Currently there are 700 public hospitals and over 600 private hospitals in Australia. What are the considerations, challenges and barriers to designing the smart hospital of today which can also stand the test of time? These questions and more are discussed in the WSP People and Place podcast ‘Future Proofing Hospitals for Changing Technology’ - a health sector deep dive with Roneel Singh, Director of WSP Technology Systems and industry experts Barbara Mackenzie, Chief Technology Officer Healthscope; Kirsty Bowyer, Associate Director Johnstaff; and Adam George, Senior ICT Project Manager Lendlease Technology.
Future Ready themes of Society and Technology were considered to understand what the world might look like and in taking action to prepare for the future. Key areas captured from the discussion include acknowledging the sector will benefit from a greater focus and capital investment on technology; budget needs to be tied to clinical design for future models of care; investment must contribute to both BAU operations and also capital cycles to achieve the digital vision; allocation of future funding should be considered within the build to allow for future change and expansion in technological capabilities; hospital operational areas are often siloed resulting in a lack of integration of technologies; and the rise of healthcare precincts i.e. local health area districts and also the connection of geographically disperse hospitals.
Aspiration versus Capability
The hospital of today may look amazing but fundamentally the layout has remained the same as those built over the last 50 years. Understanding of how digital technology is impacting clinical and patient workflow - the entire experience of consuming health care – must move forward within the sector.
Barbara says, “There is a very big disparity between the aspirations around a hospital development or around a precinct, and what can be achieved and the capability to execute. I put that down to the sheer complexity of the integrated technologies that are required to deliver a great user experience within the healthcare setting.
“We should already be using the technology and following the patterns of usage rather than bolting on technology as an afterthought. Integration means it must be dealt with from the very beginning. The ultimate for me would be to provide a frictionless experience for all the different parties consuming technology within a healthcare setting. That means getting right down into the detail of where connectivity needs to exist, what types of devices or services are being consumed and where, when and how.
“SHIFT THINKING BEYOND WHAT WE HAVE TODAY TO HOW IT’S GOING TO BE”
“If you have personnel that are working within an environment that isn't digitally enabled, then you're doing a co-design process with individuals who haven't experienced what’s possible. We are still designing the future in healthcare, and we're all struggling to know what that looks like and exactly how to execute.”
Technology as a Core Pillar
Adam says, “The challenge from the developer and constructor side is we haven’t got a data set that is going to help us change the way we design hospitals. The key thing is getting a clear client brief and the specification that is tendered to the market for a builder or developer to respond.
“The second thing that supports this is a completely matching budget and that's not only the budget for the construct, but a budget for the entire capital works project. It's a huge challenge to get a matching and supporting budget.”
“The trend now is that clinical services plans are tending to have horizons for short, medium and long-term service needs,” adds Kirsty. “So, we're looking at 10, 15 years and well beyond which means longer construction programs. This brings about asking what the technology in healthcare looks like in the future beyond the planned opening date for the hospital, and questioning have we as a team provided enough flexibility and redundancy to support the hospital of the future.
“The vision is now a digitally enabled solution or integrated technology and I think it's really important that we unpack what's driving that requirement.
“Improving patient flow from a clinical perspective is about reducing both bed block and length of stay. The technologies to support these like real-time location services, digital theatres and robotics are available but the sector is struggling to integrate them from an operational perspective. Hospitals are also wanting to reduce the pressure on Emergency Departments and ambulatory care. Technology can provide this by way of virtual care centres, virtual hospitals and leveraging platforms like Skype and other applications that allow a two-way interface.
“Technologies that can be implemented to improve the full patient experience include digital wayfinding, patient entertainment systems, bring your own devices and a simple need like uninterrupted Wi-Fi. However, the challenge for the sector is getting this right.”
Delivering Technology within a Traditional Process
Kirsty continues, “We have the inherent ability early to influence the outcome. Master planning is the vision, the aspirational framework. It needs to be established early and committed to - and you need to find key stakeholders who have the vision for change and can drive implementation.”
