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003
WHAT DOES
Now in its forth year, the Hospital Build and Infrastructure Middle
East Exhibition and Congress will open its doors at the Dubai
Exhibition and Trade Centre from 4-6th June 2012. Just like this
magazine, the event is designed as a educational platform for all those
involved in the entire spectrum of non-clinical healthcare, including
planning, design, construction, management and operations of
hospitals and health facilities.
The current worldwide economic slowdown has had far reaching
effects and ripples are still being felt around the world in almost all
industries. However, the intrinsic robust nature of the healthcare
industry has softened the impact of the economic slowdown when
compared to other industrial sectors. This phenomenon is even more
pronounced in the GCC due to the welfare-styled, publicly subsidized
healthcare systems predominant in the region. In addition, though
compulsory health insurance is becoming more widespread here, its
share of total healthcare expenditure still remains low compared with
western countries.
However, in his article on page 38, Michael Lindell introduces the
idea that hospitals are becoming an endangered species, even here in
the Middle East. He believes healthcare is in a process of devolution.
The shift is from the major acute hub to community facilities in the
workplace, in the school, and at home. In addition, the evolution in
nanotechnology applications will facilitate the devolution of diagnosis,
treatment and care into the patient. Conditions will be monitored and
treated remotely, and if appropriate automatically, therefore reducing
the need for hospital-centred care in the future. How this region
responds to this change in the future remains to be seen.
ISSUE 2 2012
Jenna Wilson
Editor
HOSPITAL
International
Licensed by
Cover:
How will healthcare be delivered in the future?
Turn to page 38 to find out
Media Production
Zone
WILL
ABAN WE
HOSPITALDON
THE FUTUS IN
RE?
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ncesmagazin
es.com
The Team
Editor
Jenna Wilson
Tel: +971 4 336 5161
jenna.wilson@informa.com
Assistant Editor
Elin Boyd
elin.boyd@informa.com
Art Director
Mark Walls
mark.walls@informa.com
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LLC
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Contents
005
010
006 INSIGHT
016
Make sure you dont miss the regions most important hospital infrastructure
exhibition and congress taking place in Dubai on June 4-6th 2012
028
034
038
042 INTERVIEW
www.lifesciencesmagazines.com
INSIGHT
60 SECOND
DOSE
KEC in deal for Madinah
medical project
The International Medical Center
(IMC) has signed a contract with
the Knowledge Economic City
Company (KEC) to set up a new
medical centre in Madinah. The
new centre will set new standards
in terms of infrastructure, services,
location and design.
mHealth will revolutionise
the future of care
The rapid emergence of mobile
health technology will revolutionise
future healthcare delivery and
management. mHealth has been
adapted to enhance healthcare
over the last decade, during
which it has become essential in
day-to-day life. The digitalisation
of medical information for
exchange demonstrates the key
changes taking place to attempt
to modernise the medical market
space.
Mubadala Healthcare signs
MoU with DHA
Mubadala Healthcare and DHA
have signed a MoU to discuss
several key collaboration areas
that will facilitate knowledgesharing, partnership initiatives
and improved access to care for
patients in Dubai. The initial areas
for collaboration outlined in the
MoU relate specifically to three
of Mubadala Healthcares facilities
- Wooridul Spine Centre, Tawam
Molecular Imaging Centre and
National Reference Laboratory.
Saudi govt hospitals to have
separate rooms for patients
The Ministry of Health in KSA
has allotted SR700 million to
add 250 new beds to ICUs in
various provinces and regions. It
has also earmarked SR40 million
to transfer long-stay patients
with chronic diseases to private
hospitals. The plan is for future
hospitals to provide each patient
with a private room instead of the
current practice of putting four or
five patients in one room.
006
Sharjah to set up
healthcare city
His Highness Dr Shaikh
Sultan Bin Mohammad Al Qasimi,
Member of the Supreme Council
and Ruler of Sharjah, recently issued
an Emiri decree setting up Sharjah
Healthcare City (SHCC) as a free
medical zone authority.
As per the decree, the newly
established healthcare city will be a
corporate body, enjoying financial
and administrative independence
with full capacity to carry out its
legal practices.
The location and geographic
boundaries of the healthcare
city will be determined upon a
resolution to be issued later by the
Ruler of Sharjah.
