What Does the Future of Urban Healthcare Look Like?

Thoughts on a ‘Healthcare Quarter’

August 6, 2018

Principal, NBBJ

Editor’s Note: This post derives from an NBBJ-hosted breakfast talk at the British Library in London focused on the future of the NHS. NBBJ Partner David Lewis was joined by speakers Jodie Eastwood, Chief Executive of the Knowledge Quarter; Peter Ward, Director of Real Estate Development at King’s College London: Guy’s and St Thomas’ NHS Foundation; and Richard Darch, Chief Executive of the healthcare consultancy Archus.

As we celebrate the 70th year of the NHS, the future of healthcare in the UK has arguably never been a hotter topic with no shortage of debate on how the world’s largest publicly funded health service will survive.

The people who work and care within the NHS remain its most valuable asset and they will continue to shape national pride in what polls have shown symbolises ‘what is great about Britain’.

But what about its places? How is the public healthcare estate adapting to the demands of an ageing population, new technologies and severe financial pressures? And how will it look in 10, 20 and 30 years’ time?

 

Creating ‘health engines’

Healthcare estates should be spaces where everyone comes together for the benefit of healthcare. Not in some utopian dream but in the form of ‘health engines’ that combine and convert the power of healthcare, research and development and industry to deliver positive progress. Instead of selling off surplus land for residential use and reducing the NHS estate, there is potential to create health ‘eco-systems’ in our cities — healthcare quarters with hospitals acting as anchor tenants surrounded by layers of research and wellness services, step-down care, commercial tenants and public social spaces.

These aspirations chime with the concept for a ‘health return’ from public assets, land and buildings to promote healthy lifestyle and wellbeing.

 

Everyone needs good neighbours

The Cambridge Biomedical Campus and Royal Liverpool University Hospital demonstrate how healthcare, research and commercial developments can benefit from being co-located. It’s important that spaces knit healthcare sites back into cities and their urban context, promote synergies between healthcare and education and create societal hubs that encourage public access and community use.

This is the point of view championed by Jodie Eastwood of the Knowledge Quarter, a partnership of more than 90 knowledge-rich organisations based around King’s Cross, St Pancras, Bloomsbury and Euston. Jodie espouses the power of cross-disciplinary partnerships saying “the real value of collaboration comes when you cross sectors.”

 

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At the Quadram Institute in Norwich, researchers and clinicians collaborate around an open atrium overlooked by research labs and balconies. (Photo courtesy of Sean Airhart/NBBJ)

Science on show

However, co-locating sectors alone is not enough. We must create buildings that actively promote formal and informal collaboration; spaces that showcase health and science in one place.

Blurring spatial boundaries can bridge the gap between fundamental research and application in practice, allowing those differing aspects of innovation to drive each other.

At the same time putting science on show, making it accessible to the public, helps to demystify scientific endeavour, while sowing seeds for education and future talent.

The Quadram Institute in Norwich is a case in point, incorporating an environment in which clinicians work alongside scientists at the forefront of food science, gut biology and healthcare research under one roof with one shared identity and entrance.

Bringing together the Institute of Food Research, the University of East Anglia and the gastrointestinal endoscopy facility of Norfolk and Norwich University Hospital, the Quadram Institute conducts bench-to-bedside research and clinical care related to health and diet.

Within a hierarchy of spaces, the clinical research facility and patient treatment areas are more private to protect patients’ and participants’ confidentiality, whilst the research space is open to showcase the science within.

 

Future proofing and flexible facilities

There are also many lessons the NHS needs to learn from when designing the next generation of healthcare facilities and buildings.

Purely clinically-led design isn’t working and must be supplemented by research-led thinking that inspires sustainable, adaptable buildings offering operational flexibility.

We must also champion strong and proven healthcare, research and technology hubs, such as the MaRS Discovery District in Toronto and UCSF Medical Center at Mission Bay, as the best breeding ground for future start-ups and world-leading innovation.

Yes, many garage start-ups have turned into multinational powerhouses but most new ventures will have a higher chance of success from being based in well-connected places that benefit from local cultural and heritage amenities.

 

Technology drives talent

Finally is the undeniable importance of digitalisation and AI to the future of healthcare and driving the talent that will drive healthcare forward. It will be fascinating to see how emerging technologies will advance the practice of medicine, improve health and empower patients to be active participants in their own care. Trends in digital diagnostics, robotics and data are allowing hospitals to put the human experience first.

