Australasian College of Health Service Management Conference
2013 Energising Healthcare Findings from a UK-Europe Health
Facility Design Study Tour Jane Carthey Chair, Australian Health
Design Council
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The Australian Health Design Council represents the Australian
health design sector in providing expert advisory services in
health facility design, planning and management to industry and
government. Heading into the future, an integral part of health
facility design is the emerging BIM technologies and AHDC actively
encourages the development, integration and sharing of data and
supporting technologies across the sector. Incorporated as a
not-for-profit association (Victoria) Web: www.aushdc.org.au About
the AHDC
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allied with NZHDC, ACHSM, AHHA, ACHI and similar groups
recently launched new website at www.aushdc.org.au with streamlined
membership application process and members only
sectionwww.aushdc.org.au and 1-day seminars and conferences on a
variety of themes/topics Organise and lead health design-related
study tours in Australia, Asia, US, Europe, UK similar to that
already undertaken in 2012; looking at offering other educational
activities e.g. preparation for EDAC exam considering a program of
awards for health design to promote excellence and interest in this
important area of design About the AHDC
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An overview is health architecture influenced by the health
system within which it is procured? Health Study Tour 2012 UK,
Norway and The Netherlands
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15 study tourists visited 14 health facilities in 3 countries
UK, Norway, Netherlands Mix of architects, health managers,
clinicians, PM/PD Hell, Norway (a little town just north of
Trondheim Airport) Study Tour 2012 AHDC/ACHSM
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Trondheim UK: Pembury, GOSH, QEII Birmingham, Manchester PFI
Kids, Salford Royal, Maggies Centre Hammersmith, London Clinic
Norway: St Olavs Trondheim, Rikshospitalet, Akershus, Oslo
Netherlands: MC Erasmus, Maasstad, Deventer, Orbis Sittard London
Oslo Birmingham Manchester Deventer Sittard Rotterdam
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HEALTH SYSTEMS COMPARATIVE DATA
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UK examples of new build were PFI overall competent but
unexceptional outcomes VFM equation still being debated Netherlands
capital works funded as part of a services contract with NFP/NGO
providers. Outcomes generally outstanding, with great focus on
flexibility, patient focus, cost effective business models and VFM.
Norway direct funded by Government (in the case of major facilities
by way of design competition, and then design and build, or
traditional contracting model) Outcomes very good, reflective of
very wealthy country and commitment to quality PROCUREMENT
MODELS
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FACILITY SIZE AND CONFIGURATION COUNTRYHOSPITALBEDSFLOOR AREA
PLANNING TYPOLOGY (from Changing Hospital Architecture RIBA, Prasad
et al) UNITED KINGDOM Tunbridge Wells (Pembury)512 beds66,250m 2
5.Street Great Ormond St (GOSH) Morgan Stanley Clinical Building
185 beds 30,000m 2 Including refurbish cardiac wing 8.Campus
(evolved over time) QEII Birmingham1213 beds136,000m
2.6.Atrium/galleria Salford Royal Hope Building242 beds36,700m 2 6
Atrium/galleria Central Manchester + University Childrens Hospital
371 beds 170,000m 2 (4 hospitals) 6.Atrium/galleria
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FACILITY SIZE AND CONFIGURATION COUNTRYHOSPITALBEDSFLOOR AREA
PLANNING TYPOLOGY (from Changing Hospital Architecture RIBA, Prasad
et al) NORWAY St Olavs Trondheim~800 beds223,000m 2
6.Atrium/galleria / 8.Campus (Institute model) Akershus Oslo~600+
beds137,000m 2 5.Street Rikshospitalet Oslo585 beds 138,590 m 2
Incl. 90 room patient hotel 5.Street / 7.Unbundled
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FACILITY SIZE AND CONFIGURATION COUNTRYHOSPITALBEDSFLOOR AREA
PLANNING TYPOLOGY (from Changing Hospital Architecture RIBA, Prasad
et al) THE NETHERLANDS Deventer386 beds55,000m 2 2.Low-rise
multi-courtyard or checkerboard Orbis Sittard~320 beds100,000m 2
6.Atrium/galleria MC Erasmus Rotterdam~1200 beds185,000m 2 4B.