It will be managed by an
administrative body, called the City
Administration, and will work under
the supervision of the Free Medical
Zone Authority and will be run by a
board of directors.
industry news
007
Winners 2011
www.lifesciencesmagazines.com
Who we are?
ELGA LabWater is the global laboratory water brand name of Veolia
Water, the world leader in water and wastewater services specialized
in outsourcing services for municipal authorities, as well as industrial
and service companies. Veolia Water is also one of the worlds major
designers of technological solutions and constructor of facilities needed
in water and wastewater services, with 96,651 employees in 69
countries.
What we do?
ELGA is specialized in the design and manufacture of Laboratory Water
Purification Systems. The ELGA team focuses exclusively on providing
purified laboratory water means and has combined experience gained
from 50 years of innovating water purification technologies, working in
partnership with major clinical diagnostic companies, and is continually
contributing to the unique technical and scientific applications expertise.
The ELGA team is experienced in meeting the challenges that arise at
all stages from concept and design, through to the build, installation and
servicing of single point-of-use water purification systems, as well as large
projects involving consultation with architects, consultants and clients.
008
ELGA representatives
Veolia Water Solutions & Technologies, Saudi-Industries and Veolia
Water Systems (Gulf) FZC are the authorized exclusive representative
local offices of ELGA LabWater in the Middle East.
More info
If you want to find out more about these products, contact
Ibrahim Alhaj, from ELGA LabWater Market Leader-Middle East,
on email: ibrahim.alhaj@veoliawater.com, on his mobile in KSA:
+966 555296629, or on his mobile in the UAE: +971 529107092.
Alternatively, visit the website: www.elgalabwater.com
Se
rv
i ce
e
al u
|V
p
es
|R
on
i li t
sib
y
www.elgalabwater.com/medica
More info
To book at stand at Hospital Build and Infrastructure 2012, email
hospitalbuild@informa.com. More information about the entire
portfolio of Hospital Build events globally can be found on the website
www.hospitalbuild.com
010
011
Conferences running alongside the
exhibition
The Hospital Build and Infrastructure Congress will consist of eight leading
conferences designed as an educational platform for anyone involved across
the spectrum of healthcare facilities.
Healthcare Management
This years annual Healthcare Management Conference offers solutions to
all crucial challenges and areas to ensure the running of a hospital in a more
efficient and effective way.
Imaging and Diagnostics Management
This conference will assist medical imaging departments, both in the hospital
setting and outpatient imaging centres, to develop and implement strategies
and techniques that result in improved profitability, increased efficiency and
continued market growth.
REGI
STER
NOW
!
To reg
ister fo
r one o
of the
r more
confer
ences,
hospit
email
albuild
@info
or call
rma.co
+971
m
4 3367
334
Leaders in Healthcare
Healthcare isnt about size; its about care. Do we really need huge hospitals or
should the focus align to specialised clinics? Either requires a framework, strategy
and vision to implement. This region is unique and its healthcare system needs
passionate overhaul. We cannot just let it replicate other healthcare systems
around the world. Therefore Hospital Build and Infrastructure has chosen
Leaders in Healthcare to address the pressing issues facing our region today,
creating a platform for solutions via debate and discussion on 6th June 2012.
N
m+ Health EW!
The Middle East is an innovative region, ahead of its times by far. While the
world works via text messages in the mHealth space, this region is focused
on remote monitoring, diagnosis and e-prescriptions. The pace is escalating
enormously via stakeholder support. To help us keep up with progress, the
m+Health conference is taking place on 6th June to discuss progress on the
strategy set at Arab Health back in January.
Surgery Management
Hospital Build and Infrastructures new Surgery Management conference
will focus on the most up-to-date technological advances that assist surgery
management professionals in navigating through the complexities of
efficiently and effectively managing their facilities operating rooms, surgical
team and equipment.
Hospital Design and Infrastructure
While demand for high level facilities is increasing as the Middle East strives
to become a world-class destination for healthcare, the Hospital Design and
Infrastructure conference will cover healthcare facilities design and construction,
and the challenges faced in this region.
Quality Standards and Accreditation
This conference will address the challenges faced by todays quality professionals
in healthcare and will offer a range of updates and solutions to build a quality
framework, address quality management across the healthcare industry and assess
current challenges in accreditation and reaccreditation. Furthermore, it is one of
a handful of events in the region that offers Continuing Medical Education (CME)
credits to all medical professionals attending.
