Thonburi Bamrungmuang Hospital
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Healthcare After Covid-19
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On the Frontline: How the COVID-19 Crisis is Challenging Our Thinking About Health Design Hospitals and healthcare centres are where the frontline battles are being fought against COVID-19 – and the pandemic has forced a rapid re-evaluation of these spaces. Designers and architects are already identifying new opportunities, in particular the need for greater flexibility. This will be essential in dealing with future pandemics and outlier events that create temporary surges in demand for healthcare every five to 10 years. “One of the largest lessons that has been learnt during the COVID-19 crisis is that our current approach to minimising the total number of beds in hospitals is very short-term thinking,” says dwp Group Health Sector Leader, Ron Bridgefoot. “The ability to provide flexible spaces that can be quickly converted to bedrooms for patients will become an important aspect of healthcare design.” This kind of flexibility won’t just need to be built into hospitals. As a recent article in the Lancet describes, the conversion of public venues, such as stadiums and exhibition centres, into healthcare facilities to isolate patients with mild to moderate symptoms of an infectious disease will also become more commonplace. Thinking ahead even further, there is the opportunity to develop devoted “health precincts” with hotels or other accommodation that have the facilities to be quickly converted to “medi-hotels” with good connection to the main health campus at times of need. In this way, isolation can be maintained in as normal a setting as possible during any possible outbreaks. “Hotels are a key component of the overall strategy for a pandemic,” says Bridgefoot. “The ability to have them close to a hospital is one thing, but the ability to take them over for use by people who need to be isolated is essential. Having a two-week quarantine in hotels for all travellers coming into the country, for example, is how Australia stopped a lot of cases.” As a consequence of the pandemic people have become more aware of personal space and distancing, and the focus in health design projects will shift toward the customer or patient. In particular, there will be new thinking about how to keep families connected in healthcare environments, through both safe physical spaces and technology. One of the consistent aspects of COVID-19 treatment has been the disconnect between the patients and their families. “I think we as designers need to come up with ways to stay connected to loved ones and design and build that into our spaces,” says Diana Anderson, a geriatric medicine fellow at the University of California, San Francisco. “I think preventing dying alone should be paramount.” It’s not only about how health design will change in a post-COVID-19 world, but also how it will increasingly influence other sectors. In a world that champions hygiene, cleanliness and safety, health design will begin to play a much more active role in informing myriad spaces, from the workplace to hospitality. Nowhere will this be more apparent than in the increased specification of durable, hygienic, and easy-to-clean materials. Another aspect of health and wellness design that will take on new value in a post-COVID-19 world is the use of innovative technologies, such as automatic doors, touch-less technology and the use of apps for registration, consultation and treatment. Going forward, the use of these technologies will increase – not only in health design but across all sectors – and this will be reflected in the way that mechanical and electrical systems evolve. "As we recover from the current crisis and prepare for any future outlier events, it is essential that we provide safe, flexible spaces for health and wellness that can deliver meaningful differences for both patients and staff,” says Bridgefoot. “The built environment, however, is just one part of a successful healthcare system and, as architects and designers, we must work collaboratively to ensure that the spaces we create support the system as a whole. It will also be essential to identify the lessons that healthcare design can offer for many other sectors to ensure we are creating safe, comfortable environments for all.” What Could the Future of Health Design Look Like? “The entire context in which we design has shifted and this changes what, how, and why we design from now on,” says dwp Regional Managing Director Australia, Michael Hegarty. “We have initiated a new program of work that we have named ‘dwp|imagine’ that seeks to keep us forward focussed and innovative in our thinking, and we will adapt to the changing needs of our clients and their project end users. Our cities have challenges of proximity and density to manage pandemics that will change the nature of urban space. Our dwp designers will learn the lessons of how spaces perform in a pandemic, including a priority being given to the wellbeing of occupants, cleaning regimes, flexibility and technical performance.” An Adaptable Future Flexibility is key to the future of health design, and the ability of care facilities to quickly respond to changing needs means a rise in spaces that enable easy adaptation. During the COVID-19 pandemic, we have seen a variety of facilities – including conference and exhibition centers, sports stadiums, gymnasiums, hotels, and even car parking facilities – transformed into temporary health facilities for isolating patients. “Temporary ‘Nightingale’ patient bays have been developed in many countries during this current crisis,” says dwp Group Health Sector Leader, Ron Bridgefoot. “While this approach provides space for staff to conveniently oversee a large number of patients and could be suitable for patients with mild cases, it is not necessarily safe for patients with severe cases. The use of single, isolation bedrooms would be a better solution, but this then poses the challenge of increasing staff.” Going forward, it will be essential to create facilities that have the built-in flexibility to enable improved patient isolation. By designing larger lobbies and other spaces that can be transformed into ICU bays, as well as patient bays that allow all rooms in hospitals to become isolation rooms, we will be better placed to successfully respond to any possible future crisis. “A facility in the Gold Coast health precinct we recently designed employed five pods of 10 ICU beds, totalling 50 beds in the public hospital with adjacent private hospitals,” says Bridgefoot. “This allowed an excellent response to the pandemic and the facility has been at the forefront of successfully responding to the COVID-19 pandemic.” The Bumrungrad International Hospital in Bangkok by dwp is another project that employs smart design principles to ensure improved protection for both patients and staff. The facility has 100% single, universal design bedrooms and patient bays, a flexible design that enables quick conversion to clean and dirty flows, and various waiting nooks that allow families to be together with good separation. In addition, hospitality design concepts have been used to create a five-star setting with calm, contemporary spaces that promote health and healing. The Value of Space The COVID-19 pandemic has challenged the definition of