ORAT - operational readiness for airports and hospitals

The challenge

Hospitals, like airports, operate as complex systems. Both facilities seem to manage at just one level above organised chaos, and it only takes one mistake for that chaos to bubble up. In a healthcare environment, a single misstep can be fatal. We can’t stop people from getting sick but can we help hospitals be more prepared to handle the unpredictable?

In this article

  • The similarities between opening new assets like airports, hospitals, and other higher operational facilities.
  • Operational Readiness Activation and Transition program, ORAT, we developed to give confidence that people, systems and the asset itself are ready to operate on day one.
  • How we developed ORAT initially for the aviation industry, and how we adapted it to hospitals, and where we're applying it next.

Airports are intricate systems of systems. They require the coordination of hundreds of connections for each passenger alone - think flights carriers, luggage, preferences, security passes and destinations, along with the dreaded connection flights. It is only when a link goes missing that we, the average passenger, begin to realise the complexity behind these travel hubs.

In June 2014 London’s Heathrow Terminal 2 opened to the public; a smooth moving of operations made possible by the preparation behind-the-scenes of 25,000 staff members, new signage and protocols, and over 175 readiness trials. Five years later, the opening of Terminal 5 resulted in flight cancellations, lost and delayed luggage, and painfully long queues. After working on the successful opening of Terminal 2, our London-based operations consultant Arlene Manyange had to figure out what processes had gone wrong with day-one operations at Terminal 5.

Arlene responded with a methodology called ORAT (an acronym for ‘Operational Readiness, Activation and Transition). The aim of ORAT is to provide both Arup and moving organisations confidence that the people, systems, and facilities involved in moving are ready to operate on day one. The methodology consists of a series of measured checks, balances (and clipboards), informed by base levels of an acceptable risk level.

An uncoordinated approach to a transition from one facility to another can be disastrous and costly. Things need to work well from day one. – Arlene Manyange


While devising the ORAT methodology, Arlene saw opportunities for de-risking other pieces of critical social infrastructure. She had previously worked for the National Health Service in the UK and recognised similarities in the highly-operational nature of airports and hospitals. Both are elaborate environments of interconnected moving parts, and where safety is paramount.

Both airports and hospitals are elaborate and interconnected pieces of social infrastructure where safety is paramount.

In 2015 Arlene moved to Australia to help the Royal Adelaide Hospital construct and move into a brand-new hospital. It was here she saw the opportunity to explore how the same ORAT thinking could be applied to the health care sector. Her multi-disciplinary team was asked to oversee the planning of an integrated transition of operations for the technical suites.

Before devising the ORAT framework, they had to determine the minimum acceptable criteria to meet to inform the decision of which departments to relocate. This may sound simple at first, but first consider the number of coordinated systems necessary to perform even the simplest of surgeries: the medical team is dependent on a room being properly ventilated and well lit, the hi-tech equipment and IT working without failure, all instruments being sterilised, blood products kept in the right environments, and the results from blood tests being reported quickly and accurately. A failure in any one of these things could bring the risk level up too high to justify moving at all.

Learning from her work in both healthcare and aviation, Arlene highlighted similarities and differences between airports and hospitals, to tailor the ORAT approach. “Hospitals are a lot less predictable than airports” says Rebecca Wright, a program and project manager from our Melbourne office. Rebecca also worked on New Royal Adelaide Hospital, after being exposed to operational readiness programs while working on Al Maktoum International Airport in Dubai.

“With a few exceptions, a passenger’s journey through the airport is quite linear,” says Arlene. “You pass through check-in then immigration and follow a more or less defined route to your aircraft. In contrast, your journey into a hospital will have various routes, whether it be it through the emergency department, general admission or outpatient services. Similarly, the touchpoints through the hospital may not be clear at the onset. You need to think a bit more creatively when it comes to your trials and your testing.”

Planning patient transition certainly requires a lot more rigour. - Rebecca Wright

“When you’re relocating an operational healthcare facility there’s also the added complication of moving potentially unwell patients. In an airport setting passengers are there with the expectation of being moved,” adds Rebecca.

A solid framework makes it easy for management teams like Rebecca and Arlene to makes sure both are achievable from day one.

Working with a defined framework makes it easy for management teams like Rebecca and Arlene to achieve both deliverables from day one. The power of ORAT is to root a system of detailed checks to cover all aspects of people, systems and physical facility readiness. However, defining and measuring the right assessments takes time, and reliably covering all the areas can be costly or not always required.

During her time in Australia, Arlene realised that, while many people in the health care sector could see the usefulness of a methodology like ORAT, not everyone needed or could afford the full service. Working closely with our digital team, Arlene saw value in streamlining ORAT to make it more accessible to organisations. This led to developing an online diagnostics tool for people and teams to assess any operational readiness program for assets such as hospitals or airports. The tool can assess the readiness-to-operate of facilities, systems, and staff, while also identifying likely risks or where work needs to be done to get these back on track. This can help organisations with setting targets with their moving, but also define road maps and to-do-lists to minimise risks. “The tool is very much meant to complement the service,” says Arlene. For many people, it’s a solid first step.

Back in Adelaide, a few months after delivering the Royal Adelaide Hospital, the South Australian Dental School reached out to Arlene’s team as they planned a move to a new facility. While at a smaller scale of infrastructure, the Dental School showed many of the same operational complexities that emerged in the larger city hospital – giving the team the opportunity to see whether ORAT could fit within a healthcare setting once more. The ability to systematically test components of ORAT on live projects has allowed to incrementally improve this methodology to suit more projects and situations, irrespective of scale or complexity. After applying ORAT to the Royal Adelaide Hospital project and the SA Dental School, the team started applying the lessons learned to other health projects, like the Perth Children’s Hospital.

Since first applying readiness and activation principles to the New Royal Adelaide Hospital, we've been excitedly applying them to a number of health care facility transitions, include South Australia Dental School and Perth Children's Hospital. – Arlene Manyange

Despite that different organisations may have different capabilities, objectives and timelines, there’s no ‘one-size-fits-all’. ORAT has proven to be solid and translatable across scales and industries, delivering solutions tailored to each context. This has been possible thanks to the day-one modular design of this tool, as a collection of checks and balances that can be snapped together to complement the needs of whoever we work with. This program has since gained traction within other teams and other areas where large organisations often relocate to new facilities – such as rail and science laboratories. Although these disciplines may appear different on the surface, they share intrinsic similarities. Similarly to hospitals and airports, they both provide services that allow people to thrive in the modern world. Furthermore, they are both expected by the public to be predictable and consistent – trains must arrive on time and medicines must be produced to the right quality and quantity.

A solid framework like ORAT makes it easy for management teams like Rebecca’s and Arlene’s to plan the operations and success assessment from day one – leaving the main worry for the ribbon-cutting ceremony to be around what size of scissors for the job.


  • Airports and health care facilities are both elaborate and critical pieces of social infrastructure; each requires a coordinated approach to providing a safe service to the public on day one.
  • A patient's journeys through a hospital is far less predictable than an airline passenger's journey; each requires different readiness trials.
  • Different organisations have different capabilities, objectives and timelines; an effective occupational readiness program needs to be flexible, rooted in world experience, and adaptive.

Lead Arup Researcher

Arlene Manyange
Arlene is an ORAT expert with the Operations Consulting team based in London.

Ask Arlene about:

  • Specialised healthcare services
  • Mental health, forensic services, and paediatrics
  • Care pathway redesign
  • Formation of Integrated Care Systems


Research TEAM

Program manager, Advisory, Melbourne office

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