Architects Congress NEW!
New for this year, this conference will address key challenges faced by
architecture professionals, focusing on the development and construction of
healthcare facilities. Even through the slowdown of new build projects, hundreds
of healthcare facilities have been planned and continue to be developed.
www.lifesciencesmagazines.com
PREKONS
meets the demands of the healthcare Sector with its modular ready building systems
Article provided by PREKONS
All images PREKONS
012
Sustainability
Modular construction is an environmentally conscious choice for the
construction industry.
With reusability of the modules, minimal site disruption and
waste, efficiency in materials, reduced environmental pollutants from
transportation and construction materials, and shorter build-time,
modular construction is more sustainable than traditional site-based
construction and is inherently eco-friendly.
Using dedicated teams, required equipment and materials, PREKONS
strategy of manufacturing within a controlled factory environment ensures
that the work is regularly inspected according to a quality assurance
regime. Combined with regular feedback this, in turn, leads to continuous
improvement. By maintaining the simultaneous off-site and on-time
production, the budget of the project becomes fixed. When you receive a
quote from PREKONS technical team that means it is a fixed budget.
It has been reported that only 63% of traditional building projects
are completed on time and only 49% to the agreed contract sum.
In contrast, over the years, more than 96% of PREKONS projects
have been completed on time and 94% on budget clearly exceeding
construction industry averages.
with Vernacare
Article provided by Vernacare
n alternative,
environmentally
friendly and time-saving
single-use system for human waste
management is now available from Vernacare, and is fast
becoming the system of choice around the world.
Used in over 50 countries and various hospitals including King Fahd
Medical City in the Kingdom of Saudi Arabia, City Hospital Dubai in
the United Arab Emirates, and in 94% of UK hospitals, the Vernacare
system is a cost-effective alternative that can help reduce the risk of
cross infection.
Offering a wide range of products, Vernacare manufacture singleuse bedpans, urine bottles, jugs, and an award-winning washbowl that
can be used with warm water and detergent. Once used, the medical
pulp products are then disposed of using the Vortex unit, therefore
eliminating the risk of cross infection. The products are manufactured
using clean, recycled, over-issued newspaper, along with a wax resin to
ensure products hold water for at least four hours. They also contain
no bleach or colouring and are similar in composition to toilet paper
when disposed of into the drainage system.
Compared to alternative systems, the Vernacare single-use system
delivers many benefits, including using 60% less water and up to 96.5%
less power. A 36% saving in operation costs can be achieved together
with an estimated 33% in time savings, allowing staff more time to
spend on patient care. The system may also support a reduction in
Healthcare Acquired Infections.*
More info
For more information on the Vernacare system please email info@
vernagroup.com , visit www.vernagroup.com or meet with us at Hospital
Build & Infrastructure Middle East 2012, Dubai, Stand Number RK34
014
uses 60%
less water
uses 96.5%
less power
a 36% saving in
operation costs
estimated 33%
time saving
may support
a reduction
in HCAIs*
Visit us at
Hospital Build & Infrastructure Middle East 2012,
Dubai. Stand Number RK34.
info@vernagroup.com
www.vernagroup.com
* A 56% reduction in HCAIs was achieved using Vernacare disposable washbowls alongside other interventions reducing Clostridium Difficile
infection in acute care by using an improvement collaborative, Power M et al, Salford Royal NHS Foundation Trust, BMJ 2010;341:c3359
A Suite Arrangement:
016
017
General benefits
From hospitals built in 1812 to those newly constructed in 2012,
no healthcare facility ever seems to have enough room for storage.
Utilizing suite provisions allows for storage in the circulating spaces,
which would have otherwise been considered corridors. The
2012 LSC requires corridors in healthcare to maintain 2440mm
(8ft) clear width. An exception is made for wheeled equipment
and fixed furniture meeting certain requirements. The circulating
space within a suite allows for greater flexibility though, permitting
non-combustible storage as long as 915mm (36in) of clear width
is maintained, per the LSC. Operationally, a facility may wish to
maintain 1220 mm (48in) or more for ease of moving beds and
other equipment. The storage must be limited to less than 4.6 m2
(50ft2). Any areas of storage greater than that must be protected
as a hazardous area.
