On Friday 12
June Darlene Cox and I went on a tour of the Royal Melbourne Hospital (RMH) in
North Melbourne.
We were
interested in a tour of the hospital as it is in a similar situation as the
Canberra Hospital. The campus is landlocked, meaning roads surround the
hospital and there is nowhere to expand on the current campus. Also RMH has
undergone and continues to undergo a series of infrastructure upgrades to
improve the ageing facility and to accommodate the increasing demand in
services.
The RMH has been upgrading older parts of the hospital with various projects completed and include the construction of additional Inpatient Units; Helipad; new buildings and refurbishment of some of the existing building. Some recent upgrades have been the intensive care unit, 300 inpatient beds, as well as upgrades to pathology and medical imaging facilities. The most recent projects are the allied health building and the Emergency Department (ED) refurbishment.
The Community Engagement manager and Director Capital Works, both from Melbourne Health, were our tour guides for the day. We met them both at the main entrance where our tour was to begin.
MAIN ENTRANCE
The main
entrance to the hospital was located just off busy Flemington Road. The drop
off zone was on street. This is not ideal, however the RMH is completely land
locked.
You are
greeted at the main foyer with a volunteer’s desk, where they can assist
patients and visitors. There seemed to be a very good use of volunteers at the
hospital. The main foyer also had a café (café Zouki), bank, florist and gift
shop. Even through the space felt cramped with the low roofing it still felt
alive and spacious.
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| Main entrance to the Royal Melbourne Hospital |
EMERGENCY DEPARTMENT
We were very
interested in the ED, as it underwent a $53 million redevelopment upgrade in
July 2009. It was good to see what was able to be done with a space that could
not be extended, only refurbished. It was also useful for the planning of the
refurbishment and extension of the existing ED at the Canberra Hospital.
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| Triage/administration main desk |
The
triage/administration desk had cables across the counter rather than glass perspex.
Both the patients and the staff preferred the cables over the glass as it was
easier to talk to one another and felt less like a compound. The marble front
counter was five years old, although you wouldn’t know it. Our tour guide said
that the front desk has held up very well to wear and tear over the years. Also
the wooden roofing soften both the feel of the waiting room and absorbed a lot
of the sound.
The ED has a total of 107 treatment stations, however there was no paediatric stream in the ED as there was an ED at the children’s hospital just down the road. Visitors in ED also had stickers with visitor written on them. This was a great idea, as when in ED it can sometimes feel like as a visitor you are not meant to be there. The sticker provides reassurance.
ED also had write up stations in acute rooms, allowing the wirte up to be done at the bedside. However this is currently only available in ED. There were also smaller write up stations in the corridors of ED, as theses station locations allowed improved line of sight for clinical staff.
Wayfinding through ED was not
very clear and we felt there was a need for improvement. It was a bit confusing
as to where you were.
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ED bedside write up in treatment bay
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ED hallway write up station
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AMBULATORY CARE (OUTPATIENTS)
RMH has also
rolled out a Q flow system similar to the system ACT Health is about to roll
out. This was located at outpatients/day services. The system had been in place
for about 12 months, there has been very little issues with the system and is
making it easier for patients to check in for appointments and go to the sub
waiting rooms. These rooms are all colour coded, making it easier to find.
Hopefully this is a good sign for the new Q Flow system that ACT Health will be
rolling out in the coming months.
Once you got a ticket from the Q Flow system it would tell you to wait in sub wait rooms in outpatients. Each sub wait room was colour coded making it easier to find. We really liked the combination of seating in the waiting rooms. Not only were there the standard single seats you see in all waiting rooms there were also double and single lounge chairs. This meant that if you needed a little more space or had a family member with you the seating arrangement would be able to accommodate this.
The Gym was bright with floor to ceiling windows surrounding almost the whole room. Although the gym was not massive, it seemed to use the space proved quite well. Also the flooring in the gym was colour coded for different types of exercises, this was incorporated into the design quit well.
