The future of Australian Healthcare

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February saw the return of Australian Healthcare Week for 2013 where some of Australia’s industry leaders get to together and discuss how to solve some of the challenges currently facing the healthcare system.

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The combination of a growing population within Australia and a changing demographic is creating the need to build health infrastructure to cope with this growth. Health facility development isn’t shy of complexities; but if there isn’t a collaborative approach from the entire healthcare community to resolve these challenges, it will leave patients at risk of not having the right medical assistance available and their health deteriorating.
The Department of Health understands that user centered design is a major component of ensuring healthcare infrastructure meets models of care now and in the future. New build and expansion projects are occurring throughout Australia and it is critical to get it right first time. The reality is the only way to achieve these outcomes is through the entire industry working together to keep abreast of the latest solutions adopted throughout Australia.
Healthcare IQ wanted to get together some of the key speakers ahead of Australian Healthcare Week to discuss where the key challenges and opportunities lie within the system and get a sneak preview of some of the insights and solutions set to be shared at the 2013 event.
It seems clear that the biggest challenges can be categorised around the overlying provision of healthcare, but what exactly does this entail? This article discusses some of the key issues the panel see having an impact on the industry.

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How is Australia going to meet its health objectives?

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Technology & Future Proofing
Technology is progressing at a fast pace and new opportunities are becoming available to enable more effective health monitoring. However, this comes at a cost and can be expensive to implement.
Consumer expectation is also changing; people have a new perception of getting the service they believe they’re entitled to when they want it. There’s an increasing assumption that every community should have access to better technology and that brings increased pressure.
Dan Owen, Senior Consultant at Arup, suggested that it’s important to see technology as the enabler and that we first need to look at the current funding and assets to see if we’re using what we are currently demanding is premature.
When implementation of new technology is the answer, due to the fast pace nature of advancements there are major design considerations that need to be factored into investments.
Jeff Robinson, Sustainable Design Leader at Aurecon, explained: “Technology will change; you need to allow for things to change over the life of the building – long life, loose fit – there has to be the capacity to be able to swap things in and out by recognising that it’s going to change. Set your infrastructure up in a way that can be adapted overtime and set your technology to a place where it has the capacity to grow.”
Mark Mitchell, Director at Billard Leece, agrees with this: “You have to remember the rate of change; it might be several years before these things get installed. You need to make sure you’re investing further in the soft technology, make sure these things can be plugged into the software rather than just buying new machines.”
As Project Director for the Victorian Comprehensive Cancer Centre, Tony Michele is very familiar with the considerations that come with implementing new technology: “The cancer centre is a fantastic example, there’s $150 million worth of equipment going into a $1 billion building. All the major vendors say beyond 7 years at a point in time it’s very hard to get those long term over-the- horizon factors into your design. You do typically design infrastructure for long term, in this case infrastructure 40, 50, 60 years, fit out, 20 but technology is somewhere near 7 and 10.
In Victoria we’re seeing a shift to recognition that technology sits on a single backbone, something that’s not previously been pursued in public hospital buildings in Victoria. It used to be separate network or cable systems for the individual components that support service delivery. Certainly within the cancer centre and the new Bendigo Hospital, we’ve pursued a single backbone for all systems to be attached to which does provide flexibility. There’s the public pressure to get value for money so you need to put in the best supporting infrastructure that technology hangs off from the money that you have.
Who was on the panel?
John Miller, Principal, Hassell Mark Mitchell, Director, Billard Leece Jeff Robinson, Sustainable Design Leader, Aurecon Andy Fodor, Clinical Informatics Specialist, Epworth Healthcare Duncan Palmer, Nurse Coordinator, Melbourne Health Len Kennedy, Logistics Manager, Cabrini Hospital Tony Michele, Project Director, Victorian
Comprehensive Cancer Centre Dan Owen, Senior Consultant, Arup.
From the government we have to see a resilient, proven technology – we tend not to trial new technology in service delivery, that underpins it – then you may get the opportunity with R&D projects to trial the new technology.”
Mark Mitchell summarised: “We need to create buildings that are around the people using the technology rather than the technology, where people have to work around the technology. It should be at the centre as an enabler. The key is adaptability and future proofing comes at a cost – you need to find the balance.”
Prefabrication and modularity
One area that is starting to be explored in Australia is prefabrication and modularity, and it’s clear to see why – there are huge benefits to be reaped.
Mark Mitchell explained that economic slowdown across Europe opens up new opportunities for the Australian healthcare market: “What we’re finding is that opportunities are emerging in prefabrication in Europe. For example, there will be some manufacturing in the UK but there is no one to sell them to, so we bring them out here for a good price.”
The panel discussed how this way of working raises the question of how much can you build off site and just plug in? Jeff Robinson highlighted that there are already examples of modularisation here in Australia, with some very large scale examples set for the near future.
