ARCHITECTURE & DESIGN Jane McElroy
Jane McElroy RIBA, a Principal and Clinical Design leader in the London office of NBBJ, has over 25 years’ experience in healthcare, residential, corporate, and community architecture. During the past 15 years, she has focused primarily on healthcare projects – ranging in scope from a highly acclaimed ambulatory care and diagnostic centre, to major academic teaching hospitals. In particular, she directs her efforts to initial briefing, user consultation, medical planning, and the integration of these aspects within the broader design context, together with a focus on the human experiential aspects of healthcare buildings.
She has worked on several of the largest new medical centre projects in the UK and Ireland, including the Royal Liverpool University Hospital and Dumfries and Galloway Royal Infirmary, which has enabled her to amass a significant body of data and critical insights about this building type. She is an innovator in surgical suite design, the design of wards and patient rooms, and women’s and children’s facilities. She has been involved in several of the first schemes in the UK to incorporate exclusively single patient rooms.
Bryan Langlands
Bryan Langlands, AIA, FACHA, a Principal and Senior Medical planner in the New York office of NBBJ, is an accomplished healthcare programmer, planner, and designer of academic medical centres, specialty centres, and community hospitals. He has worked with the NYU Langone Medical Center, Atrium Health, Jefferson Health, Penn Med, Children’s Hospital of Philadelphia, University of Rochester Medical Center, and Vanderbilt University Medical Center. Currently part of the Greater New York Hospital Association Surge Capacity Task Force looking at alternative solutions for the treatment of patients due to COVID-19, he is also a steering committee member of the Facility Guidelines Institute (FGI) 2022 Health Guidelines Revision, as well as chair of the 2022 Beyond Fundamentals Oversight Committee.
ventilator-capable. This comes down to the number of medical gas outlets, and electrical outlets, including emergency power. All new Emergency Department, Pre- and Post- surgical positions can be designed as enclosed rooms, with a full complement of gases and infrastructure to accommodate ventilators. Existing ‘bays’ (treatment positions with one wall and curtains that separate it from the next position) could be renovated into ‘cubicles’ (three walls with a wall that separates the patient from the next patient) or individual rooms (four walls and a door). Additional gases and power would be added to single occupant patient rooms to allow for two patients in a surge capacity. Prefabricated headwall systems can be designed in such a way that panels can be removed, and additional infrastructure or outlets can be installed, without major disruption.
4 Telehealth and outpatient clinics Re-thinking clinics
The dramatic increase in the use of telehealth will continue, and will lead to us to re-think how we plan and design clinics and outpatient locations. It may decrease the number of exam consult rooms, introduce the combined doctor’s office and telehealth room, increase the number of procedure rooms, and reduce – and possibly eliminate – the waiting room. We know that many hospitals have recently
48 Health Estate Journal October 2020
conducted much of their outpatient activity via ‘virtual consultation’, and this may continue, at least in part. We should consider what spaces are most appropriate for clinicians to conduct such teleconferencing from, and what impact this might have on their clinical office accommodation in terms of more cellular offices. In fact, standard exam consult rooms can be renovated into telehealth rooms.
A ‘better-informed’ population Telehealth may also lead to a better- informed population, where individuals will arrive for an in-person clinical care encounter at the right location. In the US, there may be reduced stress on emergency departments by redirecting those who are not sick to urgent care centres, primary care visits, or other units.
Innovative new models of outpatient care
Beyond telehealth, we are also creating a new kind of care that fills the gap between telehealth and in-person visits: the ‘in-car care unit.’ It’s designed to be easily deployed in hospital parking garages by fitting within existing column spacing in the typical hospital parking lot. Components of the unit could be prefabricated elsewhere, and installed quickly at the site, similar in concept to Ikea furniture.
Going forward
Traditionally, discussing the importance of flexibility in healthcare was all about ensuring that whatever we do today will not prevent a change in use tomorrow, such as floor-to-floor heights and column bay spacing. Today, however, flexibility takes on a new meaning with COVID-19; now it is also about designing hospitals to be used in a way in which they may not have been intended, but might be needed for in an emergency situation. While we have always designed for the primary use, we must now plan the same space for a secondary use. Equally, while we are all focused on how to prepare for the next pandemic, or what we call ‘designing through the COVID lens’ – negative pressure, compartmented wards, more inpatient rooms – we must also start designing for unknown ‘what-ifs.’ What if the next pandemic was transmitted through our water systems? What if the next crisis resulted in compromised immune systems where patients require positive pressure rooms?
While we have shared our thoughts on what impact we think COVID-19 may have on healthcare planning and design going forward, we must also think about alternative scenarios. The coronavirus has humbled us. Let us be better prepared going forward, and less humbled in the future.
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