The Power (and Politics) of Health Buildings Barrie Dowdeswell Executive Director European Health...
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The Power (and Politics) of Health Buildings Barrie Dowdeswell Executive Director European Health Property Network
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The Power (and Politics) of Health Buildings
Barrie DowdeswellExecutive DirectorEuropean Health Property Network
OECDOECD societies are healthier than ever, spend more on
health care - but health inequalities and variances persist
The question is simple: is the rise in costs affordable and are health care systems becoming more efficient and delivering more value for money?
Key priorities, are:
Overcoming health inequalities Managing demographic & epidemiological
transitions Delivering sustainable value
The need for a better ‘Capital Asset’ evidence base to plan for the future
A Pan-European Evaluation of Capital Investment Strategies:
The European “Fit for Purpose Capital Study” EuHPN / European Observatory as partners 14 case studies Thematic analysis across 12 dimensions of process
and effectiveness First results now - publication early 2009
Capital - as a catalyst for change
Capital - as responding to change
Capital - as a defining value in healthcare
Performance gradation of case studies, potentially extreme lifecycle variations
PFI
TR
NIR COXA
RKVAL
N 1
SIT
JP
Sustainable ‘business’ effectiveness and efficiency
‘Desig
n e
xcellen
ce’
RIKPerformancePerspectives• Core business efficacy• Financial viability• Adaptability• Lifecycle cost profile• Lifecycle economic value
Weak Strong
KAR
Five critical dimensions
Evidence-based investment decision-making
Flexible investment strategies – e.g. disinvest to reinvest – and refinancing
Technical knowledge and competency Politics
Leadership
A new paradigm?
In a future era of economic uncertainty
Growth through redistribution will be critical to resolving and heading off future health inequalities
The dynamics of change – Capital Investment, rapidly increasing community focus
Localiseddiagnosis
& careCommunity
facilities
Hospitals
Patients, € and staff are increasingly mobile
Contraction
growth
‘Hospital’networks
reconfiguration integration
Technica
l dim
ensions Societal and efficacy dimensions
Markets and PPPs are often used by Governments to outsource ‘risky’ change
Facilitating health reform, whole systems efficacy: towards a new investment balance
Institutional technical efficiency
Trajectory of reform
A political,professional& cultural barrierto change Systems efficiency
Disease pathway frameworks
Allocative efficiency
Evidence-based resource reallocation
Disease / Service Modelefficacy
We are now
squeezing
the balloon
We are now
squeezing
the balloon
COXA clinical and care / design synergyCapital investment as defining a change in systems and values
CPs
Theatre check in
Diagnosticprogramming
Recovery / rehab prog
before
after
theatre
ward and diagnostic ward
Coxa Hospital and patient flow, 90+% compliance with care programmes
Capital investment designed for whole systems networked integration
Activity – from 1,500 to 3,500
Systems – 70% patients discharged to PC
Structures – wholly integrated regional model
Quality - complication (infection) rates < .1%
Cost – 10% price reduction for 2008
PerformanceHeadlines
Rhoen Klinikum “Quality through standardisation & service volumes& new integrated portals / information highways”
Emergency
Diagnosis
Theatres
Hot floortechnologies
High intensity care
High levelcare
General care
Rehab
Patient treatment and discharge pathway
Communityportal
Polyclinic
Quickerand better community
support
A wholly integratedmulti-disciplinary model
Core principle - integrated, multi-disciplinary, systemised care pathways & capital investment / design synergy
RK – capital investment value
Public Hospital
Average cost per case
€ 3870
Capital investment element€270
RK Hospital
Average cost per case
€ 2660
Capital investment element€720
Hospitals are ‘recycled’ every ten years – technology as per cost efficiency
The capital investment and planning conflict in Europe
Service outcome evidence Benefits of integrated care pathway models of care
Capital investment outcome evidence Benefits of technically competent - care pathway shaped -
planning, design, financing and procurement
Ideological trends Towards market led episode delivery strategies The flight to PPPs, but ----- rarely evidence based
Capital / ServiceSynergy vs Dislocation
The building,its environmentand facilityservices
The clinical, technologies, careand professionalservices
PFI
A hospital isa combinationof people, technologies,buildings andfacilitiesworkingtogether forcommonbenefit
Relationship governed bya contractstructure and design set5 to 7 years prior tocommissioning - for 25 / 40 yrs
A principal aim of PFI has been macro government debt management
The problem is often (?usually) politics and evidence free ideology
Unrealistic populist manifestos ““More beds / more hospitals”More beds / more hospitals”
Emphasis on mid-term ‘apparent’ success / progress An obsession with targets Gestures – was the NHS ‘deep clean’ really relevant
Service / capital change dissonance - re time scales
The hidden hand of Treasuries Economic rationalism Aversion to planning beyond parliamentary cycles
Politics can ‘block the view’
Candelit vigil as hospital protest grows
Farce as junior health minister joins protest against NHS closures
Protests over Irish hospital closure planTuesday 18th December
Cabinet member joining hospital protest 'just doing my job as MP'
Blears accused of hypocrisy after joining protest over hospital closure
Protest over closure of cancer services at hospital
Doctors threaten to
quit
Government ignoring public on polyclinics – Lib Dems
Million protest as surgeries make way for the polyclinics
Health Warning - Fixed Assets are classically used as a
defence mechanism against change
Greve Hopital Calmette LE HAVRE - Personnel en colère
The Key Issue, stating the obvious! Investing for sustainable value
From - Cost saving and standardised guidelines To - Lifecycle effectiveness, value and sustainability
Health impact
Clinical process systemisation Adaptable capital assets
Integrated capital and revenue budgeting
Money
People Politics
Redistribution of capital assets is difficult, controversial but critical
