Space planning
some still in use – were not built to provide facilities we now take for granted, such as single-sex, single bedroom, inpatient accommodation with en suite bathrooms and access to peaceful space. Modern hospitals call for designs that
promote wellness and well-being, rather than merely the treatment of diseases, and for patient-centric design. Medical and technological advances, such as endoscopic surgery and surgical robots, digital communications, telehealth, and the shift to care closer to home (‘healthcare without walls’ is the phrase we use for this at Capita Symonds), all play into the mix of factors influencing the
design of healthcare facilities – a process centred on complex functional and user requirements; the need to meet minimum standards for infection control and sterility; easy access (including emergency routes); clinical observation; patient, staff, and visitor privacy; dignity, and security, among others. Patients are vulnerable, and staff under pressure, so, without compromising these requirements, there is a need to provide aesthetically pleasing, health-promoting environments. Important considerations include, for example, access to external views (the need for which can be affected by restriction of movement often experienced by patients and staff). Studies show that the efficiency of staff when dealing with tasks of a repetitive, technical, or intensive nature, can be improved simply through provision of an external view.
David Lawrence
David Lawrence, head of Health at Capita Symonds, says: “Healthcare, and particularly community and primary health care, is changing. The NHS in England is responding to the economic downturn through the Quality, Improvement, Productivity, and Prevention (QIPP) programme. Many Trusts are undertaking reviews of the capacity of the whole system, including the available infrastructure. “The NHS has seen unprecedented
investment. New facilities have replaced old hospitals, health centres, and GP surgeries; with many being financed, built, and maintained, by the private sector. However ONS data shows that, while investment in the NHS has increased significantly, there has not been a resultant increase in productivity. “We have to accept that investment
in new buildings has not generally increased productivity; utilisation of NHS buildings (even the new ones) is often poor; and there is duplication of space between local authorities and the NHS. The NHS wants to create an accessible range of services under one roof, branded ‘NHS’, but with different suppliers (NHS, private, and third sectors). Commissioners will want services from a range of providers without the high cost of a long-term commitment to property. Space will need to be accommodated on flexible terms, incorporating adaptable ‘plug and play’ accommodation.”
28 Health Estate Journal September 2013
for positive outcomes In summary, healthcare facilities designed with specific reference to the needs of users should provide positive outcomes, reducing stress levels, and aiding patient recovery. Supportive environments will have good internal layouts, circulation, and accessibility. A successful healing environment will be inviting, attractive, and hygienic, have natural light and views, and be warm and secure. It will significantly improve clinical productivity. In an era of increasing patient choice, healthcare providers are very aware of the importance of ensuring not only that spaces are of an appropriate size for the activities being undertaken, but also that they are an intrinsic element of high- quality, comfortable, and attractive environments. That means, of course, being neither cramped nor over-generous; while too-small spaces can be dangerous and unpleasant, rooms with square meterage to spare can become dumping grounds for equipment, and be seen as ‘informal storage solutions’. Getting it right over time can be tricky.
Supportive environments
Using ‘zones’ While predicting likely future needs over the lifetime of facilities is not straightforward, the use of zones to plan can optimise choices and trade-offs. In an era of increasing patient choice, the environment matters, and can ultimately impact provider financial viability. Patient, staff, and visitor expectations are continuously changing, and at an accelerating pace. New planning concepts and ideas evolve through the design response to these expectations. The ideal healing healthcare environment is a moving target. So how should we circumnavigate the
mass of complex trade-offs to consider when briefing, planning, and designing, healthcare facilities?
Recent research by the Health and Care Infrastructure Research and Innovation Centre shows that ‘space layout planning at the starting point of hospital design needs to consider the benefits from the users’ perspective, in addition to geometrical and topological requirements’.
Care closer to home It is recognised that any discussion about developing new models of integrated care must focus on shifting care closer to home. In many health communities, moving care closer to home starts by looking at issues such as urgent care or individual long-term conditions, and then quickly migrates to the development of new and imaginative approaches to dealing with frailty, and the more effective management of population health. One good example is the development of multi- disciplinary teams (including social care, mental health, and other services) wrapped around groups of practices using a shared record and care plan, and getting significant input from specialists that would previously have been confined to hospital. Many of these approaches are experimental, leading to evolutionary change that will be significant over time, and could eventually be radically different. The first step should be re-thinking the operation of community care. Moving care to the home setting can
produce significant savings and improve patient care. It also reduces the need for capital investment, and improves the backlog maintenance position, with further opportunities to protect clinical and clinical support space to deliver modern healthcare environments. Another of its impacts is a significant change in the demands made of healthcare facilities of all shapes and sizes.
Ergonomic evidence base Recent research by the Health and Care Infrastructure Research and Innovation
Courtesy of the NHS Photo Library
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99 |
Page 100 |
Page 101 |
Page 102 |
Page 103 |
Page 104 |
Page 105 |
Page 106 |
Page 107 |
Page 108 |
Page 109 |
Page 110 |
Page 111 |
Page 112 |
Page 113 |
Page 114 |
Page 115 |
Page 116 |
Page 117 |
Page 118 |
Page 119 |
Page 120 |
Page 121 |
Page 122
