The Roadmap to Recovery: Transforming Hospitals into Catalysts for Community Benefits

The current scorecard for U.K. hospitals and healthcare estates isn't encouraging. It's saddled with a growing maintenance backlog - over $12 billion (£10 billion) - and it's marred by pandemic scars and a staffing crisis. Combine this with a rapidly aging population facing increasing pensioner poverty and poor health, the COVID-19 patient backlog, inflation and a severe funding shortage - it creates a challenging prognosis.

So, what's the solution for now and our collective future? It's not simply a matter of paying for widespread infrastructure repairs and relying on traditional hospital design. The whole system needs a redesign to offer more comprehensive social benefits and improve the lives of patients, clinicians and community members. Getting this right can have far-reaching consequences: research shows that improved population health has a direct positive economic effect on communities.

The solution is to create a system that turns healthcare into a catalyst for positive clinician and community benefits, one that relies on tech-empowered talent, smarter architecture and evidence-based design, and a data-driven systems approach to managing the health portfolio and asset management.

To help build this new system, we've collected inputs and lessons from our global healthcare programs across Australia, New Zealand, Singapore and the U.S. and defined a five-step blueprint with the input of our cross-sector teams and subject matter experts.

1. Create bespoke community health hubs with 'service spokes'

One of the most significant pandemic lessons was the focus on the shortage of hospital beds and the lack of cover for all health issues - including elective care - not just the ones requiring trauma care. Hospitals were filled way over capacity, and options like digital diagnosis, telehealth and remote services were still in their infancy.

The issue of longer waiting lists is combined with another major obstacle for our healthcare system: easy access and proximity to the health services needed. There is no simple answer to this complex challenge; it requires several integrated steps.

One of the first, most crucial steps is to carefully design new health hub infrastructure with a circular economy and adaptive reuse approach. This relies on repurposing existing buildings to be repurposed and retrofitted to integrate new technologies and support contemporary models of care. One of the best examples of this can be found in a major hospital redevelopment at the Royal Prince Alfred (RPA) Hospital in New South Wales, Australia, where a pioneering design strategy is delivering a world-class, sustainable, integrated health and education precinct that's centered round the existing RPA hospital.

Adaptive re-use should also be paired with scalability: these new superhubs should be designed for growth and future flexibility. An example of this is the award-winning Tampa Taneja Center for Surgery in Tampa Bay, Florida, as it was built to allow for the addition of eight floors in the future as part of future expansion.

The next focus is on harnessing telehealth and digital health delivery while building new health facilities, as this will help alleviate the patient burden and improve access to health services. The key goal is to support these new health superhubs with more spokes as services to lessen the patient and clinician load at the hospitals. These spokes can include clinics on wheels, community diagnostic centers, 'one-stop shops' and pop-up shops - just to name a few in a trend that's also occasionally called ambulatory care. For example, clinics that offer procedures that don't require overnight stays are more affordable and quicker to build - this can cover areas like dermatology, ophthalmology and gynecology. This strategy is something that private healthcare is investing in for the future and is a vital part of the rise in private service investment and growth.

This infrastructure challenge emphasizes the need for evidence-based design and insight-driven care. Cross-sector teams, including urban planners, dochitects®, architects, data analysts, clinicians and inclusive designers, must design health hubs to serve the community best with new technology, but crucially while consolidating existing buildings and services for better adjacencies.

The truth: a future-proof healthcare system requires that every community's 'health hub' be designed with the community need foremost while harnessing automation and modularization in construction and maintenance to deliver cost efficiency.

1. Elevate the wellness of the clinician and carers

While it's practical to understand the insights of the people working on the ground in healthcare for future design needs, it's also pivotal to the success of the healthcare service. If we can't improve the daily working conditions and the public perception of working in the NHS, we'll never overcome the critical staff shortages. Aligned with that, the user experience also directly affects the quality of the healthcare service.

The focus must be improving the daily working conditions for first-line health carers and clinicians. It starts with design fundamentals, such as access to natural light, fresh air and common spaces to rest and recover. One of the best examples of this is the delightful fenestration design of the celebrated Blacktown Mount Druitt Hospital in New South Wales, Australia. The design offers generous natural daylight across the complex along with open common spaces while minimizing solar gain and cooling costs which were directly influenced by the thermal energy modelling during the design phases.

However, that's just the start, as there is now much more opportunity to bolster the day-to-day requirements through technology, right from paper - and admin - free AI-driven onboarding and wearables to sensor-filled smart beds and IV pumps.

The lessons from the pandemic must also be used to ensure that in any future health crises, the healthcare workers are protected physically, mentally and emotionally from the strain - and that requires both physical design choices and tech-led support.

By getting this right, it improves the lives of the staff and makes it easier to deliver care. This also creates a positive loop, raising the healthcare offering and the public perception of the healthcare system.

