New Trends in Healthcare and their Impacts on Hospital Planning and Design by Dr Musa T. Ajlouni

2/20/2015 Dr Musa Ajluni 1

New Trends in Healthcare and theirNew Trends in Healthcare and theirImpacts on Hospital Planning andImpacts on Hospital Planning and

DesignDesignاالتجاھات الحدیثة في األنظمة الصحیة وانعكاساتھا على تصمیم االتجاھات الحدیثة في األنظمة الصحیة وانعكاساتھا على تصمیم

وتخطیط المستشفیاتوتخطیط المستشفیات

New Trends in Healthcare and theirNew Trends in Healthcare and theirImpacts on Hospital Planning andImpacts on Hospital Planning and

DesignDesignاالتجاھات الحدیثة في األنظمة الصحیة وانعكاساتھا على تصمیم االتجاھات الحدیثة في األنظمة الصحیة وانعكاساتھا على تصمیم

وتخطیط المستشفیاتوتخطیط المستشفیاتCollege of Architecture and Design

20 Nov 2008

College of Architecture and Design

20 Nov 2008

Dr Musa T. Ajoluni


ContentsContentsContentsContents

üDefinition of Health and Nature of Health ServicesüüFunctions of the Health Care SystemFunctions of the Health Care SystemüüNew Trends in Health CareNew Trends in Health CareüCharacteristics of Hospital ServicesüüNew Trends in Hospital CareNew Trends in Hospital CareüüGood Hospital Design: User PerspectiveGood Hospital Design: User Perspective


“We shape our buildings andthereafter our buildingsshape us”

Winston Churchill


The two big challenges of the HealthSector are:

“Quality and Cost”


Health as Defined by WHO:Health as Defined by WHO:Health as Defined by WHO:Health as Defined by WHO:

Health is not only the absence ofHealth is not only the absence ofdisease but a state of physical,disease but a state of physical,mental and social wellmental and social well--being thatbeing thatenables individuals to live economicenables individuals to live economicand social productive lifeand social productive life

Health is not only the absence ofHealth is not only the absence ofdisease but a state of physical,disease but a state of physical,mental and social wellmental and social well--being thatbeing thatenables individuals to live economicenables individuals to live economicand social productive lifeand social productive life


Nature of Health Services

• Intangibility– Have no permanent physical qualities can not

be touched and possessed over time.• Inseparability of Production and

Consumption– The production of a service cannot be

separated from its consumption by thecustomer.


Nature of Health Services (cont’d)

• Heterogeneity– Variation in the quality of services delivered by

individuals and organizations• Client-Based Relationships

– Interactions that result insatisfied customers whouse a service repeatedlyover time


NoNo singlesingle descriptiondescription cancan fullyfully depictdepictthatthat fearful,fearful, hopeful,hopeful, andand oftenoften miserablemiserablehumanhuman beingbeing whowho isis thethe patientpatient.. ToTo somesomehehe isis aa number,number, toto othersothers nuisance,nuisance, totoothersothers aa shadowshadow;; andand toto himselfhimself hehe isis ananenigma,enigma, oftenoften ignorantignorant ofof hishis condition,condition,apprehensiveapprehensive aboutabout hishis prospects,prospects, andandembarrassedembarrassed aboutabout thethe situationsituation ininwhichwhich hehe findsfinds himselfhimself..

NoNo singlesingle descriptiondescription cancan fullyfully depictdepictthatthat fearful,fearful, hopeful,hopeful, andand oftenoften miserablemiserablehumanhuman beingbeing whowho isis thethe patientpatient.. ToTo somesomehehe isis aa number,number, toto othersothers nuisance,nuisance, totoothersothers aa shadowshadow;; andand toto himselfhimself hehe isis ananenigma,enigma, oftenoften ignorantignorant ofof hishis condition,condition,apprehensiveapprehensive aboutabout hishis prospects,prospects, andandembarrassedembarrassed aboutabout thethe situationsituation ininwhichwhich hehe findsfinds himselfhimself..