Additionally, since the circulating space within a suite is not
considered a corridor, the walls and doors do not have to be
maintained as required for corridors. There are no requirements
for a fire-protection rating or smoke resistance for the walls and
doors within a suite. Doors are not required to self-latch and
actually are not required at all. Only the suite boundary must meet
corridor requirements for both walls and doors, limiting required
maintenance of the area.
Sleeping suites
Sleeping suites (see image 1) refers to a collection of rooms housing
patient sleeping, such as an intensive care unit (ICU) or coronary
care unit (CCU). Special nursing units like these tend to have an
open floor plan and a high staff-to-patient ratio. The LSC requires
constant staff supervision within the suite, with either direct visual
In short
The requirements for suites has up until now been confusing
due to the lack of clarity in code language and a lack of
understanding of the advantages of using suites
2012 Edition of the Life Safety Code, NFPA 101 permit three
different types of suites: sleeping suites, patient care non-sleeping
suites, and non-patient-care suites
Using a suite arrangement can allow for more storage space
on a ward.
www.lifesciencesmagazines.com
Non-Patient-Care Suites
IMAGE 3: Non-Patient-Care Suite (Office space)
Summary
The use of suites in your healthcare facility can greatly help facilitate
efficiency of departments and ensure the safety of occupants. Suites
can increase the ease of operations in a unit while decreasing the
time spent maintaining fire protection features. Whether youre
designing a new hospital or evaluating an existing building, suites can
be invaluable to your facility.
018
One Partner.
A Complete Solution.
www.hill-rom.com
EEMEA@hill-rom.com
Image DORMA
DORMAs entire range of door hardware locks, latches and handles have
microbial coating for hygienic reasons. DORMA has special doors for
hospitals with low energy operators, which enable smooth passing in and
out. In addition, DORMAs rest rooms for differently able with special key
switches, push buttons and locks enable easy access. Brailed lever handles
and ICU doors are some of the prominent solutions provided by DORMA
to the healthcare industry. Another great solution is the DORMA ES200
sliding door that can be used internally and externally, as single or bi-parting
sliding doors and can be telescopic and curved. It can be linked to an access
control system to restrict entry to authorized personnel only. The DORMA
CS 80 Magneo features a unique magnetic linear drive. It is virtually silent in
operation making it ideal for use in areas of patient care.
020
Pre-register
your
visit now
Visit Hospital Build & Infrastructure Middle East to see the latest clinical
solutions in healthcare such as hybrid operating rooms, intensive and
emergency care solutions, medical equipments and devices and many more.
Hospital Build & Infrastructure will also feature many non-clinical solutions
such as the latest innovations in security, building management, prevention
of hospital acquired infections, and facilities management which will all
effect the clinical services you provide.
To pre-register
your visit or
for more
information visit:
www.hospitalbuild-me.com
Organised by:
www.hospitalbuild-me.com
023
In short
The facilities managers role is crucial and it is in this area
that Hestia FM differentiates by providing highest international
standards
Hestia FMs added value is measured through the impact on our
clients own KPIs
Hestia FM goes beyond expectations to create a unique
experience of quality care for patients, a reassuring stay for visitors
and better working conditions for medical staff.
monitored by the medical staff themselves, leading to overtime, stress
and an inevitable drop in efficiency.
This is why Hestia FM works closely with clients to design, manage
and deliver fully customised and comprehensive High Impact Solutions
that contribute directly to the operational and financial performance.
Each tailor-made solution follows a strict five-step cycle: Understand
needs, design the offer, implement solutions, monitor and deliver
commitments, improve and innovate.
These solutions add value by optimising the three principal assets of
a hospital:
People: by increasing satisfaction, motivation, and effectiveness
Processes: by enhancing quality, efficiency and productivity
Infrastructure and equipment: by improving utilisation,
reliability and safety.
Solutions are delivered to the highest standards and in compliance
with all statutory rules and regulations. Services are carried out in
a professional manner maintaining the good image of the Hospital,
ensuring a safe and optimised environment and supporting in the
achievement and retention of internationally recognised accreditations
such as Joint Commission International (JCI).
It is part of Hestia FMs commitment to clients to always be as
transparent as deemed possible: all services rendered are closely
monitored and reported periodically, highlighting all improvements and
compliance to the Key Performance Indicators (KPIs) and Service Levels
agreed upon with the client.
