Designing A Hospital That's Out Of The Box

When the first sod of soil was turned at the site of Box Hill Hospital in Melbourne in November 2011, it marked the beginning of a $447.5 million redevelopment project to replace and expand the existing 1950’s facility to ensure it would meet the current and future needs of the local community.
The Box Hill Hospital Redevelopment project involved construction of a new 10-storey clinical services building (to be known as Building A) and refurbishment of close to 50 per cent of the existing hospital (to be known as Building B). The transfer of patients began in late September 2014, with final refurbishment works expected to be completed by late 2015.
The Australian Hospital and Healthcare Bulletin spoke with Project Director Liz Maddison about the Box Hill Hospital redevelopment and how it came to fruition.
Can you tell us a little about Box Hill Hospital’s history; how it started and how it came to be the major referral centre for people living in the eastern region of Melbourne?
The need for a hospital was identified by the local community in the late 1930s with construction undertaken from 1949 to 1956 as a consequence of local fundraising and strong community involvement.
Like many community hospitals, as demand for its services grew, additional wings and extensions were added including a maternity block, a larger emergency department and a mental health facility. In the late 1980s, Box Hill Hospital was transformed from a community hospital to a major regional teaching hospital affiliated with Monash University.

Who has been responsible for the design and construction of the project?
The Box Hill Hospital Redevelopment has been undertaken by a very strong team that included:

• Architect - Silver Thomas Hanley Daryl Jackson


• Services Engineer- WSP Building Service


• Structural Engineer – Meinhardt Pty Ltd


• Environment Sustainability Adviser – Cundell Pty Ltd


• Quantity Surveyor - Donald Cant Watts Corke


• Managing Contractor – Lend Lease Buildings (formerly Baulderstone Pty Ltd)

The client organisations of Eastern Health and the Victorian Department of Health were heavily involved with the consultant and contractor teams in the specification and design of the facility. In particular, attention to the detail
of process and workflow by the hospital staff so that the operations of the hospital would be most efficient was fundamental to achieving the desired outcome.
What are the new facilities at the hospital?
On completion, the capacity of the new facility will include a much larger emergency department, 10 new operating theatres (with an 11th for future expansion), a new 18 bed intensive care unit (and 2 additional for expansion), improved women’s health services and expanded services for cardiology, cancer and renal patients. It will include a total capacity of 621 beds (an increase of more than 200) and more than 200 additional public car parking spaces. There are 40 day medical and day cancer treatment spaces as well as approximately 30 additional consulting rooms when the project is completed.
Will there be an increase in staff?
Many of the new facilities are designated for future growth and will be commissioned and staffed as demand increases and new activity is funded. There will need to be more staff to manage an increase in presentations and admissions into the future.
Is there any new, innovative medical equipment being installed?
Yes, although it may not seem awfully sexy. One example is that we are very excited by the fact that every bed in the hospital is a high tech falls prevention bed. These beds are constructed with alarms which send a signal to the nurse team if a patient at risk tries to get out of bed. The nurse can then (through our high tech nurse communications system), call the patient and ask if they want to get out of bed and reassure the patient that the nurse is on the way. This means the patient is more likely to wait for the nurse to arrive and less likely to try to get out of bed without assistance – increasing falls risks.
How has technology been integrated and will it improve administration and management?
Building A is a technologically advanced building incorporating a number of new information technologies, as well as a robust wireless and cabled network. Some of the key technology components in Building A include:

• Spectralink wireless telephones for voice and text paging


• A range of Cisco fixed telephones


• The Messenger paging system that can send text messages to wireless and fixed telephones, PCs, radio pagers and most smart phones.


• The Responder 5 Nurse Call system integrated with the Messenger system, including Bed Exit alerts


• Building Management system integrated with the Messenger system


• Proximity card based security and access system integrated with the Messenger system


• The Patient Entertainment System from Rauland, which can later be extended for clinical purposes


• The advanced Medical Monitoring system from Philips


• Omnicell automated drug dispensing cabinets in the emergency department


• Tracking of assets through the Radio Tracking Location System (RTLS)


• Advanced audio-visual facilities in theatres and meeting rooms


• A Room Booking system integrated with MS Outlook


• (practically) all new PC and printer fleet, including multi function devices with the capability for fax integration with MS Outlook;


• The Intellidesk telephony system to support the new Business Services Centre and code calls

Has the project involved landscaping, and if so, was healthy living considered in its design?
While studies indicate that there are healing benefits of nature, fresh air, gardens and sunshine etc, it is challenging for hospitals with strict infectious disease prevention and controls. The new hospital is a multi-storey building and views to the outsides are maximised as much as possible for staff as well as patients. We also have a number of rooftop courtyards and while the infection and prevention control advisers mandate against gardens, we have been able to create an external environment with artificial elements including sculptures, where patients can sit outside and enjoy the environment.

How will/has the transferral of patients been planned and managed?
The patient move is a very important and significant step in the commissioning of the new building. The entire relocation was a co-ordinated and staged process over a six-week period to minimise risk and disruption and to ensure patients and staff relocate safely into the new facility.
Preparing the new building for occupation includes a thorough clean, air sampling and testing, and stocking with equipment and consumables. There are almost 100 new clinical and non-clinical systems installed in the new building which need to be commissioned and tested in a live environment by Eastern Health staff during this period. We also have approximately 3,000 staff and volunteers who require orientation and training by our M (Move) people and trainers before we can safely move patients into the new, much larger and very different environment.
The Project Team has engaged the services of Smooth Hospital Move consultant Julie Collette who has managed a number of successful hospital moves including The Royal Children’s Hospital in Melbourne. Individual move plans have been developed and will continue to evolve as details are finalised.
What were some of the biggest challenges in delivering the hospital to the point it is now?
Planning new hospitals is very complex but this hospital has had a highly professional one team approach which has meant that problems are identified, analysed and resolved in a collegiate atmosphere. As with all contemporary hospital, the information and communication technology is the most challenging aspect of all of the project elements.
Constructing the new building next door to an operating hospital and connecting into its main services such as power and water has its own challenges. The project team has worked closely with the hospital’s management and engineering staff and have jointly identified processes which means there is a framework to deal with any problems that arise
Completion isn’t expected until 2015. What remains to be done?
As part of the redevelopment, there will be some quite significant refurbishment of the existing hospital to increase its consulting and support capacity. Some of this work has begun already with the renovation of the former Children’s ward to provide additional Pathology space. Immediately following relocation to Building A, the refurbishment program will ramp up with work starting on the ground and first floor, which includes creating a new food court and retail space.