CREATING SAFE AND SUSTAINABLE HEALTHCARE ... SAFE AND SUSTAINABLE HEALTHCARE ENVIRONMENTS USING...

CREATING SAFE AND SUSTAINABLE HEALTHCARE ENVIRONMENTS

USING INTERNATIONAL BENCHMARKS AND CASE STUDIES

Epworth Geelong Hospital

In association with Kann Finch

OBJECTIVES OF THE SESSION

1. Identify the key issues and or emerging issues that are impacting the healthcare sustainability and safety

2. Identify and discuss solutions based on case studies, evidence based design and environmental and workplace sustainability

ISSUES

Sustainability and Safety

The Issues we are facing

TOP 6 ISSUES IMPACTING DESIGN CONSIDERATIONS

1. Workforce – Safe healthcare workplace

– Ageing workforce • Ave age of nurse workforce is 44

• 36% of nurses > 50 yo

– Shortage of skilled workforce • > Portability between professions and industries

– Attraction & retention • Estimate of opportunity cost, $30 to $100k


2. Service Demand – Increased demand for services and facilities

• Pop, currently 22 million up to 36 million by 2050

– Chronic disease burden • Cardiac / Diabetes / Kidney in > 15% of deaths

– Community expectations • Informed, financial and motivated

• Access, quality and choice of service models


3. Presenting Profile of Patients

– Ageing with chronic co-morbidities

• 14% > 65 in 2010 to 23% > 65 by 2050

• 80% of elderly have 3 or more chronic conditions

– Diversity in ethnicity & care needs

• Indigenous health and immigration impacts

– Re-emergence of adolescent conditions

• Hooping cough, asthma, allergies, tuberculosis

• Mental illness & related conditions


4. Scarcity of Resources – Limited finance for capital & operations

• % GDP up from 7.9% to 9.4% in last decade

• UK 9.8%, NZ 10.3%, Canada 11.4%

• Reality check, post GFC stimulus, “plan capital spending first, save long term”

• Consider Facility Management up front plan for maintenance

– Best value for money debate • $872 million invested on preventative health across schools,

workplaces and local communities

• Operational efficiencies drive

• Increasing cost of energy (cue from Europe)


5. Disaster Response / Extreme Events – Increase incidence of extreme weather events

• Impact on core health assets

• Impact on indirect infrastructure (electricity, gas, sewer)

– Post SARS, pre-planning is now a given • Biological response

– Existing infrastructure is ill-adapted • Isolation, zoning, Infection control, security, staff safety


6. Existing ‘Legacy’ Infrastructure

– Location of existing infrastructure

• Metropolitan V’s Growth Suburbs

• Brownfield vs Greenfield

– Significant infrastructure still dated 50’s, 60’s & 70’s

• Patchwork of development & multiple refurbishments

– Ability to be flexible & adaptable is ‘stretched’

• Poor core infrastructure, capacity & redundancy


Technology

– Its here, its possible, its practical

• Broadband, wireless, Bluetooth, IPad, IPhone

– Barriers to information collection and access

• Personalised ‘Health card’ is near!

– Alignment of ‘payment’ models to ICT enabled care models

• Fee for email, fee for monitoring response etc…)

SUMMARY OF ISSUES IMPACTING DESIGN CONSIDERATIONS

• Ageing Human and Physical Infrastructure

• Increased Demand

• Increased Diversity of Service Requirement

• Tightening of Fiscal Environment

• Emergence of New Technologies and Delivery

Solutions

SOLUTIONS

Sustainability and Safety

Solutions and Implementation

SOLUTION ONE - MASTERPLANNING

Masterplanning as a basic ingredient

– Planning for expansion & contraction in brownfield

sites

– Operational and staging issues

– Planning for adaptable functionality

– Planning for adverse event response

– Planning for efficient operating platforms

Cost: A$155M MYR 500M

Size: 63,000 m²

Status: To be completed 2014

Joint venture with B+H Architects

EXAMPLE: GLENEAGLES MEDINI HOSPITAL, ISKANDAR, MALAYSIA


• Clear ‘unencumbered’ expansion zones

• Separate acute, aged care & ambulatory zones

• Incorporation of nature and natural light

• Sustainable design focus

• Compact site & department layouts for efficient operations

• Inclusive of Wellness and Recreational Zones


Joint Venture with B+H Architects


Tertiary Hospital Centre Of Excellence Hospital Residency Nursing Home Rehabilitation

Phase 1a

Phase 1b

Phase 2

Clear expansion pathways and zoning of service streams


Incorporation of natural elements, e.g. water features & gardens, into the essence of the design ensures ESD and EBD objectives can be met across all phases

SUSTAINABLE DESIGN INITIATIVES



Maximised perimeter, uninterrupted views, retention of privacy and minimised distances for travel

