Health check-up

Changing demographics in Australia are largely driving the healthcare sector, with baby boomers reaching the later stages of their lives placing a heavier strain on health facilities.

Furthermore, the global financial crisis and volatility on the sharemarket means health providers “are deemed quite a safe dock”, according to Tony Sukkar, managing director at Buildcorp.

“Their debt ratios are okay so now, not only do they have access to cheaper money, they’re able to go and take advantage [of that] and do some development plans with cheaper money and cheaper construction costs,” he says.

Around Australia, different states and territories have varying drivers. Mark Mitchell, director at Billard Leece Partnership, says NSW has several facilities that are remote from Sydney and the state aims for standardisation. In Victoria, he says it is easier to find solutions due to more flexibility.

Murray Coleman, managing director of Lend Lease’s project management and construction business in Australia, says WA and Queensland have seen demand increase due to the rapid population growth.

“However, there is demand right across all of Australia to upgrade and build new facilities,” he says.

While the health sector appears to be booming compared to the rest of the industry, Sukkar says it’s not a boom so much as steady growth.

“I think it gives the perception that it’s a boom because spending in commercial, industrial and retail is going down … the reality is it’s doing consistently what it’s always done,” he says.

According to data from the Construction Forecasting Council (CFC), health construction is forecast to increase 4 percent in 2011/12, 2 percent in 2012/13, then increase 2 percent to 3 percent each year until 2017/18.

Several large-scale health projects are dominating the sector. The $1.1 billion Royal Children’s Hospital in Melbourne opened in October 2011 and is promoting itself as Australia’s greenest hospital. Initiatives include a trigeneration plant, solar panels and a biomass fuel boiler to reduce greenhouse gas emissions by 45 percent.

Buildcorp is currently working on the $181 million stage one redevelopment of the Sydney Adventist Hospital on Sydney’s upper north shore. The project will include a clinical services building with 180 beds, 10 new operating theatres and an integrated cancer centre.

One of the most significant health developments is the $2 billion Fiona Stanley Hospital in WA – the largest infrastructure project ever undertaken in the state. It will comprise 150,000sqm of floorspace over five main buildings when it opens in 2014.

Design at the hospital has been based on techniques and elements that promote healing, such as lighting, colour, texture, views, natural light and art. It also has a high number of single-bed rooms (83 percent); heat recovery ventilation to pre-heat or pre-cool incoming air; and carbon dioxide sensors to regulate the amount of outside air.

Developments like this are changing the face of hospital design.

The evidence-based design concept is based on the idea that the built environment can have a large impact on the speed of patient’s recovery, as well as the patient’s family and staff. Ultimately, well-designed spaces enable patients to go home quicker.

“So we’re finding where the healthcare sector was reasonably insular in the way projects were being designed, referring to other hospitals in the past, they’re starting to learn from other building types,” Mitchell says.

“So what was traditionally a big box full of plain white corridors is starting to discover a need for a public realm and better interface with the community.”

The US has led the research on evidence-based design and ‘healing’ spaces, according to Mitchell, while Australia is still trying to make sense of the concept, but the research can’t be dismissed. For example, he says some research has examined the development of pre-term infants in neo-natal intensive care units to ensure there is not direct lighting on the infants and noise is limited.

“Sometimes that environment, if it’s not designed well, can affect the long-term hearing and sight of those infants if it’s not fully formed,” Mitchell says.

“So there’s quite a lot of design solutions required … for those types of environments. I think most architects are looking to do some of that secondary research to find out more about the environments and some of those design requirements.”

Billard Leece Partnership introduced evidence-based design at the Royal Children’s Hospital in Melbourne, working in association with Bates Smart and HKS as international advisors. The brief for the project was based on trying to design all bedrooms to face the park, good natural lighting to all the public spaces and creating clear wayfinding.

Spaces were allocated besides beds for families and “focusing the design of the building not just around the tightest efficiencies but around an interaction with nature, which is a prime design idea around the Royal Children’s Hospital,” Mitchell says.

The concept of healing spaces is also playing a role at the new Royal Adelaide Hospital by the Hansen Yuncken – Leighton Contractors (HYLC) joint venture. Chris Pratt, HYLC joint venture development director, says the HYLC team has spent considerable time interpreting the concept.

“We have put a lot of effort into creating a built form which allows for healing spaces and patient care and will facilitate those things, almost passively allowing these things to occur better than what would occur otherwise,” he says.

Hospital design has also undergone considerable changes in response to advancing technology and more competition between hospitals in the private sector. Sukkar says more theatres are being included in hospitals due to more operations taking place. Consumers are now also expecting higher quality accommodation, which has resulted in more one-bed rooms and less shared rooms.

Support services, such as radiology and pathology units, which once were off-site from hospitals, are now also included within the hospital.

“So it’s the readiness of information and that service that allows the hospital to be much more efficient and provide much quicker service,” Sukkar says.

While large-scale health projects have dominated the market, Coleman expects more investment in smaller, regional projects. He says the industry is also moving towards using building information modelling, which was used at Liverpool

Hospital recently to create 3D design and construction solutions.

“Flexibility is also key. Given the projected ongoing growth of this sector, the need for flexible and adaptable healthcare facilities is evident.”

Mitchell says healthcare is an exciting sector and better buildings are continually being designed and constructed, particularly over the past 10 years.

“I think there’s still a lot of work to be done and one or two big flagships doesn’t fix the whole system, but I think what they do is they start to set some good benchmarks for smaller facilities to learn from,” he says.

Sustainable health

Sustainability is starting to infiltrate hospital design. Douglas Roxburgh, senior associate at Woods Bagot, says achieving sustainable solutions in healthcare can be limited by function. Like other building types, the greatest savings can be achieved at the earliest design stages, “as well as an analytical approach to external skin properties and big moves in frame materials”, he says.

“The real power base with the greening of the built environment lies within the client base, and we have some who push us to achieve as much as possible, and sometimes we push hard to educate and demonstrate.”

John Breguet, director of health and science consulting at Woods Bagot, says as sustainability is beginning to be integrated into the base design of hospitals, the cost is also being integrated.

“The ESD emphasis is moving to the ecological sustainable design focus where success is measured in the overall operational performance of the facility and not just utility costs,” he says.

At the Royal Adelaide Hospital, in some areas of the engineering services water will be recycled indefinitely. Metering and analysis systems have also been installed so improvements can be incorporated over time.

The hospital will also have a trigeneration system, solar-boosted hot water and significant passive lighting, with most work spaces having views to the outside and 100 percent of single patient rooms

Mitchell says green rating systems are helping the green cause in health, but they also sometimes hinder it.

“Sometimes sustainability is treated as a line item, that they need to fill some boxes. I think that’s less the case now than it was in the past,” Mitchell says.

“So people are taking it far more seriously. They’re looking for intelligent initiatives that relate much more to the specifics of the site and specifics of the brief rather than trying to chase points.”