Five design paradoxes for the next generation of hospitals

Transcription

1 Prof Didier Houssin President AP-HP International Mr Jérôme Samanos Technical Director Dragages Singapore Pte Ltd Mr Dennis Keener Healthcare Medical Planning and Design Manager Bouygues Batiment International

2 The largest university hospital group in Europe 37 hospitals 22,500 beds 92,000 professionals 1,500,000 hospital days/year 5,000,000 consultations/year 1,100,000 emergencies Partnership with seven universities 13,200 students/year La Salpêtrière (XVII century) George Pompidou Hospital 2

3 AP-HP International: A subsidiary of AP-HP 3

4 A full service contractor with renowned healthcare expertise 4

5 Strong Asian roots with world-class expertise 1,200 employees* 36 projects* *At the end of

6 Summary Disruptions in hospital planning and design 1. Facing terrorist threats, should a hospital be still wide open or secured? 2. Facing Imaging and Surgery recent (r)evolutions, what should be the future design of an Operating room complex? The share of ambulatory surgery is constantly increasing, 3. What design may improve the patient experience and the flow? 4. What can we do with all those unused inpatient beds? 5. With Artificial Intelligence and Connected objects what is the future for consulting and function testing areas? 6

7 1. Security for the people 7

8 1. Security for the people Humanity and care Hospitals open in the city Hospitals open to everyone Hospitals open 24/7 Preservation of patients privacy Security constraints Prevent terrorist attacks Prevent attacks on staff Avoid kidnappings Prevent theft and degradation France was in a state of emergency for the past two years after major terrorist attacks. The threat still exists. Nearly all countries face the same risk. 8

9 1. Security for the people Designed to be open fortified by necessity This hospital was meant to be open to the city For security reasons, only one public access has been maintained Necker University Hospital (Paris) (90,000 m²) A single public entrance No entrance on the main avenue No connection to the subway No vehicles are allowed except ambulances inside the campus 9

10 1. Security for the people Question to AP-HP International: Based on recent experiences, can you share your organisation s approach to the safety of healthcare buildings and campuses? 10

11 1. Security for the people A compromise between idealism and realism Openness towards the city as a guiding principle for the conception and functioning of hospitals in peacetime: Hospital streets, shops, open gardens and monoblock hospitals But with the possible need for access control to buildings during a state of emergency (in conjunction with police forces): Large sections of the hospital may be compartmentalised; There could be different control levels (car/pedestrian, logistics/care etc.) with access badges for healthcare professionals, Security levels could be adapted (core network room, dangerous substances, etc.); With alert systems (gunshot noise detection; broadcasting of audio messages ). 11

12 1. Security for the people What we understand: At the campus level: Vehicle control and restriction Permanent Central alarm system Permanent At the building level: Pedestrian control When required To go further, You have restricted access to private cars on different campuses. How do you deal with the reduced mobility of elderly and disabled customers? What is your vision for the future? 12

13 How do the disabled move in a large campus? Segway Wheelchair Google bikes London Paris Golf carts Speed walk Sky train Singapore Robot Wheelchair on AGV Autonomous bus 13

14 2. Imaging and surgery (r)evolution 14

15 2. Imaging and surgery (r)evolution X-rays and ultrasound CTs and MRIs Virtual reality 15

16 2. Imaging and surgery (r)evolution -> s -> 2000s -> 2010s -> Eye site Video Robot-assisted Radiosurgery Classic Laparoscopy Imaging + 3D VR Surgery 16

17 2. Imaging and surgery (r)evolution Hybrid operating rooms: m² m² Proton therapy bunkers: 1,000m², 3 storeys high 17

18 2. Imaging and surgery (r)evolution Question to AP-HP International: In your point of view, what would be the best operating complex for healthcare in the next decade? Traditional theatres Hybrid theatres Radiosurgeries (CyberKnife/Proton) How do you deal with ambulatory surgery? 18

19 2. Imaging and surgery (r)evolution Operating complex principles for the next decade: 4 6 autonomous operating room modules, with one common space for induction and preparedness for each module As much as possible, have polyvalent rooms ready for equipment (imaging, robot ) Include the ambulatory surgery module within the operating complex Surgeon-in-charge using robot not far from the patient 19

