Recent Developments in Health-Facility Planning and Design in Australia

1. Recent Developments in Health-Facility Planning and Design in Australia Warren Kerr Health-Facility Architect & Planner Rhonda Kerr Health Planner UIA PHG 28th Seminar Florence June 2008

2. Outline of Presentation • To provide an overview of the Australian healthcare system providing outline of the roles of Federal, State and Local Governments in the delivery of health services and health-facilities • To describe how health-facilities are procured using public and private sector resources • To provide an overview of the work being undertaken to develop national guidelines for health-facilities in Australia • To describe recent innovations in the planning, design and operation of health-facilities UIA PHG 28th Seminar Florence June 2008

3. Background of Presenters • Both are active practitioners in private sector undertaking major public hospital projects in Western Australia through Hames Sharley • Warren has quals in both architecture and health administration, is a part time Visiting Professor at University of New South Wales in Sydney, a Board member of the research Centre for Health Assets Australasia and Chair of the RAIA Health Architects Committee • Rhonda has quals in health economics, 25 years experience as a health planner and recently has been undertaking research into medi-hotels and the funding of capital works through DRG components • Projects underway range for $80 m to $1.7 b UIA PHG 28th Seminar Florence June 2008

4. Australia UIA PHG 28th Seminar Florence June 2008

5. Australian Demographics A vast continent with a population of only 22 million A nation of migrants Only 2.4% of the population are indigenous Aboriginal people Population density 2.5 persons per sq km UIA PHG 28th Seminar Florence June 2008

6. Economic Environment • Varied natural climate • GDP ranked 12th in OECD • High ownership of residential housing • Amongst the longest life spans • Low unemployment (and high demand for healthcare architects!) UIA PHG 28th Seminar Florence June 2008

7. Australian Health Care • Australia spends about 9.7% of GDP on healthcare (up from 7.6% in 1975) • All Australians have access to free health services • Private health insurance is subsidized and not linked to employment UIA PHG 28th Seminar Florence June 2008

8. Challenges • To dramatically improve health outcomes for the indigenous population • To provide better access to medical and health services for Australians living in rural areas • To manage increased health costs in the context of increased demand associated with an ageing population UIA PHG 28th Seminar Florence June 2008

9. State Responsibilities • Each State and Territory is responsible for building, funding and operating: • Public hospitals • Mental health services, and, • Community health services. UIA PHG 28th Seminar Florence June 2008

10. National View National Health and Hospitals Reform Commission Patient Centred Care Equity of Access and Outcomes Prevention and Wellness Value for money Long term view for health Safety and quality Shared responsibility Culture of Innovation and Improvement UIA PHG 28th Seminar Florence June 2008

11. Health-Facility Planning & Design in Australia • Public health-facilities are State responsibility • Until 1980’s hospital planning & design by PWD’s • Now outsourced to private practitioners • State based health architects led to national firms • State guidelines have been replaced by national • Formation of Centre for Health Assets Australasia • Investment during 1950/60’s require replacement • Amalgamation of small private hospitals into larger companies has resulted in sophisticated services • Current boom in hospital construction UIA PHG 28th Seminar Florence June 2008

12. Health-Facility Planning & Design in Australia • Primarily government funded construction (e.g. Fiona Stanley Hospital - $1.7 billion • Increasing use of PPP’s in some States (e.g. Victoria, NSW, Queensland & South Australia) • Prompted by need for large projects (e.g. $2.0 b Marjorie Jackson Hospital in Adelaide) • More research commencing in health-facility design • Sporadic evaluation of health outcomes (e.g Forster Report on Queensland) UIA PHG 28th Seminar Florence June 2008

13. Health Infrastructure • Public sector expenditure around 2% of health budget • Private sector expenditure varies • Major projects underway: • Queensland • Sunshine Coast • Gold Coast • Queensland Childrens Hospital • Victoria • Royal Childrens Hospital • Western Australia • Fiona Stanley Hospital • Midland Hospital • Joondalup Hospital • Rockingham Hospital UIA PHG 28th Seminar Florence June 2008

