2021 is about innovation
The key point to come out of the COVID-19 pandemic, in the healthcare space, is whoever is driving innovation will win the race to the top. In the future, in order to succeed, cities and countries will need to invest in research and development in order to be the front runners of innovation in healthcare and other sectors. Innovation will differentiate countries in the future. COVID-19 has provided the perfect catalyst for this to happen.
Research is an integral part of any developed healthcare system but historically has lacked support and investment within GCC countries. Countries such as the UAE and Saudi Arabia have committed to improving health standards. To this end it is important to invest in and support medical research programmes that could help combat the burden of chronic diseases, address chronic and high-volume health issues locally and improve health service delivery to the patient population.
The advancements in medical innovations from 2020; such as telemedicine, wearables, precision medicine, artificial intelligence (AI) plus online prescriptions and delivery, will lead to a more efficient and effective way of delivering healthcare outcomes in 2021 and beyond. Innovation is the mother of necessity and COVID-19 has forced multiple innovations both inside and outside the healthcare space, globally. To date, innovations in healthcare have been primarily reactive. Countries that choose to maintain this current level of innovation and are able to develop and apply a prevention strategy, will take the global top spot for export and attraction for the wealthy and skilled.
Hospitals are expensive to run and the current general hospital model is coming under pressure to change. Technological advances will impact the design of all future healthcare facilities and as an outcome, hospitals will be smaller, smarter and more efficient, especially concerning the outpatient setting. The winners from a financial, resilience and quality of life perspective, will be those who are leading the race to innovate.
The key challenges
It has been acknowledged by health experts that this is unlikely to be the last pandemic. In fact, it’s a taste for things to come. The key challenge of 2021 and of the next outbreak and/or pandemic, will be keeping healthcare facilities running effectively in a crisis. We now have the knowledge and ability to be prepared rather than reactive in the face of a large-scale emergency.
From an on-site, healthcare facility perspective, a lack of intensive care unit (ICU) beds is still an issue in most large countries. Most hospitals do not have a large ICU, typically 100 bed hospitals will have only 20 ICU beds available. The lack of equipment, both hard and soft, is another key obstacle. The availability of personal protection equipment (PPE), for example, was something hospitals across the GCC had to be creative in coming up with alternatives for, as protecting healthcare staff was, and still is, the highest priority. Without staff, there can be no care, with the stress on front-line workers being a major challenge, globally. Despite robust growth in the sector, most GCC countries, in comparison to developed countries fall behind on health infrastructure indicators such as the number of beds, physicians and medical staff per 1,000 population.
The inability to cope with a sudden and unprecedented influx of patients was a common denominator, globally. As with any infectious disease outbreak, the necessity to segregate patients without an infectious disease from those who do suffer from an infectious disease, as well as isolation challenges within facilities, became a huge problem, especially due to such high volumes.
On March 18, 2020, all non-emergency procedures were stopped in the UAE. All focus was put on battling the spread of COVID-19. Again, on January 21, 2021, the Dubai Health Authority directed licensed hospitals and one-day surgery clinics to suspend all non-urgent surgical procedures until February 19, 2021. Overnight, private institutions were faced with the commercial obstacle of how to keep their businesses up and running in a situation where all the highest income-generating procedures were abruptly stopped. Health systems, globally, are facing catastrophic financial challenges in the light of the COVID-19 pandemic. The American Hospital Association’s May 2020 report has estimated a four-month financial impact of US$202.6 billion in losses for the country’s hospitals and health systems – an average of US$50.7 billion per month. The situation is similar in every country. Couple this suspension with the inability to send special cases overseas due to lockdown on travel, and countries are left with chronic and life-threatening cases they cannot deal with. Not only not being dealt with in the short-term, but without in-country specialist centres, they are also faced with being unable to deal with it in the long-term. In the future, in-country healthcare needs to be able to cater to all patient requirements, simultaneously.
