Good design in health infrastructure (35min)

foreign [Music] thanks for joining us this evening thank you for inviting me maybe start off by telling us a little bit about what Novell is novel is a living laboratory concept so it is a partnership between researchers academics designers Architects stroke survivors and policy makers hopefully the idea of a living lab is by bringing together all of these stakeholders we can tackle a important question and try to innovate so in our example we're using strike Rehabilitation as the demonstration project for the living lab so novel stands for Neuroscience optimized virtual living lab and the Neuroscience is there because we actually know quite a lot about how people respond to the environment with their brains we're designing a virtual environment and a virtual service that we hope will be a much better than what we currently have so what does the Neuroscience say about health environments built environments let's say interesting because I've worked in Neuroscience for 20 years now we're really at this cusp where we have the Technologies to be able to see what is happening in your brain when you're exposed to different things so we can think about neuroscience and architecture or Neuroscience in the environment on a number of different levels we're just doing a review now which is uh of all of the literature we can find on the neuroscience and the built environment so we'll be able to tell you more of that later but you can also look at the fact that the environment itself changes how people respond it also changes how the brain repairs itself after injury most of that knowledge comes actually from animals as is a lot of Neuroscience because we can study their brains and there's a whole field of work around environmental enrichment where they put animals in denuded unstimulating environments on their own or they put them into what they call enriched environments and look at how their brains change and how they might respond to damage for me I'm interested in stroke so there is actually a huge volume of research showing that if you really consider the environment and if you target physical social cognitive activity so socialization cognitive activity physical activity that that dramatically increases the rate at which an animal will have its brain repair after an injury and it's um the extent of its recovery as well there is certainly a very strong scientific basis for enriched environments improving outcome and we've seen this in aged care we've seen it in the zoo it's actually pretty fundamental uh knowledge that we have and you've experienced a number of Health environments and then let's let's use that frame of denuded and enriched perhaps give us an example of what a health environment for you is denuda we need not describe a particular hospital but what sort of environments are they environments that are unstimulating tend to be fixed usually with very poor views or quality of view the furniture within them might be fixed and so if you picture a kind of environment which is supposedly a social or communal area that has chairs lined up along the wall with perhaps a high window but nothing else to look at the colors are cream-colored Hospital wall color beige beige and that's sort of what you would call a denuded environment the other is a single bedroom that is isolated again with no view I was recently in hospital with a one of my loved ones the experience of those kinds of environments is not a happy one and not cognitively stimulating not socially stimulating few opportunities for being active and engaged so then the flip of course is that enriched environment so curious to understand from you what that enriched environment might look like might feel like how would you characterize I think again it if we flip it to opportunity so for us in Novell we're looking at talk we talk a lot about access to positive and stimulating environments if you were thinking of an environment that gave you choice and not just choice but actually really encouraged you to be active to be physically active socially active cognitively active so it's it's got interesting areas in it or it's got spaces that make you want to explore an environment as well that of course has the requirements for good light nice views of Outdoors Etc a range of things that are thinking at that level of we as humans wanting to be stimulated it strikes me as something so basic human interest in to have that amenity to have that ability to see the daylight to see the horizon to not hear clutter right is it implicit are these things that we just all know and the research is bearing that out for us we have done a number of reviews around the elements of the physical environment that might impact on outcome after stroke and what we see in the research literature for in the health environment and it is improving all the time which is fabulous is that we often have an effort that is just looking at one specific Factor whether it's daylight or noise or green View whereas we know in fact environments are more complicated than that which is one of the reasons we really love our project because we're trying to tackle that complexity but I think you have environments where you are trying to unpack different elements one of the projects that we did with one of my students Michelle Shannon was we created virtual environments and tried to unpack 16 different factors by putting someone who had had a stroke into the VR system and exposing them to all of these different environments that were exactly the same except for one thing that's actually trying to tease out the single Factor we hadn't tried this before did it work it it did work it showed us that there are certain things like you've just said access vision of the green space is preferred overlooking at a wall we have actually known that for Santa quite some time we also looked at spaciousness and noise and single versus multi-bedrooms which is a big issue for us in our project and Julie I mean I know we talk a lot about stroke rehab but I I think of the amount of projects here in Victoria they're across acute Health Subacute Health public sector residential aged care and you've referenced that briefly is what you're talking about applicable across all these projects we think so we think that what we're doing is trying to create a a method of interrogating what is most important for that particular type of surface but some of the things that we're finding that are important to our users our stakeholders and that includes stroke survivors staff policy makers designers it will be the same across other areas of Health however a rehabilitation recovery environment would not be the same as an emergency department they will have their own elements that are really critical