The recent health facility study tour organised by the Australian Health Design Council in partnership with the Australian College of Health Service Management, took 13 participants and two guides to three countries in Europe – the UK, Norway and the Netherlands.
Over a period of roughly 12 days, 14 recently-completed health facilities were visited – a very fast pace that required a high level of stamina and commitment to the cause. Study participants included architects, health service managers, government capital works officers, a health economist and a ‘token’ ED clinician.
As part of the tour activities, participants were asked to consider and discuss with colleagues the facilities visited and to evaluate them in terms of five main categories developed prior to departure. The categories were:
- Architecture/Design – including health planning;
- Patient-focused care;
- Staff work environment;
- Technology adoption and use;
- and environmental responsiveness.
A further category assessed the overall ‘Wow Factor’ of each the facilities. Albeit a very subjective measure, this last also measured the overall impression and impact that visiting each facility may have on participants’ future professional practice or project-related advocacy on return to Australia.
Analysis of the facility evaluations demonstrated an almost universal agreement that although we already do many things very well, the Australian health facility design system could learn much from the Dutch and Norwegians. In particular, Orbis Sittard, Deventer, St. Olav’s, and Arkeshus hospitals were impressive in the ways in which those who built and now run them have addressed the need to design and run a tightly-focused organisation based on a rigorous business case, utilising the best new technologies and innovative staff work practices. As a result, each delivers patient-focused care in well-designed, aesthetically pleasing, and environmentally responsible health care buildings.
We agreed that local culture drives the approach to inpatient unit design in each country. In the Netherlands, we saw innovative design that treated the inpatient unit as a temporary home for a patient with a communal living area as the central corridor. This was fitted and furnished using natural finishes such as timber, and provided good natural lighting and comfortable, domestic-scale furnishings. Orbis Sittard was one of the best examples.
As a result, we considered and discussed some of the current rules for planning inpatient units in Australia, the US and the UK that were said to be derived from evidence-based design. We concluded that there are clearly more ways to design in response to the ‘evidence’ than we see in everyday practice and, during the trip, we further extended this to the planning of staff work areas and offices.
Again, the European hospitals led the way – in particular the Dutch, with open plan work areas at both Deventer and Orbis Sittard aimed at creating a haven for staff away from patient care areas while maintaining critical connections to clinical areas.
Many of these innovations in both inpatient unit and staff workplace design may create a more patient-focused experience than we currently create in Australia in our hospitals. Such approaches would also create an inherently therapeutic and supportive physical environment for both patients and staff that could ultimately be assessed against the most important criteria that of improving health outcomes.
Clearly, project budgets in Norway and the Netherlands are larger than those for similar projects in Australia and the UK, yet the additional money spent up front has also often been used to address the whole life cycle of the facility so that it lasts longer and can be adapted to new uses in the future relatively easily and effectively. Investment in environmentally sustainable technologies such as tri-generation plants, green roofs, and creation of aquifers for heat exchange, plus a high level of investment in new technologies based on RFID chips, automatic guided vehicles and other forms of robotics, were part of each of these hospitals’ approaches to reducing staffing costs and the subsequent redirection of staff time to enhanced patient care.
The trend towards single patient rooms was evident in all three countries, but we saw this often balanced with rooms with more than one bed to enable patients to choose either solitude or company depending on their clinical need or personal preference. Where there were many single rooms, we observed that often bedroom doors were left open to corridors; alternatively, large observation windows were placed in walls between the room and the corridor to ensure close observation of patients by staff and also often to reassure patients that they were not forgotten. Although curtains were provided on these observation windows, these were rarely closed and this placed the patients on display to all passers-by. ‘Patient privacy’ versus the need for clinical observation is a clear tension, and we saw this addressed on every health project through either physical or operational means.
We visited several PFI hospitals in the UK and we could not help but contrast these with the European hospitals that are more often procured by traditional means. The quality of design and planning was generally high in the UK but the level of finishes and fit out – although acceptable – suffered in comparison to the European hospitals. This suggested to us that the UK hospitals may not last as long as the European ones and that, along the way, the internal environment of these may not feel as friendly or supportive to the patients treated there or to the staff who work in them.
However, a notable mention as part of the UK–Europe study tour was our visit to Great Ormond Street Hospital in London, a specialist children’s hospital built on a very tight urban site. The Morgan Stanley Clinical Building was built using a design and build contract, funded by charitable donations and some health department funding. Designed by UK-based architectural practice Llewelyn Davies Yeang (LDY), it provides a highly patient-focused environment with every aspect of a child’s pathway through the facility considered and designed. For example, the ceiling of the patient lift changes colour, and the corridors within the operating suite have LED lights embedded in the walls to create ever-changing scenery with moving animals popping up randomly that entice and distract a child on their way to the theatre.
Artwork was a feature of most of the facilities visited, as were innovative approaches to lighting, signage and way-finding. Other exceptional facilities visited included the Maggie’s Centre at Hammersmith and the London Clinic near Harley Street.
Some of the value perceived by participants in the study tour was expressed in their subsequent comments evaluating the tour itself, these included:
Interaction and open discussion with the varied group of professionals from across Australia and New Zealand was really beneficial.
Huge learning curve in: facilities planning, understanding health service synergies, politics of clinicians, how the model of care influences the design outcomes.
Brought me up-to-date based on real time experience, nothing was too filtered. The 3 country comparison was also excellent as it gave us another dimension.