Healthcare Facilities Design

A global perspective

Judith D Mitchell

Judith D Mitchell

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The battle to deliver high-quality care at affordable costs will only be won through refinement of process flows and a thorough understanding of long-term operational costs as well as initial capital costs.

Today, we are seeing an unprecedented global boom in healthcare facilities development fuelled by a wide variety of economic and social factors:

  • The Private Finance Initiative that is spawning significant new development in the UK
  • The creation of free zones giving rise to entire healthcare "cities" in the Middle East
  • China's transformation from a monolithic public system to a hybrid public / private model of care delivery, which is necessitating a complete rethinking of their healthcare infrastructure
  • Privately held companies leading the way in building new hospitals in India
  • Public outcry in Australia forcing policy makers and developers to work together to provide improved quality and access to care
  • The realisation that massive rebuilding of decaying infrastructure will be essential to the future of Eastern Europe's healthcare system

Hospital design is perhaps the most demanding of all building types, requiring designers to stretch across all scales of design.

Simultaneously, a multitude of forces-a shift in the burden of disease towards chronic illness, rising costs coupled with heightened demands on the part of more educated health consumers, and a global shortage of healthcare professionals-are giving rise to new thinking about how to design integrated care environments that serve patients' needs while allowing healthcare organisations to attract and retain quality healthcare professionals.

The healthcare building boom across Asia and the Middle East provides a clean slate for facility designers and a unique opportunity to forge new models without the constraints that often limit existing medical centres in North America and Europe. Most significantly, these greenfield developments create the potential to break down traditional barriers in support of multi-disciplinary practice. Service lines may now be rethought and organised around disease rather than in traditional departments, thereby creating a more patient-friendly experience where clinicians have the ability to engage in cross-speciality consultation for more efficient and effective patient care. Advancements in information systems are enabling a complete rethinking of radiology and a movement towards more dispersed models where imaging capability is decentralised and spread throughout the medical and surgical specialities. Ultrasound, CT scanners and MRIs are conveniently located in proximity to the patient populations they serve and radiologists now have the option to leverage their time by supporting multiple practices from remote locations. While the shift from inpatient to outpatient care has been occurring gradually over the last 25 years in North America, it has lagged far behind in Asia and the Middle East. However, the new developments in these regions present an opportunity to leap ahead with facilities designed to accommodate high-volume intake of ambulatory patients in welcoming environments that do not compromise patient privacy or dignity. Development of modular approaches to the planning of both inpatient and outpatient units promise increased flexibility to accommodate shifts in patient volumes as well as medical advances we cannot predict today.

Pioneering new models

Today's healthcare leaders have tremendous opportunities to change the healthcare scenario, and their challenge will be to craft financially sustainable models uniquely tailored to the communities they serve. Healthcare facilities planning, like healthcare itself, is increasing in complexity at a rapid pace. Hospital design is perhaps the most demanding of all building types, requiring designers to stretch across all scales of design addressing issues related to urban planning and campus site development, coordination of complex building systems as well as detailed room and furniture design. Poor design can have long-term impacts resulting in increased staffing and operational inefficiencies, which unnecessarily burden an organisation and may not be immediately visible to a healthcare administrator. The introduction of high tech equipment and the proliferation of computers necessitates sophisticated mechanical systems which today may account for as much as 45 per cent to 50 per cent of a total construction budget. So, making the right decisions regarding systems has become increasingly important. In the United States, healthcare facility design has long been an area of specialisation for architects and engineers; however, in many parts of the world, design teams are yet to develop the expertise necessary to successfully accomplish these complex building projects. Finding a qualified design team is central to the success of any significant healthcare project and poses a special challenge for developers in many parts of Asia and the Middle East.

Many institutions, investors and developers have a tendency to focus on high tech equipment as a tangible evidence of progress. It is important to recognise, however, that planning a state-of-the-art hospital involves much more than creating a wrapper for high tech equipment. A successful hospital design must reflect local circumstances and, in a competitive marketplace, the battle to deliver high-quality care at affordable costs will only be won through refinement of process flows and a thorough understanding of long-term operational costs as well as initial capital costs. The design of support spaces is critical for attaining operational efficiency and central to a top-quality infection control programme. Thus, the planning of a successful hospital encompasses far more than the accommodation of equipment. It intertwines building design with the design of care, with the clinical programme serving as the first critical blueprint in the development of any physical structure. Clinical programming must drive hospital design and the planned functions of the facility must be addressed in its form.

At Harvard Medical International (HMI), we have participated in a wide range of facilities design and development projects, in a wide variety of social, environmental and regulatory contexts. Our core objective of creating sustainable models for delivery of high-quality care, is reflected in our approach. We use the design process to foster dialogue about local practices and explore applicability of models being used elsewhere around the world. Through these discussions, we seek to initiate operational advancements, explore new approaches to staffing, and identify training needs. In attempting to meet this objective, we have tried to adhere to a singular guiding philosophy during the planning process: to consistently strive to make decisions and create solutions that result in a patient-centred environment, where patients want to go for care and where top healthcare professionals want to practice and teach utilising the latest healthcare technologies.

In the healthcare facilities planning process, this is accomplished by making the design process a collaborative effort involving every member of the care team. Healthcare planners work in close collaboration with doctors, nurses, quality experts and administrative leaders, all of whom bring a unique perspective on healthcare. We use tools such as computer-generated prototypical designs to simulate and study workflows within the hospital, and instigate discussions aimed at discovering how best to create effective models of delivery that meet their needs.

Addressing regulatory obstacles

The local regulatory environment is another key factor which healthcare developers and institutional leaders must consider in developing a sound development strategy. Often, healthcare regulations lag far behind current medical practice and present obstacles to forward-looking planning. This is particularly true in the developing economies where healthcare facilities have long been neglected and a rapidly expanding economy is now propelling rapid advancement in the state of care. Often, executive leaders fail to understand or consider the negative impact these regulations may have on the long-term success of their institution. In other instances they simply do not feel empowered to challenge the regulations that are out of step with advances in healthcare. We have learned that developers and institutions can influence public policy-for the betterment of healthcare delivery-through their own projects. By proactively engaging regulators early in the design process, it is often possible to identify issues of mutual concern and a strategy for addressing them. Often, projects may be used as pilots for new models, which local government officials may then use to demonstrate the effectiveness of proposed regulatory changes. It's a win-win situation for all involved, and can produce a powerful ripple effect throughout the broader healthcare community.

Global examples indicate the way forward

Not very long ago, the US academic medical centres stood alone as examples of state-of-the-art facility design. Today, innovations in healthcare facilities are taking place in all corners of the globe. In response to the catastrophic SARS outbreak of 2003, Chinese architects and engineers are creating new models for control of airborne infection. In Australia, design teams are assisting government officials in responding to a massive public outcry for improved quality of care. Lower population densities in that part of the world are driving providers to more distributed, community-based models of care that in turn will rely on highly advanced IT systems. In the UK, design firms are exploring modular prefabricated systems in an effort to build ambulatory clinics quickly and cost-effectively to meet demand for greater access to quality care. These are just a few examples of the kinds of innovation that will define healthcare environments of the future. Healthcare facilities must continue to be designed to respond to local context and needs, but increasingly, healthcare leaders will look to all corners of the globe for inspiration.


Judith D Mitchell is Director of Planning at Harvard Medical International. She has served as a consultant to Harvard Medical International since 1996 and joined HMI on a full time basis in 2000. She consults with HMI's partners in the early stages of planning on real estate development strategies, master planning and regulatory issues. She is a member of the American Institute of Architects and currently serves on the National Advisory Board to the American Institute of Architects Committee on International Practice.