Also, Hestia FMs added value is measured through the impact
on our clients own KPIs, such as average patient transport time
from room to operating theatres, clinical equipment uptime, energy
consumption, JCI pass rates, etc.
So from people driven services like reception, cleaning, staff training
and processes managing patient transport, bed allocation, medication
distribution, all the way to sterilising surgical instruments, biomedical
engineering and clinical technology management; Hestia FM aims to add
value through total facilities management solutions tailored to positively
impact the overall environment of each healthcare institution.
Hestia FM goes beyond traditional expectations to create a unique
experience of quality care for patients, a warm and reassuring stay for
visitors and family members and better working conditions for medical
staff; i.e. improving the Quality of Daily Life for all who flow through
hospital wards.
MORE INFO
Hestia Facilities Management LLC is a joint venture between the UAE
group Al Jaber and the French services company Sodexo, world-leader
in Quality of Daily Life solutions. Hestia FM is proudly participating as
the unique Healthcare Facilities Manager at this years Hospital Build &
Infrastructure Middle East exhibitions and conference, as official Gold
and Registration area sponsor.
www.lifesciencesmagazines.com
FEATURE TRANE
025
www.lifesciencesmagazines.com
In short
Introducing a national electronic health record system would be
an important tool to reduce medical errors
A national implementation of a electronic health record
system would give the UAE an attractive advantage in the
medical tourism market
A costly implementation could be off-set using a pay-peruse system and could also potentially bring revenue to the
Health Authority.
028
029
About HIE
Imagine going to a new clinic or hospital for the first time, whereby
the hospital automatically has access to your medical history, allergy
list, bio, etc. No need to file any more paperwork or conduct
medical tests that you have just recently done with another
provider. You meet a physician that already knows your medical
history, has access to your past and present lab results, images (CT
scan, EKG, MRI, etc), can read notes from previous doctors, your
medication list, operations you have had in the past and more. This
is the potential of a national HIE system that has been implemented
in certain nations around the world.
The HIE system ensures that all patient medical records
are centrally stored, which consumers, Health Authorities, and
healthcare providers (hospital, clinics, physicians, etc) can access at
any point (upon the patients consent of course) and subsequently
update appropriately (see figure 1). The concept is not new, and
www.lifesciencesmagazines.com
030
Challenges
Of course, as with any good solution, it comes with certain challenges,
and in our case the following three challenges need to be remediated:
Financials, regulation, and ease of integration and adoption.
Financial Cost Model: Implementing a solution of this magnitude
can take years and incur a hefty cost, as it needs to be integrated with
every hospital/clinic in the country and fully adopted. While the MoH
can play a critical role as a regulatory body, shouldering the cost of
such an effort can be prohibitive for any health authority, thus it is
necessary to have appropriate cost recovery models.
A viable financial model that might prove to be feasible can
031
be a pay-per-use model. This model, in which the HIE solution
can be located centrally in a cloud and providers (hospitals/clinics,
etc), can access Health Record on a pay-per-use model upon
every patient interaction with the provider. The charge can be as
nominal as 1% of the hospital visit cost, which can be ultimately
charged to the patient/insurance. The time efficiency for both the
patient and providers alone would be worth far more than the
nominal 1% fee. While this will requires an initial investment, the
cost recovery can be reaped in a short time. This brings us to next
challenge, which is ensuring adoption of the system by each and
every provider.
If we are to take a very rudimentary stab it at, we are looking at
generating $45 million dollars per year with the pay-per-use model.
This is based on the fact that UAE healthcare market for 2010 was
estimated to be $4.5 billion dollars (which is expected to grow to $8
billion by 2015). This amount would be more than sufficient to pay for
itself, while at the same time generating business and improving the
quality of care.
It is important to note that the pay-per-use model rate of 1%
is just a random number at the moment, and proper calculations
have to be made to provide a more accurate understanding.
Also, after reaping the initial investment cost for the HIE, Health
Authorities can either lower the pay-per-use rate or use the
money to invest in value added services to further benefit patients
(e.g. research).
Regulations: The patient medical records residing centrally in
a cloud are only valuable if providers continually update them
as they see patients in a standardized and auditable manner.