TheThe PatientPatientTheThe PatientPatient


qAt the moment most hospitalenvironments say to the patients, ineffect: “How you feel is unimportant.You are not of value. Fit in with us, notus with you.”qWith very little effort and money this

could be changed to something like:"Welcome! And don’t worry. We arehere to reassure you and your treatmentwill be good and helpful to you.”


PhysicalPhysicaland Geneticand Genetic

FactorsFactors

PhysicalPhysicaland Geneticand Genetic

FactorsFactors

EconomicEconomic

and Socialand SocialFactorsFactors

EconomicEconomic

and Socialand SocialFactorsFactors

EnvironmentalEnvironmentalFactorsFactors

EnvironmentalEnvironmentalFactorsFactors

LifeLife--stylestyleFactorsFactors

LifeLife--stylestyleFactorsFactors

HealthHealthServicesServicesHealthHealth

ServicesServices

Factors Affecting Health StatusFactors Affecting Health StatusFactors Affecting Health StatusFactors Affecting Health Status

HealthHealthStatusStatusHealthHealthStatusStatus


Interaction Among Major SystemsInteraction Among Major SystemsInteraction Among Major SystemsInteraction Among Major Systems

PoliticalPoliticalSystemSystem

PoliticalPoliticalSystemSystem

Social SystemSocial SystemSocial SystemSocial System

HealthHealthSystemSystemHealthHealthSystemSystem

EconomicEconomicSystemSystem

EconomicEconomicSystemSystem


Functions of the Health Care SystemFunctions of the Health Care SystemFunctions of the Health Care SystemFunctions of the Health Care SystemqqPreventive ServicesPreventive ServicesqqPrimary CarePrimary Care

qqSecondary & Tertiary CareSecondary & Tertiary Care

qqRestorative & Continuing CareRestorative & Continuing CareqqTraining and EducationTraining and Education

qqPreventive ServicesPreventive ServicesqqPrimary CarePrimary Care

qqSecondary & Tertiary CareSecondary & Tertiary Care

qqRestorative & Continuing CareRestorative & Continuing CareqqTraining and EducationTraining and Education


qqResearchResearch

qqProduction ,Distribution andProduction ,Distribution andMonitoring of PharmaceuticalsMonitoring of Pharmaceuticals

qqManagement of Emergency andManagement of Emergency andRescue ServicesRescue Services

qqFinancing and Health InsuranceFinancing and Health Insurance

qqGovernance and MonitoringGovernance and Monitoring

qqResearchResearch

qqProduction ,Distribution andProduction ,Distribution andMonitoring of PharmaceuticalsMonitoring of Pharmaceuticals

qqManagement of Emergency andManagement of Emergency andRescue ServicesRescue Services

qqFinancing and Health InsuranceFinancing and Health Insurance

qqGovernance and MonitoringGovernance and Monitoring


New Trends in Health CareNew Trends in Health CareNew Trends in Health CareNew Trends in Health Care

1.1. Health ConceptHealth Concept (QALY)(QALY)2.2. Morbidity TrendsMorbidity Trends ((epidemiological transition):

§ Changes in disease pattern§ Shifting burden of illness toward

noncommunicablechronic diseases and injuries

§ Double Burden of Disease

1.1. Health ConceptHealth Concept (QALY)(QALY)2.2. Morbidity TrendsMorbidity Trends ((epidemiological transition):

§ Changes in disease pattern§ Shifting burden of illness toward

noncommunicablechronic diseases and injuries

§ Double Burden of Disease

:


Disease Picture in Jordan• Jordan, like other middle income

countries, is witnessing anepidemiological transition, which ischaracterized by an increase of non-communicable diseases, particularlycardiovascular diseases, cancer,diabetes and chronic respiratoryconditions.

New Trends in Health CareNew Trends in Health Care (cont.)New Trends in Health CareNew Trends in Health Care (cont.)


• Chronic health problems are nowbecoming the leading causes ofmortality in Jordan withcardiovascular diseases and canceralone responsible for more thanhalf of all deaths.



