Since October I have been working on a new consultancy project that involves the renovation of a large academic hospital in the Netherlands. So just like in the last blog I ask myself: what would the researcher in me advise me, the consultant? After my blog on Material Management, this one will be about the (re)design of hospital buildings.
I have worked on many hospital (re)design projects over the past 15 years and there are some recurring things I have come across over and over again, and through my research some of these issues I started to rethink. What self-evident ideas are perhaps counterproductive?
In short the recurring issue is that hospital space is reduced, often by taking away the personal room from doctors, sharing space between people and departments and by creating less storage space. In addition primary work processes are often physically separated from administrative or logistical processes by creating for example a front offices and back offices. Driving force behind this is the fact that hospitals have been financially responsible for their buildings since around 2007. Since then much more attention has been paid to the cost of space.
At first sight a lot of space in hospitals is obsolete. For example in several studies I did for hospitals I found that the average room utilization in the outpatient department is around 30%. And inventories are often high, so reducing these would lead to less need for space. That makes sense. However, from my research I understand much better what is behind the space debate and I believe this debate should be much more than a discussion on whether a doctor should have his own room or not. It should be about what space and building design serves the flow of processes best. Let’s look at some examples of widely accepted ideas for hospital design that need some rethinking.
During my research I analyzed the work rhythm of the surgeons and observed that they live like nomads (see the blog on that) with a very variable working pattern and the outpatient department as their ‘home base’. I asked some surgeons how they feel about this work style and they told me that ‘they have gotten used to it’ but that they needed a place to get away from the ‘impetuosity of the work’. That makes sense. Should space not support the people who work in the hospital? What if the doctor performs better with this space?
A second example is material storage. I have been involved in hospital design projects in which storage space was sacrificed or moved away, probably because materials do not lobby for space. However, in most of these projects lack of space for materials caused major bottlenecks in primary processes, mostly because by moving materials away from the primary processes, those who control material processes (doctors and nurses) and those who execute transport and handling were split physically. The often informal mutual adjustment coordination between these people – which I found in my case study research – is hardly effective when people do not see each other.
A third example is about the role of outpatient secretaries and outpatient assistants. They do not only write letters and take calls, they perform planning tasks for which close collaboration with doctors is required. In a front office/ back office model, in which patient related activities and administrative tasks are physically split, informal mutual adjustment coordination does not function effectively either.
So do we need more space? Not necessarily. More space also means longer walking distances for doctors and nurses, whose time is scarce. More space can be a reason for keeping stuff you don’t always really need. But space needs to be there for those things and people who need it for a smooth and safe healthcare processes. That is what the space debate should be about.