Of course here in lies the greatest challenge of ensuring that
after each hospital/clinic visit, patient records are updated and
uploaded in the cloud accordingly by the caregivers. The role
of regulatory bodies (Health Authorities) to adopt stringent
regulations and measures are absolutely critical for this to work.
Regulatory bodies needs to tackle the issue at three levels:
Provide explicit and detailed information on usage of the HIE
cloud system (updating all patient information, lab
results, images, records, etc., along with time span allocated
for each update)
Stringent and incremental fines for delay of patient updates to
the system, while at the same providing monetary rewards for
providers that adhere to regulations. The monetary reward can
be a lesser charge for usage of the pay-per-use model (e.g. 8
AED per patient, whereby the provider can keep the
additional 2 AED)
Health Authorities need to pave the way and provide easy
means of adoption and integration for providers. The next
section will explain how this can be achieved.
Conclusion
There is unanimous agreement amongst healthcare experts
and analyst on the value and need of adopting a national
HIE model, and more importantly the solution is proven and
already implemented in some nations across the world. The key
challenges for HIE adoption resides in how it can be monetized,
localized, integrated and adopted with speed, all while taking into
consideration the population size, type of government, and patient
privacy laws. As in the case of the UAE, this article has aimed to
address the challenges of HIE adoption and how it can be adopted
in the UAE market.
By pursuing and achieving a national HIE model, the UAE will
be considered amongst the top quality of care providers in the
world. It would provide the UAE a stellar reputation in healthcare,
attracting medical tourists from the region, high-end skilled
workers, and top-notch practitioners (physicians/nurses). Given
the monetizing model, the cost would be nominal to the health
authorities (might even be a source of revenue) and would propel
economic growth and development of the nation.
References
References available on request (magazine@informa.com)
www.lifesciencesmagazines.com
TRUMPF - Neonatology
The hidden
problem
Health human resources
in the eye of healthcare
facility planners
By: Architect. Awn Sharif, M.A Healthcare Facility Planning, Doha, Qatar
034
035
www.lifesciencesmagazines.com
036
HHR PLANNING
The issue that generates 50% of the healthcare facilities operational
costs is often neglected, or not taken into account properly during
the healthcare facility planning process, it is almost always left until the
end of this process - the commissioning stage. The facilitys structural
organization and the physical/spatial interpretation need to be
considered in the early stages and HHR planners need to be present
right from the planning stage as their decisions will, to great extent,
impact the output facility performance, efficiency, waste, capital and
operational costs. In addition, the absence of HHR planning and proper
consideration of the facility organization structure in HR terms during
the planning stage will affect many aspects. Vice versa, the multiple
structural variations that organizations could take on at a later stage
after the facility is provided, would in return affect the way healthcare
facilities are used. A mismatched facility results in high capital and
operation costs and waste of precious human and financial resources
that are extremely important, especially in economic downturns.
037
HHR - THE FORGOTTEN ROLE
Opex impact
Healthcare planning and design have a considerable impact on
Healthcare Facilities Operational Expenditures (OPEX) of the ongoing
cost for running the facility, and also the Capital Expenditure (CAPEX),
meaning the cost of developing or providing the facility.
In general, there are many ways in which human resources are
influenced by healthcare facility planning, design and construction,
and could automatically imply a staff increase of 10%, 15% or even
higher than they should have been. Consequently, if the staff number
increase due to inappropriate facility planning and design, and if the
operational budget is not sufficient, then the facility will be understaffed,
undersupplied and underutilized.
References
References available on request (magazine@informa.com)
www.lifesciencesmagazines.com
038
039
Are hospitals
an endangered
species?
By: Michael H Lindell, Strategic Planner, McMullan Solicitors,
Melbourne, Australia
NATURAL SELECTION
In short
The function of a hospital has changed a lot in the past centuries
and will only continue to do so
The hospital as a system must be ready to adapt and respond
to changes in the market, technology, demographic and economy
Hospitals as care hubs will change as technology advances
and allows patients to be diagnosed, treated and cared for in
their homes.
