Group of people walking
A Smarter Hospital for the Future: a focus on people, not buildings

01

2 min read

Overcoming traditional thinking

Looking past existing service models for true transformation

Two men in front of the library
Design is everything.
Everything”
– Paul Rand

Traditional thinking about digital transformation tries to introduce digital capability into the existing way we deliver health services with the objective of improving what we currently do. This approach inevitably constrains our thinking and limits the opportunity for transformation. The advent of COVID-19 has shown that there is now a need—and an opportunity—to deliver care differently, creating an inflection point in the way digital design and capabilities can enable care. Providers and receivers of care have had to embrace change at pace and in this upheaval lies the opportunity to reimagine and shape the future not just digitally but in creating a completely new strategy. This shifts the opportunity from digital transformation to smarter, user-centred design.

The concept of a smarter hospital focuses not just on the building but its role within an integrated care system. The smarter hospital focuses on the lives of its people—those working in it, receiving care or visiting—the processes that run within the organisation, and its impact on the community and the environment in which it operates. The smarter hospital will need to operate with infection control principles at its heart in order to manage patients who test positive for COVID-19 alongside the rest of the service. The challenges of a novel virus and disease have created a closer link between research and care delivery, offering us the prospect of every patient being in a trial and turning our hospitals into real world learning environments.

Now there is an opportunity to think afresh about the role that our hospitals can play, enabled by digital capability. This is about the hospital at the heart of a local health and care ecosystem as part of a coordinated approach to clinical services, not simply about the estates. These services will often be expected to serve different populations (local, regional and perhaps tertiary) within and beyond the four walls of the hospital.

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2 min read

The “Smarter Hospital” concept

User-centred design combined with digital innovation within an integrated care system

Woman with glasses

This paper proposes a vision of a Smarter Hospital, based on user-centred design. The hospital is reimagined through the lens of patient pathways and clinician workflows, and where digital options differ for each population using the service, and the processes and buildings are designed with this intent.

The foundation for the vision is a paperless service, enabled by clinical, care-giver and patient-facing technologies including high levels of digital workflow integration with electronic health records (EHR) and patient administration systems. This foundation includes the pervasive use of data: informing patient care; enabling patient flow optimisation; maximising building operation; and ensuring effective resource utilisation.

The core of the Smarter Hospital is flexible and modular, including digital technology, interoperability, data fluidity and a secure, open digital platform to nurture innovation as technology emerges. For example, developments in voice activated notation might allow a reduction in the time spent writing electronic records, potentially breaking down some of the physical and communication barriers. between patients and clinicians. We know that using an EHR takes up a lot of the clinician’s working day; one US study states that it amounts to about 50% of a clinician’s time.1 Such digital innovation alone has implications for consultation room design, the acoustic design of the building (air conditioning, acoustic damping) and building power requirements. The advent of COVID-19 has heralded an age of e-mail, text, telephone and video consultation becoming mainstream alternatives to physical outpatient services.2 Consultations can be provided away from hospital buildings providing an opportunity for clinical staff to work remotely.

1 Arndt, B. G., Beasley, J. W., Watkinson, M. D., Temte, J. L., Tuan, W. J., Sinsky, C. A., & Gilchrist, V. J. (2017). Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time-Motion Observations. Annals of family medicine, 15(5), 419–426, https://doi.org/10.1370/afm.2121
2 Webster, P. (2020). Virtual health care in the era of COVID-19. Lancet (London, England), 395(10231), 1180–1181., https://doi.org/10.1016/S0140-6736(20)30818-7

03

2 min read

Four design components

Design to revolutionise relationships

Doctor with tablet

The application of user-centred design principles combined with current and emergent digital technologies can revolutionise the relationship between the patient, the care giver, the Smarter Hospital and the service. This can be described through the lens of these different relationships, and impact upon four core design components:

04

5 min read

Patients and families

Making the patient and their family a part of the team

Doctor with patients

Co-designing care pathways with patients will drive greater visibility and control; adopting user-based design principles to enable groups of patients or “personas” to articulate their particular needs and preferences will enable a streamlined pathway.

Key to this is creating a frictionless interface between the patient and the service. It builds on the principle of giving more visibility and control to patients, not only of their care, but in the co-designing of services.3 The interaction with patients and families should strive to be digital first but also allow for more traditional routes.

Having a digital front door of the hospital powered by a virtual assistant could allow for the automation of booking, cancelling and rebooking of appointments as well as other common queries such as enquiries about letters and appointment details.

