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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