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Future of hospital design initial perspective - sept 2020

Hospitals of the Future

In partnership with Mott MacDonald we are exploring how hospital design will change in the next decade. Building on insights gained from multiple healthcare expert workshops around the world, this is an initial perspective that share some key thoughts on how and where we may see most change. Starting with context on shifts in healthcare more generally, from slide 28 onwards it includes 22 proposals for future design focus. These range from hub and spoke ecosystems and post-Covid reconfiguration to more flexible spaces and the impact of digital theatres.

As part of a global Open Foresight programme, we are now sharing these views to gain feedback for inclusion in a more detailed point of view that will be published later in the year. If you would like to add in your opinions on which issues will be driving most change in hospitals of the future, we would welcome input either directly to us by email (tim.jones@futureagenda.rg) or via this short survey:

Many thanks in advance for your collaboration on another key topic for future change.

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Future of hospital design initial perspective - sept 2020

  1. 1. Future of the Hospital A Selection of Insights from Multiple Expert Discussions September 2020
  2. 2. The Future of the Hospital As healthcare needs and systems evolve, the format, role and features within hospitals is changing. This is an initial view of shifts that may occur by 2030 and is designed to stimulate further debate ahead of a more detailed report.
  3. 3. Multiple Discussions The insights in this presentation have been gained from multiple expert workshops around the world with researchers, regulators, doctors, HCPs, providers and payers, as well as health systems and public health specialists.
  4. 4. Contents | Two Sections This presentation shares emerging trends that may impact the future of hospital design. We begin with macro healthcare shifts and then, in more detail, explore future hospital design trends. It is the start of further open dialogue.
  6. 6. Commitment to Universal Health Coverage In 2019, the UN adopted a Political Declaration on Universal Health Coverage including financial risk protection, access to quality healthcare services and the provision of essential, effective and affordable medicines/vaccines for all.
  7. 7. Common Drivers for Change There are several global ambitions that drive how healthcare systems are being reconfigured. There are also additional regional challenges that are variously impacting different healthcare models. Improving Patient Experience Improving HCP Experience Improving Outcomes Improving Efficiency Global Ambitions Additional Regional Challenges Overcoming Workforce Shortages Improving Remote Access Simplifying Complex Processes Reducing Variation
  8. 8. New Paradigm Shifts There are four underlying systemic trends that are driving healthcare transformation. These align with the global priorities and have varied impact across different healthcare systems and regions. 1: Wellbeing • Focusing on prevention and wellbeing and a shift from sick-care to health-care 2: Value-based Care • Changing the pricing model from ‘cost-plus’ to value- based driven by social impact assessments 3: Care Closer to Home • Providing more services outside hospitals to offer convenient healthcare support where people live 4: Connected Systems • Smarter, integrated infrastructure linking healthcare system to the social determinants of health
  9. 9. Four Tiers of Healthcare Delivery Globally many see four models for healthcare delivery gaining momentum as common solutions. With current trends towards community care, the role of the hospital will change, providing more specialised services for complex cases. In Home Care • Remote diagnostics and monitoring via smartphone and in-home sensors • Telemedicine support with HCP and wider system • Increased use of online platforms (e.g. Good Doctor) Polyclinics • Ambulatory out-patient care primary care • Convenient location in transport hubs, shopping malls • Virtual / video consultations with experts in other locations Community Hospitals • Standard procedures such as maternity, knee operations and step down support • Shared resources across networks • ER / A&E with separate access and facilities Super Hospitals • Regional centres of excellence linked to universities • Major trauma centres with extensive ICU facilities • High volume of complex procedures with areas of speciality (e.g. cardiac) Drivemajorityofhealthcaresupportlocal Concentrateexpensivecomplextreatment
  10. 10. New Patient Journeys Many agree the future hospital experience should be better configured around the patient - not just the healthcare system. New patient journeys are in development. Some involve incremental change: others are more radical.
  11. 11. Complex Ageing Populations The challenge of an increasingly elderly population with more comorbidity is however introducing greater complexity. As demographics shift, hospitals will need to cater for more holistic treatment.
  12. 12. More Patient Data Improved electronic records and the wider availability of proxy data provides access to more, improved patient information. This drives greater transparency on the impact of interaction at home, in the community and in hospital. Growth in VolumeMore Variety
