vol46.1 LR.pdf - International Hospital Federation

Policy: Healthcare facility design
Figure 3: A traditional Japanese farmhouse is renovated into a group home
for the elderly
Building information modeling (BIM)
“BIM is the process of generating and managing building
data during its life cycle. Typically it uses three-dimensional,
real-time, dynamic building modeling software to increase
productivity in building design and construction. BIM
encompasses building geometry, spatial relationships,
geographic information, and quantities and properties of
building components.” – Wikipedia.
✚ telemedicine;
✚ robotics;
✚ nanotechnology.
Just as the bank building of the future shrank into the ATM and
credit cards, technology will open heretofore unimaginable
opportunities and locations for health maintenance.
Mixed-use facilities
Mixed-use facilities encourage a previously unorthodox mixing of
functions. For example, capitalizing on air rights over malls could
provide health facilities with easy pedestrian access to shopping
below. In urban areas, towers consisting of apartments,
condominiums, independent and assisted living, skilled nursing,
and hospital facilities float over commercial shopping malls.
Economics and costs
In free societies we are also free to go broke.
Healthcare administrators are constantly walking a tightrope.
Changing legislation and reimbursement formulas are causing
hospital CEOs to trim their staffs and programmes. Health and
hospital facilities will have to be lean, efficient, cost-effective, and
medically effective.
The larger the facility, the more difficult those goals will be to
achieve. Designing large hospitals will represent tremendous
financial gambles. Costs of construction will soar, as will operating
costs.
Hospital and healthcare executives are not only concerned with
initial construction and project costs, but they are very aware and
wary of the much greater costs of operation over the life of the
building. Rising energy costs, maintenance, and salaries as well as
technology are tremendous factors in operating costs.
Integrated project delivery
“The Construction Industry has suffered from a productivity
decline since the 1960’s while all other non-farm industries
have seen large boosts in productivity. The problems in
contemporary construction include buildings that are behind
schedule and over budget as well as adverse relations
among the owner, general contractor, and architect. Using
ideas developed by Toyota in their Toyota Production
System and computer technology advances, the Integrated
Project Delivery method is designed to solve these key
construction problems. The new focus in IPD is the final
value created for the owner, the finished building. Rather than each
participant focusing exclusively on their part of construction
without considering the implications on the whole process, the IPD
method brings all participants together early with collaborative
incentives to maximize value for the owner. This collaborative
approach allows informed decision making early in the project
where the most value can be created. The close collaboration
eliminates a great deal of waste in the design, and allows data
sharing directly between the design and construction team
eliminating a large barrier to increased productivity in
construction.” - Wikipedia
Impact on design principles
Now that we have examined some of the major trends facing
healthcare facilities overall, it is time to consider the impact these
trends will have on principles of design.
Figure 4: Nursing home Freude Hikoshima in Yamaguchi Japan,
designed by APL design workshop, is facing to rich sea and green
Consumer choices
As individual choices grow and are encouraged by many
insurance programmes, the result has been fierce and healthy
competition between hospitals. One result has been a spate of
mergers, acquisitions, and closures of health facilities and
hospitals.
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