“How would you design and plan new hospitals to radically improve patient experiences, clinical outcomes, staff wellbeing and integration with wider health and social care?”
That was the question posed by this year’s Wolfson Economic Prize, the annual design competition ‘for fresh thinking which can challenge orthodoxy in economics and public policy.’
We teamed up with our friends at West Hart Partnership, DSA Environment + Design, the National Association of Primary Care and the Public Health: In the Right Place community to tackle the brief. We started from the premise that to radically improve patient experiences, clinical outcomes, staff wellbeing and integration with wider health and social care, we wouldn’t design a new hospital.
As our entry puts it: “While it’s indisputable that the hospital estate is hugely challenged and needs billions of pounds of investment, our answer to the 2021 Wolfson Economics Prize question started with the healthcare infrastructure surrounding hospitals: the wider NHS estate which accommodates services away from acute sites, but which are inextricably linked with the demands we make of hospitals, their design and with the patient experiences and clinical outcomes those buildings are able to deliver.
“Our vision is that by improving the capacity of primary and community health spaces to deliver more of the ‘workhorse’ diagnostic, testing and minor treatment activity of hospitals; by making primary and community health sites places which create a very different experience for the patients using them and the staff working within them; and by using primary care spaces as arteries for wellness in communities, all of the outcomes being explored by the prize question this year can be accelerated – freeing hospitals to act as the anchor institutions within the emerging Integrated Care System model, the hubs of specialist activity: centres of knowledge sharing and research within each local health ‘ecosystem’.
“Our solution is the surgery of the future: a primary care space which sits in the right place within a community, acting as the coronary artery of the people, places and organisations which are the gatekeepers of population health.
“This is not about creating a more modern version of the GP surgery as we know it today. It is about designing the right space for community-driven, inclusive, agile local health ecosystems, which can thrive in wider Integrated Care Systems.
“Community and primary care premises must work for the unique communities they serve: this design is not a blueprint to be replicated in every detail. But its fundamentals are scalable and spreadable, because they are led by how patients feel in healthcare spaces and by how the design enables delivery of the vision of the NHS Long Term Plan - for a proactive approach to population health led by primary care, and of multidisciplinary teams working together in the community. “
Why is the surgery of the future better?
For patient experience: The site is, quite simply, a pleasant place to be. It is designed around making patients feel calm, in control of their own experience and to maximise their connection to the people, activities and local services which support healthier living. Crucially, it is an environment which is designed to be inclusive – in contrast to many existing healthcare premises. It focuses on the tiny details which make healthcare environments more accessible but also pleasant for people with physical and learning disabilities, autism, dementia and other neurodiversity – ensuring that the physical environment is reaching its full potential to build confidence for those who most rely on health services. It draws in the design features which patients ask for: use and visibility of external space, wide open areas with plenty of light, building technology and ventilation to keep patients warm in winter and cool in summer, an easy layout to navigate and a feeling of being welcome.
For clinical outcomes: The hub gives the clinical team working within the space, facilities and tools to run truly asynchronous care – combining remote and virtual consultations with face-to-face activity. By creating the right space for point of care testing, monitoring and on-site diagnostics, it can accommodate many activities which have traditionally been delivered on hospital sites and which flow directly from primary care – giving patients in both primary and acute care a better experience and helping the NHS to keep pace with the volume and backlog of diagnostic activities which are now required. By embracing inclusive design, it supports staff to work with patients who may struggle to access services remotely or who find healthcare environments particularly difficult to be in. It is designed to play a part in keeping appointments on schedule, because there are other things happening at the site, and patients do not perceive their time before or after their session with a professional as ‘wasted’.
For staff wellbeing and productivity: It is a healthier workplace. It gives NHS staff a pleasant environment in which to do their work – both face-to-face and virtually, with the technology and facilities which allow them to deliver the care they want to deliver. The link between workplace environment and employee health and wellbeing and subsequent performance is well documented and, as our biggest national employer and the service charged with the health of the nation, the NHS’s workplaces should set the tone for healthy workplace design.
For integration with the wider health and care system: The surgery of future – the healthcare estate in general - is one of the key enablers of integrated care. Our design is a space which brings together services from different parts of the system, to improve patient experiences. In so doing, it will – in turn - enable hospital design to focus on delivering complex, specialist care; innovation and research.