Accelerated design for new hospital – check out how it’s done.

In the run-up to Health Facilities Design and Development conference, I wanted to explore some of the new case studies on the agenda.

One topic that really stood out is Jeffrey Williams’ presentation in his role as Director of Nursing at St John of God Midland Public and Private Hospitals, in particular the short time it took to get the project off the ground.

I caught up with Jeffrey recently when he gave me a sneak preview on some of the features of the new hospitals, key design innovations and a breakdown of the user group consultation process:

Project overview

Construction of the new 367-bed co-located public and private hospitals has reached 70 per cent, and is on target for a November 2015 opening.

With 307 beds, the public hospital will offer a wide range of services to the communities of Perth’s northern and eastern suburbs and the inner Wheatbelt, while the 60-bed integrated private hospital will offer the choice of private health care.

State and Commonwealth Governments have jointly invested $360 million in the public hospital project that will be operated by St John of God Health Care under a public private partnership agreement. The WA-based private health care operator is investing $70 million in the private hospital.

Fast facts

  • First major hospital facilities to be built in the Midland area in more than 50 years.
  • HASSELL architects and Brookfield Multiplex are the design and construction partners.
  • The public hospital will treat approximately 29,000 inpatients, 55,000 emergency patients and 89,000 outpatients in its first full year of operation.
  • The public hospital will provide an expanded range of services from those provided by Swan District Hospital free of charge to public patients.
  • There will be 367 beds in total – 307 public beds and 60 private beds.
  • The public hospital will have 50 per cent more beds than the Swan District Hospital.
  • More than 1,000 staff will be employed at the hospitals.
  • Easy access will be provided for pedestrians, vehicles, and public transport.
  • On-site parking will include 725 staff bays and 221 visitor bays.
  • Easy drop off and access to the emergency department will be provided.
  • Patients, visitors and the community will enjoy landscaped gardens, courtyards, public art and plazas.
  • The hospitals are being built on an eight-hectare site, four times the size of the Midland Oval.

Accelerated design

The State Government released its expression of interest in September 2010 seeking responses within five weeks.

Post EOI submission, St John of God Health Care continued to work closely with its partners Brookfield Multiplex and HASSELL to develop a design within the allocated budget while awaiting confirmation of our selection to tender for the request for proposal.

Thankfully St John of God Health Care was selected and had a short 20-week window in which to prepare and submit a response.

On 1 December 2011, St John of God Health Care was announced as the preferred tenderer and, following negotiations, signed a contract with the Western Australian Government on 14 June 2012.

During the negotiation phase, St John of God Health Care, Brookfield Multiplex and HASSELL worked closely with the State Government’s consultants to ensure that any major design issues were dealt with at a high level so that construction could start as soon as possible after contractual completion.

This preparation allowed St John of God Health Care to achieve the State Government’s goal of starting work within one month of satisfying the conditions precedent, in August 2012

User group design

While we completed the design very quickly, we could only establish the design user groups after the contract was signed. This led to a concurrent construction and user consultation process that meant we had to focus on those areas where we needed to finalise the design and start building first.

We began a four-step user group process, with each group running between 16 and 20 weeks.

At the first meeting, we presented the users with a schematic design. The architects and builders then took the users’ advice and presented the modified design at the second meeting. The third stage was detailed design when we presented drawings showing room elevations and the position of furniture and equipment. The fourth meeting was a presentation of the final detailed design and allowing the users a last opportunity to highlight any remaining issues.  The detailed design was then signed off ready for construction drawings to begin.

Taking the Emergency Department User Group as an example, the users told us that the waiting room was too small and so we adapted the design accordingly. This process allowed us to drill down into the operational detail by asking them their opinion on matters such as the number of cubicles and the department’s layout.

Accelerated construction

While the user group consultations were taking place, preparatory construction work, such as piling and pouring concrete for the floors got underway. We also made decisions such as the location of wet areas to enable holes to be drilled for the later installation of pipes and drainage.

