The document discusses design responses to changing clinical practices and outlines several models for hospital space allocation. It summarizes considerations for inpatient units, emergency departments, interventional suites, and workplaces. Key points include utilizing decentralized staff stations and single rooms in inpatient units, rethinking emergency department processes to minimize wait times, and anticipating future technologies like real-time imaging in operating rooms.

1. Design Responses
to
Changing Clinical Practices
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2. Why a Re-think?
• Changing clinical practices and treatment patterns
• Multidisciplinary approach to care, clinical pathways
• Technology – clinical and support
• Staff shortages – optimum utilisation
• Patient expectations – well informed, competition
• Financial imperatives – Health $$$$ under pressure
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3. Hospital Space Allocation
Now
1950s
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4. Back of House
FOH/Family
4%
Research
10%
Education 4%
2%
Administration
10%
Ambulatory
23%
Cricitical Care
5%
D&T
24% Inpatients
18%
350 Beds
[250 multi day + 100 day]
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5. Conceptual Functional Models
• Zonal Model
– Horizontal
– Vertical
• Institutional Model
- Number of ‘mini’ hospitals
• Separation of Ambulatory Procedures
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6. Zonal Model - Horizontal
AMBULATORY
D&T
WARDS
AMBULATORY
D&T
WARDS
Norfolk & Norwich Hospital, UK
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7. Zonal Model - Vertical
INPATIENTS
PROCEDURES / INTENSIVE CARE
D &T/AMBULATORY
INPATIENTS
Royal North Shore Hospital
PROCEDURES
Sydney
D&T / AMBULATORY
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8. Institutional Model
MENTAL HEALTH
GERIATRIC
GASTRO
RESPIRATORY
ORTHO
NEUROSCIENCES
CANCER
WOMEN’S & KIDS
RPA Hospital, Sydney
VASCULAR
CARDIAC
HOT FLOOR
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9. Centre for
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10. Inpatient units
Executive – RNSH, NSCCAHS
Medical Services
Administration Admin Plant
Division of Medicine
Division of Surgery and Anaethesia
Allied Health
Clinical offices Clinical offices
Inpatient units
plant
Plant
CSSD PaLMS
Clinical offices
Clinical offices
Diagnostic +
Treatment
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11. Implications for Facility Planning
1. D&T Block with Inpatient Units 2. Horizontal ‘mini hospitals’
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12. Areas addressed today
• Inpatient Units
• Emergency Department
• Interventional Suite
• Workplace
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13. Inpatient Units
• Large number of beds on one floor – flexibility; resource sharing
• Greater numbers of 1-bed rooms
• Larger rooms
• Acuity Adaptable - patient centred care - treatment and clinical
procedures at bedside - Family and carers - infection control
• Decentralised staff stations, taking advantage of communication
systems
• Modules of 7 - 10 beds
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14. Inpatient Units - decentralised staff stations
St Vincent’s Public and Private Hospitals Redevelopment, Sydney
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15. Typical Inpatient Arrangement
Trondheim University Hospital, Norway
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16. Centre for
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17. Bed Utilization
85 beds in single rooms
=
100 beds in multi-bed rooms
Anecdotal evidence from America, quoted by BDPGroupe6 of UK/France
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18. Emergency Department
• Process Re-think Lean Thinking principles
• Patient processing Triaged according to - primary care,
short stay or admitted
• Patient waiting Minimal – more numbers of walk-through
triage stations; waiting in care area
• Short Stay unit 30-bed unit ; stays of upto 2 days?
• Imaging Dedicated, decentralised
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19. Centre for
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20. Interventional Suite
• Process Re-think Induction Rooms - why?
Pre-op Holding - increase; patient prep
• Future Technology Real time Imagery – MRI in OR
• More Equipment Larger ORs; Control Rooms
• Barn Theatres Zurich; Liverpool UK; Oswestry UK
- orthopaedic surgery,……
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