14. Innovations Queensland Sunshine Coast Hospital • Ecologically Sustainable Design • Proposed to be a ‘5 Star’ green rated hospital in Australia • Project Delivery Method • Private Public Partnership model of procurement • Latest Thinking in Ward Design • 24 bed wards broken into 8 bed pods • Majority of rooms are single beds • Decentralised staff bases with clean/dirty utilities, linen, medications and consumables within 5 steps to reduce ‘hunting and gathering’ • A mixture of patient room configurations to allow for different patient types and acuity • More generic wards and less specialised, to increase flexibility and flows UIA PHG 28th Seminar Florence June 2008

15. Sunshine Coast Hospital • Planning for the Sunshine Coast Hospital has been based on Lean principals • Lean (or flow thinking) is based on the Toyota Production System • Its aim is to provide a seamless flow of patients and services required to treat them UIA PHG 28th Seminar Florence June 2008

16. Sunshine Coast Hospital The fundamental principles of Lean Thinking in a health setting are; • Add value for the customer – deliver what patients think are important • Focus on the whole value stream – how does one activity impact on another • Improve flow by removing waste – what processes require backtracking or unnecessary movement • Where can push turn to pull – how can patients be moved into the correct care streams quickly • Manage towards perfection – solving each bottleneck until a new one is created, and then solve that one UIA PHG 28th Seminar Florence June 2008

17. What is Innovation? One View is: • Innovation and reform are like periodic adjustments on the course of a long sea voyage. • They occur because things have gone off-track a little, or because we have a new destination! UIA PHG 28th Seminar Florence June 2008

18. New Aims , New Tools • Improved health outcomes but more frequent use of services • Buildings which facilitate contemporary and future health care • Sharing the responsibilities for health management- better engagement with patients and families • Telemetry in the community and for rural and remote satellite services UIA PHG 28th Seminar Florence June 2008

19. New Ways to Improve Outcomes • Changed ward design • Powerful Ambulatory activity centres • Partnerships-in-care • Effective communication • Equipment libraries • Medical testing centres • Indigenous health hubs in hospitals • Short stay assessment areas UIA PHG 28th Seminar Florence June 2008

20. New Ways to Improve Outcomes • Enhanced Communications • At ward level • With community based service providers • With ambulatory services ,and • With patients and their families • New Pathways for Care • Early identification of care path through assessment units and allocation of patients to most effective setting UIA PHG 28th Seminar Florence June 2008

21. New Ways to Improve Outcomes Sunshine Coast Hospital • Focus on the flow of patients and services • Manage towards optimal outcome clinical and for the patients experience Midland Hospital • Integrate wellness activities • Invest in the areas where the community meets health care • an outdoor gym • fire pit UIA PHG 28th Seminar Florence June 2008

22. Investing in Health Short term vs. longer term cost management “We shape our buildings and thereafter our buildings shape us” Winston Churchill The challenge is to link capital investment and health outcomes UIA PHG 28th Seminar Florence June 2008

23. Linking Health Outcomes with Capital • Australian Hospital Cost Data based on Diagnosis Related Groups • Including Differentiated Capital by type • Wards • Offices • Imaging • Operating theatres • Critical care • Major equipment • Costed to include life span UIA PHG 28th Seminar Florence June 2008

24. National Capital Formation • Projecting Diagnosis Related Groupings to provide both the expected demand and the necessary minimum capital response • Results in linked capital to outcomes • Smooths out the blockages associated with unbalanced investment • Funds design related to outcomes • Patient outcomes linked to capital and • Improves Staff safety and retention. UIA PHG 28th Seminar Florence June 2008

25. Thank you Warren Kerr Health-Facility Architect & Planner Rhonda Kerr Health Planner HAMES SHARLEY Architects and Planners UIA PHG 28th Seminar Florence June 2008