DIGITAL SPACE MODELLING
understand people’s movement in any environment. Agents can be programmed to mimic human behaviour and the ‘social forces’ that drive their decisions; for example in a train station or airport they might avoid proximity to neighbours, pause at a café for a cup of coffee, or stop at a travel information board, pass through a turnstile, or go up an escalator, based on their destination preferences. They make their own choices about appropriate actions based on the dynamics of their environment.
Numerous factors were considered to accurately model patient journeys. We incorporated triage categories for patients of varying acuity, a distinction between adult and paediatric patients, mimicked the time spent in the waiting room and treatment areas, and also the additional accompanying people to reflect the appropriate proportion of patients who arrived with friends or family. Developing behavioural visualisations that mimicked ‘group behaviour’ to model patients arriving with a carer or companion was an important step. This was key to evaluate and understand, given that patients attending with a second person significantly increase the overall number of people contributing to the demand on the space.
Understanding flow and mitigation options
Our healthcare, architecture, and digital experts worked closely with Whittington, to ensure that patient flow and potential mitigation options were understood within the hospital context. We mapped and modelled different patient journeys, assessing for the factors above, as well as average waiting times and patient flow to different treatment areas within the Emergency Department. Using MassMotion to model for all these factors allowed us to see the waiting room occupation throughout the busiest day, identify the scale of the problem – e.g. severity of the lack of waiting space in a social distancing scenario – and review potential solutions.
The modelling demonstrated that if no action were taken the temporary socially distanced capacity of the waiting area would exceed 250% of its capacity – with more than twice the current amount of space needed for an adult waiting area. In a secondary paediatric waiting area, with a much higher proportion of patients being accompanied to the hospital, the model showed this area of the hospital could potentially reach 500% of capacity at the very busiest times. Our model helped the busy Whittington team to understand the scale of overcrowding anticipated during peak periods when social distancing measures were in place with a new perspective – in a way that a spreadsheet of patient numbers just
44 Health Estate Journal May 2021 About Arup and Alan Dunlop
Alan Dunlop is an Associate at Arup, and works as a Project manager. He led the Whittington resilience project for Arup, and has successfully managed many projects over his 23-year career – spanning sectors including healthcare, education, offices, data centres, sport, and infrastructure. The many healthcare schemes that he has completed include refurbishments, extensions, and new-build developments. Early in his career his work with two major contractors gave him first-hand experience of site planning and management, and how designs and drawings translate into the construction of the finished product on site.
He is committed to developing new skills that help schemes run even more effectively, including embracing new approaches and digital technologies. For the Whittington project he acted as the project integrator, bringing together the digital, healthcare, and architectural skills of the Arup team. He enjoys working in close collaboration with clients, as with the Whittington Health NHS Trust team, and delivering projects that improve lives and communities. In 2020 he also applied Arup’s MassMotion software to deliver a community engagement project, supporting a local school in ‘return to school safely’ planning during the COVID-19 pandemic.
Arup is a global engineering consultancy. It says its healthcare experts are ‘focused on outcomes, shaping healthcare environments and processes which promote healing, efficiency, and resilience’. This team includes designers, planners, engineers, consultants, and technical specialists, 'highly experienced in planning and implementing world-class healthcare facilities’.
couldn’t do. This approach can easily be replicated for other NHS Trusts, to provide clinical and estates leadership and management teams with a clear understanding and powerful visualisation of the potential implications of social distancing in their facilities.
Preparing for winter
Drawing on the evidence from our analysis and modelling, we presented Whittington with a range of options to manage the demand of patient attendance under socially distanced conditions. These included operational changes – such as introducing more reception staff at peak times or limiting people accompanying patients, and spatial interventions like re- configuring the existing waiting area, repurposing adjacent spaces, or creating new ones. We modelled these different improvement scenarios for the hospital team to view and assess. Options were reviewed considering not only how they ensured that the hospital was prepared for the winter – adhering to stringent requirements associated with COVID-19, but by also thinking about how to improve the overall experience for patients and staff throughout the year.
The modelling and analysis supported the hospital in building an evidence-rich business case to successfully apply for additional central government funding to expand or re-design its waiting space. Our work did more than establish that
Whittington’s concerns were valid. It supported informed decision-making about how to tackle the problem.
Looking to the future
While our combination of data analysis, MassMotion modelling, and healthcare expertise were developed in response to the challenges posed by COVID-19, their application can deliver benefits far beyond the pandemic response. From assessing and improving existing facilities, to informing the design of new- build hospitals, such as the 40 planned for delivery by 2030, expanding our application of these technologies can deliver efficiencies in patient journeys, capacity planning, and clinical adjacencies, to improve the experience of patients and staff. As the Trust’s Jonathan Gardner says: “Arup’s approach could be beneficially applied to other hospital departments and patient journeys when reviewing and managing healthcare capacity-related challenges during the COVID pandemic, and beyond.”
There’s a huge opportunity for hospitals to interrogate and leverage the rich data they hold via this technology. Data which has languished in databases and spreadsheets can be repurposed and enriched to enable more informed operational and design-related decisions, optimising capacity, and ultimately supporting greater resilience.
hej
©Arup
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