26 Apr Building healthcare for the future
Modern hospital buildings should be part of the of the solution rather than the problem, says Richard Cantlay, Global Head of Healthcare Buildings at Mott MacDonald
Right across the globe, healthcare provision and the challenges associated with it sit high on the political agenda. Many factors contribute to failure or success in the prevention, treatment and management of illness, disease, infirmity and disability. But having the right infrastructure and buildings is most certainly a big factor. Whether it is improving access to healthcare in developing countries, or reacting to new clinical practice and technology in developed countries, the effects are felt in the healthcare estate, which can either hinder or help the change.
As a proportion of global healthcare spend, investment needed in healthcare buildings is small. But in the context of the construction market, the level of investment is enormous. The investment absolutely has to deliver good value for money. The best measure: faster, better clinical outcomes.
The construction industry’s role is to create environments where doctors and nurses can achieve uncompromised clinical excellence, and where the most important people in this process – individuals, families and communities – get healthier, quicker.
Looking ahead, the healthcare sector faces some fundamental questions that will need the combined attention of many different problem solvers. For example, how does society build hospitals today that will keep pace with the rapid rate of change in medicine, society and technology? How can estates change the fabric and layout of facilities to make patients feel more comfortable, and so aid their recovery? How can government departments target better use of technology and primary care to meet the growing needs of an aging population? How do economies pay for the necessary improvements, against a climate of financial uncertainty?
Addressing these challenges is vital for the future of healthcare in developed and developing countries alike. Converting our solutions into adaptive facilities, connected systems, more accessible care, properly supported clinicians and healthier lives is how we can all make a difference. They are challenges we all relish and are working to resolve.
Trends in emerging countries
There is a real effort to match care with health needs, dependent on the burden of disease. Buildings are part of the solution. There is an emphasis on creating buildings that aid day cases – getting patients in and out quickly. Technology is key for this evolution. We are seeing an increase in mobile health clinics. The wide prevalence of smartphones in Africa is also encouraging people to take control of their own health. Apps for fitness tracking and antenatal care, as well as smart messaging are already making a big difference.
Many hospitals are now able to show patients how to hold their records on their phone and in the cloud, rather than a central database in the hospital itself. In South Africa, they struggle with huge problems of overcrowding. Often, people start queuing at 4am for repeat prescriptions of HIV or diabetes pills. Now they can directly text the manufacturers, who are creating depots in townships where patients simply present a barcode. Another example is in Sri Lanka, where subscribers are now able to measure their blood pressure and heart rate so doctors can diagnose problems digitally and remotely. Certain clinics are linked to Harvard University, so patients are able to get a consultation in the States via video link-up.
Mott MacDonald is going to be working on the Fleming Fund, an initiative by the UK Department of Health to help tackle the global problem of antimicrobial resistance in low- and middle-income countries. The threat of bugs developing resistances to drugs is well known, but not enough is yet being done. Drug resistant infections could kill an extra 10 milllion people across the world every year by 2050 if they are not tackled. We’re already seeing resistance to strains of tuberculosis and malaria. Sadly, there has been misuse for a long time, bringing real difficulties to overcome. Of course, it’s not just in human medicine, but also veterinary, with farmers throwing sack loads of antibiotics into fish farms or injecting all their cows, whether sick or not.
We’ll be helping to plan laboratories and upgrade data, working with medical and veterinary staff in the UK and abroad to promote a holistic approach and provide appropriate training, lab work and epidemiology.
In recent years, we have seen a growing realisation among healthcare providers that although a building won’t cure you, it could contribute to the healing process. Or, at least, the building should not hinder the healing process.
If we’re being honest, then that’s where we’re starting from: buildings should not get in the way of recovery. Healthcare trusts are understandably keen to improve their environments, whether it is air quality, access to daylight or setting temperatures and artificial lighting that suits both patients and clinicians. But they also have other factors to consider, most notably energy efficiency. 40 per cent of energy production in the European Union is directed to the building sector. It is little wonder that energy efficiency is therefore the primary focus of regulators and voluntary schemes in healthcare facilities.
The upshot of concentrating on energy efficiency is increased air tightness: eliminating leakiness reduces heat loss and improves energy efficiency, which again is a good thing. However, it also means that any air pollutants coming into the building or generated inside the building have less chance of escaping.
With attention so fixed on vehicle pollution it may surprise you that in hospitals the most likely source of pollutants is the chemicals that occur throughout surgery rooms, operating theatres, and laboratories. In this indoor environment, even everyday disinfectants such as rubbing alcohol can react with other chemicals inside the building to produce gases such as ozone, a common component in smog. Tests find the same compounds inside the building as you would in an outdoor traffic environment. Indeed, recent studies have shown that healthcare workers reported more indoor-related symptoms than people working in office buildings.
The fabric of buildings themselves, and their fittings and furnishings, are another major source of compounds that can make us ill. Designing and specifying healthier buildings is still a niche skill, and more prevalent in the office sector than healthcare, at the moment. There is an increasing number of office owners who are determined to protect the wellbeing (and productivity) of their staff by minimising the use of construction materials that contain potentially harmful chemicals.
