1 Joram Nauta dr Myra van Esch Bussemakers

1 Joram Nauta & dr. Myra van Esch. Bussemakers From innovation to practical hospital development Joram Nauta & dr. Myra van Esch-Bussemakers Hospitals of the New Generation: The options for decision makers, March 6 2014, Bratislava

2 Joram Nauta & dr. Myra van Esch. Bussemakers 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

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

4 Joram Nauta & dr. Myra van Esch. Bussemakers 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

5 Joram Nauta & dr. Myra van Esch. Bussemakers 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

6 Joram Nauta & dr. Myra van Esch. Bussemakers Emergence of new models Re-emergence & revitalisation Public Health - 1950 Community, Diversity Lifestyle Hospital Acute Care 1950 2005 Chronic Illness 2005 - Morbidity compression but also Comorbidities Aged Care 2010 -

7 Joram Nauta & dr. Myra van Esch. Bussemakers Healthcare infrastructure & financing State controlled (1972 -2008) 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

8 Joram Nauta & dr. Myra van Esch. Bussemakers Transition phase (2009 - ……) 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

9 Joram Nauta & dr. Myra van Esch. Bussemakers Expertisegroup Dutch Center for Health Assets From ØGovernment 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

10 Joram Nauta & dr. Myra van Esch. Bussemakers 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

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

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

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

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

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

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

17 Joram Nauta & dr. Myra van Esch. Bussemakers How to create Competitive Edge? Decrease costs Building Design Building Assembly € 20 € 1 Operational Phase € 60 -200 Increase ‘value of design’ , knowledge transfer between phase (using BIM), decrease operational costs and increase revenue earning capacity through effective processes (supported by infrastructure).

18 Joram Nauta & dr. Myra van Esch. Bussemakers 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).

19 Joram Nauta & dr. Myra van Esch. Bussemakers 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

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

21 Joram Nauta & dr. Myra van Esch. Bussemakers Strategic Research Partnerships Research programme aimed to contribute to design, planning & evaluation of healthcare facilities. Erasmus University Medical Centre, Rotterdam(2009 -2013) - 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 ( )

22 Joram Nauta & dr. Myra van Esch. Bussemakers 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

23 Joram Nauta & dr. Myra van Esch. Bussemakers Eu. HPN links across Europe Members Associates

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