“THE MASTER PLANNING PROCESS CREATES ASPIRATION”
Barbara says, “It often comes down to the maturity of the organisations involved and their capability to deliver contemporary services that are easy to access whilst still being secure. On top of that, there's all of the complexity around integrating disparate technologies – so for the user it becomes a frictionless experience.”
“The challenge is converging the interconnectivity - everything should be using similar infrastructure, whether it be network, computing storage, or security infrastructure,” Adam continues.
“The ICT roadmap has to be intrinsically linked to delivery at day one models of care or day two or day 365 - then it becomes very difficult to remove some of those technologies and their investment. Although, this requires ICT strategy and architecture that's really robustly tested and a matching budget aligned to the clinical design.
“There's a great example in the aviation industry where a client has appointed what they're calling a ‘Master Technologist’ to work from masterplan all the way through, becoming their advocate through design and delivery construct.
“For significant and complex investments such as in the health sector, partnering with global and regional expertise should be considered - and holding the IP all the way through the project. The role, strategy, budget, roadmap, and making sure that everyone understands the decisions that come with that on the way.”
“I was in the position of master technologist from inception through to build on the Sydney Adventist Hospital redevelopment,” Barbara explains. “We started bringing technology online from 2013 and I still maintain that nowhere else in Australia has there been a hospital facility delivered to this level of integration as a result of the same team being involved throughout.
However, it really wasn't planned that way, I just happened to be in a position at the beginning and all the way through. This approach though needs to be supported within healthcare infrastructure construction.”
Kirsty says, “There is a want from the client, capital funding streams and the public sector to get there. So, there are things in the construction lifecycle that we can do also to support them in doing better. There are multiple critical points in a project where key decisions around technology have to be made – let’s call these ‘anchor points’.
“Opportunity arises at the end of scoping design and at the beginning of design development to have an anchor point for the ICT scope and technology scope – to ask ‘what's changed now?’ - to look at the future again, and really refine these requirements. Also, in procurement, prior to contract award, you've got a period where you're out to tender and the project is fluid. Another anchor point is in post tender negotiations in terms of refining any needs or changes, additions or operational requirements. Also, during construction and commissioning and handover.
“I think that we need to be very critical in our post-occupancy evaluations as well. We need to drive a philosophy of continuous improvement – this is essential for the success of future projects.”
Adam says, “Critical decisions need to be tied back to the original intent of what was specified - what the outcomes are for either patient experience, visitor experience, clinician experience, clinician workflow outcomes, etcetera.”
Barbara concludes, “The co-design needs to have an experienced champion. When we talk about future-proofing, I may be out of step with the rest of the world, because that doesn't frighten me. When we talk about integrated facilities, as a technologist, that translates into what has to be built into the walls as the building goes up versus what can I see and therefore deal with later.
“That comes down to the cabling, which is a lot harder than it sounds to get right. Down into that really basic infrastructure level, how do I build flexibility and supportability into that?
“What will it cost me to go back and put a connection point somewhere later when I've got to carve up a hundred meters of hospital to get a cable back to somewhere. So, if I can mitigate that by not skimping on that solution from day one, then I don't need to worry about what I don't know yet.”
COVID-19 Key Learnings
The panellists were also asked about the impact of COVID-19 on the sector. Key take-outs include:
- We discovered that we can do a lot more without being in a hospital than we ever thought. We then very quickly understood that our infrastructure isn't up to the job for virtual care inside a facility.
- Smaller scale builds are now being undertaken - much more targeted and a very different design going forward.
- There was a leapfrog in thinking about really starting to virtualise and move care out into the community.
- Precincts and jurisdictions that prior to the pandemic made investment in infrastructure, in particular telehealth infrastructure, have certainly reaped the benefits.
For more information on the impact of COVID-19 Is Technology Redefining Healthcare Delivery?
To listen to the full ‘Future Proofing Hospitals for Changing Technology’ podcast
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