De-risking healthcare delivery through smarter design and construction

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9 February 2023 | 9 min | Featured article

By its very nature, healthcare facility design and construction involves a significant level of risk – financial, timeline, political and quality. What the COVID-19 pandemic has shown is that facilities must adapt to new external pressures very quickly, including responding to changing models of care, societal demands and medical treatment advancements.

Governments have made significant commitments to deliver healthcare infrastructure over the coming years, including approximately AUD 8 billion in Victoria; AUD 11.9 billion in New South Wales and AUD 9 billion in Queensland. The New Zealand Government has committed NZD 1.3 billion in capital investment.

"How can industry become smarter around delivering healthcare outcomes for today’s people and future generations?"

Demand for services continues to increase, exacerbated by an ageing and expanding population, scarce and costly construction materials, and widespread labour shortages. The war in Ukraine has led to higher fuel prices, increased power costs and timber shortages, resulting in greater construction challenges.

Despite rising interest rates, which should slow construction activity and relieve some of the pressure, it is predicted that construction costs will continue to increase. For example, the figures in Australia are a 6.9 per cent rise in Sydney, 8 per cent in Melbourne, and, even higher, a 10.5 per cent in Brisbane^[1]. In such an environment, how can industry become smarter around delivering health facilities in a timely and cost-effective manner, while also delivering the healthcare outcomes for today’s people and future generations.

Aurecon explores these challenges and potential solutions to consider in our Healthcare Reimagined thought leadership series.

In this article, Aurecon’s Industry Leader, Health, Education and Research, Hayley Wardrop, and Health Leader, Queensland, Robbie Claase, explore how de-risking healthcare infrastructure delivery can allow facilities to flex with changing community needs and unpredictable external events, while also optimising cost, quality and efficiency.

De-risking delivery is a collective outcome. Consequently, the guidelines needed to inform investment decisions will involve the blending of the following five smart design and construction considerations:

1. Understanding the user journey and health ecosystem

To address a modern salutogenic model of healthcare with staffing shortages, personalisation of health services, increasing regulations, and ageing infrastructure, health facility developers and owners are looking for ways to minimise impacts on patient service levels.

There’s a symbiotic relationship between the culture, health processes and engineering design of a healthcare facility, which couples care with function.

The most obvious is being able to create healthcare environments that promote long-term, preventative health and well-being outcomes. From a design perspective, this involves placing users (patients and staff) at the centre of design to determine a structural layout that allows people to move through spaces easily and navigate flow pathways in a timely manner. In addition, it involves the design of environments inside clinical settings that mimic nature, with areas for pleasant escape to ease stressful situations.

The health sector has the highest attrition rate in the Australian labour force, so by placing users at the centre of design, facilities become attractive places to work. Designs need to consider their need for efficiency and workflow with rooms that are multifunctional and can adapt to changing models of care, efficiently supporting staff movement and their expected level of service provision.

CASE STUDY

New Royal Adelaide Hospital, South Australia

The New Royal Adelaide Hospital was planned, designed and built around the needs of patients and staff. With nearly four hectares of green space, there is a strong focus on natural light and environment.

All general inpatient beds are single rooms to provide high-quality and personalised care, a healing environment, high levels of privacy and infection control. Key features of rooms and gathering spaces include windows that open to allow access to fresh air with views to surrounding parklands and gardens.

2. Adaptability for the future

The pandemic brought into sharp focus the need for healthcare infrastructure to be flexible and adaptable. If resilience and adaptability is designed into a project, there’s less risk of costly changes in the future. Above all, this means that the provision of health services can continue to meet changing demands which makes work better for staff, and health service experiences better for patients.

Historically, a limitation to achieving this was that physical hospital structures were built with a long design life of 50 or 100 years. What these designs haven’t necessarily accounted for are the pandemics, climate change impacts, rapidly changing models of care or technological advancements we’re experiencing today. In the future, the risk is that existing spaces won’t be able to adapt to, or adequately respond to, these concurrent influences.

How do design teams evaluate all design possibilities to deliver the most flexible spaces without a large budget impact? This will involve de-risking the delivery of facilities so they can be repurposed to suit future needs as and when required:

Conceptually designing interior rooms to minimise wasted space and provide adaptability, maximise the flow of people and minimise cross infection.
Allowances in the structural form and building services systems. The adoption of a structural grid design approach to the location and function of mains services, risers and system distributions. This is made possible by using upper rigid structural support grids, combined with increasing structural spans, to provide a greater volume of open interior space while taking advantage of material strength.
Digital engineering and analysis tools with flexibility for more advanced structural and services solutions able to be modelled digitally to determine which design is best-for-fit.

Together, these de-risking elements also create the opportunity to reduce embodied carbon and increase sustainability by maximising space, reducing materials usage and being able to reuse formwork in the future. An example of this application is the Gandel Wing at Cabrini Hospital in Melbourne, Victoria.

Every aspect of the design was scrutinised from the perspective of the patient and staff, rather than solely around the requirements of equipment, building services and site configuration. The structural layout was optimised to afford natural light and views towards nature from each room. All floors comprise long spans to reduce the number of columns so that spaces are maximised and future layout changes can be accommodated.