1. Use digital health to lessen the load on hospitals and clinics

Arguably, the greatest opportunity for positive healthcare change lies in the smartphones and wearables in patients' homes. A study by McKinsey found that 60% of patients believe virtual consulting is more convenient than in-person care. But it's not just about patient convenience. Research from a virtual patient engagement program, that used home-based medical devices to collect patient data and biometric indicators that doctors and nurses reviewed in real time, showed a 28% reduction in hospitalizations in chronically ill patients. This means it doesn't matter where the patient is located, which makes the community healthcare system much more inclusive and equitable.

Best of all, these digital solutions aren't just for the chronically ill. The combination of telehealth, wearables and remote health services can offer a wide range of help for different kinds of patients, making it more convenient for them and the healthcare providers and taking up less strain and resources at local and regional hospitals.

However, a foundation required for success is achieving the right standard of technical literacy in the target communities, especially among the older age groups. This service needs a digital education element to ensure that the remote technology services are effectively understood and used.

When this is done correctly, it can improve results for both patients and healthcare providers. Virtual ward capability is being successfully delivered at the new Alexandra hospital in Singapore to support the delivery of patient care outside of the hospital setting. The pilot program was so successful it is now being rolled out nationally.

1. Boost social and economic impacts for the community

Creating bespoke community health hubs with 'service spokes' will automatically create jobs, both in construction and operational stages, but the benefits can extend far beyond that. By using integrated design to create mixed-use healthcare precincts, you can also tackle one of the biggest challenges: the influx of new staff and medical expertise. This is done by offering education alongside medical and wellness services to help train the next generation of healthcare providers and workers.

One of the most successful examples of this integrated, mixed-use design approach is the award-winning Christchurch Outpatients Building in New Zealand. The five-story facility brings 27 health services together under one roof, but that's just the start. It is co-located with the simulation center for healthcare practitioners and students with operating theatres, hospital wards and clinics, as well as virtual reality training technology. It's a pioneering approach that brings together students, clinicians, educators and the wider industry to help tackle the issue of staff shortages and bring social and economic value to the surrounding communities both now and into the future. The urgency of the project was exacerbated by the earthquakes of 2011. The standardized design delivered long-term operational flexibility as well as supporting the rapid construction. The project was delivered three months early as well as 10% under budget - the savings were re-invested back into the health program.

Hospital services have globally raised their community impact by offering non-traditional health services. For example, select hospitals have high schools on their campuses designed to train the next generation of health and science leaders while others support local vegetable gardens and food pantries and work with community organizations to address nutritional needs. Some even provide affordable housing to seniors and low-income members of the community. The result: driving health equity and community benefits and placing more emphasis on prevention rather than cure.

1. Invest in lifestyle-driven community intervention

One of the most effective medicines for future healthcare is not found in pills or tablets but in lifestyle change, as cardiovascular disease, which is largely preventable, costs the NHS over $22 billion (£18 billion). This type of change requires education and engagement, which includes building multifunctional healthcare facilities that offer added social value. An example of this is a healthcare project in the South Pacific Islands of Kiribati, as it has been designed to meet a wide range of needs, from social value and health equity to sustainability and community health, but all wrapped within community engagement and education.

A second example of design that prioritizes engagement and education is the new Women's & Children's Hospital in Adelaide, Australia. The architects share that the design responds to the hospital's multi-faceted role as a workplace, sanctuary, assembly point, "accidental playground" and landmark, and have drawn on the design team's collective experience in a range of sectors to create an integrated health campus. It also offers direct access to Adelaide Park Lands. "For children, women and their families visiting and spending time at the hospital this offers both a place to play as well as supporting recovery and recuperation," said Jorge Anaya lead medical planner for the project.

Within education, prevention must be prioritized, not just the cure, and the latest technology can help boost earlier screening and treating of disease. The best part of this approach is that it can be the most cost-effective and sustainable of all options as it doesn't require anything to be built at scale. It also saves NHS resources, allowing funding to be redistributed to other vital healthcare needs.

The success of this approach relies on prioritizing and supporting preventative programs, especially ones that rely on community partnerships and stakeholder engagement. In the past, the NHS has had success with these programs, such as the world's first national Diabetes Prevention Program which resulted in a 7% reduction in new cases within the timeframe.

All these opportunities and programs need to be integrated into one strategy that focuses on community health services, but crucially, it shouldn't solely be the responsibility of the NHS: this is where hospital-community partnerships and third-party investment are proven to offer social benefits.

Prescribing a healthier future

Creating a healthcare system that offers social value starts with designing for the patient, the clinician and the community, but the long-term solution requires a complex mix of talent, technology and track record.

The result: healthcare facilities move beyond concrete and glass assets into living catalysts for improved community health and wellness, economic growth and lifestyle change.

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