to understand the user's needs so let's maybe drill into that a little bit and talk about this idea of good design and we hear a lot about biophilia salutogenics all these other buzzwords let's call them whereas you're caught in the research the newer side so in your mind what does constitute good design two things I'll pick up on just for that question one is biophilia is a theoretical construct you know it's it's an explanation of why that kind of approach might work one of the things we have done is look at all of the different theories that underpin design there's at least 12 if not more so I think what's really interesting and important in fact is identifying what theory you're adopting is part of your design and then making sure you carry it all the way through which includes not just the theory behind why you're designing but then how are you measuring to support that design uh and then really at the end looking at whether or not you achieved what it was that you were set out to do right to me good design is meeting the needs of your users so that's your particular Patient Group it's your staff and staff are critical especially now in health because it's a very high stress environment we're trying to keep our our staff but it's also good design is thinking about the future of the building not just how it is now so is it going to be flexible is it going to be sustainable um does it meet good environmental credentials because I think we have to get to that too so a good design is really meeting our needs of our users our staff our patients our our user group having that future thinking for the flexibility of it so it can adapt to New Uses as the health service changes now we have a huge interest as we should in Virtual care and virtual Rehabilitation and Rehabilitation closer to home and new models and we should do that it's very old-fashioned to have people coming into hospital to have care and we actually don't want them in hospital so good design starts even before we talk about a building yeah absolutely and how much of that is happening in the Novell as well so that good design is something to do about the way care is delivered absolutely that it may actually result in digital tools or wearable devices right talk to us a little bit about that we didn't want and this is the beauty of a multi multi-stakeholder living lab we did not want to only create a new design for a building because a building is there for a purpose which is why I say good design is about meeting the needs of your users and of course meeting the economic needs of sustainability into the future so we didn't want to just do the building we wanted to do the service as well because in my view a redesign whether it's a remodel or a rebuild is an opportunity for innovation that's your opportunity big change Holden yeah yep so don't don't just do what we've done before think about the whole thing think about the service model think about how the service model is supported by the environment they actually have to be brought together one of the things we did early on in Novell was we wanted to look at how the design guidelines for the building talk to the clinical practice guidelines for the service Yeah in our example in Rehabilitation so we pulled up the Australian clinical practice guidelines for rehabilitation and we pulled up the Australian guidelines for the built environment for Subacute care and we tried to see how they really supported each other and the answer was that there wasn't even a common language for us to be able to make sure that best practice care and best suggestions and practice for guidelines were leaked and that was the start of us going well we have to create a way that we can build the service Innovation and the building at the same time it strikes me I think of some of the built examples over the past 10 maybe even 15 years here in Victoria we've been fortunate we've had buildings like The Royal Children's the Comprehensive Cancer Center gosh even Bendigo Health they tend to be very large buildings to put you on the spot a bit do they reflect do you think good desire in the way you've described it a whole building is a very big beast what I would say is that I would love to have seen evaluation of those buildings by the users of those buildings I would also love to see awards for a building's ability to meet the needs of its users not just for it being beautiful I think what we see is that there are elements of all of those examples that probably work incredibly well but I also here that there are elements that that don't so they haven't met the needs and why is that well we are told that it is a a case sometimes of not having the time to do the consultation not having the time to really be able to think about innovating a service model which is what you would like to see at the same time as innovating the building it's a feature of how we currently commission perhaps that just means that that lead up time it might be inadequate to try and really nail everything and if we did nail everything assuming that we've nailed parts of it in some of these buildings what difference does good design make for the consumer why is it so important of the research that is out there now there's really clear examples that good design can change a number of things not just for the users but for the whole kind of way our health system functions if you get a design a good design that allows a person who's had a trauma to come into hospital and have efficient care and feel safe and know what's going on so they're in control they will get out of Hospital more quickly they'll have a positive experience and those benefits will flow on into the future for them if we have someone in our new facility our goal is to try and help them transition more quickly homes but it's not just about length of stay moving to a new model of care which might have much stronger virtual element so that faster transition be more able to be autonomous and practice more not be tied to the bed there are lots of things that I think a good design will do that can help people recover more quickly help their families feel supported get staff to be able to deliver their care more efficiently as well the hospital building is not just a thing it it is there to actually support best care that's its job right and so to me if you get that right you're going to elevate so many different elements so what strikes mean what you're saying Julie is we all know a building can't cure cancer of course but it can help the people who are striving very hard to cure cancer to help other people get as well as they can that says much about the staff as it does for the patient so tell us what does it mean for staff I think we can look at poor design for staff and go well you know that doesn't