HEALTHCARE PLANNING
Digital capabilities: enlarging the comfort zone for all
Professor Terry Young, a specialist in research in health technology, health services, and information systems, who runs his own consultancy, and Steve Powell, a former Consultant Interventional Radiologist and Clinical director at a large teaching hospital, discuss the sometimes conflicting demands of healthcare providers and patients in terms of the optimal location for medical care provision.
When planning new healthcare infrastructure there is a tension between those providing services and those needing to use them. Healthcare providers and their workforce are typically drawn to co-locate services close to a secondary acute site with generally bigger facilities. This makes sense with nearby support for emergencies, colleagues from different specialties available for opinion, and sufficient equipment to meet almost any eventuality. However, service-users can struggle to find their way around larger sites, while travel to them can be longer and more complicated, and parking congested. Users prefer smaller, more personal facilities within easy reach, but this means more of them. In this article we explore these tensions, and the ground rules for the optimal size and location for such facilities.
Polyclinics The idea of polyclinics that emerged in the latter years of the first decade of this Millennium has recently been revived, with an interest in community diagnostic and treatment centres, in order – for instance – to meet the inequity of access to diagnostic facilities in the UK as compared with European neighbours. This tension between developing larger sites on or near existing infrastructure, rather than smaller sites away from acute hospitals, has been all too evident. While some standalone centres have been built with easy access and good parking – meeting the needs of end-users – others have appeared in hospital car parks or next to hospitals, meeting the needs of healthcare professionals. Behind this lies a fundamental paradox in healthcare: the best ways to deliver care are often the poorest ways to receive it. Behind this is an information paradigm, since healthcare professionals need to ‘cluster’ to maximise their impact, while patients prefer a personalised experience. We show this in Figure 1, where the X-axis represents centralised to remote, and the Y-axis stretches from large to small.
Digitisation and digital connectivity impact almost all aspects of healthcare provision.
The information-access paradox It looks like the result of this tug-of-war between centralised and remote, big and small, must trade off the satisfaction of one group against another. Perhaps if we can understand the rationale for these differing views, we may find a ‘comfort zone.’ For service-users, this may be to skip a long trek on public transport or from a car park to a clinic, avoiding the need to rest along the way, the confusion of hospital signage, or crossing crowded spaces. It may mean consulting with someone they know and who knows them. For healthcare teams it may mean the security and convenience of their own bricks and mortar, colleagues, policies and procedures, or even the (surely outdated) bleep system. Our first aim in this paper is to provide
a rationale for setting limits on what constitutes too big or too small. We may not find the ideal balance, but hope to describe the space in which it must lie. To reach a solution, planners must balance what is sufficiently connected, safe, secure,
and familiar, for healthcare workers, against a good patient experience. They must also propose what is functional. A single scanner or endoscopy suite in an isolated location will offer a poor return on investment, requiring intense staffing relative to the number of diagnoses delivered, since the staff required cannot be shared across isolated clinical suites or scanners. Configuration is also important, since back-to-back control rooms in scanning facilities, for instance, can release staff for other tasks.
Economies of scale For diagnostic facilities there are economies of scale. An endoscopy unit’s decontamination suite is most efficiently provided when servicing a minimum of four suites. In medical imaging, scanners are best clustered, while there is an optimal number of clinical consulting rooms per member of administrative staff. Ancillary space such as changing facilities may not be given enough consideration, but can be
April 2023 Health Estate Journal 27
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