Australasian College of Health Service Management Conference 2013 Energising Healthcare

1. 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

2. About the AHDC • 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

3. About the AHDC • 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 section • ½ 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

4. Health Study Tour 2012 UK, Norway and The Netherlands • An overview – is health architecture influenced by the health system within which it is procured?

5. 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

6. Study Tour 2012 – AHDC/ACHSM UK: Pembury, GOSH, QEII Birmingham, Manchester PFI Kids, Salford Royal, Maggies Centre Hammersmith, London Clinic Norway: St Olav’s Trondheim, Rikshospitalet, Akershus, Oslo Netherlands: MC Erasmus, Maasstad, Deventer, OrbisSittard Trondheim Oslo Manchester Rotterdam Deventer Birmingham London Sittard

7. HEALTH SYSTEMS COMPARATIVE DATA

8. HEALTH SYSTEMS COMPARATIVE DATA

9. HEALTH SYSTEMS COMPARATIVE DATA

10. PROCUREMENT MODELS • 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

11. FACILITY SIZE AND CONFIGURATION

12. FACILITY SIZE AND CONFIGURATION

13. FACILITY SIZE AND CONFIGURATION

14. FACILITY EVALUATION CRITERIA Architecture /Design ☆☆☆☆☆ Patient-focussed Care☆☆☆☆☆ Staff Work Environment ☆☆☆☆☆ Technology Adoption + Use☆☆☆☆☆ Environment☆☆☆☆☆ OVERALL WOW FACTOR☆☆☆☆☆ • 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

15. EVALUATION RESULTS Key: • Note • Northern Europe rather than the UK may be the benchmark for quality health facilities

16. Study Tour 2012 – AHDC/ACHSM • Architecture + Design – includes Health Planning • OrbisSittard, The Netherlands • Deventer, The Netherlands (eq) • GOSH, UK (eq)

17. Study Tour 2012 – AHDC/ACHSM • Patient-focused care • OrbisSittard, The Netherlands • Akershus, Norway • Deventer, The Netherlands

18. Study Tour 2012 – AHDC/ACHSM • Staff work environment • OrbisSittard, The Netherlands • Deventer, The Netherlands • St Olav’s, Norway

19. Study Tour 2012 – AHDC/ACHSM • Staff work environment • OrbisSittard, The Netherlands • Deventer, The Netherlands • St Olav’s, Norway

20. Study Tour 2012 – AHDC/ACHSM • Staff work environment • OrbisSittard, The Netherlands • Deventer, The Netherlands • St Olav’s, Norway

21. Study Tour 2012 – AHDC/ACHSM • Urban environment (contribution to) • OrbisSittard, The Netherlands • Deventer, The Netherlands • Akershus, Norway

22. Study Tour 2012 – AHDC/ACHSM • WOW! Factor • OrbisSittard, The Netherlands • Akershus, Norway • Deventer, The Netherlands • St Olav’s, Norway

23. FUTURE QUESTIONS/DISCUSSIONS • How does the PFI process affect design outcomes in the UK? • Birmingham QEII Salford Royal • Manchester PFI Tunbridge Wells (Pembury PFI)

24. 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 Riks Orbis

25. FUTURE QUESTIONS/DISCUSSIONS • Innovative staff workplaces and work practices – change management and system-related issues: • The Netherlands • Orbis • Deventer

26. Study Tour 2012 – AHDC/ACHSM • Notable technology innovations • AGV – Norway, The Netherlands • Robots in pharmacy – Akershus • Patient information systems – Trondheim, Masstaad • Underground radiation bunkers – • The London Clinic, London • ‘Barn Theatres’ at Salford Royal • (not a big success!)

27. Study Tour 2012 – AHDC/ACHSM • Other Facilities with WOW! Factor • The London Clinic • Maggie’s Centre, Hammersmith • Plus a few Honourable Mentions: • Maasstad • Tunbridge Wells (Pembury) • GOSH (for its preservation of heritage - integrated with new facility)

28. Study Tour 2012 – AHDC/ACHSM • The London Clinic

29. Key Lessons

30. FACILITY PLANNING THEMES • 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.

31. 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

32. 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

33. IPU PLANNING – Single Vs. Multi-bed

34. IPU LAYOUT - Data

35. TECHNOLOGY UPTAKE • Key • (e) – facility enabled for future uptake of technology

36. INNOVATION THROUGH ADOPTION OF TECHNOLOGY • Barriers to Adoption of Technology • Limited available capital funding • Cost benefit analysis didn’t 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

37. In Summary

38. IN SUMMARY • The tour was invaluable but really only a taste of what’s out there to be learnt, constant immersion/challenge is necessary to keep the tools sharp • We can’t 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 Olav’s) • 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

39. IN SUMMARY • 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 • Thanks • AHDC thanks Roger Carthey + Kelvin Steele for contributing to this analysis! • Also Darryl Carey, Keith Joe, Jane Carthey for photographs

40. Thank you! Australian Health Design Council www.aushdc.org.au