Building a 2020 vision: Future healthcare environments

Building a 2020 vision: Future healthcare environments

Architecture Research Unit (Maru) for the Nuffield Trust, focusing on the possible future shape of health facilities.

The healthcare sector and the construction industry are both undergoing a phase of accelerated change and modernisation, and a new vision for healthcare environments is emerging. Healthcare is changing: services are being

redesigned around patient needs and buildings will need to follow this trend. This means making buildings that are better suited to the patients who use them, for their comfort and convenience.

The construction industry is looking to make improvements in the quality of the design of health buildings in terms of functionality, technical performance and therapeutic impact. Improving the production of buildings means customising designs to take advantage of standardisation and modular production while providing a unique design specific to the site and location. More sustainable use of resources in social, economic and environmental terms will drive development decisions.

Four key principles will influence the planning and design of the future healthcare environments:

* A social model for healthcare

* Quality of the patient experience

* Quality of design

* Sustainable development

A strategic plan for healthcare will mean planning care in an integrated way across a local health community, bringing care closer to where patients live and work, using technology to help deliver a networked information system, decentralised diagnostics and minimally-invasive treatments.

Four settings for care will be developed: home, health and social care centres, community care centres and specialist care centres.

Realising this vision will mean generating a dialogue between the healthcare sector and the construction industry, between informed clients and expert design teams. The design process can be a catalyst for change, bringing together ideas about new patterns of care with innovations in the design and delivery of buildings. A new culture is needed to foster the vision that will disseminate research through a knowledge system, encourage best practice through exemplary projects, and create expert teams through training and development.

A SOCIAL MODEL FOR HEALTHCARE

A social model for healthcare means:

* Joining together health and social care

* Ensuring equity of access

* Creating a healthy living environment.

LIVING IN A HEALTHY ENVIRONMENT

Urban regeneration projects must help to create healthier environments to improve the overall health of society, particularly of those with the poorest health. Regeneration will create a platforn for community development that will sustain an improved environment.

Regeneration provides the opportunity for healthcare buildings to be integrated into development strategy at all levels to make a positive contribution to the local environment.

ACCESS, EQUITY AND SOCIAL INCLUSION

A major theme of the healthcare agenda is to improve access to healthcare by eliminating unacceptable variations and to improve standard health outcomes across the whole country.

In developing a whole systems approach to healthcare delivery, ease of access by public transport will be a critical success factor and should be a major consideration in the selection of sites and design of infrastructure for care delivery.

Each locality will need to develop its existing infrastructure, making the most of the existing building stock and preserving and enhancing the capital and use value where appropriate.

NEW WORKING CULTURES

Seamless care will be the challenge of the future and the creation of interagency partnerships will be the new working culture. Social services and healthcare can be reorganised jointly, collaboration will be enabled by pooled budget mechanisms and by taking a whole systems approach to the needs of different care groups such as older people and children. Co-location of services in shared facilities may follow.

QUALITY OF THE PATIENT EXPERIENCE

Quality of the patient experience means:

* Organising care around the comfort and convenience of patients

* Bringing care closer to where people live and work

* Enhancing the self esteem of the workforce

THE PATIENT AND CARERS’ EXPERIENCE

In the modernised NHS, care delivery will be designed around the patients’ and carers’ needs taking account of their experience, comfort and convenience as well as clinical tasks. This will involve the redesign of the processes of the organisation of care and the development of bookable patient pathways through the care.

Providing access to health information for patients will encourage health awareness and promote health gain. Health information and advice will be provided in paper, telephone and electronic forms in all health facilities and in many non-health organisations such as supermarkets, libraries, schools and sports centres. Easy access to information in the home will soon be realised with digital TV development.

Patterns of healthcare delivery will be more directly influenced in future by the patient’s viewpoint. User consultation Mill shift to the early stages in planning when patients can directly influence and support organisational change.

MANAGING CLINICAL NETWORKS

Already healthcare is being reorganised into clinical networks that are being managed around explicit patient care pathways, such as the cancer and cardiac pathways. Providing these pathways to link the patients ‘experience through primary, community and specialist care will ensure better continuity of care. Within the network, care will be considered from a whole systems approach with appropriate interagency working to ensure seamless care. The networks will be integrated across organisations and institutions and staff will work flexibly to meet patients’ needs.

The patient pathway will be streamlined into and out of the healthcare network cutting out any unnecessary patient visits by providing one stop shop services and making the results from diagnostic tests quickly available.

