GHP September 2016

28 | ghp September 2016 Innovation & Technology The Future of Healthcare Design: How Clever Engineering Can Help Priorities in healthcare are shifting from transferable to non-transferable diseases, including cancers, diabetes and heart disease, as well as injuries. Pre-empting and building in flexibility for future needs is crucial, although can be extremely difficult whilst balancing budgeting limitations. This poses a key challenge in the future design of our hospitals and healthcare facilities. Hospital running costs significantly outweigh the con- struction costs, with the capital outlay often matched in year two or three. Incredible effort is therefore needed to maximise efficiencies through adjacencies of departments, care givers, patient pathways and the reduction of building energy consumption. For the New North Zealand Hospital (NHN) project which we are working on in Denmark, the architectur- al plan pushes together four central cores which carry patients vertically through the building, allowing imme- diate access to diagnosis, treatment and rehabilitation departments. This reduces patient treatment time but equally allows for more to be treated in a given period for the same building operational cost. The NHN is being designed to comply with challeng- ing energy consumption targets for buildings built in 2020. This 115,000m2 building is at the lowest current UK hospital energy consumption level, as the ‘marginal gains’ theory has been used by the de- signers to explore energy consumption. All elements have been rigorously challenged, from underground aquifers used as a seasonal energy store (saving 40% of the running costs of conventional cooling systems), through to varying ventilation rates for individual bedrooms as the sun moves around the building and varying light colour temperature and illumination levels. At this Danish site two construction methodologies are adopted in parallel, based on functional need and future adaption. The lower two diagnosis and treatment floors are constructed using a conventional in-situ concrete frame, providing long spans and reg- ular column grids which aid future adaption of clinical areas as medical technologies change. Mechanical and electrical systems which support diagnosis and treatment are located on a support accommodation tramline between ‘on-stage’ and ‘off-stage’ areas of the hospital. In this way, the ‘on stage’ patient treat- ment areas of the building, which are likely to modify during the building’s life span, can be adapted with no disruption to other areas of the building. For the upper two in-patient floors, a pre-fabricated module construction principle has been adopted as these individual rooms can be designed at a more cost effective domestic level of construction. Pre-fab- rication processes have improved significantly in recent times with increased use in hotel and student accommodation buildings. We are able to take this pre-fabrication innovation and apply it to in-patient accommodation, providing hotel quality bedwards at a much reduced cost compared to traditional construc- tion. Pre-fabrication allows us to ‘beta-test’ the patient rooms (and their technology) to provide a high quality known end product. Innovative building materials such as cross laminated timber are becoming an increasingly proven option for pre-fabrication. These known modern materials and construction methods are vital to helping us overcome the key challenge of building in flexibility whilst reducing construction time. At an operational level, new hospitals are also embrac- ing automation as a means to manage the delivery and removal of supplies. At NHN, automatic goods vehicles (AGV’s) transfer goods from the central logis- tics building, via an underground tunnel network and dedicated lifts. Waste is removed via dedicated waste chutes local to each department – with the AGV’s taking the waste back to the logistics building on their return journey. New hospitals are now required to incorporate a robust and flexible IT infrastructure – systems such as pneumatic tube systems, laboratory conveyor testing systems and da Vinci robotic surgery must be provid- ed for. Additionally mobile phone platform technology will allow hospital communication and control systems to become more closely integrated. In meeting the needs of future healthcare buildings, those who design and engineer the facilities need to think long term. With forecasts that tell us that over the next 50 years the number of peo- ple over 60 years of age is expected to surpass those under the age of 14, we must consider our changing needs. Considering the wider needs of the population and adopting different strategies aid development of new models of efficient patient care. In some parts of the world such as Scandinavia, large scale consolidation programmes are underway, while here in the UK we are seeing the opening of specialist units, such as Cramlington - the first dedicated emergency hospital in the UK. Papworth heart and lung research institute is another example of a hospital designed for the future, with its direct tunnel link to the high dependency unit enabling a significant increase in basic and clinical research capacity, resulting in 40% new recruitment. Designs for major hospitals are also advancing with Pembury being the first hospital in the UK to be built with single bedrooms for all patients. In the diverse hospital environment, no one model has proven to be the ‘best solution’, but each facility has its own particular advantages. With new hospital buildings designed for a sixty year operational life span – and considering how medical treatment has changed in the last sixty years – we cannot with any confidence predict the way the hospital of the future will function. Engineers of new hospital buildings need to strike a careful balance between total building flexibility (and the consequent cost and inefficiency) and bespoke design (and the resulting inflexibility for adaption). Understanding the healthcare environment, drawing on what others have done across the world and close stakeholder collaboration are all absolutely vital to maximising hospital efficiencies, where minimising a hospitals running costs is a key driver to delivering facilities that can focus on patient care. Company: Ramboll Name: Neil Harvey Email: [email protected] Web Address: Address: Christchurch House, 30 Waterloo Street, Victoria Square, Birmingham B2 5TJ United Kingdom Telephone: +44 121 230 1650