MUSIC THERAPY
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| Q Flow machine |
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| Outpatient waiting room |
Once you got a ticket from the Q Flow system it would tell you to wait in sub wait rooms in outpatients. Each sub wait room was colour coded making it easier to find. We really liked the combination of seating in the waiting rooms. Not only were there the standard single seats you see in all waiting rooms there were also double and single lounge chairs. This meant that if you needed a little more space or had a family member with you the seating arrangement would be able to accommodate this.
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The ambulatory care reception desk
also had cables across the counter with some parts covered with glass perspex
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NEW HOSPITAL TOWER
The RMH has
recently completed a new allied health building that opened in October 2012. It is a three storey building connected to the North Wing of the
hospital that provides allied health services for both inpatients and
outpatients. This new allied
health building is home to rehabilitation services such as speech pathology and
a gym.
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Rehabilitation gymnasium
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The Gym was bright with floor to ceiling windows surrounding almost the whole room. Although the gym was not massive, it seemed to use the space proved quite well. Also the flooring in the gym was colour coded for different types of exercises, this was incorporated into the design quit well.
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The image cover the whole wall as you
walk into allied health. The people featured are people who had used the
services previously.
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Entrance into a speech
pathology room, with a nice use of people on the sign who have been using the service |
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Occupational Therapy
Entrance
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One of the Allied Health sub waiting
rooms, with different seating
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The new
allied health building also incorporated some great signs for services. The
inclusion of people in the signs makes it that much easier and relatable.
Particularly the sign that has great messages on it such as achieving better
health and respecting our community, as you can see in the pictures.
YOU MAKE A DIFFERENCE AWARD
We came across the You
Made a Difference Awards on our tour and were interested in what the award
meant. The You
Made a Difference Awards recognise individuals or teams for making a
difference for patients, visitors or staff. We thought this was a great idea as
it promotes and shows appreciation to those who most deserve it, as nominations
are provided by patients, visitors and staff. Simple things such as this award
promotes better care and can be very rewarding to staff and volunteers.
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Pictures of past and present winners of the You Make a Difference Award
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MUSIC THERAPY
On our tour
we came past a group playing some great live music. RMH has been running music
therapy almost daily since 1997 with great results. We definitely noticed a
positive difference around the live music, everyone seemed more relaxed and had
a smile on their face. This is certainly something health services in Canberra
need more of.
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The live band playing some great
songs with a piano accordion and all
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INPATIENT UNIT
The
inpatient units were refurbished about 10 years ago. These units where divided
into 32 bed pods, there were single bed rooms in this arrangement but
unfortunately we could not find out what the ratio was for single bed to
multi-bed rooms. The room layout for
both single and multi-bed rooms were a standard layout, similar to the current
layout at the Canberra Hospital. There seemed to be limited future proofing
done at the time of refurbishment, this includes no bedside write up
infrastructure and a large central nursing station with poor line of site to
rooms. There was also the constraints of the old building layout. The 32 bed
inpatient units were shaped liked a capital T, making it very difficult to
design nursing stations that maintain line of site to rooms. In a situation
such as this it might had been better to work off a decentralised nurse station
model.
There were
clocks in each room at the end of the beds with dates and days on them. This
was a great idea, as it allowed patents to keep track of what day and date it
is. This was in responses to feedback from consumers and
carers.
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Inpatient clock at the end of patients beds
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There were also very informative messages on porters
through the hospital such as fall prevention and how you rate your exerances
with the health services. What was even better about them was the amount of
different languages these signs were in. All in all the hospital provided a lot
of information in several different languages.
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One of the many posters around the
hospital with messages in several different languages and interpreter services
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LESSONS LEARNT
We gained a lot from the tour of RMH and it would be worth noting a with a few key points that in the case of RMH need to be kept in mind when planning for both refurbishment and constructing new facilities:
- Always plan for the future, not for what you providing currently. This means including future proofing in design.
- You need evidence base design to work with spatial constraints to gain the best outcomes.
- The use of colour and green spaces are very important.
- Line of site from nursing stations needs better incorporation with the design of inpatient units.
- Incorporating a wide range of languages with all information and clearly mark interpreter services
- Adaptable seating arrangements in waiting rooms are very important.
- The use of people in signs provides a greater message than just words.
- Volunteers are very valuable and can be used for more than just finding your way around the hospital
HIP Project Officer
Nicholas Wales
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