33..Demographic Transition:Demographic Transition:

§Population growth rates will fall§Life expectancies will increase§Fertility rates will decline in allregions



East Asiaand Pacificpopulationpyramids,2005 and2025


Figure 2.4: Total Fertility Rate, Jordan

01234

56789

1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050

Year

Birt

hs p

er w

oman

, ove

r life

time

Source: United Nat ions Populat ion Division, 1998 World Populat ion Prospects


•• Preventative care versusPreventative care versussickness care; designingsickness care; designinghospitals as allhospitals as all--inclusiveinclusive"wellness centers""wellness centers"


44.. Health Delivery TrendsHealth Delivery Trends•• Extended CareExtended Care•• Home CareHome Care•• Day CareDay Care

44.. Health Delivery TrendsHealth Delivery Trends•• Extended CareExtended Care•• Home CareHome Care•• Day CareDay Care



5.5. Health Promotion and MaintenanceHealth Promotion and Maintenance6.6. Wholeness PerspectiveWholeness Perspective7.7. Care vs. CureCare vs. Cure

New Trends in Health Care(cont.)New Trends in Health Care(cont.)New Trends in Health Care(cont.)New Trends in Health Care(cont.)


8.Medical technology Trends

Technology moves fasterthan the speed of medicine,designers should be at theabsolute forefront ofcombining specializedservices with world classdesign to create the nextwave of technology-enhanced hospitals.


99.Patient driven.Patient driven• A growing interest in more holistic, patient-

centered treatment and environments .Thismight include providing mini-medicallibraries and computer terminals so patientscan research their conditions andtreatments, and locating kitchens and diningareas on inpatient units so family memberscan prepare food for patients and families toeat together.


10.High ExpectationsA more demanding andsophisticated consumer isdriving new changes in thedesign and delivery of healthcare and health-relatedenvironments. Hospitalsresemble hotels while centersof excellence are demandinginnovative thinking in terms ofoperations and technology.


11.11.Turbulent environmentTurbulent environment12.12.Limited resourcesLimited resources13.13. High CostHigh Cost14.14. Stem CellsStem Cells15.15. Genome MapGenome Map

New Trends in Health Care(cont.)New Trends in Health Care(cont.)New Trends in Health Care(cont.)New Trends in Health Care(cont.)


1900 1950 1970 2000 2025 2050

Sanitation

87

84

81

77

71

68

47

BasicDiagnostics/TreatmentModalities

(i.e.Antibiotics)

Progressin HeartDisease

Diagnosis/

Treatment

HealthCare IT

Genomics

Average LifeSpan in the US

Health Care ImprovementsHealth Care Improvements


• Use of hand-held computers and portablediagnostic equipment to allow moremobile, decentralized patient care, and ageneral shift to computerized patientinformation of all kinds. This mightrequire computer alcoves and data portsin corridors outside patient bedrooms.

1616..Information & CommunicationInformation & CommunicationTechnologyTechnology


Today Tomorrow

Location Hospital Decentralized, at home

Time Symptomatic, curative Preventive, lifetime

Focus On the process and provider On the patient

Scope Cure Patients Care for Citizens

Methods Invasive Less invasive

Healthcare is changing…Healthcare is changing…


Characteristics of Hospital Services

§ Individualistic ,Not Standardized§ Sensitivity of Services§ Humanistic, depends mainly on

Human Inputs§ High Professionalism


Characteristics of HospitalCharacteristics of HospitalServices(cont.)Services(cont.)

§ Diversity : HR, Patients (Internaland External customers§ Heterogeneity and complexity of

