Recent Developments in Health-Facility Planning and Design in Australia

1
Recent Developments in Health-Facility Planning
and Design in Australia

• Warren Kerr
• Health-Facility Architect Planner
• Rhonda Kerr
• Health Planner

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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

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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

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Australia
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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
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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!)

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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

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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

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State Responsibilities

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

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National View
National Health and Hospitals Reform
Commission Patient Centred Care Equity of
Access and Outcomes Prevention and Wellness Value
for money Long term view for health Safety and
quality Shared responsibility Culture of
Innovation and Improvement
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Health-Facility Planning Design in Australia

• Public health-facilities are State responsibility
• Until 1980s hospital planning design by PWDs
• 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 1950/60s require replacement
• Amalgamation of small private hospitals into
  larger companies has resulted in sophisticated
  services
• Current boom in hospital construction

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Health-Facility Planning Design in Australia

• Primarily government funded construction
• (e.g. Fiona Stanley Hospital - 1.7 billion
• Increasing use of PPPs 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)

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Health Infrastructure
Public sector expenditure around 2 of health
budget Private sector expenditure varies Major
projects underway Queensland Sunshine
Coast Gold Coast Queensland Childrens
Hospital Victoria Royal Childrens
Hospital Western Australia Fiona Stanley
Hospital Midland Hospital Joondalup
Hospital Rockingham Hospital
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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

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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

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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

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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!

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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

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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

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New Ways to Improve Outcomes

• 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

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New Ways to Improve Outcomes

• 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

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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

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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

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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.

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Thank you
Warren Kerr Health-Facility Architect Planner
Rhonda Kerr Health Planner HAMES
SHARLEY Architects and Planners