Function comes first in hospital design
Planning process requires dedication of a full array of frontline staff
Concerns have arisen recently about a possible delay to preparatory work for the redevelopment of Queen Mary Hospital in Pok Fu Lam.
It is opportune to look at the planning of such a decade-long project and how a delay undermines the dedication of frontline staff and the project planning team.
The government has committed billions of dollars to building new hospitals and redeveloping old ones.
Each will take at least a couple of years. How can one be sure the facilities built now will best suit service demands later, in terms of capacity, quality and technology adoption?
It is prudent to apply the concept of "function before form". Function includes the projected capacity required to meet future demands and a service model to ensure quality care. These should be determined before work starts.
The above can be addressed in a cluster clinical services plan setting out how a cluster provides services to the public. It delineates the role a hospital plays in and outside a cluster.
For instance, Queen Mary is the only hospital in the West Cluster providing emergency medical services, which is based on demand in Central and Western district. Given the citywide demand for liver transplants and the need to concentrate expertise, Queen Mary Hospital is also the only centre providing such services in Hong Kong.
To project service demand, a statistical analysis can be conducted, based on service usage, future demographic changes and residential patterns. This relies on clinical input from frontline workers.
But the most essential part of the work is in determining an up-to-date and evidence-based service model. Hospital planners should step out of their office and work closely with clinical leaders - that is, the end users - obtaining their consensus to develop a service model of good standards of care. Active engagement of doctors, nurses and paramedics is an integral part of this exercise. The resulting model will significantly affect a hospital's design.
In the beginning, each discipline will identify its service gaps, improvement measures and the service model it aspires to. Related specialties then agree a service model and implementation plan.
The model of care usually involves a change in workflow or protocol. Often, it is a mammoth challenge to a deep-rooted culture.
The service model will inform the design of the hospital. This translation from service to hardware is an expression of passion and determination in good medical care.
Dr Libby Lee is deputising director (strategy and planning) of the Hospital Authority