Hospital design and planning processes are going through a major revolution led by the many technological advances and the digitalisation of the Healthcare industry, according to WSP | Parsons Brinckerhoff Technical Director, Roneel Singh.
A hospital’s spatial design requires entirely new thinking at masterplanning to accommodate today and future technological advances. There is a need for a specialist to masterplan the technology backbone and operational systems that must be designed to handle evolving needs. Taking a holistic view of technological impacts on the built form is essential when designing new healthcare facilities.
Roneel Singh, who is also Head of the Technology Systems Team in Australia and New Zealand, says the impact of technology on design is similar to the changes in healthcare architecture that have developed in response to patient-centric models of care. The new approach, he says, has seen healthcare planners become part of the team from the early planning stages with their decisions impacting on the overall operation and management of the facility.
“Health planners do a phenomenal job – a hospital was once designed as a rectangular box. But with input from health planners the models of care have changed and so have hospital designs resulting in a change in the built environment,” Singh says.
Among the factors pushing change is that equipment is being modernised and digitalised, so it is smarter and better. Another is the drive in the healthcare industry for facilities to be smarter and more efficient and progressive.
Companies active in healthcare need to have a competitive edge in patient care, Singh says.
“Hospitals have become a business, so like any business, they want to make operations cheaper, better and faster. Operational efficiency is now a key metric in both public and private healthcare facilities”
To a certain degree, hospitals aim to be like a hotel, one “where you stay for the shortest time”. On another level it’s about optimising staff so that “nurses can spend more time doing their core task, which is caring”.
Technology will have a bigger impact and be more important than many design teams expect
Interestingly, digitalisation in hospitals has grown to such an extent that Standards Australia has a project team working on what is believed to be the world’s first digital hospital guidelines, which will set out the fundamentals of design and the relevant definitions.
Singh says most planning and design teams generally don’t yet consider that the technology that will form part of hospitals will be as important as the architecture and health planning.
Quite the contrary, Singh says.
“It should be at the forefront of design.”
A key enabler in this process will be technology specialists who can develop technology masterplans as part of the early stages of planning and design. WSP | Parsons Brinckerhoff has already undertaken the Dell Children’s Medical Centre in Dallas, a fully integrated hospital.
Greater use of technology and automation means more physical space is needed
There are practical reasons for doing the technology masterplanning up-front, Singh says. Much of this involves the physical space required.
For example, if a hospital is going to use robotic autonomous vehicles to collect pills from an automated dispensary and deliver them to patients, there are safety and functionality issues to consider.
“If you put AVs into the same corridors as people, do the corridors need to be wider?”
Linen services are also increasingly becoming automated.
Think of hospitals not so much as the rectangular boxes of the past, but more as evolving precincts, Singh says.
Like other precinct-type developments with substantial back of house facilities – such as airports and hotels – hospitals need to plan for the routes that automated technology will use and where the control and operational aspects will be housed.
Hospitals need their own technology base, like a data centre
Singh says the more technology is applied for day-to-day operations, the more designers and developers are “essentially creating a data centre’’ inside the hospital.
Large digital theatres that look like “command and control centres”, for instance, need to be catered for. Digitally-enabled medicine also involves large machines used for remote medicine and HAPTICS-enabled robotic medicine, which can enable a doctor to perform a consultation at significant distance from the patient.
Underpinning such technologies is the need for real-time connectivity, and the physical and quite specific needs of the machines to be adequately housed.
Right now that’s not generally provided.
Instead, much of the time, hospitals have used “bolt-on solutions” where technology, data and communications centres are situated. This is not the most effective approach.
For one thing, it is important that upgrading cabling, racks or other infrastructure doesn’t necessitate taking a ward apart.
Good design can enable elements to be compartmentalised for easy access or replacement.
Part of the masterplanning process of technology involves looking at the proposed individual wards, the patient beds within them and the IT terminals likely to be associated with each bed.
There needs to be forethought into who will be looking at these terminals, the structural support that will be required for them, and how people will move around them or sit near them.
Once the masterplanning has considered the spatial allocation of technology then the design process can consider the backbone that will support and enable it.
Take for example the number of new developments utilising Radio Frequency Identification (RFID) and Real Time Location Services (RTLS) based technologies to improve efficiency and lower operational cost, Singh says.
The technology assists staff to keep track of patients, equipment and other crucial elements and it’s a scenario that has an impact on the design considerations.
“You have got to have physical infrastructure to support wireless infrastructure.”
That might mean a communications room with 20, 30 or 40 racks, he says.
“This takes up a lot of space.”
It also needs to be air-conditioned to keep the heat-generating IT and data equipment at the optimum operating temperature.
Think of a hospital as a city that needs to operate 24/7
Planning also needs to take into account the support that will be needed for digital medicine. To ensure 100 per cent uptime of life-critical functions and procedures such as robotic surgery, there will be a need for an uninterrupted power supply and back-up generator, for instance.
“We need to take the smart city planning process into precincts [like hospitals],” Singh says.
The new digital hospital, with more technology and larger IT requirements, simply requires different design to the former type of facility that only had to find space for facilities management and some IT, Singh says.
The forecast trends in advanced technology in hospital developments show how crucial it is for technology to be a core part of the early phase masterplanning, allowing for cost, risk and spatial allowances, and operational methodologies to be discussed and agreed upon prior to the design development stage.
That means engaging with the planning early, rather than the traditional approach of only considering technology “post-fact”.