Podium with two or more towers/blocks over Maasstad Rotterdam570
beds 84,000m 2 132,000m 2 including Health Boulevard 5.Street
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Architecture /Design Patient-focussed Care Staff Work
Environment Technology Adoption + Use Environment OVERALL WOW
FACTOR FACILITY EVALUATION CRITERIA Architecture /Design
Aesthetics, use of colour, materials and finishes Layout, way
finding Natural light + ventilation Future proofing and expansion
strategies Patient-focussed care Patient-centred Innovative
approach to care delivery Continuum of care e.g. integration of
primary with hospital care settings Staff Work Environment Happy
staff program Amenities and work environment Work processes support
patient centric care Technology Adoption + Use Automation where
appropriate Integration into clinical environment Ease of use
Future proofing Environment Contribution to urban setting Community
integration Environmental responsibility WOW Factor overall
impression + summary of the above assessments
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EVALUATION RESULTS Key: Note Northern Europe rather than the UK
may be the benchmark for quality health facilities
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Study Tour 2012 AHDC/ACHSM Architecture + Design includes
Health Planning 1.Orbis Sittard, The Netherlands 2.Deventer, The
Netherlands (eq) 3.GOSH, UK (eq)
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Study Tour 2012 AHDC/ACHSM Patient-focused care 1.Orbis
Sittard, The Netherlands 2.Akershus, Norway 3.Deventer, The
Netherlands
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Study Tour 2012 AHDC/ACHSM Staff work environment 1.Orbis
Sittard, The Netherlands 2.Deventer, The Netherlands 3.St Olavs,
Norway
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Study Tour 2012 AHDC/ACHSM Staff work environment 1.Orbis
Sittard, The Netherlands 2.Deventer, The Netherlands 3.St Olavs,
Norway
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Study Tour 2012 AHDC/ACHSM Staff work environment 1.Orbis
Sittard, The Netherlands 2.Deventer, The Netherlands 3.St Olavs,
Norway
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Urban environment (contribution to) 1.Orbis Sittard, The
Netherlands 2.Deventer, The Netherlands 3.Akershus, Norway Study
Tour 2012 AHDC/ACHSM
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WOW! Factor 1.Orbis Sittard, The Netherlands 2.Akershus, Norway
3.Deventer, The Netherlands 4.St Olavs, Norway
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FUTURE QUESTIONS/DISCUSSIONS How does the PFI process affect
design outcomes in the UK? Birmingham QEIISalford Royal Manchester
PFITunbridge Wells (Pembury PFI)
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FUTURE QUESTIONS/DISCUSSIONS Cultural differences that appear
to impact on facility design: IPU design UK QEII Norway
Akershus/Riks Netherlands Orbis, Deventer Illustrate different
attitudes to: Privacy Observation Space needs Single vs multi-bed
rooms QEII OrbisRiks
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FUTURE QUESTIONS/DISCUSSIONS Innovative staff workplaces and
work practices change management and system-related issues: The
Netherlands Orbis Deventer
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Study Tour 2012 AHDC/ACHSM Notable technology innovations 1.AGV
Norway, The Netherlands 2.Robots in pharmacy Akershus 3.Patient
information systems Trondheim, Masstaad 4.Underground radiation
bunkers 5.The London Clinic, London 6.Barn Theatres at Salford
Royal (not a big success!)
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Study Tour 2012 AHDC/ACHSM Other Facilities with WOW! Factor
The London Clinic Maggies Centre, Hammersmith Plus a few Honourable
Mentions: Maasstad Tunbridge Wells (Pembury) GOSH (for its
preservation of heritage - integrated with new facility)
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Study Tour 2012 AHDC/ACHSM The London Clinic
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Key Lessons
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Health service planning and facility briefing appeared out of
step with service requirements of built environments. That is a
number of facilities were over built which resulted in closure of
services & beds within 12 months of opening. Orbis, Deventer
PFI projects all experienced budget pressures to the extent scope
was removed during BAFO negotiations - ? Problems with the PSC QEHB
removed all office accommodation in order to build (shell) future
clinical areas Salford RMCH Pembury adopted an open office
environment due to space/budget pressure The impact & extent of
the change management required was under-estimated by most projects
Development of new models of care predominantly occurred post
facility planning Open plan office environments were a common
feature in a number of facilities usually as a result of budget
pressures. FACILITY PLANNING THEMES
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GUIDELINES AND APPROVALS PROCESSES The medal table for the
facilities visited showed the Netherlands and Norway to have the
highest quality facilities Both countries have a hands-off approach
to guidelines adopting a steering not rowing approach Culturally,
both the Netherlands and Norway took their responsibilities for
provision of healthcare very seriously this was reflected in their
facilities The UK relies on NHS guidelines and the PFI procurement
model and according to the medal table was consistently lower
overall in the perceived quality of the projects
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OPEN PLAN OFFICE ENVIRONMENTS Trend in Europe towards open plan
office environments Deventer Orbis Maasstad Tunbridge Wells Queen
Elizabeth Hospital Birmingham Open plan office areas appeared
flexible and adaptable and liked by staff. Reliant on adoption of
technology/paperless office model In comparison, trend in UK is
limited QEHB driven to the solution due to budget pressures and the
need to reduce scope from the project Tunbridge Wells adopted an
open plan strategy due to budgetary pressures
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IPU PLANNING Single Vs. Multi-bed
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IPU LAYOUT - Data
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TECHNOLOGY UPTAKE Key (e) facility enabled for future uptake of
technology
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INNOVATION THROUGH ADOPTION OF TECHNOLOGY Barriers to Adoption
of Technology Limited available capital funding Cost benefit
analysis didnt stack up (Deventer & AGVs) Immature
technological solutions at the time of planning Limited integrated
systems available. Orbis SAP. QEHB developed in-house including
interfaces to proprietary system
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In Summary
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IN SUMMARY The tour was invaluable but really only a taste of
whats out there to be learnt, constant immersion/challenge is
necessary to keep the tools sharp We cant just adopt what others
do, there are no shortcuts, or easy answers Others responses are
shaped by their environment and their circumstance - we need to
filter what we see on these trips to suit our local circumstance
Guidelines are valuable, but must be only guidelines, or creativity
can be stifled (e.g. 3-bed wards at St Olavs) The consolidation of
funding for service delivery with the funding for capital, as
adopted in the Netherlands, seems to result in high quality,
functional, patient focused facility outcomes, and cost effective
service outcomes
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IN SUMMARY Thanks AHDC thanks Roger Carthey + Kelvin Steele for
contributing to this analysis! Also Darryl Carey, Keith Joe, Jane
Carthey for photographs The outcomes of capital works projects are
determined by the parameters of the system within which they are
acquired, and the goals that are set by that system. The highest
quality facilities seemed to be the result of considerable time
applied to thinking HARD about how to do it (run hospitals) best.
Much of what we see is cultural, rather than absolute, for example
the differing views and outcomes we observed in looking at IPU
design
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Thank you! Australian Health Design Council
www.aushdc.org.au