HOSPITAL DESIGN
organisation. This ‘champion’,” he added, “needs to be somebody who can stand and represent your organisation’s culture and help develop and articulate its shared values and professional ethos.” Something ‘which tended to be missing’ in some public sector procurement more generally was ‘a sense of ownership and pride’, i.e. that a new facility was ‘for your city, your organisation, and for the next 50-60 years’. Such thinking needed to be ‘driven’ through the client organisation. He said: “It’s not repairing a flat roof; it’s about how changing the health and wellbeing can work within your organisation. There has also been an ‘on/off’ relationship with the idea of design review, with DQI and AEDET in some areas, and indeed Scotland has perhaps retained the design review concept more strongly than England. As you go through the process, you do need to consider how you are doing, and the idea of bringing in CABE or some other organisation as a design review panel needs resurrecting. It’s an important process, and ensures some degree of equity and commonality of ambition. Certainly, if you are not doing well enough on design, you need to be told by an organisation with the teeth to address that, and help you get through it.”
Looking at the longer term The ‘mid-term of an investment’ for a new hospital, Christopher Shaw said, would currently be around 2040-2050, but ‘most people in the NHS’ would ‘find it extremely hard to know what might happen the next year, let alone longer term’. With this in mind, some sort of briefing and planning around what the healthcare estate’s longer term future – beyond the ‘life’ of the current NHS Long Term Plan, would be useful, since when planning and designing new healthcare buildings, their 40-60 year life required decisions that would affect them long- term to be made now. He said: “We all know about Net Zero Carbon, but we will also need to be thinking ahead, as far as is practicable, about things such as the
The Sunshine Coast Hospital, Queensland, Australia – Masterplan.
distribution of services, and how we can create healthcare facilities that are flexible and adaptable to changes which may be quite difficult to determine. We need to plan for growth and change; in the last 30 years we have seen tremendous changes in the population we are serving, and the way the NHS works. We thus need to be able to create a new kind of infrastructure that isn’t just replicating the general hospital, but is doing things entirely differently – and works with the world of information technology, new ways of working, and changing societal demands.” Looking ahead, he said the hospital planners and designers might in fact need to be less specific, and, as he put it, ‘to work with Lego’, ‘i.e. to be comfortable working with quite crude ideas early on in the business case processes, rather than insisting and expecting your design team to produce a nicely polished rendered masterplan and image in very short time’. Instead, built into the thinking would need to be the strategic decision-making and the options appraisal processes, and a ‘sense of comfort’ working with fairly crude initial stage design. Christopher Shaw added: “Building things into BIM models, you can start to get a lot of information early on, and something I remind design teams of quite often is that
functional content is not a schedule of accommodation. The latter is something that comes comparatively late on, whereas functional content will tell you how things are broadly – and you need to work towards that from a strategic to an outline level, and be comfortable that there are different levels of detail appropriate to those different stages.” He continued: “I use the term ‘Lego’ a lot, because it’s quite colourful, and explains some of the basic planning you need to do early on in planning a hospital to get the right organisation of spaces and equipment.”
The West Cumbria Hospital Cancer Centre, England – Competition.
The options appraisals process Christopher Shaw stressed here that design teams needed to be comfortable talking to clients about the ‘impact and implications’, so that the options appraisal was a genuine one. He said: “On a lot of projects I have found an assumption that there is only one preferred option, and that that it is there because that is historically how it has arrived. You do, however, need to go more finely through those processes, and part of that is having a mindset open to failure and change; that is the purpose of this early-stage design engagements.” The process of working with a range of stakeholders also perhaps required some re-thinking to improve its efficiency; otherwise it could be ‘extremely time-consuming and costly’ – to both the NHS and other organisations. There was a danger too, at times, that stakeholder engagement could be used ‘as an excuse for not doing proper change management’. The latter was, Christopher Shaw said, ‘something the NHS really needs to pick up on and pull away from the design process’. He elaborated: “This is important, so that you don’t, as a design team, end up talking at length about different ways of working and organisations or pathways. These need to come in, but that whole discussion about how you best manage your organisation and its role is a separate discipline, and can get in the way of the design of good healthcare infrastructure.”
March 2021 Health Estate Journal 23
©Medical Architecture
©Medical Architecture
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