The increase in remote consultations allows patients to interact with healthcare professionals from home or from a local community resource, such as a library or health centre. Many of the standard clinical assessments could be digitalised and carried out before the appointment or admission. All this creates capacity and more time for longer interpersonal interactions in those circumstances or stages when this is more important.

When patients unavoidably need to attend the hospital, their journey could be enhanced by wayfinding technology. Imagine a journey concierge app allowing you to book your appointment with a prereserved parking spot, having your smart phone autoroute to that parking space, and augmented reality providing wayfinding support to navigate within the building to the correct consultation room. A patient portal could give the patient access to a summary of their records, discharge notes, correspondence, and possibly a transcript or recording of their consultation. This portal could be used for patient education material in multi-media format. Medical records could include patient-generated text such as preferences, patient reported outcome measures and therapeutic goals. This has significant implications for how we evaluate consultations.4

An ongoing relationship with the patient can be facilitated through digital access. Interaction need no longer be limited to the time the patient is physically in the hospital. This relationship creates the possibility of community monitoring using the IoT (internet of things), devices in the home, or wearables, to track at-risk individuals. The delivery of individualised and preference-specific content could allow for a rich economy of disease management tools to emerge. The use of gamification apps can enhance chronic disease management and the development of patient experts, and virtual reality or augmented reality therapeutic options can improve pain control.5 There is a small step from this to connecting patients and families who have similar conditions or care pathways to create a network of support and information around the hospital.

3 Alhonsuo, M. and Colley, A. (2019). Designing New Hospitals - Who Cares About the Patients? In Proceedings of Mensch und Computer 2019 (MuC’19). Association for Computing Machinery, New York, NY, USA, 725–729., https://doi.org/10.1145/3340764.3344898
4 Greenhalgh, T., Shaw, S., Wherton, J., Vijayaraghavan, S., Morris, J., Bhattacharya, S., Hanson, P., Campbell-Richards, D., Ramoutar, S., Collard, A., Hodkinson, I. (2018). Real-World Implementation of Video Outpatient Consultations at Macro, Meso, and Micro Levels: Mixed-Method Study. J Med Internet Res, 2018;20(4):e150., https://doi.org/10.2196/jmir.9897
5 Li, A., Montaño, Z., Chen, V. J., & Gold, J. I. (2011). Virtual reality and pain management: current trends and future directions. Pain management, 1(2), 147–157., https://doi.org/10.2217/pmt.10.15

05

5 min read

The workforce

Returning to the joy of care

Doctors with the new born child

Redesigning services with the workforce, for the workforce, and including digital enablement of streamlined care will be critical to enhancing job satisfaction—now more important than ever for people who have cared through the COVID-19 crisis and may be suffering from stress and burnout.

Delivering digitally enabled care, anchored in a new Smarter Hospital building, provides a unique opportunity to attract staff to the hospital, and to offer services they would enjoy delivering and of which they can be proud.

One of the most stressful aspects of clinical practice can be when pressure of the procedural workload gets in the way of patient care. Much of this workload could be automated. Sifting through general information to find the essential updates and navigating to find the most appropriate evidence-based treatment pathways can be increasingly time-consuming. Augmenting access to the latest research with artificial intelligence to provide decision support could reduce the pressure of processing large bodies of current practice and guidelines. There is an opportunity to address unexplained variation between clinicians in a supportive and educational way, providing a less stressful and a more rewarding way to deliver care.

The introduction of poorly designed EHR systems can be a significant source of stress for many hospital staff. In one US study, 70% of doctors reported stress related to health information technology.6 Streamlining EHR implementation to enable the optimisation of passwords and authentication technology, the provision of clinical adoption support, and using sentiment analysis could help to embed user practices on IT systems. Having mature bring-your-own-device (BYOD) strategies might help to normalise the experience. of hospital technology.

The environment itself has a significant impact on wellbeing. A building designed with light and green space helps promote a calmer and more relaxing environment for everyone.7 Access to leisure facilities, and the provision of dedicated sleep pods and rest rooms can all be important components of an effective working environment.

Other technology changes could include recruitment, induction and training, talent deployment and improving the environment of the workplace.8 There are significant opportunities to rethink scheduling and rostering systems, using platforms designed to link staff to shifts in a more controllable way. If applied to temporary and ‘bank’ staff, the provision of flexible working conditions could go some way to address the recruitment and retention challenges currently faced in some staff groups.

