FUTUR E HOS P I TAL
which has cut off the supply of experienced construction workers.3
Of course, there
are other construction companies, but the expertise of the architects and engineers who are involved with building the complex buildings that hospitals are, will be spread very thinly across so many refurbishments and new builds – especially, if there is to be innovation and change. The Royal College of Physicians (RCP) published a report recently to add to the general debate about the way a hospital of the future should look.4
They focused on
how to: l Design hospital services around the needs of patients rather than the ‘system’.
l Ensure that patients receive better, quicker services from hospitals.
l Improve staff wellbeing in hospitals to enable better workforce retention and delivery of services.
It is essential that, in the wholesale rush to build new hospitals and re-furbish many more, structural re-design and plans to reconfigure services takes into account future delivery means, ensuring that the hospital is as flexible as possible. This is a lesson learned from the painful experience of COVID-19, where operating theatre departments were made into intensive care units, surgical wards became COVID wards and many other re-configurations, depending on the local needs at the time. However, as the RCP suggests, the most
important aspect of planning new hospitals is to improve the experience for the patient and not the system.
Looking ahead For many years, we have built hospital departments where we wanted to put them, for the good of the system, guided by the Health Building Notes. Now we should be including patients in the planning teams and
ensuring that, for example, pharmacy and X-Ray and phlebotomy services are relatively close to outpatients, so that elderly patients are not spending time and energy traipsing long distances around the hospital to be tested or to be seen.
There has been some speculation that diagnostic services should be on the High Street, or in easy reach of transport and all in one place, so that it is an easy service to access. When attending outpatients then, all the tests are completed. This would be a good plan, in any case, but health is not as simple as this in many circumstances. When primary care needs answers they cannot find, that is when the hospital service comes into play. Sometimes many specialist services and diagnostic tests are undertaken before answers can be found.
It is certain that the experience of many patients attending hospital is not what it should be, and the RCP report focuses, in part, on patient experience. It cites the example of when technology can help with taking the place of consultations in hospitals by using video calls, as we have experienced during COVID-19. The wholesale shift to remote appointments, although not without challenges, has undoubtedly made accessing
healthcare simpler for many patients and shows the way forward.4
Technology
Digital transformation is likely to be high on the agenda of the new hospital builds, but is changing so rapidly that it will be difficult to imagine how healthcare can keep up with the developments and how the hospital infrastructure can be made to be flexible. Robotics and artificial intelligence, machine learning and utilising the smart elements of 5G to connect everything together are just the start. Many of them will have a definite impact on how healthcare is delivered, most of which are beyond the imagination of this author! Many operational efficiencies will be possible with integrated systems that manage digital supply chains, automation and next-generation interoperability. Many of the investments in digital transformation will need to be paid for up-front with a fairly long pay-back time. It will be interesting to see if the ‘powers that be’ will be willing and able to make the necessary investment. It is predicted that AI is firmly the technology likely to have the greatest impact on the transformation of healthcare and therefore the design of the hospital of the future. It may be able to increase provider productivity, improve diagnostic accuracy, enhance patient experience and deliver, overall, a greater quality of care for the patient. Technology promises much, but there are also difficulties with the equipment itself; the limitations of no physical contact (meaning a longer process and lower confidence levels in diagnosis) and a less personal experience.
Shifting care away from the hospital This element of healthcare has long been on the political agenda. They could not have foreseen that a pandemic would facilitate the change where many communications between patient and their doctor would be via phone or the internet. If diagnostics can be enabled on the High Street and patient consultations are on-line, with much care delivered at home, the hospital will become de-centralised and possibly more specialised
SEPTEMBER 2021
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