RESTRUCTURING
Table 2: How health systems need to change to be better able to prevent and manage NCD.
Current view
Geared towards acute conditions Hospital-centred Doctor-dependent Episodic care Disjointed care Reactive care
Patient as passive recipient Self-care infrequent Carers undervalued Low-tech
Evolving model of care
Geared towards long-term conditions Embedded in communities Team-based
Continuous care Integrated care Preventative care Patient as partner
Self-care encouraged and facilitated Carers supported as partners High-tech
(Source – Report on communicable diseases Imperial College London and Qatar Foundation 2012).
radiation and chemotherapy as cancer therapies could even be replaced through more targeted nano-therapies. At the same time, we may also see a new world in diagnostic imaging, using in vitro nano- cameras rather than large magnet-based devices. The enabler for this technological change
will be the advances in computer science which continues to shape the medical environment. Given that a typical mobile phone boasts computing power far in excess of the systems that carried Apollo 11 to the moon in 1969, we can easily predict that much more is to come. What is clear is that the potential for
change within the healthcare environment is enormous. The manner in which diseases are diagnosed and treated could be revolutionised within 10 years and would have a significant impact on the built environment that supports the delivery of healthcare services. The challenge then is that the buildings
that we create today have to be up to the task of meeting all these changes for the next 60 years. We even need to ask ourselves the ultimate flexibility question – if this were not a hospital then what could it be? Clearly, the health planners, architects and
engineers charged with designing healthcare facilities of the future need to understand the full scale of the potential developments on the horizon and plan sufficient flexibility into their designs to allow those changes to occur. This long-term level of understanding will
not simply be gained through discussions with local clinicians or patient user groups alone, but by interacting and collaborating with scientists and clinical researchers.
The impact of change on the acute healthcare estate So, what does all this mean for the day-to-day business of shaping healthcare environments that will be fit for the future? Well, first of all, we can examine the basic model of how we approach the problem now. Modern acute hospital accommodation can be divided in four main building types
IFHE DIGEST 2013
Use performance data to drive continuous
Performance Monitoring
improvement and to inform portfoilio strategy AssetMAP
Integrated Design and Delivery
Deliver the retrofit
strategy cost effectively and with minimum risk
Assets
Opportunities What retrofit
strategy offers the best outcome?
– the hot areas (diagnostic and treatment); the hotel accommodation (wards); the administration (offices); and the industrial elements (laboratories, pharmacy, laundry, catering, etc). The need for change of each of these accommodation types was the subject of work carried out in the Bouwecollege in Utrecht, Netherlands in 2005 (Fig. 3). This model is very helpful in aligning functional building types with their need for flexibility, complexity of services and, ultimately, cost differences. However, since this model was developed
things have moved on and we must now consider what proportion of each of the
functions will be carried out in the community or at home and what could be outsourced to local or remote third-party providers. This can only be ascertained by an analysis of the future clinical and ancillary services to be provided, the models of care associated with those services and the attitude towards public/private partnerships etc. Only then can the accommodation necessary to support the effective delivery of the service be fully considered. In short, every healthcare estate will need
a clinically led development control plan for the short, medium and long term. It will also be essential that this plan includes all the satellite facilities in the vicinity i.e. in-patient, outpatient, general practice and community care. This is critical to facilitate the future adoption of a less centralised, more dispersed service delivery model. This holistic approach will be the basis of a vertically integrated system incorporating prevention, intervention and care, enabled by a powerful digital intelligence platform. Once we have fully considered the many
complex changes that could occur over time on the estate, we can turn our attention to the condition of the building stock within the health estate at large. Given the complex nature of the problem, it is important that we have planning models to help frame our multi- discipline approach to the building stock. One such model is the AssetMap (Fig. 4). This model was originally developed to guide clients through the process of interrogating
Understand Main Drivers
How can your
portfoilio best support your business?
Which of your assets offers the best improvement potential?
Priority Assets
Develop detailed strategy including architecture, engineering, finance and delivery
Retrofit Strategy Figure 4: AssetMap – an evaluation model to enable realisation of the potential of the existing estate. 17
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