work making it harder for staff to do their job making it more demanding for them to operate within that environment whether it's because they can't see a person that they're worried about or whether it's because they have to walk really long distances to get anything that they need they get lost in traffic all of that contributes so if you can create an environment that works well for staff and for the patients the patients will also feel supported they'll feel safe they'll feel able to do things for themselves and all of that helps there was a a great story actually from the children's Redevelopment and there was some nice research that was done there around wayfinding and legibility of the building they looked at what the staff had to deal with every day in terms of people getting lost throughout the facility and that was before they did the the readers on and the statistics are huge you know it's an average staff member getting interrupted or being asked five times a day by someone whether it's family member or a patient how do they get around where can they find X Y and Z that's every every single staff member so if you get that redesign part right all of a sudden that's gone because people know their way around so it's interesting it's rather than costing more money as it's often framed good design cost money it actually saves money in terms of the delivery you know efficient delivery of care is that a conclusion we can start to make I think we need to frame cost differently to what we do now and it's one of the things where building up in Novell which is how do we think about the built environment as adding value okay to Health Care yeah and not also just think about it in terms of its first capital cost but think about it in its longer term benefit and what's needed to sustain it but also if you get the design right it should be flexible into the future and that will actually save you money be more sustainable I think just extending the way we think about cost to think about value not just cost and I think that that value can be a co-designed metric too can't it it can be the outcomes that consumers value or the outcomes that staff very much so in fact I think that's vital I think we have to get away from just thinking about length of stay as the only metric that's important in healthcare we have to think about what can you gain from delivering excellent Health Care to the patient to the staff member and to the system it's much more than just length of stay or preventing Falls for example so Julie I'm curious now we've talked a lot about past examples the rch and my mind goes to being able to manage your own environment and I think of the Leaps and Bounds that Victoria have made in mental health spaces post the Royal commission where consumers can manage closing their own door dealing with what they see through the window but I'm curious to understand as we go on there seems to be a never-increasing Reliance on new technologies new gadgets that people can use what does the future of good design look like is it more technology or are we at a precipice of trying something different technology has a really important role in the future certainly in our example of this demonstration project for rehabilitation a huge challenge we have now is that people feel that they have to stay by their bed because they've got to wait for the doctor or they have to wait until someone tells them when their appointment is or they don't know where they're allowed to go or they don't track their progress or there's a lot of things that are actually fundamentally wrong with that approach technology can help free us up can help the patients free be freed up can help the staff be freed up so as an example if we were able to flip it so that it truly was patient-centered care which we talk about all the time that really deliver if we're truly going to flip that then what we will end up with is a doctor going oh I'm doing my rounds now where is Mrs Smith she's in the she's in the garden great I'll go and see you there not Mrs Smith has to stay by the bedside because the doctor is going to be coming around on the ward round or um she would like to go and do her therapy is the room available yes it is great can I book a slot and I'll go down there now this might sound like a pipe dream but in fact I think it is coming let alone our move to having maybe hybrid treatment where you've got some patients who are in person and some patients who are at home linking in to join in a group this is happening now it's quite real that's what struck me a lot of what you're describing is available now right what we have to make sure we do is we have to make sure that the technology that we have is built for purpose fit for purpose about our users about our staff and about our patients just make sure that we don't just jump on the next good thing but actually really make sure it works and it's simple to use so the good design in the future might be good design of Technology too absolutely and you talked about consumers being able to manage their environment he also talked a little bit about them being able to comprehend their environment help presumably eligibility tell us a little bit about meaningfulness in their built environment well that's a great question it's really important one of the things that has always struck me as a therapist is that when I have a patient coming to a new environment and I might say hello my name's Julie I'm here to support you on your recovery from your whatever today is our first day so let's get to know each other would you like to go somewhere in the building and they'll say I don't know am I allowed to go somewhere or where do you want me to go so either of those answers is I have no control over my space I'm sitting in my bedside chair which I know I have control over the second part of that answer is you are going to tell me what I'm allowed to do so there's an imbalance in the control there a lot of my earlier research before I started getting to built environment was around people's activity within hospitals and I can tell you that most people will spend 80 percent of their day in a hospital in or beside their bed now if I then flip that into a recovery concept wouldn't even in mental health wouldn't we want people to feel that there were spaces that were safe for them that gave them choice and variety that gave them opportunity to express themselves differently feel differently and they would actually then go to those places so I'm curious about meaningfulness then in having those Dimensions because I think there's a cultural Dimension to it as well right um how have you embedded First Nations people in some of the research that you've done in terms of co-design and what they value or I know many we often