Tuesday, May 7, 2013

HFDD Conference Report – 11 April 2013

In late February 2013, Kerry Snell and I attended the International Quality and Productivity Centre’s Health Facilities Design and Development Conference in Sydney.  The conference discussed the challenges of creating health facilities to meet future demands on the sector from the perspective of project managers, construction firms and academics.

The conference opened with the keynote presentation via Skype from Professor CraigZimring of the Georgia Institute of Technology.  Professor Zimring discussed the development of evidence based design and its implementation in the US context.  Studies quoted by Professor Zimring noted that US hospitals are unnecessarily dangerous, with one in twenty patients contracting a healthcare acquired infection.

Zimring stressed the importance of evidence based design as a clinical tool that can improve the quality and safety of the hospital experience, and provided a number of examples where this can proven to be the case.  Curtains used in the hospital context have been linked to outbreaks of infection, leading to exploration of other options, such as antimicrobial fabrics, blinds that are controlled electronically and not touched by staff; and electrostatic opaque glass. 

In addition, the rising levels of hospital noise – generated from increasing equipment noise, staff discussions and hard surfaces, among other factors – were shown to have detrimental impacts on patient recovery.  Excessive noise, i.e. noise of over 35 decibels, can cause ventricular arrhythmias, disrupt sleep, elevate heart rate, increase the need for pain medication, decelerate wound healing, alter gastric myoelectrical activity and autonomic nervous function.  To mitigate the effects of noise, it is necessary to have soft surfaces (which meet infection control requirements), a reduction in public address announcements, enclose sources of noise such as equipment and require staff to speak softer and in designated areas.

Lighting and visibility also impact on the length of patient stay and mortality rate.  Studies found that the death rate of particular patients was 70% higher in darker rooms, while another study found that other patients stayed one day less in sunny rooms and required 22% less pain medication.  Lack of patient room visibility by nurses resulted in a 30% higher mortality rate for high acuity patients in a cardiac ICU ward.   There was also a 31% higher fall rate in low visibility rooms.  Nurses need to be able to easily see each other and their patients to effectively coordinate care.

Professor Zimring noted some US examples of where evidence based design has made a positive impact on patient outcomes – Fort Belvoir Community Hospital, where recovery has been improved by the use of infection control compliant soft panels to minimise noise and the use of single patient rooms;  the Southcentral Foundation, an Alaskan native operated health service, where employees have no private offices and care is delivered in a multidisciplinary team approach; and the Dublin Methodist Hospital, which has employed decentralised nurses’ stations, hand washing sinks on entry to encourage compliance and single rooms with a uniform configuration of equipment to facilitate treatment.

Professor Zimring emphasised the need for continuous learning and quality improvement through evidence, simulation and “systemness”, as well as a focus on patient experience and empowering patients to take up a role in their own care.

Tony Michele, the Project Director for the Victorian Comprehensive Cancer Centre (VCCC) spoke about this new project.  The VCCC has three objectives: to reduce the cancer burden by 2029, to establish a world class centre of excellence in cancer (increase percentage of patients participating in clinical trials to 15%), and to increase investment in biomedical research.  The VCCC is first and foremost a medical research facility, but it does have 100 inpatient beds.  In terms of project management there were 2 deliverables:  the creation of a collaborative entity and the development of a purpose built facility.

Aladin Niazmand, the Director of Health Projects International (HPI), spoke about the role of modular design in increasing flexibility and reducing costs and building construction times.  Modular and prefabricated designs have become cheaper and more efficient every year for two decades.  There is currently incredible variety and functionality in modular design options.  HPI has produced a mobile app of International Health Facility Guidelines which allows for departmental planning on an industrial scale, 3D modelling and room layout sheets generated from models.  Prefabricated hospital construction is innovative and is not “boxy”.  One third of construction can be completed in a day using prefabricated materials.

David Walker , Executive Director of the New Bendigo Hospital Project spoke about the challenges of constructing a new regional hospital on an existing site.  The existing Bendigo Hospital has been on the same site since the 1850s, and much of the land around it is protected by heritage listing, making permission to work on it difficult to obtain.  It is the only public hospital in Bendigo and is a teaching and regional referral hospital.  The site is split across a number of roads, and some services are spread out across Bendigo – the thinking is to bring services like Mental Health into an integrated facility to help reduce stigma.  $630 million has been estimated for the redevelopment of the hospital.  Patient wayfinding has historically been an issue.  The website is the main communication tool and receives 42000 hits per week.  Projects, MOCs and sketch plans are available online.  Four information sessions are held each year, with attendance figures ranging from 40-200 people.

Ronald Hicks, Principal and Head of Health + Research at consulting firm Rice Daubney, spoke about the challenges of the integrated cancer centre (ICC) concept in an Australian context.  The  ICC concept finds its origins in the US during the 1970s, though there has been marked development of the concept since then.  In the Australian context there is a diverse approach to service with varying degrees of integration.  Some of the design challenges of ICCs are the requirements for broad levels of consultation and interaction.  Traditional stakeholder interactions involves speaking with clinicians; ICCs mandate interaction with service users, the consumers/patients/families.  Both experience-  and evidence-based design should be incorporated into design and planning.  It is also important to note that not every part of the facility is/should be ruled by clinicians.  Hicks also advocated an integrated approach to parallel therapies.  There also needs to be an appetite for innovation.  Two examples noted by Hicks were the Prince of Wales Comprehensive Cancer Centreand the Chris O’Brien Lifehouse at RPA.

Trisha Ansell, the Project Manager at Barwon Health, presented on the complexities of decanting a complex health facility, namely the Barwon Health Children’s Ward.  The old ward contained mostly shared rooms and bathrooms, which posed significant infection control concerns.  There were limited staff and parent facilities.  Treatment rooms were also used for storage.  A new ward was constructed within a fully operation hospital.  Some of the challenges were:
o   architects with limited experience in health
o   access for builders and construction noise
o   infection control
o   interruption to services
o   temporary accommodation required
o   reduced number of beds.

Barwon Health chose a local architect so that they could be familiarised with the hospital so that they could be called on assist later with smaller projects.  The transportation of materials and waste to and from the building site was also an issue.  These, and other, challenges were managed through a comprehensive decanting process.   The new ward contains dedicated spaces for parents and staff, including a kitchenette, lounge, TV, washing machine and bathroom; more space for cancer patients, negating the need for travel to Melbourne; single or double rooms; a playroom; and a staff base made from glass, allowing noise to be decreased but for staff to be visible.  Ansell’s final message about managing these kinds of projects was to “under-promise and over-deliver”.

Heather McGowan.

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