Growth essentials for the future
According to the BMI Research’s Burden of Disease Database, non-communicable diseases (NCD) such as diabetes, heart disease, cancer, respiratory ailments, and mental health disorders, are expected to grow to 3.9 million disability-adjusted life years (DALY) lost by 2025, in the Gulf. There needs to be a shift of burden of chronic disease healthcare demand during a crisis. Most public hospitals in the GCC are functioning at over 80 per cent bed capacity utilisation, during non-pandemic times, and these overcrowded healthcare facilities could benefit from specialised centres of care (CoEs) as well as long-term care and acute care rehabilitation centres, where patients can be referred. This could be coupled with other facilities being available to switch functions, such as pre-identified hotels, much as we have seen in countries such as the UAE, UK and Malaysia.
We have seen a visible shift in some GCC countries where a large portion of upcoming projects are in specialised facilities focusing on one or a limited number of specialties with the aim to develop centres of excellence (CoEs). The Abu Dhabi Proton Centre (ADPC), part of the existing Gulf International Cancer Centre (GICC) is a good example in the UAE. Each country will need to appoint a taskforce to determine its shortfalls when it comes to treatment of chronic disease in-country and develop a roll-out plan to eliminate any gaps.
One of the most prominent emerging trends in life sciences currently, is the surge in demand for biotechnology-based pharmaceutical products. Pharmaceuticals and medical equipment are two priority sub-sectors listed under the 2030 Dubai Industrial Strategy, which aims to promote the UAE as a global platform for knowledge-based, sustainable and innovation-focused businesses. In 2021, countries that focus investment on research and development facilities will be the frontrunners for national security, export potential and high levels of quality-of-life offerings. Investment in Biosafety level 3 (BSL-3) labs, which is applicable to clinical, diagnostic, teaching, research or production facilities and the highest level of biological safety as well as Biosafety level 4 (BSL-4) labs which consists of work with highly dangerous and exotic microbes (two examples of such microbes include the Ebola and Marburg viruses and can be extended to COVID-19) will make for the winners of the race to innovate over the next decade.
Becoming resilient in two weeks
Primary care needs to evolve into primary care 2.0, being crisis prepared, coupled with a reduced demand on hospitals. In the GCC, it is becoming increasingly difficult to deliver comprehensive and well-coordinated care due to the limitations of healthcare facilities original design. Newer models of primary healthcare centres need to evolve over the coming years. These models will be part of the plan to reduce dependence on hospitals. Building upon lessons learnt from COVID-19 and other pandemics, we are looking at an approach that’s fundamentally about flexibility, adaptability and the use of technology to protect patients and front-line workers, and to allow healthcare facilities to deliver normal operations for business continuity and in-country resilience.
New healthcare facilities have the opportunity to design built-in solutions from inception. Existing healthcare facilities have three options, all of which can be implemented within two weeks:
- Prefabricated structures: These can be stored in warehouses and rolled out as required and is a cost-effective and very quick solution. These structures could be temporarily erected on site when required, using spaces such as carparks or external grounds. The structure could be built on-site and can be used as a “spill-over” facility. These types of structures have already been used for setting up PCR Testing Sites, but these could extend to a full emergency ICU suite.
- Permanent structures: Facilities could build permanent structures on-site, again using redundant or non-essential spaces, these could then be used for storage while not in use.
- Redundancy: White space is an ideal solution for preparing for the future needs of hospitals. This space can be equipped for flexible use with the option of a quick conversion into an intensive care unit (ICU). Most hospitals do not have a large ICU, typically 100 bed hospitals will have only 20 ICU beds available. Additional floors can be built into pre-existing towers, or basements could be adapted to create whitespace, which in turn could easily, quickly and effectively convert into more wards or ICUs during pandemics. Creating white space is a way to rethink our hospital capacities. When not in use for emergencies such space can be used for research and development purposes OPD’s, storage or administration.
A quote from U.S. President John F. Kennedy is very apt in these unique times. “The Chinese use two brush strokes to write the word ‘crisis’. One brush stroke stands for danger; the other for opportunity. In a crisis, be aware of the danger — but recognize the opportunity.”
It’s reassuring to see many countries have not allowed this crisis to destroy them, rather shape future priorities.
Louca BA. Arch. (hons), Dip Arch UCL, ARBUK, RIBA, has over 25 years of international experience in the design and delivery of major complex projects with a particular focus on healthcare. As an award-winning architect he holds a B.A. (Hons) in Architecture from the University of Greenwich and a Diploma in Architecture from University College London, UK.