Blacktown Hospital Tour

On Monday 15 February Darlene Cox, Kerry Snell and I drove to Sydney to visit the new Blacktown Hospital expansion. Peter Rophail the transition manager for Western Sydney Local Health District organised and provided the tour just two days before the new building was to be handed over. This meant there was lots of activity throughout the building. We are very thankful of the time Peter gave us for the tour.

Blacktown Clinical Services Building

  

Co Design

The project won a gold medal, in the co-design category at the APAC Forum - Asia Pacific’s premier healthcare conference. Western Sydney Local Health District identified that there was a need for strong community engagement in the planning of the hospital. They were wanting the people of Blacktown to own it. Throughout the planning hundreds of consumers where involved through the many methods such as master planning, user groups, focus groups, and getting out to the community and talking to people about what they want.

Consumer engagement was difficult at the beginning as there was not a strong culture of community involvement. Once models were developed to better involve consumers things improved. They learnt by trailing approaches. They were clear about the need for consumer input and were open to making change along the way. For example, while they started out with a single consumer representative on a user group through the process they found that it was better if there was two or three consumers involved in one user group.

How did consumers influence the design?

·         Adequate number of free parking spots for patients undergoing cancer treatment

·         A significant proportion of their inpatient rooms have a carer zone so that carers can stay overnight with adult patients

·         Attractive images on the ceiling for patients in radiation therapy

·         Provision of easily accessible interpreter services for non -English speaking patients

·         Toilets to accommodate patients with intravenous drip stands

·         Consumer was on the panel that selected the 25 large print photographs for the walls throughout the hospital

Core Values

The project included core values that whenever a decision was made the team would referred to the core values and how it supported them. These values are:

·         Mutual Respect

·         Accountability

·         Integrity

·         Teamwork

·         Trust

·         Quality

·         Consumer involvement

Wayfinding 

Furniture Colour for Wayfinding

The new clinical service building uses colour for wayfinding. This is cleverly integrated into the build. This was in response to consumer feedback. One of the consumers said: “a hospital space does not need to be white and sterile”. Every room and every ward had their own colour to improve way finding. The intent is to assist with orientation to wards and inpatient rooms. Their research informed this design decision and it will help patients and visitors to find their rooms. We really liked this approach. The only thing that could be improved is placing a coloured tile next to the sign with the room number. These wayfinding methods are proven to improve the experience for the consumer and it will be good to see how it goes when the building is open.

The Hospital also related all its wayfinding colours to the external colouring of the building, this brightened up the whole space and again made it feel less clinical.

Community Arts Program 

Blacktown Hospital engaged a Canberra based art company called Health Arts Research Centre to improve community engagement in the design, selection and creation of art within the building. This includes an 80 m mosaic, with 13 different works designed by community groups such as Indian elderly and Arabic community groups. There is also involvement from local aboriginal artists Leanne Tobin, who designed The Call Of Home, which is a suspended sculpture of more than 80 unique hand blown glass eels.

The art project also included a photo completion where people could submit their own photos with a chance to be displayed throughout the hospital. The selection panel was a consumer, art specialist and the General Manger. You can find further information on the Arts & Cultural Program here.

The Call Of Home by Leanne Tobin to be
installed in the foyer of the Blacktown Hospital

Example of the large scale photos in public areas

Hospital Street

Layout

The main entrance into the new Blacktown clinical services building comes into a long open corridor called Hospital Street. A lot of contemporary health facilities include a hospital street. This layout makes the environment feel less clinical and more welcoming. It is also very effective way to connect the existing hospital with the new building.

Main Reception

The volunteers will be located at the main reception desk, to better include them within the hospital. This decision was made after feedback form volunteers that they wanted to feel part of a team and be more involved in assisting patients and families.

Off the main reception was lifts and clearly mark stars to the outpatients and inpatient spaces, making for easy wayfinding.

Inpatient Unit

The design includes an additional 180 beds for acute inpatients. These inpatient beds included 65 single bed rooms, three four bedded rooms and the rest being two bedded rooms. The bathrooms where out bound with double doors. All inpatient rooms had glass windows for better line of sight. This was one of the design principles of to see and be seen.

Convertible couch to bed

Eight rooms per ward provided a carers zone where family and carers could stay the night on a couch that converted into a bed and the two bedded room had reclining chairs that converted into beds to sleep on. This meant visiting hours where revised to allow for flexibility. This was feedback from the multicultural community.

Even though the outbound bathrooms reduced light the room it still felt very bright and welcoming.

Patient entertainer system included internet, free to air TV and their Electronic Medical Records (EMR). The TV is on an arm located above the bed, and could recode clinical information such as observations.

Inpatient Single Bed Room

This was to improve line of sight, with the ability to draw a curtain across for privacy.

The design of the nurse station is very open and a significant move away from the fortress we see in most wards. It will invite communication.

Nurses station in the inpatient areas

Nurses station in the inpatient wards

The floor design is to help with dementia and cognitive decline. This is done by guiding people through the space with visual cues as marked out on the floor to help with wayfinding.

QR Code

Defects Liability for the Building

There was throughout the building QR codes that could be used by NSW Health to note any issues with the building before handover. This meant that you could simply use the QR Code in each room to log any issues with the room and it would go on their data base.

Computers on Wheels (COWs)

We went to have a look at a medical ward in the older clinical tower with a 28 bed ward that included six COWs per ward with fourteen charging bays through the ward. The inclusion of an Electronic Medical Record was a key success to the integration and use of COWs. Other new builds that we have previously visited have had issues with COWs and where not used to the full extent.

Computer on Wheels

Paper light

Blacktown Hospital is one of the first hospitals in NSW to go paper light. What this means is that the use of paper documentation for inpatients is reduced and more information is logged electronically, such as the Electronic Medical Records. Currently the inpatient unit at Blacktown is using one page per person per a day, this is expected to reduce even further with the introduction of a closed loop medication system which is coming in August.

The tour provided some fantastic information on new hospital design and how the community is involved in the planning of their hospital. We have taken lots away from the tour and again would like to thank Peter Rophail for the tour and providing use with so much great information.

Nick Wales

Project Officer

Tour of the Royal Melbourne Hospital

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. 

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. 

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.

ED bedside write up in treatment bay

ED hallway write up station

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.

Q Flow machine

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. 

The ambulatory care reception desk also had cables across the counter with some parts covered with glass perspex

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. 

Rehabilitation gymnasium

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.

The image cover the whole wall as you walk into allied health. The people featured are people who had used the services previously.

Entrance into a speech 
pathology room, with a nice 
use of people on the sign 
who have been using the 
service 

Occupational Therapy 

Entrance

One of the Allied Health sub waiting rooms, with different seating

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.

Pictures of past and present winners of the You Make a Difference Award

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. 

The live band playing some great songs with a piano accordion and all

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.

Inpatient clock at the end of patients beds

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.

One of the many posters around the hospital with messages in several different languages and interpreter services

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