Building Design for Service Redesign

Susan FrancisSenior Architectural Advisor, Future Healthcare Network and NHS Estates

Health and dis-ease

‘Health cannot be narrowly defined: it is not just about the absence of sickness, nor just about living longer, but about a better quality of life.

..Improving health is as much about employment, occupation, housing, transport and the environment, education and living standards- including poverty - as it as about treatment within the health service.’

Philipp R, Baum M, Mawson A, Calman K. Humanities in medicine: beyond the millennium. London: Nuffield Trust 2000

Integrated planning

pro

cure

me

nt

Changing workforce

New Clinical models

Building design

Impact of technology

inside hospitals

outsidehospitals Public Private Partnerships

Who

le s

yste

m c

onfig

urat

ion

Centralisation of decisions: historically unbalanced

Centralisation Decentralisation

Workforce

Patient safety

Patient experience

Affordability

Interface of care and design

Centralisation Decentralisation

Patient safety

Patient experie

nce

Service delivery

IT opportunities – remote diagnosis

High tech equipment

Afford- ability

Workforce

Role changes

Clinical networks

Service clusters and building types

New hospital components?

Children’s Services

ComplexSurgery

Theatres

A&E Majors: trauma

Short stay

ambulatory care Maternity &

neonatal care

Diagnostics

A&E Majors: surgery

A&E Minors

Critical Care

Stepdown

Primary care components?

HP &Children’s Services

IntermediateRehab Care

Primary CareUrgents

Short Stay

& Ambulatory Care

Assessment & CDM

Core services

Social Care

Complementary Medicine

A&EDiagnostic

Investigation

Critical Care

Acute Inpatient

Care Community Care Facilities

Ambulatory- 23 hr investigations & surgery

Outpatients- Generalised- Specialised- One Stop

–Rehabilitation–Low–Dependency–Respite–Shared Care–Home Care–Social Care

Co

mm

un

ity

+ P

rim

ary

Car

e

Patient Hotel

Chest Pain Elderly

Assessment

Medical Surgical

areas

Peri Acute Care

Graduated care processGraduated care process

Patient flows and adjacencies

-functionality and planning relationships

Redefine health and social care

SE Belfast PCT

Royal Hospital Belfast

Sperrin Lakeland

Whole system planning

Peterborough

Salford

Liverpool

FHN projects

FHN projects

Redevelop and Regenerate

Whipps Cross Hospital

Redesign

ACAD and BeCad

West Middlesex

Birmingham

Mid Essex

Therapeutic environment

‘The first requirement of a hospital should be that is should do the sick no harm.

Little as we know about the way in which we are affected by form, colour, by light, we do know this, that they have a physical effect.

Variety of form and brilliancy of colour in the objects presented to patients is the actual means of recovery.’

Florence Nightingale Notes on Hospitals 1885

Art, architecture and design

‘Architecture is also about the spiritual needs of people as well as their material needs. It has as much to do with optimism, joy, re-assurance; of order in a disordered world; of privacy in the midst of many; of space in a crowded site; of light on a dull day. It is about quality.’Sir Norman Foster. RIBA Gold Winner. Better by Design 1994

‘Creativity and imagination stimulate the spirit, and , in so doing, speed the recovery process. They are powerful medicine indeed.’Lord Richard Attenborough. President of Arts for Health

Evidence

ScientificSocial Design

Prevailing culture of measurement

Scientific studies link patient outcomes

light

heat shielding

humidity

temperature

music

art

noise levels

Measuresreduced length of stay

incidents

physiological

Social studies link attitudes

Satisfaction

Patients more positive about treatment where they were more comfortable and rated staff treating them more highly Sheffield

Front line staff believed in the healing benefits of art and design Exeter

Staff recruitment and retention C&W

Experience

Perception of their hospital experience Leeds

Easing stress, taking mind off immediate worries and putting in a better mood C&W

Role not only in making a normalising experience but also making it special Bristol Children’s

Ask the Patient

Priorities Picker Connection to staff

Conducive to a sense of well being

Convenient and accessible

Confidentiality and privacy

Caring of the family

Considerate of impairments

Close to nature

Link to care culture MacmillanHolistic Inclusive Respectful Supportive

Control

Aedet Toolkit

FUNCTIONALITY• uses

• Access

• spaces

IMPACT• Character and innovation

• Form and materials

• Internal environment

• Urban and social integration

BUILD STANDARD• Performance

• Engineering

• Construction

Added value

Added value

Added value

Excellence

Design benefits

Social and physical context

Landmark

Wayfinding

Welcoming

First impressions

Fit for purpose

Access and location

Space standards, relationships and flows

Safety and security

Adaptability, elasticity, agility

PerformanceEngineeringConstruction

Build Quality

Sustainability: social

economic

environmental

Intuitive wayfinding

Impact

Form and materials

Public, social and

private spaces

Primary and community care

Social Spaces

Sensory Stimulation

Therapeutic landscape design

Integrate art, architecture & design

Make coherent arrangements: human scale, proportion, balance

Delight the senses: light, views, colour, aroma, texture

Stimulate the mind, body and spirit

EU Network 15 member countries

Design Quality Indicators Portfolio of exemplar projects

The design resource relationship

Adding value

1 1 Capital cost

5 2

Maintenance cost

200 10

Running cost of the business

Design fees 0.1

Business case for good design

New valuation methodsSocial and environmental performance

Modernisation of care

Patient safety

Design quality

Urban regeneration

Sustainability

King’s Fund Enhancing the Healing Environment

CABE Healthy Hospitals Campaign

People Patients firstChampions forservice redesign and building design

ProcessIntegrationModernisation Sustainability

Place LocationTherapeutic

Design a catalyst for change

Vision and Dialogue