think about as I did Growing Up people who not from an English background trying to navigate a complex environment like a hospital how does some of those avatars or you know that difference and what they might hold as meaningful come into some of the work that you do I think if you're designing specifically for People First Nations people it's absolutely critical that you have them at the table and are working with them from time Dot and I know that that does happen so when there are specific facilities for Aboriginal and Torres Strait Islander people there are some great examples in Australia where they've done that really well but we have people who are very diverse coming into our hospitals and it is a challenge actually to find the stakeholders the consumers to bring them in and have them as part of your co-researcher team that's what we've called them so anyone that's involved in our project um whether they're a policy maker or a stroke survivor or an architect anyone that comes to contribute he's becomes a co-researcher in our project which I think is important we try to give them that sort of power in in the relationship co-design is not simple even co-design for vulnerable populations like people with mental health disorders or who've had traumatic experiences what often happens is that the designers rely on the thoughts and experience of the staff to be the voice of those consumers sometimes things get lost in translation I don't so I would say I've had 30 years of experience in working with people with traumatic brain injury and when we started this project and really brought in a large number of stakeholders from as as consumers stroke consumers Consultants or researchers it was uh really there were there were things in there that I'd never heard and I'd worked in this field for a long time and they're going oh gosh no this is what I want and this is what was missing there are ways that we can effectively co-design you can't co-design with a cast of thousands that is a challenge I think you have to though really put it in as a priority for good design and make sure you do it so it sounds like you know if I were to summarize good design is as much about the design of the servers but then it's a design designing the design process to actually get to good design I agree and I think that that's what we're aiming for models and service models that will come out of this project because we will then evaluate an array of them to come up with a final idea but what we've really done is create a methodology so we've created a method of working through these complex processes and trying to find ways to interrogate them with rigor and do it in a way that is inclusive and do it in a way that has this co-design potential or a core actually so that we we we know that at the end of this it will it be representative you've used the word interrogation evaluation I'm guessing you're not sensing that there's much of that going on in our built-in health-built environments at the moment tell me a little bit about do we do enough post-occupancy evaluations do we go away and actually ask people I mean this is the claim made by the design team about this particular environment but how is that resonating for you it's not very much uh it's not very much done it's not very much done and yet to me it's critical if we have a brief and functional briefs that really get to the core of what you're trying to change then it seems absolutely imperative to me that you have to check and know whether you met that brief but the other thing that I think is really important in improving Health Systems like we do in improving health care so I'm I'm also a clinical trialist so I do randomized controlled trials the highest level of evidence and I have to report whether they work or not um into the public domain post-occupancy should be an evaluation of did you make your ambitious hopefully targets for this building and for this service and they I believe should be made public and be transparent and people should be actually applauded for doing that so not criticized for it actually applauded for that because how can Health Systems learn and how can we improve if we don't know whether things work so I think what's missing is actually uh a standard approach to how we do this and then the willingness to actually put some money in to the projects if you have a huge Hospital project there might be some parts of it that we know already from previous research and evidence that are going to work quite well and maybe they're not your target but if you've really made a big effort to try and radically change the emergency department or how ICU functions or the waiting room at Pharmacy or whatever then I think you can work at it at a modular level you can go right let's let's look at that because we really wanted to solve that problem do you see any client around the world who does that well in Sweden it is a policy um that they are required to have this sort of learning that comes at the end of a publicly contributed to if not fully funded building its public money I think is quite reasonable to have that as a as an approach where there's a standard that they apply there needs to be a way that we can have an evaluation that is also done in a rigorous way I know in Queensland they've thought about that and I think have done a bit of work to try and create a standard but we have nothing across the whole of the country I think we're about to change that with the australasian health infrastructure Alliance where we've agreed to actually develop a national standard for post-occupancy evaluations and it does seem to me that if we can have an agreed way of measuring the outcomes of buildings then we've probably got a much better way of determining what constitutes good design because we can point to here's what the evidence says and if you do those five or six things you're more than likely on the pathway to good design absolutely there's a obligation I would have thought to think about good design because it has a greater longevity oh completely agree with that so Julie what's interesting ultimately there'll be a young architect who'll get stuck in a in a lift with a a very important client and they'll be asked what are the three things you need to know to design a fantastic Health environment going forward you've got to understand your users which includes patients and staff you've got to know the evidence because I think we've got to use that too in all of our designs so what does the research tell us and then also do something quite beautiful and stimulating because good design is a combination of all that functionality evidence and something gorgeous wonderful I love Aesthetics thank you

2023-05-26 06:10

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