HEALTHCARE PLANNING SYSTEMS


to themselves, unless there has been a major failure in their activities’. He said: “They may operate well, indifferently, or badly, they may or may not meet clinical standards, performance targets, or financial balance, and indeed they may be valued (or not) by patients, staff, and communities. What is fundamentally clear, though, is that in most cases they fail to contribute as fully as they could to the wider requirements of the health and social care system they serve.” The Working Group believes that if hospitals continue to be planned, designed, and financed, largely as independent standalone units, they will have limited ability to adapt ‘to meet wider systemic future healthcare challenges’.


Sharing news of their UK work Pete Sellars explained to the Congress audience that he and Paul Fenton would share the work they are leading in the UK to develop ‘A common language and approach for undertaking healthcare planning’ – work they argue is ‘hugely important and much needed’ to improve how the current planning, design, and construction, of both new and existing hospitals is undertaken. Although driven by the ambition to change healthcare planning delivery in the UK, Pete Sellars said the fundamental concept and principles were ‘very much transferable globally across all healthcare settings’.


Five key areas of focus The pair’s presentation was divided into five key areas: 1. The background to, rationale behind, and drivers for, developing ‘a common language’ and approach for healthcare planning.


2. Setting out the three ‘key stages’ of this common language, and how it can be applied.


3. Highlighting the aims, benefits, ambitions, and challenges, in influencing change.


4. Progress to date, the tools and support, training development, the Working Group, and the next steps.


5. A Q/A and discussion session.


The need for change and a ‘common language’ Beginning by explaining why there was a need for ‘a common language’ around healthcare planning, Pete Sellars acknowledged that strategic healthcare planning was ‘not easy’. Not only were there many diverse stakeholders to engage with, but each of these


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professional roles tended to bring what he dubbed ‘their own specific suite of ideas and unique vocabulary in how the collective should comply with the programme brief’. Pete Sellars said: “It’s clear that most people actively involved in healthcare planning – regardless of their professional or personal background – aim to deliver a new hospital and services that improve clinical outcomes, and provide an environment that enhances staff wellbeing, and bring better patient outcomes and experiences.” Healthcare planning decision-makers,


meanwhile – whether at national, strategic, or local level – had to consider ‘a wide range of complex, competing, demands’. “For example,” Pete Sellars explained, “public health experts will be attentive to health inequalities and future healthcare demands, architects will focus on aesthetics and functional layouts, engineers will prioritise infrastructure resilience, system efficiency, and new technologies, and clinicians, patient safety, clinical ethics, and quality.”


Patient priorities He continued: “Our evaluation of previous successful hospital investment programmes suggests the greatest success comes when all key stakeholders share a common language of understanding.” A key benefit of this for ‘investment decision-makers’ was that it gave them ‘the evidence’ to easily explain their rationale for recommending their decisions to key stakeholders in government or policy. In recent decades, Pete Sellars and


the Working Group believe hospitals in England have been encouraged – ‘by custom, policy, and law’ – to act as independent bodies, ‘largely answerable


…Healthcare facilities need be designed and planned using acuity and the optimal patient care pathways for the local population as the key determinants of the clinical care


24 Health Estate Journal November 2022


How investment decisions are driven Pete Sellars said his experience was that investment decisions about healthcare capital assets were ‘almost always driven by business cases that link planned activity (outputs of hospital services) to a m2


cost value, and primarily focused on the hospital as a standalone entity’. He said: “We all want to see hospitals driven by new and emerging technologies, and changing epidemiology and demography, taking into account the requirements and expectations of clinicians, patients, and different modes of governance and public accountability.” To achieve this, a move to a more appropriate way to determine the clinical workloads of hospitals, and the economic appraisals to support these investments, was required. A new ‘common language’ would not only, he said, provide ‘the rational means to discuss and agree on what is to be delivered and constructed’, but should also ensure that all involved understood how to effectively deliver future healthcare planning requirements, and that decisions were not simply driven ‘by who shouts the loudest’. The IHEEM CEO’s next slide showed


the Working Group’s ‘Three Key Stages’ towards the ‘common language’: 1. Using Acuity to determine the clinical care service models.


2. Using System-Wide Economic Modelling, rather than ‘traditional’ m2 capital costs, to determine the benefits of the investment.


3. Using an integrated health infrastructure planning framework, ‘through a common language to help facilitate and unite dialogues between stakeholders and decision-makers’.


Extending the definition of ‘Acuity’ Turning to ‘Acuity’, Pete Sellars said the World Health Organization defined it as ‘relating to the severity of a patient’s condition’ (‘Low, Emergent, and Critical’). He said: “Our healthcare planning approach broadens this to also use Acuity to measure patient and population health


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