Natural expansion pathway for ‘critical’ areas across the phased development

SOLUTION TWO – A ROLE FOR THE PRIVATE SECTOR

An expanded role for the private sector – Accessing private infrastructure for public use

– Extending the continuum of care • Home care & Remote care support

– Teaching & research opportunities

– Modified public / private models (e.g. BOOT)

EXAMPLE: THE EPWORTH GEELONG TEACHING HOSPITAL,

VICTORIA

Status: In Design


• A Private ‘not for profit’ operator

• An integrated clinical, teaching & research model, co-located with an University

• Supporting overall demand growth within Region

• Network of healthcare services with affiliations to international providers


VICTORIA


TYPICAL INTEGRATED CLINICAL TEACHING

ENVIRONMENT


VICTORIA

EDUCATION

CLINICAL

SUPPORT

CLINICAL

32 BED

IPU

32 BED

IPU


CLINICAL LEARNING INTEGRATION


VICTORIA


Environmental & Operational Sustainability


SOLUTION THREE – SYSTEM REDESIGN

Rethinking care delivery systems – Home based care – Super clinics / community based care – Ambulatory & Day Care – Expanded Sub Acute Models

• Aged Care • Mental Health • Rehabilitation

SOLUTION THREE – SYSTEM REDESIGN

• Continuum of system design & response

– Prevention / Intervention / Recovery

– Must be accessible and equitable

– Must be cost effective (capital & operational)

– Must be safe and secure

– Must support a salutogenic approach

– Must match need to the ‘best’ outcome

– Must align with workforce structures

– Must align with community wants & expectations

Principles of Design Diagram by Silver Thomas Hanley

HOME

HOME

HOME

HOME

SOLUTION FIVE – DISASTER MANAGEMENT PLANNING

Planning for disasters is inherent to the design – It will happen

– Perimeter control is essential

– Inherent building adaptability & response

– Department & Intra department containment zones (ED, ICU, Theatres)

EXAMPLE: NIAGARA HEALTH SERVICES, HEALTH CARE COMPLEX,

ONTARIO, CANADA

Cost: AUS $900 M

Size: 100,000 m²

Status: In Construction

Joint Venture with B+H

Architects

• Site location selection

• Perimeter management

• Isolation of patients and staff on presentation, transfer & treatment

• Facilities & equipment selection

• Ventilation and air management systems

• Separation of clean and dirty flows • Departmental Zoning & Structuring


ONTARIO, CANADA

Contained

ED Zone

Tent

Deployment

Zone

GROUND FLOOR


ONTARIO, CANADA

Critical Care and

OR Contained

Zone (with

Imaging

Provision)

SECOND FLOOR


ONTARIO, CANADA

FIFTH FLOOR

Containment

Ward


ONTARIO, CANADA

SOLUTION FIVE – ICT & ROBOTICS

The time is now for ICT solutions

– Integrated ‘system wide’ medical record

– Home monitoring & response systems

– Application of robotic assistance care

– Advanced logistics & supply solutions


Designing for remote presence technology and assistance systems


Smartphone apps now playing doctor


Designing for Cyberknife, Bio Technology and Robotic Surgery

SOLUTION FOUR – ICT & ROBOTICS

Designing for AGV’s, Intelligent Pneumatics, drug management systems

SOLUTION SIX – MODULAR & PREFABRICATED DESIGN

A place for modular and prefabricated products – Not new to the Sector and or Industry

– Fast track construction (time savings)

– Refurbishment projects (time and operational savings) – Remote locations / skilled labour shortage (regional

Australia) – Cost savings (estimates of 10-25%)


Modular bathrooms, operating theatres and clinics


Modular plant, building elements and facades


BIM enabled, uniform planning grid and building services platform = Flexibility

CONCLUSION

1. With respect to meeting the healthcare needs and wants of developed societies, the challenges are comparatively clear and understood.

2. Equally, many of the solutions appear plausible and accessible should there be the right incentives for providers to invest.

3. Whilst architecture can and does play a key role in the provision of quality healthcare outcome the future is likely to be shaped by government policy with respect to how public and private sector participants are reimbursed

CONCLUSION

FOR FURTHER INFO CONTACT:

MR BRUCE CROOK

DIRECTOR

SILVER THOMAS HANLEY (AUS) PTY LTD

Phone: +61 413 814 011

Email: [email protected]

THANK YOU & QUESTIONS?

SILVER THOMAS HANLEY

• Recognised international health planners

• Only healthcare, with over 2000 projects

• Projects of any scale and complexity

• Services include:

• masterplanning, feasibility studies, healthcare

planning, design, interiors, operational consulting,

contract documentation & admin, BIM leadership

EVIDENCED BASED DESIGN

• Drawing upon extensive evidence based

design (EBD) principles

• Founding member of EDAC,

part of the Centre for Health Design.

STH is 1 of 30 advocate firms worldwide.

Date post:	27-Apr-2018
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