” IEEE Trans. Eng. Manage. 57 (2): 310–322. https://doi.org/10.1109/TEM.2009.2037142.
Ngullie, N., K. C. Maturi, A. S. Kalamdhad, and B. Laishram. 2021. “Interrelationships among critical success factors for the planning of municipal solid waste management PPP projects in India using structural equation modelling.” Waste Manage. Res. 40 (7): 859–869. https://doi.org/10.1177/0734242X211061955.
Nunnally, J. C. 1994. Psychometric theory. New York: McGraw-Hill.
Opawole, A., and G. O. Jagboro. 2017. “Factors affecting the performance of private party in concession-based PPP projects in Nigeria.” J. Eng. Des. Technol. 15 (1): 44–57. https://doi.org/10.1108/JEDT-09-2015-0058.
Osei-Kyei, R., and A. P. C. Chan. 2015. “Review of studies on the critical success factors for public–private partnership (PPP) projects from 1990 to 2013.” Int. J. Project Manage. 33 (6): 1335–1346. https://doi.org/10.1016/j.ijproman.2015.02.008.
Osei-Kyei, R., and A. P. C. Chan. 2017a. “Developing a project success index for public–private partnership projects in developing countries.” J. Infrastruct. Syst. 23 (4): 04017028. https://doi.org/10.1061/(ASCE)IS.1943-555X.0000388.
Osei-Kyei, R., and A. P. C. Chan. 2017b. “Implementing public–private partnership (PPP) policy for public construction projects in Ghana: Critical success factors and policy implications.” Int. J. Constr. Manage. 17 (2): 113–123. https://doi.org/10.1080/15623599.2016.1207865.
Othman, A. A. E. 2015. “An international index for customer satisfaction in the construction industry.” Int. J. Constr. Manage. 15 (1): 33–58. https://doi.org/10.1080/15623599.2015.1012140.
Pardo-Bosch, F., and A. Aguado. 2016. “Sustainability as the key to prioritize investments in public infrastructures.” Environ. Impact Assess. Rev. 60 (Sep): 40–51. https://doi.org/10.1016/j.eiar.2016.03.007.
Pereira, M. A., D. C. Ferreira, and R. C. Marques. 2020. “A critical look at the Portuguese public–private partnerships in healthcare.” Int. J. Health Plann. Manage. 36 (2): 302–315. https://doi.org/10.1002/hpm.3084.
Preston, C. C., and A. M. Colman. 2000. “Optimal number of response categories in rating scales: Reliability, validity, discriminating power, and respondent preferences.” Acta Psychol. 104 (1): 1–15. https://doi.org/10.1016/S0001-6918(99)00050-5.
SC of PRC (State Council of the People’s Republic of China). 2014. “National new urbanization plan (2014–2020).” [In Chinese.] Accessed March 16, 2014. http://www.gov.cn/zhengce/2014-03/16/content_2640075.htm.
SC of PRC (State Council of the People’s Republic of China). 2017. “On the cooperation mode of using government and social capital implementation opinions on supporting the development of elderly care service industry.” [In Chinese.] Accessed August 21, 2017. http://www.gov.cn/xinwen/2017-08/21/content_5219295.htm.
Shang, L., and A. M. Abdel Aziz. 2020. “Stackelberg game theory-based optimization model for design of payment mechanism in performance-based PPPs.” J. Constr. Eng. Manage. 146 (4): 04020029. https://doi.org/10.1061/(ASCE)CO.1943-7862.0001806.
Shen, L., V. W. Y. Tam, L. Gan, K. Ye, and Z. Zhao. 2016. “Improving sustainability performance for public-private-partnership (PPP) projects.” Sustainability 8 (3): 289. https://doi.org/10.3390/su8030289.
Swamy, R. R. D. T. V., P. Tiwari, and A. Sawhney. 2018. “Assessing determinants of PPP project performance: Applying AHP to urban drinking water sector in India.” Property Manage. 36 (1): 67–85. https://doi.org/10.1108/PM-08-2016-0046.
Tang, L., Y. Yue, X. Xiahou, S. Tang, and Q. Li. 2021. “Research on performance measurement and simulation of civil air defense PPP projects using system dynamics.” J. Civ. Eng. Manage. 27 (5): 316–330. https://doi.org/10.3846/jcem.2021.14919.