services§ Clinical Freedom.§ 24 Hours Operation§ Interdependence of Sub-Systems


اقسـام المرضـىالعيادات الخارجيةوالطوارئ

االطفال.. الباطنية النفسية .. الجراحة الخ.... التوليد

الخدمات المساندةالمختبرات

االشعةالطب الطبيعي

الصيدلية الخدمة االجتماعيةالتطوير الطبي السجالت الطبية

اقســام الخدمــات خدمات الطعام

التدبير المنزلي والمصبغةالتعقيــــــــم

المستودعات الصيانة

Interdependenceof Sub-Systems


غرفة الفحص

غرفة تحضير العالجا

ت

محطة التمريض

المستودع

المطبخ

غرفة المريض

المختبر

غرفة العمليات

غرفة الوالدة

االشعة



غرفة غيار االطباء

غرفة غيار الممرضات

التنظيفوالغسيل

المواد المعقمة

غرفة الوالدةواإلنعاش

الحاضنات

غرفة

التحضير

قاعة مرضى الوالدة

غرفة المخاض

الدخول

الخروج



§ Most work has urgencydimention(can not wait)

§ Mistakes and Ambiguity are nottolerated

§ Traffic(people,materials,equipment,information)

§ High Pace of Change .

Characteristics of HospitalCharacteristics of HospitalServices(cont.)Services(cont.)


The Most Complex Organization

• “Even small healthcare institutionsare complex, barely manageableplaces… Large healthcareinstitutions may be the mostcomplex organizations in humanhistory.”

- Peter Drucker


New Trends in Hospital CareNew Trends in Hospital CareNew Trends in Hospital CareNew Trends in Hospital Care§§ ShortShort HospitalHospital StayStay (ALOS)(ALOS)

§§ IntegrationIntegration ofof ambulatoryambulatory andand InpatientInpatient CareCare

§§ MoreMore FocusFocus onon DiagnosticDiagnostic FacilitiesFacilities

§§ ShortShort HospitalHospital StayStay (ALOS)(ALOS)

§§ IntegrationIntegration ofof ambulatoryambulatory andand InpatientInpatient CareCare

§§ MoreMore FocusFocus onon DiagnosticDiagnostic FacilitiesFacilities

§§ HealthHealth-- shoppingshopping (one(one-- stopstop-- shopping)shopping)

§§ FutureFuture medicalmedical MallMall (( shops,shops, bank,bank,sports,sports, fitnessfitness centre,centre, nurses’nurses’ school,school,kindergarten)kindergarten)..

§§ HotelHotel associatedassociated withwith hospitalshospitals

§§ HealthHealth-- shoppingshopping (one(one-- stopstop-- shopping)shopping)

§§ FutureFuture medicalmedical MallMall (( shops,shops, bank,bank,sports,sports, fitnessfitness centre,centre, nurses’nurses’ school,school,kindergarten)kindergarten)..

§§ HotelHotel associatedassociated withwith hospitalshospitals


§More Privatization and Payment Sharing§More focus on Hotel Services (Amenities)§ Open Visit Hours§More patient Privacy§ Open medical chart§More Private rooms§More Competition

New Trends in Hospital Care (cont.)New Trends in Hospital Care (cont.)New Trends in Hospital Care (cont.)New Trends in Hospital Care (cont.)


§§ The call for more hospitality and familiarity:The call for more hospitality and familiarity:ü Bright entrance

ü Friendly welcome zone

ü Home-like hospitals

ü Nicely designed gardens

ü Natural materials, natural daylight

ü Help to diminish anxieties

§§ The call for more hospitality and familiarity:The call for more hospitality and familiarity:ü Bright entrance

ü Friendly welcome zone

ü Home-like hospitals

ü Nicely designed gardens

ü Natural materials, natural daylight

ü Help to diminish anxieties



§§ QQIQQI

§§ CostCost ContainmentContainment

§§ DayDay CareCare UnitsUnits

§§ PaperlessPaperless DigitalDigital HospitalsHospitals




§§Maintenance firstMaintenance first§§Small & medium size hospitalsSmall & medium size hospitalsvs. large hospitalsvs. large hospitals§§General vs. Specialized HospitalsGeneral vs. Specialized Hospitals§§More affiliation and sharingMore affiliation and sharing


§ Growth and Adaptation:H A hospital facility will never be

complete

H It is born to grow. Finished formsare to be avoided

H We need Hospital designs whichallow changes and extensions,independent of size or age ofbuildings



§ Adaptation to:

ü Medical progress technology

ü Patients needs

ü Political changes

Must beleft open



Order Process Manual Automated

Experience Individual Best Practices

The Process Fragmented, isolated disease mgt.

