Healthcare service delivery is a fascinating and challenging industry. The work is driven by many variables including a growing population, ageing demographic, frequently changing Medicare reimbursement and other co-funding models as well as a fast pace of technological advancements in medicine and medical devices.
Construction of hospitals, medical precincts, and facilities has become extremely challenging in these times. It is important for capital project administrators, architects and construction professionals to recognize changing trends and take the necessary shift in thinking about the healthcare infrastructure and project delivery.
In this blog, we discuss a few trends in hospital industry and some basic things to keep in mind if you are venturing into design and construction of healthcare facilities.
Creating mini inpatient facility with 15,000 to 50,000 square feet and about 10-15 inpatients beds for observation and short stay use. These are both energy and staff efficient for operational purposes and have gained popularity in recent times. Microhospitals are full-service and open 24/7, with an emergency room, lab, pharmacy, radiology and surgical services. From a design and construction purpose, the smaller size of the project offers the project team quick turnaround and funding. This model has seen success in urban and suburban metro areas, where the small infrastructure and more number of microhospitals offer easy accessibility to patients and shorter waiting lines.
2. Modernization of the ED
Emergency departments are always go-to for patients who may not be aware where else to go for care. On occasion, the patients with non-acute medical conditions also rush to the emergency, this results in bottlenecks and patients may often end up getting unnecessarily expensive treatment. Studies show that the combination of hospital staff shortages and a significant rise in expected emergency visits in the next three-four years hospitals will have to reconfigure their emergency departments to provide for the growing number of patients and avoid staff burn-out and other bottlenecks.
Designers and planners are now working with staff stakeholders to create innovative ways for “rapid treatment” so that patients are able to get immediate attention and are not expected to spend hours in waiting and observation. Longer hours of waiting and observation also increases chances of infection. Other design improvements will create efficient triage areas, semi-enclosed seating pods and departmental layouts that separate low-acuity patients from those in need of more acute care.
3. Infection Control
Consultancy and research companies predict an intensification of the development and application of innovations in structural and interior space design, and related technologies and materials, intended to reduce the spread of infections in hospitals. Design innovations and production solutions will allow for the availability of specialised and modular items that can improve hygiene and reduce infections.
Adapting single patient rooms’ bathroom showers to include offset drains and sloping sides to minimize the spread of infection and contamination; specialized light fixtures can kill bacteria without harming patients. These lights have high-intensity, visible, indigo-colored light; and contraction teams will be able to practically and economically adapt infection-resistant materials, such as copper alloy surfaces, on which certain microbes die within one or two hours.
4. The Medical Village
Planned hubs for diagnosis, primary care, and specialised treatment and general services like health-related training, exercises and cooking classes. These combined services will mean a reduced number of people rushing to an emergency. The medical villages will be located in populous areas, creating community-based health initiatives and move toward keeping populations healthy. They include a large central family medicine practice and are surrounded by selected specialists that agree to offer patient access and share improvement processes, outcomes and data for quality patient care. This model will offer an increasing range of services on an outpatient basis, including some surgical and invasive procedures that only require an overnight stay.
5. Behavioral Health
As more research and acceptance gathers around the issues of mental health, an acute patient population entering inpatient psychiatric facilities requires a different set of planning and design for healthcare facilities. There is a growing importance of mitigating risk of patient and employee harm. This means that existing facilities are pursuing upgrades to become safer for patients and staff. Safety systems and measures are now extremely essential – products like door top alarm systems with both visual and audible signals; gas alarm systems; interior polycarbonate security windows that are required to satisfy impact standards; and securing of furniture to walls and floors are a great way to upgrade healthcare facilities.
Other trends include the incorporation of open nursing stations resembling hotel check-in reception areas and more patient control of their immediate environment with dimmable lighting systems, patient adjustable environmental control systems, and both air systems and water provisions in bathrooms.
Designing with the Right Stakeholders
Including the hospital staff for successful redevelopments and new building design can add a lot to the success of the project. Here is a great example of a project that utilized proper stakeholder management:
Cairns Base Hospital Emergency Department was named Queensland’s second most under pressure emergency department by the Australian Medical Association in 2008.
Under Arup’s project management, and “during the design and construction stage of the redevelopment, the ED increased from 30 to 52 treatment spaces including 12 short-term fast-track beds. This was achieved through complex staging whilst keeping the ED fully operational 24/7 and with no reduction in the clinical service capacity.”
Arup’s experienced team of professional project managers led and facilitated staged planning and risk assessment involving the entire project team and stakeholders to identify staff and patient safety requirements. This led to the development of a detailed implementation plan to enable the ED to remain fully operational which were then integrated with the procurement strategy and contract documentation to drive the client’s requirements for clinical service continuity.
This project is a great example how positive clinical staff involvement during planning, design, procurement and construction phases can result in decreased stress and increased safety for patients and staff as well as improved efficiency in clinical service delivery.
It goes without saying that infection prevention and control requirements are critical to the planning of a healthcare facility and need to be incorporated into plans and specifications. All areas of a healthcare facility should be designed, constructed, furnished and equipped to minimise the risk of transmission of infection. In particular, the design and layout of the facility should facilitate the application of standard and transmission-based precautions by all staff.
A primary step in Healthcare construction is understanding the difference between regulation and best practices. Due to the higher level of safety and protection required at hospitals, it is essential that planners and construction teams are aware of all local regulations and are able to deliver a building that meets the norms and adheres to best practices.
Healthcare Associated Infection (HAI) is the most common complication affecting patients in Australian hospitals. The Australian Commission on Safety and Quality in Health Care estimates that at least half of all HAIs are preventable.
The design of healthcare facilities can influence the transmission of HAIs. Ensure you include these key features to minimise transmission include:
- surface finishes that are easy to clean and maintain;
- ventilation, air conditioning, cooling towers and water systems that meet prescribed standards; and
- the ability to isolate patients who are infectious or immunocompromised; and workplace design
Workplace design features include:
- separation of clean and dirty work flows;
- ready access to hand hygiene facilities and personal protective equipment (PPE);
- adequate storage; and
- adequate systems and procedures for waste management, cleaning, and linen handling
The redevelopment of Alfred Hospital Intensive Care Unit is a great case study for managing infections and the Aspergillus fungus spore. Aspergillus is a fungus whose spores are present in the air we breathe. Though not harmful to healthy humans, can be a serious threat to people with immune deficiencies – like those being treated in an ICU. The project management team detailed the steps that they took to reduce.
“To reduce contamination in the ICU’s sterile environment, the building design required a well-sealed building envelope, pressure testing of the building following construction, pressurising the ICU relative to the outside environment and the use of airlocks at all entries. HEPA filters were also used in the central air-handling plant to reduce the potential ingress of Aspergillus spores and other particulates through the air supply.
Alfred Hospital ICU used two main methods to manage the risk of cross infection: 100% outside air supply and switchable glazing. Arup’s approach was to design out this risk by using 100% outside air – exhausting all the return air from the ICU.
Another risk of cross infection is fabric-based curtains and blinds which provide privacy for patients and control sunlight and glare. To overcome this problem, Arup and the design team recommended switchable glazing in the roof lanterns and patients’ rooms. The glazing uses liquid crystal technology to become transparent when an electric current is applied and opaque when the current is removed. This enables staff and patients to manage privacy and sunlight without surfaces or materials that are difficult to clean or disinfect.”