YESTERDAY
Early in Greek history, hospitals emerged as Halls for Dreamers. Patients
rested and were cared for by physicians who were also
www.lifesciencesmagazines.com
040
TODAY
Today I think we are in a precarious position. We have a catchment
now, which has exceptionally high expectations for every facet of its
healthcare. Demographic shifts have skewed the population to be older
and inevitably more demanding of services. The costs associated with
healthcare delivery are rising significantly. The existing institutionalised
model is outmoded and intrinsically expensive to operate and maintain,
as often a massive, complex aggregation it is formidably difficult
to modify. Collateral damage and disruptions associated with such
alterations are often extensive and risky. A major part of the recurrent
expenditure associated with todays structures, are people costs. The
development of super-specialities is exacerbating this trend. There is now
ominous evidence that many of todays medical edifices are not safe
places. Infection control is proving to often be an intractable problem.
It is interesting to recall Florence Nightingales writing on nursing where
she made rule number one - Do the patient no harm. We thus have a
dilemma emerging - should we bring vulnerable patients and their families
into highly sophisticated, yet dangerous settings? Keeping these places truly
safe is becoming more difficult. Todays hospitals reflect momentum from
earlier eras, understandably they involve entrenched practices, which
in todays care environments are often extravagant, inappropriate and
unresponsive. In this atmosphere there is now injected a
developing commercial imperative, sometimes
expressed in terms of cost-control,
sometimes in terms of profitability.
This focuses attention on
the care of older people.
A high proportion of
inpatient beds are
occupied by older
patients, often
041
for long-stay treatment, this is an extravagant way to care for this growing
population and as a consequence, care for other patients is limited. The
character of care is now changing. Diagnostic precision has advanced to a
level where surgical interventions can be much more thoroughly targeted
and thus less exploratory in nature. This has led to a significant reduction in
patients stay and to the creation of short-stay facilities. Other less invasive
procedures using sound, catheters and keyhole approaches are accelerating
turnover. This trend is lifting the numbers being treated and making access
even more important. Historically major hospitals have grown in the heart
of large cities and their growth often results in complex campus structures.
Access too often is tortuous and intimidating. The essence of the hospital
conundrum is that our wants are significantly greater than our healthcare
needs. The resources available to address such needs are often insufficient.
It is not a politically palatable strategy but rationing is happening now and
will become a more and more pervasive part of healthcare delivery. The
interesting issue will be the rationale behind decision-making - is it welfare,
economic, risk mitigation or political appeal? Political attention too often is
focused on the dramatic and superficial rather than the logical and prudent.
Hospitals of today, to a significant extent, are mirrors of other eras.
Challenges are presented to develop new approaches to the timeless issue
of appropriate healthcare.
TOMORROW
The Sword of Damocles in hospitals evolution is change. When
the pace of change was glacial, planning could move in a thorough
predicable and careful manner. The pace of change today is rapid
LEARN MORE
Mr Lindell is speaking on this subject at the Architects Conference
as part of the Hospital Build & Infrastructure Congress running
from 4-6th June 2012. To find out more about the conference
and how to book your place as a delegate, visit the website www.
hospitalbuild-me.com or call +971 4 336 7334
www.hospitalbuild-me.com or call +971 4 336 7334.
and is accelerating. Planning must be radically different and it should
be predicated on creating the capacity to cope with the certainty
of change. Massive consolidated aggregations are not suited to such
thinking. This challenge calls into question initial siting. It really would
make more sense to create facilities on open sites outside city centres
where space is allowed for future developments to be woven into a
complex without massive dislocation and disruption. To maintain the
continuing humanity of such a complex it may be prudent to create a
tranquil courtyard as a sanctum at the heart of a complex or village.
Thus with turbulent activity around, the identity and stability of the
structure would be sustained.
Healthcare is in a process of devolution. The shift is from the major
acute hub to community facilities into the workplace, into the school,
and into the home. The evolution in nanotechnology applications will
facilitate the devolution of diagnosis, treatment and care into the patient.