ClinicalDecisions Personal preferences Guide lines / evidence based

The processes are changing …The processes are changing …

Information Fragmented, isolated Consolidated / complete

Today Tomorrow


Traditional Versus Patients OrientedHospitals

Patients OrientedHospitals

TraditionalHospitals

Patients

Patients


New Hospital vs. old HospitalNew Hospital vs. old HospitalNew Hospital vs. old HospitalNew Hospital vs. old Hospital

OldOld ModelModel NewNew ModelModel OldOld ModelModel NewNew ModelModel InstitutionalInstitutional WelcomingWelcoming InstitutionalInstitutional WelcomingWelcoming

HospitalHospital asas centrecentre PartPart ofof communitycommunity networknetwork HospitalHospital asas centrecentre PartPart ofof communitycommunity networknetwork

DiseaseDisease basedbased WellnessWellness basedbased DiseaseDisease basedbased WellnessWellness basedbased

PhysiciansPhysicians asas providersproviders PhysiciansPhysicians asas partnerspartnersPhysiciansPhysicians asas providersproviders PhysiciansPhysicians asas partnerspartners

PatientPatient andand familyfamily asas consumersconsumersPatientPatient andand familyfamily asas consumersconsumers

Ambulatory care and inpatient facilityAmbulatory care and inpatient facilityAmbulatory care and inpatient facilityAmbulatory care and inpatient facility

Quantity focused Quality and cost focusedQuantity focused Quality and cost focusedQuantity focused Quality and cost focusedQuantity focused Quality and cost focused

Patient subjects of treatmentPatient subjects of treatmentPatient subjects of treatmentPatient subjects of treatmentInpatient facilityInpatient facilityInpatient facilityInpatient facility


The Hospital as a Medical Knowledge Factotory

Medical Knowledge

High QualityCost Effective

needsActivities InformationAssessmentneeds

produces


التصمیم الجید للمستشفى من وجھة نظر المستخدمالتصمیم الجید للمستشفى من وجھة نظر المستخدم(Good Hospital Design: A User Perspective)(Good Hospital Design: A User Perspective)

التصمیم الجید للمستشفى من وجھة نظر المستخدمالتصمیم الجید للمستشفى من وجھة نظر المستخدم(Good Hospital Design: A User Perspective)(Good Hospital Design: A User Perspective)

والجمالیةوالجمالیةالنفسیةالنفسیةالعواملالعوامل§§ المرضىالمرضىقبلقبلمنمنوالثقةوالثقةالرضاالرضاوالجمالیةوالجمالیةالنفسیةالنفسیةالعواملالعوامل§§

والموظفینوالموظفینللمرضىللمرضىالنفسیةالنفسیةالراحةالراحة

المحليالمحليالمجتمعالمجتمعرضىرضى

المجاورةالمجاورةاالبنیةاالبنیةمعمعالتناسقالتناسق

المرضىالمرضىقبلقبلمنمنوالثقةوالثقةالرضاالرضا

والموظفینوالموظفینللمرضىللمرضىالنفسیةالنفسیةالراحةالراحة

المحليالمحليالمجتمعالمجتمعرضىرضى

المجاورةالمجاورةاالبنیةاالبنیةمعمعالتناسقالتناسق


العملالعملوضغطوضغطالخدمةالخدمةحجمحجم

الخدماتالخدماتبینبینالمتبادلةالمتبادلةالعالقاتالعالقاتواالقسامواالقسام

داخلداخلوالحركةوالحركةالعملالعملتدفقتدفقنماذجنماذجالمستشفىالمستشفى

العملالعملوضغطوضغطالخدمةالخدمةحجمحجم

الخدماتالخدماتبینبینالمتبادلةالمتبادلةالعالقاتالعالقاتواالقسامواالقسام

داخلداخلوالحركةوالحركةالعملالعملتدفقتدفقنماذجنماذجالمستشفىالمستشفى

النواحي العملیة النواحي العملیة §§ النواحي العملیة النواحي العملیة §§

الجید للمستشفى من وجھة نظر الجید للمستشفى من وجھة نظر التصمیمالتصمیم(User Perspective)(User Perspective)المستخدمالمستخدم

