title: Project coalitions in healthcare construction projects and the application of real options: an exploratory survey.
abstract: OBJECTIVE
  Exploring the impact of the type of project coalition on types of flexibility by analyzing considered and exercised flexibilities in separated and integrated project coalitions in the design and construction phase and the operations and maintenance phase of a healthcare construction project.
  
  
  BACKGROUND
  Flexibility in healthcare construction projects is increasingly needed in order to deal with growing uncertainties. Until now, little research has been carried out on how and to what extent flexibility is incorporated in different types of project coalitions chosen by healthcare organizations.
  
  
  METHODS
  An exploratory survey was conducted among health organizations in both cure and care. Questions were asked on the position of the real estate department within the organization, the type of project coalitions chosen and the rationale behind this choice, and the extent to which flexibility in terms of a real option was considered and to what extent it had been exercised in a project coalition.
  
  
  RESULTS
  Integrated project coalitions pay more attention to flexibility in advance in both the process and the product, but exercise them to a lesser extent than separated project coalitions. The economic feasibility of real options is higher in integrated project coalitions.
  
  
  CONCLUSIONS
  The study shows that real options thinking is already incorporated in real estate management of healthcare organizations, although more flexibility is considered in advance of the project than is actually realized during and after construction.
  
  
  BACKGROUND
  Built environment, construction, decision making, hospitals, planning.
authors.affiliation: CORRESPONDING AUTHOR: Maartje van Reedt Dortland, Eendrachtstraat 30, 8012 VX Zwolle, the Netherlands; Maartje.vanreedtdortland@live.nl.
authors.forename: Maartje
authors.initials: M
authors.lastname: van Reedt Dortland
authors.forename: Geert
authors.initials: G
authors.lastname: Dewulf
authors.forename: Hans
authors.initials: H
authors.lastname: Voordijk