Hospitals of the New Generation: The options for decision makers, March , Bratislava From innovation to practical hospital development Joram Nauta & dr. Myra van Esch-Bussemakers 1

Overview: -The Netherlands; a turbulent past for health care infrastructure planning -What can be learned from these experiences -How is new knowledge generated & distributed -Role of European Health Property Network Joram Nauta & dr. Myra van Esch- Bussemakers 2

Background: Current employment TNO: Netherlands Organisation for Applied Scientific Research – Dutch Centre for Health Assets ( Sustainable healthcare buildings Boardmember: European Health Property Network ( Previous: Netherlands Board for Healthcare Institutions (strategic planning of healthcare infrastructure) Joram Nauta & dr. Myra van Esch- Bussemakers 3

Dutch health care sector in a nutshell Since 1945 ‘Bismarck’ insurance system (social) private health insurance funds health care organisations are private trusts health care organisations are (not) for profit ownership of assets belong to the hc organisations Joram Nauta & dr. Myra van Esch- Bussemakers 4

A persons “ healthcare costs” over his/her lifetime - focus of a healthcare system Traditional focus of health systems - curative/acute (hospital) care Demography brings new challenges: Aged care, multimorbidities Joram Nauta & dr. Myra van Esch- Bussemakers 5

Hospital Morbidity compression but also Co- morbidities Public Health Acute Care Chronic Illness Aged Care Community, Lifestyle Diversity Re-emergence & revitalisation Emergence of new models Joram Nauta & dr. Myra van Esch- Bussemakers 6

Healthcare infrastructure & financing State controlled ( ) Government backed finance No risk for health care organisations (& banks) Functional budgets (based on beds, bed days, no of medical staff) Planning & Investment approval (new/renovation) Following guidelines & budget restrictions The bigger, the better Joram Nauta & dr. Myra van Esch- Bussemakers 7

Transition phase ( ……) Market mechanisms => Competition, Mergers & Acquisitions of Hospitals by 3 rd parties Role of Insurance companies becoming more important Specializing /Diversifying of services Income on basis of production (DRG’s) => Quantity & Quality of Care Commercial loans by banks=> Businesscase for investment Optimising instead of Maximizing=> Planning & Design Optimisation No guidelines or approval Joram Nauta & dr. Myra van Esch- Bussemakers 8

Expertisegroup Dutch Center for Health Assets From  Government advisors (by law) with own R&D Guidelines Best practices (national & international) New models of care & strategic asset planning To Independent researchers in TNO (Netherlands Organisation for Applied Scientific Knowledge) to aid decisions makers, planners and architects Partially funded by Ministry of Health to help healthcare sector during transition period Joram Nauta & dr. Myra van Esch- Bussemakers 9

Some of the Innovations Core hospital model/Layer’s Approach Life cycle costing model Strategic Planning & Financing tools (financing) Logistics & patient flows Evidence based design /Healing Environment Joram Nauta & dr. Myra van Esch- Bussemakers 10

What has been happening? Core Hospital Concept (2004) by VenhoevenCS Winner ideas competition organised by Bouwcollege From Ideas To reality Joram Nauta & dr. Myra van Esch- Bussemakers 11

Layers approach Joram Nauta & dr. Myra van Esch- Bussemakers

Relations layers approach Joram Nauta & dr. Myra van Esch- Bussemakers 13

Division functions Proportional division of the floor area over the layers Joram Nauta & dr. Myra van Esch- Bussemakers 14

Uden – Ziekenhuis Bernhoven hot floor industry hotel office de Jong Gortemaker Algra architecten en ingenieurs Joram Nauta & dr. Myra van Esch- Bussemakers 15

Core Hospitals Meander Medisch Centrum (by AtelierPRO), Amersfoort Hot floor Patient hotel Offices (outpatient) Joram Nauta & dr. Myra van Esch- Bussemakers 16

How to create Competitive Edge? Building Design €1 Building Assembly €20 Operational Phase € Increase ‘value of design’, knowledge transfer between phase (using BIM), decrease operational costs and increase revenue earning capacity through effective processes (supported by infrastructure). Decrease costs Joram Nauta & dr. Myra van Esch- Bussemakers 17

Competitive Edge: Evidence Based Design Proven Healing Environment Outcomes: increased perception of quality of care; higher customer (patient, staff or visitor) satisfaction; faster patient recovery; less medicine intake; fewer medical errors; lower infection rates; desired behavior (e.g. fewer falls, less aggression); enhanced operational efficiency and productivity; personnel retention; patient safety patient waiting According to Blair et all, 2011 an investment in EBD of 8% on top of the normal construction budget, has a return on investments within 3 years, due to significant improvements in above mentioned outcomes (Fable Hospital 2.0). Joram Nauta & dr. Myra van Esch- Bussemakers 18

Vision on Evidence Based Design We see a future where the design of health assets is used to support the strategic goals of the organisation (and therefore is systematically evaluated). Our aim is to provide scientific evidence to support design decisions that improve the performance of the building and its users and be able to predict the future performance of health assets in the design phase We use Post Occupancy Evaluations to evaluate design decisions to improve the design of a building and to generate (scientific) evidence to built an EBD knowledge model Joram Nauta & dr. Myra van Esch- Bussemakers 19

Patient Satisfaction Staff Efficiency Costs Building Performance FlexibilityStaff Satisfaction Patient Safety Joram Nauta & dr. Myra van Esch- Bussemakers 20

Strategic Research Partnerships Research programme aimed to contribute to design, planning & evaluation of healthcare facilities. Erasmus University Medical Centre, Rotterdam( ) - Focus on Energy Saving (through procurement) - Improving of patient’s circadian rhythms by using dynamic light - Operating Theatre process & design optimisation resulted in knowledge & practical innovations and knowledge exchange () Joram Nauta & dr. Myra van Esch- Bussemakers 21

European Health Property Network Founded in 2000 as a not-for-profit trust Mission: to bring together healthcare professionals with interests in planning, designing, constructing, maintaining and financing all kinds of healthcare buildings Aim: to link infrastructure development with the principal drivers in health and healthcare systems Members: government health estates departments; R&D organisations; academic departments; professional associations; healthcare architecture practices Joram Nauta & dr. Myra van Esch- Bussemakers 22

EuHPN links across Europe Members Associates Joram Nauta & dr. Myra van Esch- Bussemakers 23

Thank you Joram Nauta dr. Myra van Esch-Bussemakers Dutch Centre for Health Assets TNO European Health Property Network ( Joram Nauta & dr. Myra van Esch- Bussemakers 24