Swift movement through the pathways will require a rapid flow of information to support the care. Developments in information and communication technologies will enable all patient administration and records to be linked throughout the network. Much of the patient pathway will be bookable from primary care centres.

LOCATING CARE AS NEAR TO HOME OR WORK AS POSSIBLE

New technologies in medicine biomedical engineering and information handling create the option of cascading care out of hospitals into settings nearer to where people live. This strategy is compatible with patient convenience and prevents unnecessary journeys.

Clinical equipment in general is getting smaller, more automated and more mobile. Near patient testing is developing with easily available test kits and smaller automated pathology testing equipment. Much of the basic diagnostic testing required will be located in primary and community care settings in future.

Telemedicine video conferencing is developing at all levels; between the home and the clinical worker; between primary and specialist care and by “store and forward” systems eg emailing text, images or sound recordings from primary to specialist care for opinion.

VALUING THE WORKFORCE

The human resource of the workforce is the most essential ingredient in healthcare delivery. A more generic workforce, with fewer demarcations between professional groups and subgroups will deliver future healthcare. The aim is both to minimise the communication difficulties inherent in demarcation and to minimise the number of different people that patients see, to increase patient trust and confidence.

The estate has a role in enhancing staff morale and contributing to the recruitment and retention of staff. Staff will be assisted in their task by high quality working environments, which both enable convenient and efficient working and contribute to staff well being and pride.

QUALITY OF DESIGN

Designing for patient centred care means making buildings that:

* Are sensitive to the physical and emotional needs of patients and support busy staff

* Give reassurance to relatives and friends

* Express the value that society places on healthcare

Design quality for patient centred care is achieved with the overlapping of three fields:

* Functionality: convenient and efficient in terms of eg access, space planning, use and adaptability; being ‘smart’ and ‘intelligent’ in the use of technology

Technical performance: integration, co-ordination and performance of the structure, engineering services, systems, fabric, finishes and fittings; integrating production and design to generate standardised and modular components

* Impact: effect of the design on the senses and the mind by enhancing the patient and visitor experience, user satisfaction and staff morale; the contribution the building makes to place and community, the quality of its visual form, internal environment, identity and character

Some special considerations for healthcare design are as follows:

THERAPEUTIC POTENTIAL OF THE ENVIRONMENT

It is now widely acknowledged that the design of the environment has the capacity to enhance healing by reducing patient stress and raising staff morale. Therapeutic environments stimulate the senses and the mind, offer comfort, control and variety to patients and staff through the sensitive use of light, colour, texture, aroma and sound. They aim to be calming and distracting by integrating art, architecture, interior and landscape design.

PUBLIC, SOCIAL AND PRIVATE SPACES

The concept of a health building as a hierarchy of spaces from public to social to private emphasises differences in character as well as function. The public entrance and circulation may be formal and welcoming, re-assuring and legible, and a place for events and exhibitions that generates a sense of occasion. Social spaces create convivial and stimulating places for informal exchanges that reassure or distract:a place to be whilst waiting, a place to pass the time en route to somewhere. Private spaces need to be designed to respect confidentiality and dignity creating calm environments that promote healing.

CONTRIBUTION TO PLACES AND COMMUNITY

Making places as opposed to merely functional spaces requires design that acknowledges the particular nature of the site, the role of the building and the opportunities created for complementing its core activities. This means, for example, designing to take best advantage of sunlight and views; creating connections between the spaces outside and inside both physically and visually to give a sense of time. Civic qualities are reflected in the way the design responds to local buildings but also in the facilities the building offers to the local community such as public art and public space.

SUSTAINABLE DEVELOPMENT MODULAR DESIGN

Spaces may be classified into three types: unique, repeatable and modular. This classification helps to resolve the tension between standard isation and customisation both of which are deliverable.

Spaces that are unique to a project may be the public spaces where the opportunity to convey the special attributes of the place and the organisation can be expressed in design.

Repeatable spaces are those which can be replicated within and across projects using standard plans and layouts. Bathrooms, toilets and stores are obvious examples but this could extend to include clinical rooms such as those for consultation and treatment.

Modular designs may be devised for technical rooms or suites (operating theatres, diagnostic suites, intensive care suites, even bed areas) and other highly serviced spaces with precise specifications based on firm and quantifiable data. Assembled off site with the capacity to be .plugged in and out’, these modular units economically facilitate replacement and upgrading with minimal disruption to service continuity. The internal decor of the units can be customised to individual specifications.