In those early days, we included around 130 square metres of expansion space on each floor. This built-in flexibility meant that we were well prepared for short-and long term expansion and design changes.

Managing expectations

From the word go, we made it clear to the user groups that the construction budgets were fixed.

The WA Health Clinical Services Planning Framework was a useful tool as some things were a given and did not need to be included in the design discussion.

For example, we had already made sure that we had the right number of beds and could explain to the users that we were working with a 30-bed medical ward, a 24-bed short stay surgical unit, or a 12-bed intensive care unit.  We also knew that St John of God Midland Public Hospital was a Level 4 hospital for cardiology and a Level 1 hospital for intensive care.

We were therefore clear about what we were trying to achieve and this allowed the users to understand the clinical scope so they could focus on how the unit might work and how we could make workflow more efficient.

Innovation in design

We standardised all of the rooms that are common across multiple areas of the hospital. For example, a dirty utility and a clean utility have the same layout in all areas.

We will be using swipe access widely throughout the hospitals for security, including to high traffic areas such as emergency department and restricted areas such as drug rooms.

All patient bedroom ensuite rooms were manufactured offsite as ‘pods’ to a standard, including a standard bedroom pod and a mental health pod, and installed within a short timeframe. While this was cost neutral from a construction perspective, cost and time savings were achieved in the installation.

We decentralised our staff stations, meaning that most ward areas have two or three staff stations instead of one centralised staff station and so clinicians will be closer to their patients.

Finally, we designed to accommodate future expansion. When the State Government issued its proposal for a 307-bed public hospital, they said that the hospital must have the capability to expand to 464-beds by 2021.

The design accommodates expansion in several ways:

1. Intensive Care Unit and Coronary Care Unit

This 12-bed shared unit has six rooms configured for intensive care patients and six rooms configured for coronary care patients. The six coronary care rooms can quickly be converted to intensive care rooms as the required services are already in place and space exists in the adjacent area for 12 coronary care beds to be installed with minimal disruption.

2. Operating theatres suite

The operating theatres suite is designed to cater for the maximum 464-bed capacity with nine theatres and three procedure rooms. These are all of equal size and configuration meaning that the three procedure rooms can easily be converted into theatres, while the procedure rooms can be re-located to a nearby area of the hospital.

3. Private beds

The two 30-bed private wards have been integrated in such a way that when the State Government wants to expand the public hospital from 307 to 367 beds, these can easily be converted into public hospital beds and St John of God Health Care will build a stand-alone private hospital on a nearby site.

4. Additional wing

The expansion to 464-beds can be achieved by adding a new wing extending out from the existing ward block on the northern side of the hospital. Again, this is designed to be achieved with minimal disruption to existing hospital operations.

Lessons learnt

I have two roles and two sets of responsibilities on this project: the first is clinical design and the second is transition and operational readiness. I have learnt lessons across both of these areas.

It was challenging in terms of the limitations on which people within WA Health that we and the other tenderers were allowed not access during the bid preparations. If we were to go through the same process in the future, we would request earlier and wider access to key players in the public sector.

Secondly, we would focus on operational preparedness earlier. While we had a firm view of how we would run the hospital, we did not start working through this in earnest until after the building program started. If we had begun earlier, we would have benefited from additional preparation time.

However, all aspects of the project, including the partnership with WA Health and the North Metropolitan Health Service, in particular, have worked really well. In terms of construction and commissioning, everything is on budget and on track for opening in November 2015

Working in partnership

The traditional public private partnership means the State saves on design, construction and facility management, but continues to deliver the service. As our model also includes clinical services delivery, the State Government can achieve further efficiencies.

Overall, it has been a very positive process, with the focus now firmly on completing construction, operationalising our commissioning program and finalising the details of the patient transfer from the existing Swan District Hospital that will close when the new hospital opens.

Hear more from Jeffrey during his presentation at Health Facilities Design and Development Victoria.