20 2. Imaging and surgery (r)evolution Henri Mondor s new operating complex: Daycare Inpatients Emergencies Ambulatory 4 ORs Recovery stage 1 Dressing rooms Supply Neuro-ENT Plastic 6 ORs (1 hybrid) Digestive 4 ORs Cardiovascular 4 ORs (1 hybrid) Emergency 3 ORs 20

21 2. Imaging and surgery (r)evolution Ambulatory 4 ORs New Lariboisière: 22 ORs (3 hybrid) Daycare Programmed 8 ORs (1 hybrid MRI) Recovery stage 1 Interventional imaging 5 ORs Emergency 5 ORs 21

22 2. Imaging and surgery (r)evolution Question to AP-HP International: With robotic surgery, don t you think the surgeon would be more comfortable and efficient in another room? How would you ensure personnel safety with continuous imaging? 22

23 To avoid crowding in the operating room A solution with dedicated spaces for: - Surgery - Imaging control - VR experience 23

24 2. Imaging and surgery (r)evolution A solution is to split the use of CT scans and MRIs between imaging and surgery 24

25 3. Customer ambulatory experience 25

26 3. Customer ambulatory experience Pros More efficient use of expensive equipment Less acute care beds => Reduction of healthcare spending Consequences Work with a tight flow means: Dealing with more patients and accompanying persons A tighter daily schedule New organisation Apply principle of walking forward Need to offer a friendlier environment Be on time 26

27 3. Customer ambulatory experience Question to AP-HP International: What are your most recent designs? So far the person accompanying the patient has been largely neglected. Are you now considering him as a customer? 27

28 3. Customer ambulatory experience Straightforward flow Productivity oriented 28

29 3. Customer ambulatory experience Diagnosis and treatment Room Room Room Room Lounge Examination Examination rooms Examination Straightforward flow Productivity oriented Waiting area Discharge Shops Cafeteria Information desk Lobby Admission Waiting area Waiting area 29

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31 4. What to do with all those beds? 31

32 4. What to do with all those beds? Bed capacity projections at AP-HP International Today, AP-HP has nearly 22,500 inpatient beds. With the development of ambulatory medicine and surgery, projections are leading to bed count reduction and more single rooms. Examples: New Lariboisière (2023): -20% New Bichat-Beaujon (2028): -30% 32

33 4. What to do with all those beds? We understand that AP-HP International reduces its bed count when: Closing and demolishing old buildings Reorganising existing campuses Another scheme is being tested out in Nantes: Diagnosis and treatment areas are in the central building Inpatient wards are located in satellite buildings connected with bridges Those small buildings will eventually be rented or sold in the future. Inpatient wards Diagnosis and treatment 33

34 5. What is the future of consultations? 34

35 5. What is the future of consultations? Question to AP-HP International: Now, everyone is talking about telemedicine and connectivity. Will it really be necessary to go to the hospital in the future? Do you foresee an evolution in your practice? Is this going to have an impact on clinics and functional testing departments? 35

36 5. What is the future of consultations? Based upon a definition: Telemedicine, teleconsultation, telemonitoring Following experiences in tele-expertise on the diagnosis of diabetic retinopathy (16,800 cases in 2016) Using a regional IT tool and benefiting from a national impulse (support of experiments, tariffs) A three year plan ( ): To develop telemedicine in all AP-HP hospitals at a team level using regional IT tools To develop telemedicine at AP-HP for primary care physicians and their patients Three quantitative objectives: Teleconsultations 2,000 (0.04%) 50,000 (1%) Tele-expertise 31,000 50,000 Telemonitoring 12,600 30,000 Total: 45, ,000 36

37 5. What is the future of consultations? At what speed will it change? 37

38 How do we design for the future? Hospitals that we design now will be commissioned in a few years time and are expected to last 30 years. However, we have no idea how patients will be treated even five years from now! Will hospitals remain as havens of peace? Will surgeons be replaced by radiologists in operating rooms? Will daycare departments work like assembly lines or look like shopping malls? Will inpatient wards still exist? Will consultation and exam departments still exist? So many questions, with no answers. 38

39 Thank You 39