SUSTAINABILITY

The concept of sustainability addresses the need to develop a more long term understanding of buildings that acknowledges not only the current needs, but limits resources needed for future changes and cost and performance in use and over time. This has consequences for the design in terms of land use, space and environmental services.

To be sustainable, design and construction will need to meet three key criteria, ‘the triple bottom line ‘whose objectives may be summarised as:

Social: to design, build, maintain and adapt buildings to meet the changing needs of society; to support and encourage working and social corrfmunities by taking account of the impact of development on the local community (for example: land use, employment, community development, transport)

Economic: to develop a more holistic costing framework that takes account of whole life costing and best value.

Environmental: to meet a ‘green agenda ‘globally, locally and internally; to limit global threats such as the greenhouse effect and the depletion of the ozone layer, protect aspects that people need and value, and take stewardship of natural resources.

FUTURE SETTINGS FOR HEALTHCARE

The way care is organised will take account of the patients ‘experience as they move through the four settings in the local health community:

* The home

* Health and social care centres

* Community care centres

* Specialist care centres

All centres will be electronically networked to provide communications systems for patient records, appointments and basic diagnostic testing. The designs will be patient-centred, therapeutic, sustainable, adaptable, robust, durable, accessible, functional, technically excellent, visually attractive and contribute to the place and community. To ensure equity and social inclusion the location strategy for healthcare will be based on the following elements. Health and social care centres will retain their very local nature. Community care centres will be located at the heart of the community they serve. Specialist care centres will be on central city sites, close to transport hubs and near to centres of activity such as retail, work, leisure etc.

HOME

The aim is to sustain patients independently in their own home or home substitute through a seamless partnership of health and social care. Chronic diseases and disabilities, earlier discharge from specialist care and rapid intervention in a crisis will all increasingly be managed in the home. Remote monitoring of care using information and biomedical sensor technologies will provide information about the patient’s condition including accidents; automated drugs delivery systems are being developed.

Homes will be designed to be adaptable to changes such as household structure, homeworking, episodic or sustained periods of social and health care, and to provide building infrastructure for ‘smart’ communications and sensors.

HEALTH AND SOCIAL CARE CENTRES

Health and social care will bring together primary healthcare, social care, information and advice, and the voluntary support groups sector to provide seamless care from pooled budgets; developed around existing care provision leading to local diversity of organisation and design. NHS Direct will be the gateway to out of hours care, to primary care social care and emergency care;but the GP will continue to be the gatekeeper to specialist care. Centres will include nurse led minor injuries and walk-in services;healthy living centres will include screening clinics, travel health advice, exercise and fitness and outreach specialist consulting using direct telemedicine consultations.

Health and social care centres will be designed to: Support inter-disciplinary team working with a mix of dedicated and shared spaces

Offer a limited range of standard rooms types with varying patterns of use eg personalised space for those who work in the building most of the time; shared rooms for less frequent users; meeting and occasional office space for outreach and domiciliary services

Generate variety in the ambience of the spaces, such as welcoming public areas, restful social rooms and confidential and dignified private spaces

COMMUNITY CARE CENTRES

The core activities of basic diagnostic services, day interventions and nurse led inpatient care including intensive rehabilitation will provide as much as possible of the patient pathway in a local community setting. Further services might include child development, mental health resources centres, day centres for older people, home substitute nursing homes and palliative care centres selected to suit local needs. Consultation and day interventions will be undertaken by primary care practitioners and specialists either face to face or by telemedicine links. They will be supported by local automated pathology testing and basic imaging diagnostics with reporting links to specialist care units.

Community care centres will be designed to:

Be landmark buildings with local character that are intimate in scale and contribute both physically and socially to the regeneration of the local community

* Offer a diversity of spaces for patients and staff eg public areas for cultural and social activities such as exhibitions, events, library, cafe; social spaces for reception and waiting to stimulate and support informal exchanges; single rooms with high levels of confidentiality and dignity for consulting, diagnosis and treatment

* Offer a standard range of room types such as consulting and examination, treatment, interview, group activities and bedrooms

* Create a diverse and therapeutic environment with user control and a sense of being connected to the world outside by means of landscape, artworks and daylight

Copyright Wilmington Publishing Ltd. Sep 2001

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