الجید للمستشفى من وجھة نظر الجید للمستشفى من وجھة نظر التصمیمالتصمیم(User Perspective)(User Perspective)المستخدمالمستخدم

..النواحي الفنیةالنواحي الفنیة§§ ..النواحي الفنیةالنواحي الفنیة§§


سھولة الوصول إلى الخدمة من قبل المریض سھولة الوصول إلى الخدمة من قبل المریض ••AccessibilityAccessibilityومقدم الخدمة ومقدم الخدمة

AdaptationAdaptationالمرونةالمرونة••Economy and efficiencyEconomy and efficiencyاالقتصاداالقتصاد••SafetySafetyاألمان األمان ••

التصمیم الجید للمستشفى من وجھة نظر التصمیم الجید للمستشفى من وجھة نظر (User Perspective)(User Perspective)المستخدمالمستخدم

التصمیم الجید للمستشفى من وجھة نظر التصمیم الجید للمستشفى من وجھة نظر (User Perspective)(User Perspective)المستخدمالمستخدم


“We shape our buildings andthereafter our buildingsshape us”

Winston Churchill


sustainabilityWe needWe needsustainable designsustainable designpractices topractices topreserve andpreserve andensure the needsensure the needsof futureof futuregenerations.generations.


•• Architects, engineers andArchitects, engineers anddesigners should create facilitiesdesigners should create facilitiesthat don’t simply serve asthat don’t simply serve ashealth carehealth care--delivery sites, butdelivery sites, butthat actuallythat actually enhance the careenhance the carebeing delivered.being delivered.

•• Architects, engineers andArchitects, engineers anddesigners should create facilitiesdesigners should create facilitiesthat don’t simply serve asthat don’t simply serve ashealth carehealth care--delivery sites, butdelivery sites, butthat actuallythat actually enhance the careenhance the carebeing delivered.being delivered.


placemakingcreates environments thatcelebrate the human condition– places where people feelcomfortable, safe, part of alarger community. This takesan understanding of thebroader issues of context,scale and the public realm asmuch as an emphasis on detailand quality.


Florida HospitalWatermanTavares, Florida


§§ NewNew designdesign modelsmodels shouldshouldpromisepromise:: LOWERLOWER COSTCOST &&HIGHHIGH QUALITYQUALITY OFOF CARECARE““ONEONE SIZESIZE FITSFITS ALLALL”” isis nonomoremore validvalid..

§§ NewNew designdesign modelsmodels shouldshouldpromisepromise:: LOWERLOWER COSTCOST &&HIGHHIGH QUALITYQUALITY OFOF CARECARE““ONEONE SIZESIZE FITSFITS ALLALL”” isis nonomoremore validvalid..


§§ AsAs healthhealth carecare designers,designers,youryour missionmission shouldshould bebe totoimproveimprove thethe healthhealth carecareexperienceexperience forfor thethe consumerconsumerandand providerprovider aa likelike..

§§ AsAs healthhealth carecare designers,designers,youryour missionmission shouldshould bebe totoimproveimprove thethe healthhealth carecareexperienceexperience forfor thethe consumerconsumerandand providerprovider aa likelike..


IntegratingIntegrating DesignDesign andand CareCareshouldshould bebe ourour avenueavenue totoqualityquality andand costcost effectiveeffectivehealthhealth carecare..

IntegratingIntegrating DesignDesign andand CareCareshouldshould bebe ourour avenueavenue totoqualityquality andand costcost effectiveeffectivehealthhealth carecare..

Design

Care


Thank You

New Trends in Healthcare and their Impacts on Hospital Planning and Design by Dr Musa T. Ajlouni

Healthcare

Transcript of New Trends in Healthcare and their Impacts on Hospital Planning and Design by Dr Musa T. Ajlouni