For example, many hospitals in the United States are already being designed with extra-wide corridors, allowing robots to deliver medicine and other critical supplies directly to patient rooms. Meantime, IBM’s Watson is being utilized to diagnosis illnesses — especially those that are hard to detect — which then impacts the experience of patients and the quality of care they receive.

The NHS needs to sell a vision of the future now, instil public confidence and demonstrate it has a plan to create a future for itself. What’s needed is true collaboration, openness and innovation, inclusivity, community and a need to think flexibly. Don’t let’s design for just one need but let’s create a sustainable health and wellbeing community for the next 70 years.

Banner image courtesy of Timothy Soar/NBBJ.

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Neuroscience Is Optimizing the Office

How a Molecular Biologist and an Architecture Firm Teamed up to Reimagine the Workplace

July 3, 2018

Partner, NBBJ

@ryanjmullenix

Editor’s Note: This post was originally published by the Wall Street Journal. It was co-authored by Ryan Mullenix, partner at the architecture firm NBBJ, and John Medina, developmental molecular biologist, author and affiliate professor of bioengineering at the University of Washington School of Medicine.

 

As competition for employees and ideas increases, employers are looking to office design to give them an edge. That’s why companies like Amazon, Google and Samsung have asked us to create spaces that directly affect how their employees think and feel. Our research over the past four years has shown how design affects human biology and experience, allowing us to maximize comfort and productivity. This means creating spaces with all five senses in mind and thinking about the impact of everything from diet to color theory. Here’s a look at how the office of the future could promote the health of the organization and the individual.

 

Keep It Down — Unless Brainstorming

Neuroscience tells us: The human voice evokes some of the most potent emotional responses in our auditory experience. Voices in excess of 55 decibels — roughly the sound of a loud phone call — cause measurable stress. Even more disruptive are overheard “halfversations,” in which the listener is privy to only one side of a dialogue; our brains automatically imagine the other.

How design can help: Sonically diverse environments — private phone booths, outdoor gardens and acoustically buffered spaces for activities like brainstorming and team-building exercises — keep noise away from traditional desk setups. Sounds found in nature, like moving water, can be particularly helpful for drowning out disruptions. At Amazon’s Spheres, an office for 800 employees that opened in Seattle this winter, a rushing brook and waterfall permeate the workspace with continuous, calming white noise.

 

Go Green

100876_02_Spheres_N17_mediumNeuroscience tells us: Exposure to plants makes us less emotionally volatile and error prone; even pictures of plants have a calming effect. As a bonus, certain plants give off antiviral, immune-boosting chemicals called phytoncides that promote office health.

How design can help: Amazon’s Spheres contains more than 40,000 plants and hundreds of species, but just one plant per square meter can benefit mental and physical health — while creating a more pleasant-smelling work environment.

 

Seek Visual Relief

Neuroscience tells us: Humans have an evolutionary need for private spaces that offer a sense of safety, but we also crave vistas for inspiration — a condition known as prospect refuge. Open spaces foster creative thinking, while close confines increase focus. Specific colors have been shown to enhance or hinder these abilities.

How design can help: Enclosed, comfortable booths promote focus, while open floor plans with low seating, high ceilings and outdoor views can aid in brainstorming and creative ideation. At Tencent’s headquarters in China, seating along the windows provides views of the surrounding hillsides, while benches in secluded outdoor garden spaces give employees private, peaceful retreats. Colors should be deployed wisely: blue for stimulation, green for focus, and orange for decision-making.

 

101014_00_Samsung_N9_mediumGet a Move On

Neuroscience tells us: Just 30 minutes of aerobic activity can boost executive function and reduce stress; outdoor exercise increases these effects. At just 1.8 miles an hour — a moderate walk — reaction time and quantitative skills improve.

How design can help: The layout of each floor should encourage physical activity, with elevators hidden in favor of stairs, indoor and outdoor workout spaces where possible, and designs to accommodate walking meetings. At Samsung’s North American headquarters, employees are no more than one floor away from an outdoor terrace, where they can attend yoga classes or walk through campus gardens for meetings.

 

Eat to Think

Neuroscience tells us: Mediterranean-type diets — rich in fruits, nuts and vegetables — have been shown to boost cognition, particularly executive function, which is responsible for problem-solving and impulse control.

How design can help: Our design for the Bill & Melinda Gates Foundation campus courtyard included blueberry plants, which employees can pick and enjoy.