Conditions will be monitored and treated remotely, and if
appropriate, automatically. Site-based care is being
eroded, and developed outreach approaches are
proliferating. Such initiatives will allow older patients
to be released from acute centres and returned to
home, but they must be supported at home. There
will in the short-to mid term be an escalation in
those older patients with Alzheimers and care
environments must enable such individuals to
be safely housed without extravagant reliance
on trained staff. The economic pressure on
healthcare delivery will demand patients and
their care partners assume much greater
control of care delivery. This will often involve
device or system support, helping patients
care for themselves. The pervasive digital
interactivity of this millennium will
allow such care autonomy to
be supported. Clearly urban
structures should be part
of a truly prosthetic living
environment. The future will
contain surprises they may
be technological, commercial,
social, medical, military or
political. The atomised
hospital of tomorrow must
be responsive as a facility, as
a network, as a village, even
as an attitude. Hospitals are
an endangered species and
will remain so. They must be
taught to anticipate, not just
react. They will reflect our
vision if we dare to have
one.
www.lifesciencesmagazines.com
QuestionsandAnswers
Lee Zebedee
BIM Manager, Ramboll, Dubai, UAE
Q. What is BIM?
A. There is a wide range of definitions of Building Information
Modeling (BIM), most of which struggle to succinctly capture the
real essence of BIM. At its best BIM is the process of collaboratively
developing an accurate digital prototype of the built asset. This
digital prototype should be data rich, offering a wide range of
benefits to all stakeholders throughout the whole life of the asset.
There is a tendency for BIM to be seen as a tool for construction,
but for the enlightened the real benefits comes in the long-term
operation of the building. This should not be limited to the asset
management; it should also be considered as a tool for all aspects of
the use of the building.
The BIM model for construction should be built with embedded
data that can be harvested and built on by the various stakeholders
042
Q&A Ramboll
043
LEARN MORE
Lee will be speaking on the subject of The role of BIM in delivering
modern healthcare facilities at the Architects Conference running
alongside the Hospital Build & Infrastructure Exhibition in Dubai
on June 4-6th 2012. Lees presentation is part of the session on
Present and future of healthcare architecture II on June 5th. To
find out more about the conference, or to register your place as a
delegate, please visit the delegate zone on the website:
www.hospitalbuild-me.com or call +971 4 336 7334.
the easier and less disruptive the operational maintenance becomes.
This requires accurate, reliable data about the equipment and services
within the facility. Effective BIM models deliver such information.
Certainty of delivery and operations enables improved, more
cost-effective healthcare provision and less disruptive maintenance.
Our experience proves that a collaborative BIM approach allows the
building detail to be developed and communicated more effectively
leading to improved coordination and quicker delivery.
An accurate, well structured, easily accessible, digital record of all
parts of the building (i.e. a BIM model) can prove an invaluable way of
providing the above objectives. For example, if a maintenance engineer
knows exactly what and where everything is, repair and maintenance
becomes easier and more certain. If virtual maintenance checks are
carried out before construction then the risk of key maintenance being
needed in clinical areas is reduced.
In summary, healthcare facilities need to be operated and maintained
in a manner that minimises impact on clinical activities. Virtual prototyping
and accurate asset recording using BIM can help this happen.
This is a project for Birmingham City University where Ramboll are the structural
engineers. It is a fully coordinated model with input from the architect, the M&E
Engineer and Ramboll. The name of the project is Birmingham Institute of Art and
Design (BIAD)
www.lifesciencesmagazines.com
Pembury Hospital, UK
044
Hygiene
Productivity
Comfort
Trane Healthcare Solutions to optimize your healing environment
Learn how Trane HVAC systems, services and solutions can help you achieve
better patient outcomes while improving your operational efficiency.
Visit us at stand RM 30, Sheikh Rashid Hall.
HOSPITAL BUILD
& INFRASTRUCTURE
MIDDLE EAST 2012
Pre-register
your
visit now
Organised by:
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In intensive collaboration with ENT specialists, we have created a new, ergonomic surgical
workplace. KARLSTORZ particularly considered that ENT specialists spend many hours of
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OFFICE1 1/02/11/A-lb
We optimized the indispensable computer workstation and the paths to the microscope,
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in the U-shaped OFFICE1.
KARL STORZ GmbH & Co. KG, Mittelstrae 8, 78532 Tuttlingen/Germany Telephone: +49 (0)7461 708-0, Fax: + 49 (0)7461 708-105, E-Mail: info@karlstorz.de
KARL STORZ Endoskope East Mediterranean and Gulf (Offshore)., Solidere Beirut Souks, Block M, 3rd Floor, 2012 3301 Beirut, Lebanon,
Phone: +961 (1) 999390, Fax: +961 (1) 999391, E-mail: info@karlstorz-emg.com
www.karlstorz.com