What next for healthcare design? The need to plan for the unknown

By Steven Bentley, project director at Ramboll

The New North Zealand Hospital project in Denmark is a example of a modern hospital built to provide flexibility for the future

  • The number of people aged over 60 is increasing
  • Hospital designers need to consider future populations when creating new facilities
  • The New North Zealand Hospital project in Denmark provides a benchmark for low-cost, high-impact design

Steven Bentley, project director at Ramboll

Over the next half a century it’s expected that the number of people over the age of 60 will exceed those under the age of 14.

This alters how we should plan for future generations.

In meeting the needs of future healthcare buildings, those who design and engineer the facilities need to think long term

In meeting the needs of future healthcare buildings, those who design and engineer the facilities need to think long term.

Instead of primarily designing our hospitals and care units to deal with transferable diseases, the rise of non-transferable diseases means we need to consider these as well. This includes cancers, diabetes and heart disease, as well as injuries.

Pre-empting and building in flexibility for future needs is crucial, although this can prove difficult when facing budgeting limitations.

Getting the right balance is the key challenge in the future design of our hospitals and healthcare facilities.

Hospital running costs significantly outweigh the construction costs, with the capital outlay often matched in year three or four. Therefore, incredible effort is needed to maximise efficiencies through adjacencies of departments, care givers, patient pathways and the reduction of building energy consumption.

For our engineering consultancy appointment at the New North Zealand Hospital (NHN) project in Denmark, the architectural plan pushes together four central cores which carry patients vertically through the building, allowing immediate access to diagnosis, treatment and rehabilitation departments. This reduces patient treatment time, but equally allows for more patients to be treated in a given period for the same building operational cost.

NHN is being designed to comply with challenging energy consumption targets for buildings built in 2020.

Getting the right balance is the key challenge in the future design of our hospitals and healthcare facilities

This 115,000sq m building is at the lowest current UK hospital energy consumption target level.

The ‘marginal gains’ theory has been implemented by the design team to limit energy consumption and all building design 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 varying ventilation rates for individual bedrooms as the sun moves around the building, to circadian lighting controls which vary light colour temperature and illumination levels through a typical day.

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 regular column grids which aid future adaption of clinical areas as medical technologies change.

At the Danish site two construction methodologies are adopted in parallel based on functional need and future adaption

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 treatment areas of the building, which are likely to need modification during the building’s life span, can be adapted with little disruption to other operational areas of the building.

For the upper two inpatient 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-fabrication 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 inpatient accommodation, providing hotel-quality bed wards at a much-reduced cost compared to traditional construction.

In the diverse hospital environment, no one model has proven to be the best solution, but each facility has its own particular advantages

Pre-fabrication allows us to beta-test the patient rooms, and their technology, to provide a high-quality 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 while reducing construction time.

At an operational level, new hospitals are also embracing automation as a means to manage the delivery and removal of supplies.

At NHN, automatic goods vehicles (AGVs) transfer goods from the central logistics 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, laboratory conveyor testing systems, and da Vinci robotic surgery must be provided for. Additionally, mobile phone platform technology will allow hospital communication and control systems to become more closely integrated.

Considering the wider needs of the population and adopting different strategies aids 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.

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

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 60-year operational lifespan – and considering how medical treatment has changed in the last 60 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 hospital’s running cost is a key driver to delivering facilities that can focus on patient care.

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