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Fit for purpose: Designed for life


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Faced with increasing competition over the last decade, hospitals are having to be more flexible and efficient to survive. How can traditionally cash-strapped and risk-averse institutions incorporate new design ideas and improve the interaction between medical staff and patients? Designed for life: future-proofing hospital design is part of Fit for purpose, a series of articles sponsored by Philips on innovation in global health systems.

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Fit for purpose: Designed for life

  1. 1. DESIGNED FOR LIFE Future-proofing hospital design In the longer term, we also know that the advent of day surgery, telemedicine and remote medical consultations conducted via the Internet means that we will need fewer traditional hospitals. Yet the exact shape of hospital requirements in 20 years’ time—let alone 50 years’ time— is hard to predict. GROWING PAINS E legant penthouse VIP rooms and gourmet menus put Mount Elizabeth Novena Hospital in Singapore in the running to be the most luxurious hospital built anywhere in the world. Even the standard private rooms in the new 333-bed hospital have beds canted towards the windows so patients can easily enjoy the healing powers of natural sunlight. Ambient lighting is designed to dim automatically, reflecting circadian rhythm and promoting sleep. The drive to create a “stressless healing environment” could become so successful that administrators may have difficulty getting well-insured patients to leave. This is a trivial concern, however, compared with the headache suffered by hospital designers elsewhere in the world. In much of Europe and North America, the challenge is to emulate this standard of care cost-effectively and for populations ten or 15 times larger than Singapore’s 5.3m inhabitants. We already know that factors such as lighting,1 heating, ventilation, room size, hospital layout, location and access, not to mention infection control, are all crucial to recovery. The significance of hospital design to the patients and families using the hospital has also been recognised: the architect’s initial designs for the Alberta Children’s Hospital in Calgary, Canada were redrawn by an “advisory group” of teenagers. The colourful outcome (pictured) was inspired by toy building blocks. SPONSORED BY: The Future Hospital Commission set up by the Royal College of Physicians in London recently commented that hospital stays have shortened, and that chronic conditions, such as diabetes, heart disease and intractable pain, can be managed remotely, so patients do not have to come to hospital. The number of patients, however, has soared by 37% in the past decade. The ageing of the population means that the UK has a higher number of people with multiple problems, while more are simply too frail to care for themselves at home, unaided. The commission has produced a list of 50 recommendations, including the provision of weekend diagnostic and laboratory services to speed patient throughput. The National Health Service (NHS) is unlikely to be able to fund these initiatives. Meanwhile, dozens of new high-tech facilities have been built in the UK using investment from the private finance initiative (PFI)—the biggest being the £545m University Hospitals Birmingham NHS Foundation Trust—but these have caused controversy because of the constraints imposed by the high cost of long-term mortgage repayments to non-government lenders. This controversy has contributed to an effective moratorium on new hospital building in the UK, according to Paul Whittlestone, the global lead in healthcare strategy at IBI Nightingale, a specialist architecture firm overseeing two of the largest live hospital developments in Europe (in Glasgow, Scotland) and in North America (in Montreal, Canada). The issues with privately funded hospitals need to be separated from the end result—the hospital, says Mr Whittlestone. The time it takes to approve and finance hospitals means that too many are being built to solve problems from two or three years ago, when the process was started. Others in the field are concerned that medical culture is often surprisingly resistant to change, which can mean healthcare innovation is frequently blocked. Rosalyn Cama of The Center for Health Design in Connecticut, US, has been involved in hundreds of hospital projects in
  2. 2. her 37-year career. “People working in hospitals need to ask themselves why they’re actually doing lots of the things they do,” says Ms Cama. “For example, the provision of some services in end-of-life care doesn’t change the outcome, it just prolongs it.” HEALTH BYPASS A UK academic body called the Health and Care Infrastructure Research and Innovation Centre (HaCIRIC) has been set up to find ways to optimise hospital development.2 According to its director, David Gray, emeritus professor of construction management at Reading University, two main theories of hospital design are now emerging. The first involves a “cheap and cheerful” office block to be used for patient accommodation and administrative space. Such buildings, incorporating simple innovations such as natural air flow and window views for bedridden patients, would be erected alongside costlier buildings to house the sophisticated requirements of operating theatres, imaging equipment and laboratories. The second involves turning hospitals into compartmentalised health factories. Everything else is sacrificed to make each process—from joint replacements and hernia repairs to hysterectomies—as efficient and rapid as possible, reducing recovery times and length of stay. “You have to design the service, then build around it,” says Mr Gray. “The problem is that even in the seven or eight years HaCIRIC has been running, it has been difficult to keep pace with changes like the drive to manage chronic conditions in people’s homes.” As many healthcare systems go from crisis to crisis, leaving them insufficient time to develop a longer-term strategic view of future needs, the current challenge for hospital designers is to create buildings that can adapt to future healthcare needs. In Mr Whittlestone’s view, this requires identifying areas of expansion, such as diagnostic imaging, then building flexibility into the surrounding interior and exterior architecture. Designing generic hospital rooms means that they can be easily adapted to changing technologies. The departments earmarked for expansion can be afforded space to extend outwards. This can be achieved by surrounding them with so-called “soft space”—such as staff rooms—which can be easily repurposed and moved elsewhere, or by locating them where extensions can be built outwards. Looking ahead, the process to build the next generation of new hospitals in the UK—when it begins—will benefit from better thinking about the future of healthcare, says Mr Whittlestone. Yet it will still require hard political decision-making to invest for the future of hospital care rather than the present—or even the past. Simply replacing old hospitals with new ones may win public support in the short term, but it is not sustainable. E sther I Bernhofer, Patricia A Higgins, Barbara J Daly, Christopher J Burant and Thomas R Hornick, “Hospital lighting and its association with sleep, mood, and pain in medical inpatients”, Journal of Advanced Nursing, November 4th 2013. 2 “How should we create 21st century healthcare infrastructure to deliver best value?”, HaCIRIC, September 2011 1