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RESTRUCTURING


routine – such as cycling or walking the last 2 or 3 km to their offices – this would have a major impact on the wellness of the populous. Major hospitals are typically located in the


hearts of towns and cities. As healthcare practice changes and fewer beds are required within hospitals, there will be spare land capacity on each site. These existing healthcare facilities could become the heart of the new Wellness campuses. The hospital would, effectively, become a high-tech diagnostic, specialist treatment and research facility with a medi-hotel co-located on site. This Wellness campus would contain end-


of-trip cycling facilities, free gymnasiums and swimming pools. There would be an exclusion zone around the central hub, which would typically be 5 km radius. At the 5 km boundary, there would be multistorey parking where people would commute partly to work by car and finish the rest of the journey by bicycle. Figure1 demonstrates the model where


at the heart of the community, there is a specialist acute/diagnostic/treatment/ research facility. This facility would have minimal patient beds as in-patient care would generally be provided in the distributed community facilities. The red zone indicates the outer


perimeter of the city where general commuter transport is permitted. At this outer zone there will be park & ride facilities where vehicles can be parked and exchanged for a bicycle or it is possible to walk into the centre of town. There would also be limited electric vehicular transport for people with disabilities. Also, at this outer perimeter, there would


be newly built sports centers incorporating a range of free facilities such as swimming pools, tennis courts and gymnasiums. The green zone indicates the ‘no car zone’


in which there are only roads for emergency and service vehicles. These areas are generally clear and safe for commuters to enjoy their stroll and cycle to their offices. This would mean that people would


drive/commute to the outer perimeter each morning, park their cars in the ‘park and ride’, potentially take part in some form of sport or exercise and then complete their journey to work by bicycle or by foot. It is acknowledged that very few work places have end of trip facilities, therefore a number of shower pods would be strategically located around the city to provide adequate coverage for those


Hospital estates could be rebranded as ‘Wellness Centres’ and integrate with more community-based facilities and activities.


workers that would wish to take a shower after their short cycle/walk.


Healthcare facility design As already discussed, there are major changes in the way we live our lives which will impact on the way that healthcare will need to be delivered. The increase in chronic, cardiac and mental health illnesses over the next 30-40 years will mean that a lot of the health facilities we currently have, or are building, will not be suitable. As diagnostics, treatments and recovery


rates improve there will be less requirement for in-patient accommodation. It is more likely that, where traditional inpatient accommodation is required, it will be provided in distributed health centers and community hospitals based out in the communities. This then leads us to rethink the central


hospital model. It is likely that the city centre hospital will retain A&E, diagnostics and specialist clinical services. In addition, there will be stronger links with universities and increased research. Furthermore, with the semi-privatisation


resulting from the move towards PPP delivery, there will be more collaboration with the private sector – particularly pharmaceutical companies. It is envisaged that hospitals of the future


will be co-located with universities and research institutes. Given that hospitals tend to have large parcels of city centre land, there is every likelihood that the Universities and private sector companies will relocate to what was originally the hospital estate.


We estimate that the on-site inpatient accommodation will be less than 10% of what is normal today. However, there will be a much higher demand for hotel and short stay facilities for visiting families, research work and clinical staff. Co-sharing of hotel rooms with minor surgery recovery suites will become commonplace, ensuring capacity can fluctuate without impacting on the patient experience. The key to all of this will be complete


flexibility in what we are designing today for tomorrow. Other key issues, such as single patient


rooms will also be addressed. The huge benefits in terms of patient dignity, security and infection control outweigh the perceived social benefits of multi-bed bays, which are preferred by the minority. This is a debate we should put behind us, find the capital expenditure to resolve it and move on to the next challenge. Recent studies carried out by Fiona


Stanley Hospital (Perth, Australia) found that the extra capital expenditure required to provide an increase of 53% (23% to 80%) single beds was recouped in 3.6 years due to the other savings gained in the overall treatment process. Further consideration has also been


given to infection control and the impact that hospital design has on this. A recent study into a number of hospitals in Queensland, Australia, established that over 90% of hospital facilities are served via HVAC systems which recirculate large proportions of air within the building in an effort to save energy. Further analysis of one of these facilities discovered that the actual amount of fresh air being delivered was well below that which was required or that the system had been designed for. In some cases, air was being recovered


from areas that are considered ‘dirty’ and recirculated to areas that are required to be ‘clinically clean’. At present, typical healthcare design


briefs do not specify targets for Indoor Environmental Quality (IEQ). This is something that needs to change. HVAC systems have the potential to greatly hinder or improve the cross infection rates within a hospital. It is essential that designers have the adequate experience and knowledge to provide solutions that ensure the continuous flow of fresh air from clean to dirty zones. Energy consumption is often cited as the


‘A hospital is one of the largest single energy consumers in a city. It has a unique load profile with high daytime demands for cooling and evening demands for hot water. When this is combined with the load profiles of offices, schools, restaurants, cinemas, etc, there are very real opportunities to provide district energy schemes where the base heating/hot water load can be generated as a by-product of the electricity generation.’


IFHE DIGEST 2013 81


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