 

Banner image courtesy of NBBJ.

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Every Hospital Can Be Modernized

How to Upgrade Aging Facilities to Accommodate State-of-the-Art Operating Rooms

June 12, 2018

Medical Planner, NBBJ

Editor’s Note: This post was originally published by Healthcare Design.

Operating rooms provide a critical component of a hospital’s continuum of care and constitute a substantial slice of annual revenue, not only in direct earnings from procedures, but also in their patients who fill hospital beds. It’s critical that hospital administrators maintain the productivity of their existing OR suites as well as provide procedural flexibility as market demands necessitate.

However, hospital administrators don’t always have the luxury of building new facilities when they need newer or larger ORs to support procedures that are increasingly more technologically complex and clinically demanding.

How can organizations find the space they need to meet these demands within their existing hospitals and avoid costly new construction? One strategy is to improve the productivity of existing surgery space by capturing and repurposing it, both horizontally and vertically.

 

Repurposing Space Horizontally

Most ORs in older hospitals are roughly 400 to 500 square feet. However, new technology demands, increases in the size of surgical teams, and the financial demands for ORs to be multipurpose—with the flexibility to support multiple specialties, such as cardiology, neurology, and oncology—have resulted in general ORs needing to be sized up to 600 to 650 square feet, with some specialty ORs requiring 750 square feet or more.

One way to increase OR square footage is to capture and renovate adjacent “soft” space, such as a clean core or storage space, which can add 100 to 300 square feet. The hospital project team then must develop new processes and operational models to replace the lost space and functional areas.

Another way to create space horizontally is by converting two substandard operating rooms into one highly functional one, which usually gains additional support space, as well. While reducing the number of ORs might seem counterintuitive, it can increase utilization, as one functional OR is preferable to two obsolescent ones. It can also expand a facilities services by making it possible to accommodate multiple specialties and procedures, which can maximize revenue as well as enhance recruitment and retention of the surgical staff.

 

Creating Space Vertically

New equipment competes for space not only in the room but also in the service space above the ceiling. The typical floor-to-floor height in a new facility is 16 to 18 feet, which allows room for changes in the necessary structural and mechanical systems. However, many existing buildings may have as little as 12 feet between each floor.

One strategy to address this issue is to replace large mechanical air ducts with more, smaller-sized ducts. This solution reduces the height of space required above the ceiling, however one tradeoff is that the increased number of ducts can congest overhead space, making it more difficult to arrange other equipment like electrical connections, lighting, boom mounts, and access panels.

A hybrid OR with integrated ceiling, at the University of Washington Medical Center in Seattle. © Sean Airhart/NBBJ

Hybrid OR with integrated ceiling, University of Washington Medical Center. © Sean Airhart/NBBJ

Another option is to use an integrated ceiling in which some or all components are prefabricated and coordinated systematically before being built into the room. Because prefabricated systems can be engineered more precisely than individual systems installed in the field, they yield a more compact, efficient design that can be accommodated in tighter floor-to-floor heights.

Different levels of integrated ceiling systems are available, from units that have all major and minor components integrated and prefabricated as an entire piece of equipment to others that include only the major structural and mechanical systems with space for the smaller components to be added in later.

An integrated ceiling can also be installed on-site quickly and easily, which can shorten construction and installation timelines.

 

Planning Steps

Operating rooms are complex spaces that require meticulous planning and design to successfully add space that will allow for more efficiency. Older hospitals considering updating their ORs need to evaluate their current state and determine which strategy to pursue.

For some facilities, their rooms may have enough square footage, but their ceilings and equipment may be outdated and inflexible. In these cases, innovations like an integrated ceiling can make it possible to update equipment and create flexibility for future technology within the existing walls.

Other facilities seeking to expand their ORs will need to determine which rooms are in a position to be merged to create the right square footage. Some steps to consider in this process include:

  • Understand the needs of surgical staff and the hospital’s surgery business plan.
  • Evaluate the physical plant, from the square footage of standard ORs to floor-to-floor heights and ceiling system infrastructure.
  • Assess room utilization and productivity.
  • Understand departmental support procedures.
  • Get input and involve surgeons in the planning and design process.

Once a facility determines that an upgrade is needed, the design team can develop a strategy to shift an aging group of ORs into high gear with the right amount of space to support the care needs of its patients and staff.

Banner image courtesy Russ Ward/Unsplash.

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