Healthcare building designers told to 'think like Ford'

Medical sector should take lead from motoring industry to introduce standardisation in building design, conference hears

Is standardisation of the healthcare estate the answer to achieving efficiencies and improving outcomes?

The healthcare construction sector needs to take the lead from the motoring industry and look towards standardising design in order to cut costs and improve efficiency.

We tend to build a kit car every time we build a healthcare facility and what we need to achieve is a step change, introducing standard solutions that do not reduce quality, but we think can actually increase quality and improve healthcare outcomes while still giving us all a choice

That was the take-home message from speakers at this week’s IHEEM Conference in Manchester.

They accused the NHS of ‘building a kit car from scratch’ every time it constructs new hospital facilities.

This has led to the six principal supply chain partnerships within the P21+ construction framework initiative coming together to explore the use of ‘repeatable solutions’ that will help to create standards for future developments.

Alan Kondys, framework director for integrated health projects for the VINCI/Sir Robert McAlpine P21+ joint venture, told the audience: “The challenge we have taken on between the six of us is to work as a team to deliver the Government’s cost reduction programme.

In the motoring industry the phrase is no deviation without an explanation. What we are doing is bringing this level of standardisation to NHS facilities

“The concept for repeatable solutions for healthcare design came from the Ford Anglia. Compared to the original, today’s equivalent model is 50% cheaper, more reliable, better quality, and more secure - all challenges within the Government’s QIPP agenda for public sector efficiencies.

“Ford achieved this by having elements within its solution that are standardised, for example a standard chassis and components.

“We tend to build a kit car every time we build a healthcare facility and what we need to achieve is a step change, introducing standard solutions that do not reduce quality, but we think can actually increase quality and improve healthcare outcomes while still giving us all a choice.

“In the motoring industry the phrase is no deviation without an explanation. What we are doing is bringing this level of standardisation to NHS facilities.”

The six partners have started the process by exploring the potential of standardising elements in the design of five particular acute hospital settings – single rooms with en suites, four-bedded bays with en suites, and three types of outpatient consultation rooms – three-sided couch access, two-sided couch access and no couch.

Rosemary Jenssen, Kier Health’s representative on the P21+ cost reduction programme ‘repeatable rooms’ working group, said: “The starting point was absolutely about the patient and improving the quality and consistency of the environment while achieving enhanced outcomes. It was about using the evidence available and through this we identified five rooms within the acute hospital setting that are repeated many times.”

We need to move away from one-size-fits-all, but provide a number of options, all of which use the same components and have been designed in an HBN-compliant way

The group then reviewed the available evidence for each room design and held patient workshops and expert panel sessions. With input from the Royal College of GPs, the Royal College of Nursing, the Infection Prevention Society, design and construction professionals, and staff and patients, it is now beginning to test solutions and evaluate schemes, both from within the P21+ framework and outside.

Jenssen said: “The response is that the majority of people support repeatable solutions as a way of driving down costs within healthcare construction. However, the general consensus is that one solution would not fit all and it needs to be flexible, particularly in terms of refurbishment solutions. We need to move away from one-size-fits-all, but provide a number of options, all of which use the same components and have been designed in an HBN-compliant way.”

The team is now looking at the impact of standardising key building components such as bedhead trunking, lightings, flooring, ceilings and sanitary ware.

How rooms are laid out is also being reviewed, with the team exploring the patient/doctor relationship and the types of seating used in consulting rooms, as well as the possibility of reintroducing carpet as standard.

David Kershaw, P21+ programme director at Balfour Beatty, said: “This is very much the first step, not the beginning of the end. We will not be creating a mandatory design approach, but a preferred benchmark that will be regularly reviewed.”

This is very much the first step, not the beginning of the end. We will not be creating a mandatory design approach, but a preferred benchmark that will be regularly reviewed

He claimed the potential savings for an average scheme from using standard suspended ceilings, doors, sanitary ware, lighting and partitions could be in excess of £18m. The team will now look at the likely impact of standard M&E components like air handling units, pipework, nurse call systems, fire alarms and chillers.

And Kershaw called for NHS trusts to contact the group if they were working on development schemes.

He said: “We are compiling all the workshop comments and feedback and we want to test these components and room designs and get feedback.

“This isn’t the start of it; just the beginning of how we redefine and improve design.

“Any trusts with schemes on the horizon, we would love to talk to you. Also we want to know of any other room types we should be looking at, or whole departments or wards.”

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