The story of clinical facilities planning

For the past two months I have been working on a project involving clinical facilities planning.  This is still a very novel concept in South Africa. It involves planning the hospital’s flow during the design phase.

As far system strengthening is concerned the physical and spacial relationships within the system and the subsequent influence of each relationship on others impact on the full systems operation and efficiency.  Some of what we attempt when we implement improvement programs is to fix wrongly designed systems, physical structures that are outdated, outgrown and to accommodate new technology within the existing structure.   A way to truly fix a system is to rebuild it…correcting the old model.

It is very hard to simply action the rebuilding of an entire physical structure to resolve system issues.  Therefor physical structure is hardly considered a leverage point when improving a system.  It is only a leverage point if it is designed to suit the system’s needs.  Once built we can only manage constraints and inefficiencies with improvement programs to manage limitations, bottlenecks, matching demand and capacity or even work around system failures.

Hospitals are subject to rapid change and a clear operational concept and accurate scope of services is essential during design.  The ability to forecast trends and change requires clinical insight and not just architectural design capability.

Reading through international literature on clinical facility planning, I was amazed to read a statement that there are more than 600 studies demonstrating the impact of hospital design on outcome measures such as reduction in staff turnover, staff stress and even patient pain level perception.   This obviously implies a link between facility design, perceived quality of care, patient safety and error and nosocomial infection.  Some factors to consider are single versus multiple bed rooms, ability to observe patients, distance between beds, availability of hand wash facilities, slippery floors, and distance from nurse station to patient room.

Clinical oversights in facility design in units where I have worked include a unit where the sluice room had limited space to test urine and no cupboard space to store urine and pregnancy test containers.  The sluice room had only a tiny sink and could accommodate one person at a time.  This resulted in an overflowing messy sluice room during busy times, bottlenecks, running around to obtain pregnancy tests, urine sample bottles etc.  Another example is that it was decided to remove an electronic patient system as it was not effective.  In an independent study conducted afterwards, one of the main reasons given by nursing staff for the ineffectiveness was the location of electronic devices within the facility and its subsequent impact on flow and patient care. And then the steps at an emergency exit at a ward for bedridden patients, the mind boggles.

There is a fine balance in meeting the needs of the clinical facility user (patient) and facility management.   By marrying the financial aspects, clinical intent and the physical infrastructure design, a plan can be developed that appropriately balance the patient journey and operational efficiency.

I’m involved in a facility that is being rebuilt with a structured transition from old to new.  My role is to write the functional narrative, which is the expression of the intent and flow within all functional spaces such as patient rooms, utility rooms, medication rooms, nurse duty stations.   As we are hoping to impact a paradigm shift in culture during the transition the narrative is crucial, it is the story of the new facility after all.

I feel privileged to be part of the change process and I hope that it will result in safer patient care and improve access to care in the new facility.