UIA PHG 28 th Seminar Florence June 2008 Recent Developments in Health-Facility Planning and Design in Australia Warren Kerr Health-Facility Architect

UIA PHG 28th Seminar Florence June 2008

Recent Developments in Health-Facility Planning and Design in Australia

Warren KerrHealth-Facility Architect & Planner Rhonda KerrHealth Planner


Outline of Presentation

To provide an overview of the Australian healthcare system providing outline of the roles of Federal, State and Local Governments in the delivery of health services and health-facilities

To describe how health-facilities are procured using public and private sector resources

To provide an overview of the work being undertaken to develop national guidelines for health-facilities in Australia

To describe recent innovations in the planning, design and operation of health-facilities


Background of Presenters

Both are active practitioners in private sector undertaking major public hospital projects in Western Australia through Hames Sharley

Warren has quals in both architecture and health administration, is a part time Visiting Professor at University of New South Wales in Sydney, a Board member of the research Centre for Health Assets Australasia and Chair of the RAIA Health Architects Committee

Rhonda has quals in health economics, 25 years experience as a health planner and recently has been undertaking research into medi-hotels and the funding of capital works through DRG components

Projects underway range for $80 m to $1.7 b


Australia


Australian Demographics

A vast continent with a population of only 22 million

A nation of migrants

Only 2.4% of the population are indigenous Aboriginal people

Population density 2.5 persons per sq km


Economic Environment

Varied natural climate GDP ranked 12th in OECD High ownership of residential housing Amongst the longest life spans Low unemployment

(and high demand for healthcare architects!)


Australian Health Care

Australia spends about 9.7% of GDP on healthcare (up from 7.6% in 1975)

All Australians have access to free health services

Private health insurance is subsidized and not linked to employment


Challenges To dramatically improve health outcomes for the

indigenous population To provide better access to medical and health

services for Australians living in rural areas To manage increased health costs in the context

of increased demand associated with an ageing population


State Responsibilities

Each State and Territory is responsible for building, funding and operating: Public hospitals Mental health services, and, Community health services.


National ViewNational Health and Hospitals Reform Commission

Patient Centred CareEquity of Access and OutcomesPrevention and WellnessValue for moneyLong term view for healthSafety and qualityShared responsibilityCulture of Innovation and Improvement


Health-Facility Planning & Design in Australia Public health-facilities are State responsibility Until 1980’s hospital planning & design by PWD’s Now outsourced to private practitioners State based health architects led to national firms State guidelines have been replaced by national Formation of Centre for Health Assets Australasia Investment during 1950/60’s require replacement Amalgamation of small private hospitals into larger

companies has resulted in sophisticated services Current boom in hospital construction


Health-Facility Planning & Design in Australia Primarily government funded construction

(e.g. Fiona Stanley Hospital - $1.7 billion Increasing use of PPP’s in some States

(e.g. Victoria, NSW, Queensland & South Australia) Prompted by need for large projects

(e.g. $2.0 b Marjorie Jackson Hospital in Adelaide) More research commencing in health-facility

design Sporadic evaluation of health outcomes

(e.g Forster Report on Queensland)


Health InfrastructurePublic sector expenditure around 2% of health budget

Private sector expenditure varies

Major projects underway:Queensland

Sunshine CoastGold CoastQueensland Childrens Hospital

VictoriaRoyal Childrens Hospital

Western AustraliaFiona Stanley HospitalMidland HospitalJoondalup HospitalRockingham Hospital


Innovations Queensland Sunshine Coast Hospital Ecologically Sustainable Design

Proposed to be a ‘5 Star’ green rated hospital in Australia

Project Delivery Method Private Public Partnership model of procurement

Latest Thinking in Ward Design 24 bed wards broken into 8 bed pods Majority of rooms are single beds Decentralised staff bases with clean/dirty

utilities, linen, medications and consumables within 5 steps to reduce ‘hunting and gathering’

A mixture of patient room configurations to allow for different patient types and acuity

More generic wards and less specialised, to increase flexibility and flows


Sunshine Coast Hospital

Planning for the Sunshine Coast Hospital has been based on Lean principals Lean (or flow thinking) is based on the Toyota Production System Its aim is to provide a seamless flow of patients and services required to treat them


Sunshine Coast Hospital

The fundamental principles of Lean Thinking in a health setting are;

Add value for the customer – deliver what patients think are important

Focus on the whole value stream – how does one activity impact on another

Improve flow by removing waste – what processes require backtracking or unnecessary movement

Where can push turn to pull – how can patients be moved into the correct care streams quickly

Manage towards perfection – solving each bottleneck until a new one is created, and then solve that one


What is Innovation?

One View is: Innovation and reform are like

periodic adjustments on the course of a long sea voyage.

They occur because things have gone off-track a little, or because we have a new destination!


New Aims , New Tools

Improved health outcomes but more frequent use of services

Buildings which facilitate contemporary and future health care

Sharing the responsibilities for health management- better engagement with patients and families

Telemetry in the community and for rural and remote satellite services


New Ways to Improve Outcomes

Changed ward design Powerful Ambulatory activity centres Partnerships-in-care Effective communication Equipment libraries Medical testing centres Indigenous health hubs in hospitals Short stay assessment areas



Enhanced Communications At ward level With community based service providers With ambulatory services ,and With patients and their families

New Pathways for Care Early identification of care path through

assessment units and allocation of patients to most effective setting



Sunshine Coast Hospital Focus on the flow of patients and services Manage towards optimal outcome clinical

and for the patients experience

Midland Hospital Integrate wellness activities

Invest in the areas where the community meets health care • an outdoor gym• fire pit


Investing in Health

Short term vs. longer term cost management

“We shape our buildings and thereafter our buildings shape us” Winston Churchill

The challenge is to link capital investment and health outcomes


Linking Health Outcomes with Capital

Australian Hospital Cost Data based on Diagnosis Related Groups

Including Differentiated Capital by type• Wards• Offices• Imaging• Operating theatres• Critical care• Major equipment

Costed to include life span


National Capital Formation

Projecting Diagnosis Related Groupings to provide both the expected demand and the necessary minimum capital response

Results in linked capital to outcomes Smooths out the blockages associated

with unbalanced investment Funds design related to outcomes Patient outcomes linked to capital and Improves Staff safety and retention.


Thank you

Warren KerrHealth-Facility Architect & Planner

Rhonda KerrHealth Planner

HAMES SHARLEYArchitects and Planners

Documents

UIA PHG 28 th Seminar Florence June 2008 Recent Developments in Health-Facility Planning and Design in Australia Warren Kerr Health-Facility Architect