  13. 13. Evidence Informed Practice Multiple digital / technology innovations and the ability to use emerging evidence of what achieves good health outcomes, are driving a change in way clinical services are organised. Many focus on greater sub-specialisation.
  14. 14. COVID-19 Pandemic Impact The COVID-19 pandemic is accelerating some key emerging trends, halting others and questioning whether there will be wider reinvention of healthcare in the years ahead.
  16. 16. A New Healthcare Philosophy? Many see that by 2030 we may be experiencing a new approach to healthcare - with significant innovation in hospital business models and design.
  17. 17. Significant Change Ahead Experts see more change in hospitals by 2030 than in the last 30 years as physical and virtual trends align with digital delivery and early prevention.
  18. 18. 22 Potential 10-year Shifts From our discussions with multiple experts around the world we see 22 potential areas for 10-year shifts that will impact future hospital design thinking.
  19. 19. Patient-Centric Hospitals Including patients and key stakeholders in the design of new hospitals and the wider ecosystem creates a more human-oriented environment.
  20. 20. Connected Hospitals The next generation of hospitals will be a part of a connected community heath ecosystem. Enabled by pervasive 5G networks all elements will be interoperable.
  21. 21. Hospitals as Part of the City Ecosystem With the focus increasingly on prevention, hospitals are better integrated with other urban activities such as transport, education, leisure and the workplace.
  22. 22. Digital First Approach In order to integrate technology across the full hospital lifecycle, digital technologies are included up-front in the initial planning of hospital design.
  23. 23. Hub and Spoke Successful adoption of hub and spoke ecosystems in India are provoking others to rethink the structure and interconnection between different hospital assets.
  24. 24. Adaptable and Flexible Estates To accommodate changing future demands, many consider that more flexible approaches to hospital facility layout, structure and use will be essential.
  25. 25. Resilient Hospitals As critical infrastructure, hospital location and design are rethought. Resilience to storms, frequent flooding, extreme temperature and wildfires is a priority.
  26. 26. Net-Zero As leading cities all aim to be net zero by 2050, hospitals are designed to achieve radical reduction in carbon footprints and lower overall energy use.
  27. 27. Post COVID-19 Hospital In the wake of Covid19, the balance between public and private healthcare is challenged. Some see a long-term shift in funding priorities for public hospitals.
  28. 28. Check In vs. Check Out Post-COVID-19 there is separation of hospital admission and discharge as well as theatre entry and exit. This leads to the redesign of patient and HCP flows.
  29. 29. Proof of Immunity Access to some health facilities is driven by a combination of digital identity, proof of immunity and proof of no infection – all validated before entry.
  30. 30. Distinct But Flexible Zoning Increased separation of patient admission, treatment and automated ancillary activities define more distinct zones. These can be flexed as need.
  31. 31. Pods Not Wards The adoption of more flexible spaces enable patient assessment, diagnosis and even treatment to become more personalised, relaxed and convenient.
  32. 32. Flexible Supervision Networks of connected nursing stations with real-time monitoring allow flexible, overnight stay supervision to be the norm.
  33. 33. Self-Cleaning Materials Aware of the rising risks from contagion, designers specify materials that are increasingly self-monitoring and self-cleaning when needed.
  34. 34. New Room Thresholds There is a focus on separating patient, family and nursing access so that healthcare professionals can support patients without personal compromise.
  35. 35. Accelerated Recovery To reduce expensive time after the ICU, patient recovery is migrated outside the core facility - but is supported by increased remote supervision and analysis.
  36. 36. Separation of Emergency Department Some regions talk about creating different facilities for emergency response to prevent cross-infection from patients and separate health resources and staff.
  37. 37. High-Rise Hospitals The benefits and risks of building high-rise facilities are hotly debated: It requires a balance between access, cost, footprint, colocation and contagion risk.
  38. 38. Digital Theatres An increase in technology enabled surgery adds theatre complexity but also drives a growing dependency of input and supervision from an extended team.
  39. 39. Robotic Surgery The use of robots for high precision, repetitive surgery impacts cleaning standards, remote supervision as well as the required levels of human support.
  40. 40. AI and Unstructured Data As self-learning AI develops, the ability to deal with unstructured data delivers major improvements in diagnosis. AI is embedded into many clinical decisions.
  41. 41. QUESTIONS
  42. 42. Your Perspective As we build the informed global view on the future trends for hospital design, we would very much welcome your perspective on three key questions. Impact • Which of these trends will have greatest impact on hospital design by 2030? Innovation • Which areas will see the most innovation and change and why? Gaps • What else will drive significant change in future hospital design? Please complete the survey on
  43. 43. Future Agenda Limited 84 Brook Street, London W1K 5EH | @futureagenda Mott MacDonald Limited - Dubai Festival Tower, 2nd Floor Dubai Festival City 11302 UAE |