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Building the Hospital of the Future

Article-Building the Hospital of the Future

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Putting emphasis on fit-for-purpose, efficiency, and financially responsible designs, the Design & Build conference at Building Healthcare Innovation & Design Show 2018 has an engaging agenda in store for attendees. The conference track will be discussing the impact of various construction elements such as engineering, operations and technology on the healthcare business, and ways of cutting cost in construction and improving healthcare operational system efficiency by design, among other topics.

In an interview with Arab Health Magazine, Ben Gonzalez, Vice President, HKS MENA Health Director, and the co-chair of the Design & Build conference shared some in-depth insights about what really goes on behind planning, designing, building and operating a healthcare facility and certain important factors to consider when designing a hospital. These include:

Patient and Family Experience: The overall patient experience includes interaction with the caregiver as well as the built environment. It is well researched that satisfying experiences lead to happier, more engaged patients. Involved patients will be willing to ask more questions and follow advice and medication orders. In the MENA region, healthcare can be a sensitive topic and many patients do not want to discuss their personal health issues in public. 

Gonzalez said: “Therefore, designing with privacy in mind becomes integral in the patient experience. Family support is a major factor in a patient’s healing process, so patient rooms, lobbies and waiting areas need to be well designed to accommodate multiple family groups.”

Efficiency: “We should develop layouts that are effective and efficient, minimising the travel time for caregivers. The less time a caregiver spends walking, the more they can spend with patients. This also includes making practical use of multi-purpose spaces and consolidating spaces when possible,” he added.
Flexibility and Adaptability: Clinical models of care will continue to evolve as technology advances. Hospitals should consider strategic design initiatives such as modular layouts, universal rooms, location of soft spaces and adaptability of the engineering systems through an interstitial floor.

Sustainability: Rising energy costs and a harsh Gulf regional climate mean that sustainability is being pushed to the forefront. Designers need to be more responsible in designing energy-efficient buildings through simple, passive design solutions (such as how the building is oriented in relation to the solar path) and developing energy model analysis. Several of the Gulf countries do have a minimum sustainability requirement for government projects.  

Optimising Speed and Quality
When asked about how hospital design and construction processes can be improved, Gonzalez highlighted a number of factors, such as:

BIM in Manufacturing: The benefits of Building Information Modelling (BIM) are not only limited to the modelling of buildings, but they can prove to be valuable to the management of the construction process. Hospitals that are virtually built can be monitored, eliminating issues that could potentially arise during the construction process. Furthermore, this data-rich model can be used by the project owner for future maintenance and operation of the building. Other benefits of using BIM in manufacturing include cost savings, accelerated processes, and higher quality results.

Prefabrication: “A client ultimately looks for efficient project delivery, optimising speed and quality, and minimising material wastage. The process of prefabrication can assist in achieving these goals. Constructing sections or modules of standardised rooms such as bathrooms, patient rooms and other building elements at a controlled manufacturing site will result in project schedule savings as several construction activities can be carried out in parallel,” he explained.

Design Directly to Manufacturing (Design Directly Working with People Building- Sub-Trades): Hospital construction projects feature many variables that can hinder the project team’s performance. By using the design-build approach that integrates the design and construction phases, project managers can more easily overcome these hurdles and improve their team’s performance. “Some of the biggest benefits of design-build are rapid delivery, smooth processes through an integrated approach, better value and fewer problems. This is all dependent on developing a good contract with an experienced contractor,” Gonzalez added.

Earlier Involvement of Construction in Design to Assist with Constructability and Cost Issues: Having the construction team involved in the early stages of the design process provides the project owner with the benefit of having multiple experts at the table from the outset. This brings added value to the owner by providing price checks consistently as the architect is developing the design. It ensures that the project stays on budget and on schedule by mitigating risk, as issues are detected and discussed during the planning phase.

Changing Approaches to Healthcare Delivery
With rapid developments in technology, people expect to be kept healthy as opposed to being only treated when they are ill. Gonzalez sheds light on elements that will provide greater flexibility in the future when it comes to designing spaces.

