Published: 14/07/2005, Volume II5, No. 115 Page 41

Strategies for improving clinical care often overlook building layouts. This can be a costly mistake. Ralph Murray explains why

In the quest to improve clinical care, it is surprising how much designers’ input is underestimated. Evidence clearly shows that getting designers and clinicians to work together offers greater capacity and flexibility in patient care. It ensures planned maintenance has less impact on the availability of clinical functions.

By challenging the status quo designers, with support from hospital staff, can improve policies and services and deliver better value for money.

By reorganising the flow of patients, materials and staff and modifying internal spaces at North Cumbria Acute Hospitals trust’s Cumberland Infirmary, it was possible to create more operating theatres, intensive treatment unit beds, high dependency unit beds, day-case theatres, imaging rooms and dialysis stations - all of which enabled medical staff to deliver better services.

So where and how can designers work with practitioners to innovate, enhance clinical practice and reduce costs? First, and most obviously, is the layout of the building. Much is said about the importance of interdepartmental relationships and co-location, particularly to reduce travel distances.

Co-location is convenient and efficient and allows the specialists involved in the patient’s episode to be close by. It can bring together operating theatres, intensive treatment units, high dependency units and maternity - and place anaesthetics in the centre.

In the fight against infection, designers can play their part by thinking laterally about solutions from other sectors. Designs and working practices from the food and pharmaceutical industries are transferable to healthcare, but the NHS has to be receptive to designers with experience outside healthcare.

AMEC has had considerable success in using computer modelling, which plots air movement in wards to avoid crosscontamination and improve safety.

Good extraction also avoids the expense of high concentrations of single-bed accommodation.

With the help of clinicians, designers should be alert to issues such as family-patient relationships and producing appropriate facilities.

Different environments, for example, can be provided for adolescents, or parents can have their own, discreet space.

A building that allows clinicians to care for patients supported by parents and siblings when appropriate - with separate facilities for privacy at other times - offers great potential for improved response to treatment.

In clinical practice, the need to relocate or change often leads to design alterations. During the development of a hospital, technological advances can occur between the brief and the building being finished. The challenge for designers is to adapt to these with minimal adverse impact.

Even when the change appears to be small - for example adapting a minor procedures area to provide general anaesthesia - the resulting changes in space allocation, configuration and mechanical and electrical issues are significant.

Collaboration between designers and clinicians is vitally important, and design development can trigger changed thinking that leads to better operating arrangements.

Recent guidance on bed-spacing is a response to healthcareacquired infection problems, but co-operation and understanding between practitioners and designers can result in airhandling solutions that deliver real benefits.

Ralph Murray is a healthcare consultant at AMEC.