Torchia, M., A. Calabrò, and M. Morner. 2015. “Public–private partnerships in the health care sector: A systematic review of the literature.” Public Manage. Rev. 17 (2): 236–261. https://doi.org/10.1080/14719037.2013.792380.
van Prooijen, J. W., and W. A. van der Kloot. 2001. “Confirmatory analysis of exploratively obtained factor structures.” Educ. Psychol. Meas. 61 (5): 777–792. https://doi.org/10.1177/00131640121971518.
Villalba-Romero, F., and C. Liyanage. 2016. “Evaluating success in PPP road projects in Europe: A comparison of performance measurement approaches.” Transp. Res. Procedia 14 (Jan): 372–381. https://doi.org/10.1016/j.trpro.2016.05.089.
Wang, Y., and L. Zhang. 2019. “Status of public–private partnership recognition and willingness to pay for private health care in China.” Int. J. Health Plann. Manage. 34 (2): e1188–e1199. https://doi.org/10.1002/hpm.2757.
Wang, Y., and Z. J. Zhao. 2018. “Performance of public–private partnerships and the influence of contractual arrangements.” Public Perform. Manage. Rev. 41 (1): 177–200. https://doi.org/10.1080/15309576.2017.1400989.
Wibowo, A., and H. W. Alfen. 2014. “Identifying macro-environmental critical success factors and key areas for improvement to promote public-private partnerships in infrastructure: Indonesia’s perspective.” Eng. Constr. Archit. Manage. 21 (4): 383–402. https://doi.org/10.1108/ECAM-08-2013-0078.
Xiong, B., M. Skitmore, B. Xia, M. A. Masrom, K. Ye, and A. Bridge. 2014. “Examining the influence of participant performance factors on contractor satisfaction: A structural equation model.” Int. J. Project Manage. 32 (3): 482–491. https://doi.org/10.1016/j.ijproman.2013.06.003.
Yu, B. 2018. Research on PPP financing model of Guangxi health and wellness characteristic town construction. Guangxi, China: Guangxi Univ.
Yuan, J., W. Ji, J. Guo, and M. J. Skibniewski. 2019. “Simulation-based dynamic adjustments of prices and subsidies for transportation PPP projects based on stakeholders’ satisfaction.” Transportation 46 (6): 2309–2345. https://doi.org/10.1007/s11116-018-9940-1.
Yuan, J., W. Li, X. Zheng, and M. J. Skibniewski. 2018. “Improving operation performance of public rental housing delivery by PPPs in China.” J. Manage. Eng. 34 (4): 04018015. https://doi.org/10.1061/(ASCE)ME.1943-5479.0000615.
Zhang, H., L. Yu, and W. Zhang. 2020. “Dynamic performance incentive model with supervision mechanism for PPP projects.” Eng. Constr. Archit. Manage. 27 (9): 2643–2659. https://doi.org/10.1108/ECAM-09-2019-0472.
Zhang, Q., O. B. Lan, and B. T. H. Lim. 2021. “Mapping perceptions and implementation of corporate social responsibility for construction firms via importance–performance analysis: Paths of improvement.” J. Manage. Eng. 37 (6): 04021061. https://doi.org/10.1061/(ASCE)ME.1943-5479.0000954.
Zhao, X. 2009. Research on performance evaluation of PPP project. Beijing: Tsinghua Univ.
Zhao, X., X. Wang, Y. Xiao, and J. Yuan. 2020. “Modeling and performance evaluation of PPP projects utilizing IFC extension and enhanced matter-element method.” Eng. Constr. Archit. Manage. 27 (8): 1763–1794. https://doi.org/10.1108/ECAM-08-2019-0429.
Zou, W., M. Kumaraswamy, J. Chung, and J. Wong. 2014. “Identifying the critical success factors for relationship management in PPP projects.” Int. J. Project Manage. 32 (2): 265–274. https://doi.org/10.1016/j.ijproman.2013.05.004.
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Journal of Infrastructure Systems
Volume 29 • Issue 4 • December 2023
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© 2023 American Society of Civil Engineers.
History
Received: Sep 28, 2022
Accepted: May 21, 2023
Published online: Aug 11, 2023
Published in print: Dec 1, 2023
Discussion open until: Jan 11, 2024
ASCE Technical Topics:
- Bibliographies
- Buildings
- Business management
- Client relationships
- Construction engineering
- Construction management
- Engineering fundamentals
- Facilities (by type)
- Financial management
- Government
- Health care facilities
- Information management
- Infrastructure
- Local government
- Organizations
- Practice and Profession
- Project management
- Public private partnership
- Structural engineering
- Structures (by type)
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