The use of refurbishment, flexibility, standardisation and BIM to support the design of a change-ready healthcare facility

Healthcare in the UK is a very important sector; it provides state of the art accommodation that meets the need of patients, visitors, medical professionals and other staff. The UK Government is currently cutting costs within the different sectors of the economy, while there are raising figures in UK National Health Service (NHS) spending. These are due to a growing and ageing population, advancement in modern healthcare delivery and special needs for different facility users. There is a UK Government proposal set out that requires the delivery of £15-20 billion in efficiency savings over the three year period from 2011 (Department of Health, 2010-2015). This study has understood that cost savings can be achieved by adopting and implementing a framework that supports refurbishment, flexibility, standardisation and Building Information Modelling (BIM). These cost savings can be achieved through Mechanical Engineering and Plumbing (MEP) clash detections using (BIM). 65% of hospital designs are centred on MEP services (interviews). The NHS needs to save cost when responding to possible future changes without compromising the quality of standard provided to the public. A change-ready healthcare facility is proposed to address the issue of change and the design of quality spaces that can enhance effectiveness and efficiency in the delivery of health and social care. A change-ready healthcare facility can be described as a facility that accommodates known or proposed future changes creating novel pathways to increase the quality and life span of facilities. There is also a large chunk of NHS estates that is underutilised EC Harris, (2013). Therefore, healthcare facilities need to respond to future changes in order to optimise their spaces. To achieve quality and cost efficiency in healthcare buildings, key considerations are refurbishment and reconfiguration, optimisation of flexibility, maximising standardisation and implementation of BIM. This research explores opportunities to save costs, time and improve quality of healthcare facilities by making emphasis on the design delivery process. Therefore, the new RIBA Plan of Work 2013 was used as a mechanism to help translate ideas into physical form and yet has been hindered by lack of development and ability to keep up with technological development such as BIM. This is the rationale for developing a framework. The RIBA Plan of Work is accepted nationally. Due to the UK BIM mandate by 2016, this research is focused on the use of BIM to support both space standardisation and space flexibility within a refurbished or new building. Space is a vital component competent in every healthcare facility. It provides the environment for healthcare services to be performed, and links one functional space to another, it can be designed for multifunctional usage. Healthcare spaces are complex entities due to the range of services and technology they support and the number, variety and quality of requirement combined with a rapidly changing environment. Flexibility enables a facility to easily respond to changes, while the introduction of standardisation supports staff performance by reducing the reliance on memory which will reduce human error. But the main question that emerges from current literature is how healthcare designers and planners manage healthcare spaces that cannot easily be standardised due to the constraints of existing structures, diversity in patient and staff needs? With analysis of different flexibility frameworks in the Architecture, Engineering and Construction (AEC) industry, there is a need to improve the existing frameworks. Therefore, a framework for designing a change-ready healthcare facility was developed through a sequence of data analysis starting with literature, preliminary data, questionnaire survey and interviews. Three frameworks for designing a change-ready facility were revised, organised and merged to produce a state of the art framework. Three frameworks were revised as different research methods were required. The successful framework can guide the design process of embedding different flexible design options for a defined project brief to save costs and improve design efficiency. The framework was validated with some of the top 100 architectural practices in the UK, NHS Estates, facility managers and the RIBA through an interview process. Further research and development arising from this research focuses on the process of applying BIM to record or identify key decisions taken for each of the different design options generated from a single brief to inform the designers, clients or other stakeholders involved while collaborating. Findings of this research are described in five peer-reviewed papers. The only certainty in healthcare is change Gressel and Hilands, (2008)

An Ontology Approach for Knowledge Acquisition and Development of Health Information System (HIS)

This paper emphasizes various knowledge acquisition approaches in terms of tacit and explicit knowledge management that can be helpful to capture, codify and communicate within medical unit. The semantic-based knowledge management system (SKMS) supports knowledge acquisition and incorporates various approaches to provide systematic practical platform to knowledge practitioners and to identify various roles of healthcare professionals, tasks that can be performed according to personnel’s competencies, and activities that are carried out as a part of tasks to achieve defined goals of clinical process. This research outcome gives new vision to IT practitioners to manage the tacit and implicit knowledge in XML format which can be taken as foundation for the development of information systems (IS) so that domain end-users can receive timely healthcare related services according to their demands and needs

A systematic review and critical appraisal of quality indicators to assess optimal palliative care for older people with dementia

© The Author(s) 2019Background: A challenge for commissioners and providers of end-of-life care in dementia is to translate recommendations for good or effective care into quality indicators that inform service development and evaluation. Aim: To identify and critically evaluate quality indicators for end-of-life care in dementia. Results: We found 8657 references, after de-duplication. In all, 19 publications describing 10 new and 3 updated sets of indicators were included in this review. Ultimately, 246 individual indicators were identified as being relevant to dementia end-of-life care and mapped against EAPC guidelines. Conclusions: We systematically derived and assessed a set of quality indicators using a robust framework that provides clear definitions of aspects of palliative care, which are dementia specific, and strengthens the theoretical underpinning of new complex interventions in end-of-life care in dementia.Peer reviewedFinal Published versio

Emerging communities of child-healthcare practice in the management of long-term conditions such as chronic kidney disease: Qualitative study of parents' accounts

Background: Parents of children and young people with long-term conditions who need to deliver clinical care to their child at home with remote support from hospital-based professionals, often search the internet for care-giving information. However, there is little evidence that the information available online was developed and evaluated with parents or that it acknowledges the communities of practice that exist as parents and healthcare professionals share responsibility for condition management. Methods. The data reported here are part of a wider study that developed and tested a condition-specific, online parent information and support application with children and young people with chronic-kidney disease, parents and professionals. Semi-structured interviews were conducted with 19 fathers and 24 mothers who had recently tested the novel application. Data were analysed using Framework Analysis and the Communities of Practice concept. Results: Evolving communities of child-healthcare practice were identified comprising three components and several sub components: (1) Experiencing (parents making sense of clinical tasks) through Normalising care, Normalising illness, Acceptance & action, Gaining strength from the affected child and Building relationships to formalise a routine; (2) Doing (Parents executing tasks according to their individual skills) illustrated by Developing coping strategies, Importance of parents' efficacy of care and Fear of the child's health failing; and (3) Belonging/Becoming (Parents defining task and group members' worth and creating a personal identity within the community) consisting of Information sharing, Negotiation with health professionals and Achieving expertise in care. Parents also recalled factors affecting the development of their respective communities of healthcare practice; these included Service transition, Poor parent social life, Psycho-social affects, Family chronic illness, Difficulty in learning new procedures, Shielding and avoidance, and Language and cultural barriers. Health care professionals will benefit from using the communities of child-healthcare practice model when they support parents of children with chronic kidney disease. Conclusions: Understanding some of the factors that may influence the development of communities of child-healthcare practice will help professionals to tailor information and support for parents learning to manage their child's healthcare. Our results are potentially transferrable to professionals managing the care of children and young people with other long-term conditions. © 2014 Carolan et al.; licensee BioMed Central Ltd

HealthCare Partners: Building on a Foundation of Global Risk Management to Achieve Accountable Care

Describes the progress of a medical group and independent practice association in forming an accountable care organization by working with insurers as part of the Brookings-Dartmouth ACO Pilot Program. Lists lessons learned and elements of success