It seems an effective solution when on site it can be difficult to source local production, the solution may be available elsewhere. As for the products themselves, as it’s in a factory rather than being built in a yard you tend to receive a high quality finish.
Tony Michele explained exactly how much potential there is to look at sourcing materials offsite when looking at design: “There are big modularisation opportunities, as on site you’re trying to install very complex service systems. Take rooms, for example: 80% are generic and there are approximately 12 different types of rooms within a hospital facility, so it makes sense to look elsewhere. Essentially, look at your common room types for modular.”
Energy Efficiency
The panel then continued to discuss the increasing emphasis on a building’s energy efficiency credentials. They agreed that incorporating standards into buildings is an absolute must, both with the focus on sustainability and energy prices set to increase well into the future. It’s something that is a relatively small additional cost when you’re building a new hospital.
Of course, there are also still opportunities to improve existing buildings that don’t currently have good efficiency standards. That’s been recognised and the Government Buildings Initiative and the Co-generation Programme. With such developments in the quality of technology on the market in terms of services, lighting, air conditioning, etc, the group agreed it also makes good business sense too.
Tony Michele emphasised the importance of energy efficiency, stating it as one of the key factors in winning his project brief: “We were heavily criticised for not hitting our green star target as part of the design brief as a starting point, but what did win the brief was focusing on energy efficiency.
We were very keen to see the efficiencies on the design were already there. We saw the investment into energy efficiency being of a greater benefit to the community – that’s where we are starting to see a push, good design; good building should give you a good outcome on efficiency.”
Looking to the future, the group posed the question of just how much of a role a community centric building such as a hospital can play in driving energy efficiency on a wider scale. Jeff Robinson explains:
“We should be asking ourselves, can we use our hospitals as a driving force to extend out into the wider the community into the future? Can we create a community approach to energy by using a hub? Naturally it’s a challenge, as with a PPP the initial thing is to keep capital expenditure down. The thing to consider in the future is the lever the hospital has in the community and can that be used to get a better energy efficiency result community wide. For example, in Christchurch a proposal of using the central energy plant in the hospital as the starting point to look at a heating grid in the city.”
Delivering the end result
Another topic discussed by the group was the importance of delivery models, and the role they play in achieving a successful end result.
However, the answer seems to fall not on the process itself, but rather on the softer elements of change; communication, culture and buy in.
As Dan Owen explained: “If you work within the health sector, you understand that one approach doesn’t fit all for change. The rule of thumb is that for every $1 you spend on I.T., you should be spending $1 on business change. The implementation is not about I.T., it’s about the business change. You need to understand what your business needs.
Fundamentally, it’s not the model itself; it’s the people and the discipline and commitment of the team across the party. Some approaches can look perfect on paper but fundamentally what it comes down to is what it can deliver.
It comes down to sharing risk, using a policy approach balanced with a practical approach to risk. What that tends to do is drive the culture, where you do a better job instead of a satisfactory job. Having the risk setting in the right place delivers the best outcome.
“Technology will change; you need to allow for things to change over the life of the building – long life, loose fit – there has to be the capacity to be able to swap things in and out by recognising that it’s going to change. Set your infrastructure up in a way that can be adapted overtime and set your technology to a place where it has the capacity to grow.”
“We should be asking ourselves, can we use our hospitals as a driving force to extend out into the wider community into the future? “
Culture
As Nurse Coordinator at Melbourne Health, Duncan Palmer has on the ground experience in factors that may lead to a resistance to change: “From a clinician’s perspective, the biggest culture challenge we have is resistance to change and working with other clinicians – nurses and doctors are notorious for not liking change.
“One of the reasons clinicians see they’re only doing things in a safe way is because their primary drivers are care and safety. You get used to the systems and processes that you’re using, you learn them and refine the research and development. Naturally with change the overall resistance from a clinician comes from the concern of asking, ‘Will I be able to care for my patient in the same way’
“From a local point of view, doctors are time based, whereas nurses will think more locally – you have to tailor your approach depending on the drivers of the individual.”
As a Senior Consultant at Arup, Dan Owen has been involved in a variety of projects. He sees the key reason for failure as over ambition in either the technology, company or the procurer. “Get it wrong and it can be the barrier to change.
One way that this can be overcome is through proving results and building trust – the change has to be demonstrated and that has to be recognised.”
Stakeholder engagement also plays a key role in understanding the potential obstacles that a change can bring. Andy Fodor, Clinical Informatics Specialist at Epworth Healthcare, said it’s essential to look not just at the positives and support, but to find out why people are against you and try to get them to turn around, by getting to the crux of their objections and turning them into positives that can be reiterated to other stakeholders.
Bring in teaching and the education around the issues and there is more chance of pushing it and driving it forward.
Healthcare Quality Week
October 20-26 2013
www.nahq.org