personal space around the world, and we believe that the greater recognition of social distancing is here to stay for near-future generations. “The effects of this will certainly be felt in health design,” says dwp Group Health Sector Leader, Ron Bridgefoot. “We will see a rise in collaboration, greater use of technology for meetings and consultations, and more planned programming of treatments, procedures and diagnostics that improve patient/family care. The notion that we have to see the GP face-to-face will also be challenged.” At dwp, this focus on patient and family care is already a key concern in all hospital and wellness projects, with dedicated waiting nooks, separate rooms for consultations and treatments, and the maximisation of technology prior to visiting a facility. This approach showcased in the world-leading Bumrungrad International Hospital in Bangkok by dwp, which cares for more than 1.1 million patients a year and is one of the world’s top ten medical destinations. “Our largest health project to date is completely customer focused,” says Bridgefoot. “It allows people to be consulted, treated and undergo diagnostic examinations and procedures within a safe and secure environment.” Driven by evidence-based research and design principles, it utilises a flexible design, automatic doors to major procedural and diagnostic rooms, single universal design bedrooms and patient bays, and waiting nooks that allow families to be together with good separation. Likewise, atthe icare Medical & Wellbeing Suites in Sydney, dwp created an oasis of health and wellness that puts the patient first. “We utilised centralised consultant rooms and interactive digital displays for connection and fluid patient flow,” says dwp Group Health Sector Leader, Ron Bridgefoot. “Under a soft fabric canopy, a concierge welcomes guests to seamless service, highlighting icare brand’s focus on community engagement.” Careful consideration of circulation spaces will also become more important, particularly in high-risk spaces such as hospitals. One-way traffic circulation may become more commonplace, as well as flexible
Cairns Hospital MRI
circulation that allows quick conversion when necessary. This will likely necessitate the increased application of instructional graphics and wayfinding in health interiors. Healing Environments One of the driving principles of successful health projects is a material palette with a focus on durable, hygienic, easy-to-clean materials. This will not only continue to be a key aspect within the health sector, but will increasingly set a precedent for projects in other industries, from the workplace to hotels. There will also be a high level of interest in “smart” materials with innovative qualities that enable even more hygienic environments. As these concerns become the driving motivations, designers will be thinking less about the surface aesthetics and more about the technical aspects, meaningful materiality, and fundamental usages of buildings. “At dwp, we are already designing facilities that employ innovative ‘smart’ materials that minimise bacteria spread and breeding,” says dwp Group Health Sector Leader, Ron Bridgefoot. “We also use sustainable finishes and fabrics that are easily cleaned and maintained in all our health projects. In a world where people increasingly value hygiene and cleanliness, we believe this expertise will be put to use in different kinds of projects.” There will also be a growing interest in healthcare facilities that promote healing and wellbeing through the design of the space itself, from air filtration systems that don’t rely on recirculated air to increased natural light. “The capture of sunlight is fundamental to our thinking at dwp and is a clear direction we strive for in all our designs,” says Bridgefoot. “There is proven research that shows that sunlight is beneficial for people with certain diseases, including COVID-19.” Healthy Innovation Another aspect of health and wellness design that will take on new value in a post-COVID-19 world is the use of innovative technologies. Even before the pandemic, these industries had been increasingly using technology for improved safety, security, and customer/patient interactions. In many of these spaces, where hygiene and cleanliness is paramount, the use of automatic doors, comprehensive CCTV, touch-less technology, and the use of smartphone apps for consultancy and review is already commonplace. Going forward, the use of these technologies will only increase, not only in health design but potentially across all industries. At Thonburi Bamrungmuang Hospital in Bangkok, for example, dwp modified an existing shopping mall into a high-end specialty hospital offering cutting edge medical services. “The original floor plans and building systems were adapted to incorporate both current and future trends in healthcare technology,” says Bridgefoot. “Existing features such as large atriums, escalators, lifts, onsite parking and accessibility were used to create a whole new high-tech medical concept.” In a recent article on Fast Company, an American surgeon also predicted the global rise of “telehealth” services, in which health providers will execute the majority of their office visits virtually. This could have a lasting legacy on how health facilities, in particular GP offices, are designed in the future.
Bumrungrad International Hospital
Collaboration At dwp, we believe that collaboration is the key to successful healthcare design. The built environment is just one part of the system and needs to support the system as a whole – particularly in the use of innovative technologies. Flexibliity The ability to provide flexible spaces that can be quickly converted to bedrooms for patients will become an increasingly important aspect of healthcare design. Conversion The conversion of large public venues into healthcare facilities to isolate patients may become more commonplace in the event of future outlier events. Health Precincts There is an opportunity to develop “health precincts” with hotels that can quickly be converted to “medi-hotels” with close proximity to hospitals in times of need. The use of hotels to quarantine people is also essential to containing a pandemic. Personal Space The new value placed on personal space will be reflected in healthcare environments through greater use of technology for meetings and consultations and larger common areas that support social distancing measures. Flow and one way circulation Circulation space will become more considered, with one-way traffic circulation and increased wayfinding and informational graphics. Technology There will be a new focus on how to keep families connected in healthcare environments, through both safe physical spaces and technology. Low Touch The use of innovative low-touch technologies and hygienic materials in healthcare projects will start to inform projects in other sectors. The cross-sector expertise at dwp will enable this to happen seamlessly. Visit our online Covid-19 Health & Hospital Design resources For more information on how dwp|research the world of health and wellness in a post-COVID-19 world, contact dwp Group Health Sector Leader, Ron Bridgefoot – ron.b@dwp.com or Group Creative Director, Scott Whittaker - scott.w@dwp.com
The World of Health after Covid-19
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John Hunter Children's Hospital PICU