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News archive - January 2017
What is next for healthcare design?
Clever engineering and integrated design of hospitals can not only improve the rate at which patients recover, but can also ensure sites are managed more effectively. Throughout Europe this is widely acknowledged, but current UK hospital design needs to catch up, explains Steven Bentley, project director at Ramboll.
Over the next half a century it is expected that the number of people over the age of 60 will exceed those under the age of 14. This alters how we should plan for future generations. In meeting the needs of future healthcare buildings, those who design and engineer the facilities need to think long term. Pre-empting and building in flexibility for future needs is crucial, although this can prove difficult when facing budgeting limitations.
The right balance
Getting the right balance is the key challenge for the future and incredible effort is needed to maximise efficiencies through adjacencies of departments, care givers, patient pathways, and a reduction in building energy consumption. For our engineering consultancy appointment at the New North Zealand Hospital (NHN) project in Denmark, the architectural plan pushes together four central cores which carry patients vertically through the building, allowing immediate access to diagnosis, treatment and rehabilitation departments. This reduces patient treatment time, but equally allows for more patients to be treated in a given period for the same operational cost.
NHN is being designed to comply with challenging energy consumption targets. In addition, two construction methodologies are adopted in parallel, based on functional need and future adaption.
The lower two diagnosis and treatment floors are constructed using a conventional in-situ concrete frame, providing long spans and regular column grids which aid future adaption of clinical areas as medical technologies change.
For the upper two inpatient floors, a pre-fabricated module construction principle has been adopted as these individual rooms can be designed at a more cost-effective domestic level of construction.
Pre-fabrication processes have improved significantly and we are able to take this pre-fabrication innovation and apply it to inpatient accommodation, providing hotel-quality bed wards at a much-reduced cost compared to traditional construction. Pre-fabrication allows us to ‘beta-test’ the patient rooms, and the technology within, to provide a high-quality end product.
Innovative building materials such as cross-laminated timber are becoming an increasingly-proven option for pre-fabrication. These construction methods are vital to help us overcome the key challenge of building in flexibility while reducing construction time.
At an operational level, new hospitals are also embracing automation as a means to manage the delivery and removal of supplies. At NHN, automatic goods vehicles (AGVs) transfer goods from the central logistics building, via an underground tunnel network and dedicated lifts. Waste is removed via dedicated waste chutes local to each department - with the AGVs taking the waste back to the logistics building on their return journey.
Striking a balance
New hospitals are now required to incorporate a robust and flexible IT infrastructure - systems such as pneumatic tube, laboratory conveyor testing systems, and da Vinci robotic surgery must be provided for. Additionally, mobile phone platform technology will allow hospital communication and control systems to become more-closely integrated.
In some parts of the world, such as Scandinavia, large-scale consolidation programmes are underway, while here in the UK we are seeing the opening of specialist units, such as Cramlington - the first dedicated emergency hospital in the UK.
Papworth heart and lung research institute is another example of a hospital designed for the future, with its direct tunnel link to the high dependency unit enabling a significant increase in basic and clinical research capacity, resulting in 40% new recruitment.
Designs for major hospitals are also advancing, with Pembury being the first in the UK to be built with single bedrooms for all patients.
In the diverse hospital environment, no one model has proven to be the best solution, but each facility has its own particular advantages.
With new hospital buildings designed for a 60-year operational lifespan - and considering how medical treatment has changed in the last 60 years - we cannot, with any confidence, predict the way the hospital of the future will function.
Engineers of new hospital buildings need to strike a careful balance between total building flexibility, and the consequent cost and inefficiency, and bespoke design, and the resulting inflexibility for adaption.
Understanding the healthcare environment, drawing on what others have done across the world, and close stakeholder collaboration are all absolutely vital to maximising hospital efficiencies.