Achieving climate resilience for healthcare facilities - Aurecon

3. Climate resilience

Achieving climate resilience will involve identifying environmental factors that may threaten the future performance of healthcare facilities, such as rising temperatures, severe storms and floods, bushfires and increasing sea levels.

Project specific resilience plans, and upgrade plans, can be developed in response to the identified environmental factors, and in recognition of the fact that future works need to contribute to decarbonisation.

A community resilience plan is also developed prior to occupation of a hospital project, relevant to the preparation required for a potential event, and the action to be taken during and after. It needs to address the requirements for staff and patient safety, together with the anticipated healthcare facility needs of communities in response to environmental factors. Each plan outlines the mitigation and minimisation measures to be put in place by the health facility.

4. Digital design

Greenfield spaces for expanding facilities are in short supply so many developments require new buildings to fit together with existing structures, like a neat puzzle. The limitation to these brownfield developments is usually the lack of accurate as-built information to enable smart and efficient interface decisions to be made early in the design phase.

What’s exciting for de-risking healthcare delivery is that digital engineering can configure the integration of new buildings with existing structures.

One example is using digital scanning, for example digital point cloud surveys, to capture the current as-built state of services and structures at key interfaces. The data is then converted into a 3D model used to document the required upgrade works.

There are 360° photograph methods that can also complement digital scanning data to make it more easily accessible and understandable to a broader audience. Such a combination of data both reduces the interface risk and helps build an understanding of the site, its constraints and opportunities.

Employing today’s digital techniques makes utilising brownfield development sites less risky by reducing uncertainty throughout the construction phase, whilst also making certain that facilities are multi-functional, adaptable and resilient.

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5. Modern methods of construction

Market conditions affect all health facility projects: pressing delivery schedules, supply chain constraints, finite budgets, labour shortages and climate change impacts and transition risks.

These factors, together with the sheer volume of projects to be delivered in coming years, are pushing the healthcare sector to find innovative ways to deliver infrastructure sooner, together with reducing patient disruptions and retaining high-quality built form outcomes.

Embracing modern methods of construction (MMC) is one way to de-risk delivery, with its ability to rapidly deliver high-quality, bespoke and sustainable facilities in line with patient and staff needs.

Mass and rapid deployment of infrastructure through standardisation helps to de-risk timeframes for construction. How it does this is by incorporating a range of approaches spanning off-site, near-site and on-site premanufacturing.

Infrastructure is delivered to site with efficiencies realised through the repetition-based core shell and some standardised elements (such as bathrooms and plant rooms), but also allows for bespoke building shapes, façade treatments and architectural uniqueness across a programme of concurrent deliverables (Figure 1).

Figure 1: The circular process of modern methods of construction to deliver a program of concurrent projects.

An example of MMC is the Monash Medical Centre Emergency Department expansion in Melbourne, Victoria.

In response to the rapidly emerging crisis of the COVID-19 pandemic, Monash Medical Centre Emergency Department urgently required additional accommodation to treat and isolate patients presenting with COVID-19.

The existing Emergency Department at Clayton was undergoing a major reconfiguration and expansion project and as such there was no opportunity for the hospital to respond to the evolving COVID-19 escalation through the conversion of existing operational areas into isolation and resuscitation bays. Monash Health therefore decided to construct a temporary resuscitation unit to expand the facilities available to assist in the quarantining of critically ill patients during the pandemic.

Aurecon designed ventilation, electrical, fire protection and hydraulic solutions to meet the critical clinical and functional requirements of the modular units – including containment via negatively pressured ventilation and HEPA filtration of exhaust from each bed bay. Complete rooms to isolate and treat patients were manufactured and built to the specifications of Monash Health.

The temporary facility has now been relocated to another Monash Health campus to be re-utilised, with the Monash Medical Centre Emergency Department Expansion Project now complete.

Young girl playing badminton with her family at park.

How can we reimagine our healthcare infrastructure to provide an agile, sustainable, and efficient healthcare system?

A significant mindset shift is required by organisations across the supply chain to reimagine how design and construction of infrastructure is approached using MMC, particularly in the way that earlier stages of design must be more detailed than a traditional building programme.

This is for several reasons:

The need to control assembly tolerances since components cannot easily be realigned onsite
To inform onsite works (such as foundations and building services), which occur in parallel with the factory build

Considerations for project owners are the need to garner user input to a precinct’s form and function early in the planning phase, and how a structure’s layout can adapt well in the future when environmental factors dictate a change.

The benefits of adopting MMC include maintaining a facility’s existing operations with minimal disruption by construction works; faster builds; minimal material wastage; and better scope for reuse or recycling of modules.

Digital design is a great enabler of MMC, able to digitally represent multiple iterations of building design rapidly, envision configuration changes in the future, and determine how new structures can fit with existing assets – particularly within tightly constrained spaces.

De-risking healthcare delivery

De-risking delivery requires a holistic approach across the entire health ecosystem. It starts with understanding the user journey and continues through the design and delivery of infrastructure that is adaptable, resilient, smart and cost-effective – for today and tomorrow.