6 Gardner, R.L., Cooper, E., Haskell, J., Harris, D.A., Poplau, S., Kroth, P.J., Linzer, M. (2019) Physician stress and burnout: the impact of health information technology. Journal of the American Medical Informatics Association. 26 (2), pp. 106–114., https://doi.org/10.1093/jamia/ocy145
7 Edwards, L. and Torcellini, P. (2002). A Literature Review of the Effects of Natural Light on Building Occupants. National Renewable Energy Laboratory., https://doi.org/10.2172/15000841
8 Brambilla, A., Rebecchi, A., and Capolongo, S. (2019) Evidence Based Hospital Design. A Literature Review of the Recent Publications About the EBD Impact of Built Environment on Hospital Occupants’ and Organizational Outcomes. Annali Di Igiene. 31(2):165-180., https://doi.org/10.7416/ai.2019.2269

06

5 min read

The community

A seamless care journey

Group of people selecting food

A Smarter Hospital should contribute to a vibrant spirit of community participation beyond its walls, supported by open and secure digital platforms. These platforms should be harnessed as the basis for fostering health start-ups, device companies and industry partnerships.

These ecosystems can have a significant impact on local employment and business development. The services of a Smarter Hospital will be characterised by a highly porous, virtual border between the service within the building and the community, in terms of the experience of the patient and care giver. This is likely to involve a network of buildings serving different clinical needs, such as community hospitals with diagnostic facilities and step-up or step-down beds.

The integration of services into place-based care programmes will be important, ensuring links to population health management (prevention and wellness) programmes. Diagnostics and interventions should be provided as close to the patient as possible using the assets and resources in the primary care hubs. Although novel contracting and workforce planning may be needed, leveraging digital capability offers the opportunity for the community to enter the building, and the hospital to be a part of the community. The connectivity of 5G could allow for more community monitoring and streamed mobile diagnostics.9 The availability of any-time-any-device EHRs are the foundation of such a way of working. Digital links to the community provide more opportunity for local voluntary groups to be more closely integrated into hospital services such as transport or befriending services.

9 Latif, S., Qadir, J., Farooq, S., and Imran, M.A. (2017) How 5G (and concomitant technologies) will revolutionize healthcare. Future Internet., https://doi.org/10.3390/fi9040093

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2 min read

The environment

The greenest hospitals in the world

Arial view of the city

Increasingly we all need to play our part in minimising our environmental impact, and this applies no less to hospitals. There are opportunities especially in newly built premises to set a global example of sustainability excellence.10 The methodology of digital twins is a powerful way of creating intelligent buildings which exploit building sensors to monitor and capture environmental and asset performance.

This isn’t limited to sustainable heating and energy generation solutions but extends to single-use plastics and the adoption of intelligent preventative ‘fix before fail’ operating processes. Carbon neutral designs, delivered using sustainable development standards, also embrace advances in materials usage, land use, energy transport, water and wastewater management.

There may be opportunity to join local energy networks that create heat exchange systems. The provision of services via digital channels could act to lessen one of the most significant environmental impacts of a hospital—by reducing the travel requirements of its staff, patients and visitors, further enabled by electric-vehicle staff transport systems and digital platforms for lift sharing.

10 Dhillon, V.S., Kaur, D. (2015) Green Hospital and Climate Change: Their Interrelationship and the Way Forward. Journal of Clinical and Diagnostic Research. 9(12):LE01-LE5., https://doi.org/10.7860/JCDR/2015/13693.6942

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2 min read

An inflection point

Reshaping care for the future

Woman thinking

The disruption of the COVID-19 pandemic creates an inflection point in the delivery of healthcare. There is an opportunity for user-led design to enable patients and healthcare professionals to reshape care for the future, enabled by technology. The shift to a patient and carer view, combined with the capabilities of technology, creates possibilities to transcend the walls of the hospital, and for healthcare to step up to its responsibilities in addressing environmental impact. All this has been accelerated by a new virus and a new disease that has forced us to look again. It would be a shame not to embrace the opportunity this crisis has given us.

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About the author

Mark Davies

Mark Davies, Chief Medical Officer
IBM and Watson Health, Europe, Middle East and Africa

Mark joined IBM as Chief Medical Officer for Europe, Middle East and Africa in 2018. He has over 20 years’ experience as an NHS. General Practitioner in the UK. He has a long-standing interest in informatics, health policy and system redesign and has held a number of clinical leadership roles at the Department of Health, Cabinet Office and, most recently, as executive medical director of NHS Digital. In 2003 he founded one of the largest social enterprise providers in the UK — Local Care Direct, which developed an early model of integrated urgent care using multi-professional groups which continues today to cover a population of 3 million people. He is a non-executive director of the British Medical Journal.