The challenge for designers is finding healthier materials, and then verifying these new products have been used in construction, with no substitutions made. It asks for a totally new tactical approach, backed by education of suppliers. But the more projects that ask these questions, the less they become a novelty and the quicker the markets will emerge. If you buy a bottle of shampoo in the EU, all the ingredients are listed on it. But not so in construction materials. Like a parent of an asthmatic child, who will be acutely aware of finishes and textiles, designers will need to act like ‘mom’ for their clients in the building process. In a recent office fit-out project, we developed a list of more than 300 products, with an assured ingredients list for each.
No perfect solutions
Designing with human-friendly materials and avoiding volatile compounds as far as practical in facilities management and clinical treatments helps solve the dichotomy of opposing outcomes for energy efficiency and air quality.
This is a complex area, and demonstrating quantitative metrics is hard. But when you consider the office environment, there’s an obvious business case for proactively safeguarding employee health: greater alertness, improved wellbeing, less absenteeism. In the life or death situations of healthcare, a positive indoor environment that affects productivity and improves performance also makes a lot of sense.
Case study: Healthcare infrastructure
Project: Health PPP
Client: International lenders and development banks
Expertise: Lenders’ Technical Advisory (LTA), providing due diligence
The Turkish Ministry of Health is building some of the world’s largest hospitals to meet increasing healthcare demands as a result of a fast-growing population. The programme will renovate healthcare infrastructure throughout Turkey, bring together smaller hospitals under 38 integrated health campuses, and increase the quality and efficiency of the health service. The key challenge of these projects was liaising with the Ministry of Health and sponsors in a country new to PPP projects, to arrive at a contractual agreement (in particular, the service specifications and payment mechanism) that was in line with international PPP best practice for risk allocation, and therefore bankable for the international lenders.
Our infrastructure finance, investment transaction and health specialists from the UK collaborated closely with our team on the ground in Istanbul and really went the extra mile to meet every client’s expectations for face-to-face support. We worked with the Ministry, sponsors and their advisors to develop a commercial solution where the risk profile would be acceptable to the lending community. We advised sponsors on their environmental and social due diligence, which was essential to meet the standards, public disclosure and consultation requirements of lenders such as the International Finance Corporation, the European Bank for Reconstruction & Development and the Overseas Private Investment Corporation.
We have been instrumental in assisting sponsors and the Ministry of Health to move forward towards a commercial solution that will meet the expectations of international and Turkish lenders alike. To date, six of our 12 projects have successfully reached financial close. In 2015, building began on the Bilkent Integrated Healthcare Campus, the world’s largest greenfield healthcare scheme covering over 1.2M sq m, providing 3804 beds and parking for 7209 vehicles.
It will include over 100 operating theatres and is expected to treat around 35,000 patients per day and employ approximately 8000 staff. Early in 2016, the Etlik Integrated Healthcare Campus, also one of the world’s largest hospitals with 3577 beds across more than 1M sq m, received the green light for construction to start.
Case study: Integrated design
Project: Eastern Oncology Medical Centre
Location: Hong Kong
Client: Hong Kong Sanatorium & Hospital
Expertise: MEP Design service
The Hong Kong Sanatorium & Hospital Group is the flagship private hospital operator in Hong Kong. Their main healthcare campus is situated at Happy Valley where the existing site is insufficient for expansion of their cancer treatment facilities. The key requirement is to design and construct a new 18 storey hospital at a new site on the eastern side of Hong Kong incorporating the “State of Art” Proton Therapy System in Hong Kong.
We are working closely with the equipment vendor to understand the facility requirements for this new emerging medical equipment which has resulted in the design of a 4 level basement, due to the constraints of the site and the building footprint.
A key issue will be avoiding radioactive leakage through MEP duct penetrations on the shielding wall of the proton radiotherapy facility. We are adopting BIM for coordination of MEP services duct routing and penetrations such that no radioactive leakage path will exist. To achieve Gold rating in energy certification, we are designing energy efficient features including a chilled ceiling system, heat wheel/ heat pipe for energy reclaim, photovoltaic panels, and a high efficiency lighting system.
We continue to work seamlessly with other members of the international design team, the vendor and customer to deliver the first Proton Therapy facility in Hong Kong.
Case study: Health financing
Project: Scottish NPD Model and investment programme
Client: Scottish Futures Trust and various NHS Boards
Expertise: Technical Advisory; Procurement; PPP Models
The Scottish Government wished to design a new Public Private Partnership (PPP) model to develop a pipeline of hospitals, schools and other facilities across Scotland. Our role was to assist them in developing a model which addressed the perceived weaknesses in the previous PPP models used and provide a more efficient and effective model for their investment pipeline.
We worked collaboratively alongside the Scottish Futures Trust and their legal and financial advisers to develop the new NPD (Non Profit Distributing) model. Our focus on the technical and technical commercial issues involved developing the areas of the Project Agreement and the supporting technical schedules (output specifications, payment mechanism and energy provisions) to provide the overall commercial risk balance agreed at the outset.
We have been appointed as technical advisers to the NHS Boards on the first four Scottish healthcare projects that adopted this model with projects ranging in size from £50m to £200m. These projects are currently either nearing the end of construction or in operational stage.
This new NPD model has been used to finance and deliver a large pipeline of public infrastructure, including 7 hospitals that have been delivered faster and on an improved value for money basis. Across the UK and worldwide, there is growing interest in the model of healthcare finance.
Curated from Article – Collaborate