Predictive Health Analytics, Wearables and Diagnostic Apps: Advancements in nanotechnology, coupled with home monitoring technology will allow physicians to treat and monitor patients remotely. 
He emphasised: “This means that the healthcare system will be disrupted, and support to use these technologies will be required as homes become extensions of hospitals. Wearable devices will empower patients to work in real-time, giving them the opportunity to monitor their own health. The sensors on these devices can collect biometric data to help diagnose, supervise medicine and even detect serious conditions.”

Community Healthcare: Gonzalez stressed: “We are seeing a trend for smaller facilities integrated within communities, and more mixed-use clinics. There are higher expectations for user experience, and patients are demanding more in terms of convenience, the latest technology and prompt access to treatment. Mixed-use models are integrating retail and residential offers alongside hospitals, clinics or ambulatory centres. As care is decentralised, it will encourage physical activity but also walk-in appointments driving preventive care. This will increase the need for buildings and spaces to be multifunctional and adaptable to technology development.”

Healthy Hospital Environment
According to Gonzalez, a healthy hospital environment is a result of the collaboration between the patient and the healthcare provider. Factors impacting the healthcare system as well as the caregiver affect the quality of a hospital. Attaining better healthcare quality requires supportive leadership, high staff morale, smooth operation processes and dedicated focus on patient experience.

Research suggests that there is a high correlation between the healthcare environment and patient outcome. Patients entering a healthcare facility feel stressed due to the unfamiliar environment and uncertainty about their health. Being isolated from their families and social relationships can make them feel anxious and apprehensive. Hence, it is crucial that hospitals are therapeutically designed. Such considerations include not only reducing environmental stressors such as crowding in public spaces, unwanted noise, or unpleasant odours, but also providing positive distractions, access to nature through courtyards, and offering spaces that allow patients to interact comfortably with their families. 

“One such certification that measures the impact on people is the WELL Certification. WELL provides a performance-based framework to measure and evaluate buildings on their direct impact on people, particularly on the quality of air, light, water, fitness, nourishment, comfort, and safety, among other factors,” he concluded.

Focus on Regional Trends at Building Healthcare
Gonzalez shared: “When Gary Walton (co-chair) and I set out to plan for the Design & Build sessions, we considered: attendee feedback from previous events, current market landscape, responsible and sustainable design, and efficiency with a quality execution. We decided to focus on three key points. 

“First, we want to be aligned with the overall conference theme of “delivering fit-for-purpose healthcare facilities.” I thought this was very important as the market begins to mature and certainly given the current shift toward private growth and participation. Second, we want to provide content that is relevant to this region. The challenge is to not focus on macro or global trends but instead on those that can impact the regional market at a micro level. Third but not least, based on the feedback from previous conferences, we understand the desire to better integrate design and build topics in a holistic manner. We are thrilled to have put together what we believe is an exciting agenda and are looking forward to the presentations.”

Digital Future
Gonzalez underlines the technological changes and developments that will have an impact on clinical design in the near future.

Medical Records: Currently electronic health record (EHR) systems are mainly stored on servers. As security technology develops further, more healthcare entities will adopt web or cloud-based systems, enabling patients and healthcare providers to access their information securely via any device such as laptops and/or smart phones.

Telehealth: Technology offers new ways for providers to connect with patients in a more flexible manner. One such method is telehealth, which uses digital information and communication technologies, such as computers and mobile devices, to access healthcare services remotely and manage your health care. The technology used to provide telehealth will only improve with time; especially when combined with other technologies such as artificial intelligence, remote monitoring, wearables, and mobile health apps. This will result in a transformation of spaces within healthcare facilities, and possibly a reduction in cost as more patients will be cared for by shared physicians. 

3-D Printing: Developments in the field of 3-D printing have the potential to significantly transform the care provided at hospitals. Increasingly, this technology is being used to improve prosthetics for patients, as well as in joint replacement surgery. In the future, 3-D printing may even revolutionise organ transplants and body parts.

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