As the technology available to treat patients develops, so hospital design evolves to accommodate it. With the Gulf region undergoing a massive hospital building programme, valued at about $14bn, (see table, page 8), it will soon be home to some of the most advanced hospital design and technology in the world.
But while changes in healthcare technology, from new imaging machines to hospital-wide equipment tracking systems, have for the past decade informed the interior design of hospitals in general, there is a further consideration influencing the design of the new generation of Gulf hospitals.
“Hospital design has undergone a paradigm shift, becoming patient centred,” says Alexander Wu, director of design at the US’ HDR Architects. “This still involves designing with the technology in mind, but the patient’s experience is the key influence.”
A major new trend in treatment is to bring the technology to the patient’s bedside rather than transport them through the hospital. This human-centred approach reduces patients’ exposure to disruption and noise, and can help the healing process, according to hospital designers and medical professionals.
Wu led the design team that created the 360-bed Cleveland Clinic Abu Dhabi, which is due to be completed in 2012. He says the patient-centred approach is a feature of many of the hospitals currently being designed and built in the UAE and wider Gulf region.
The new Al-Mafraq Hospital in Abu Dhabi will put the patient at the heart of the design, according to its architects at the US’ Burt Hill. “Patients and the public will feel as if they are entering a hotel environment,” the firm says in its design presentation for the project. “Non-clinical finishes, furniture and ambience will provide a warm and friendly setting, essential in today’s approach to healing environments.”
With the Gulf states now seeking international partners to operate private hospitals, rather than having the government run them, there is a greater emphasis on the design and technology of the new generation of Gulf hospitals. Five-star accommodation and furnishings are almost as important as installing the latest technology, because of the need to attract patients from around the region to ensure a return on investment.
“In contrast with more developed markets, where a large amount of infrastructure is already in place, the Middle East has the opportunity to design and build solutions that take a more revolutionary approach” says Diederik Zeven, senior director and general manager of Philips Healthcare Middle East.
The US’ HKS Architects was appointed in March 2008 to design a 160-bed women and children’s hospital, Um Danat al-Emarat, in Abu Dhabi. Its design includes hotel-style features such as a spa, as well as a wide choice of food and drink outlets.
Qatar’s Hamad Medical City, a 190,000- square-metre complex with 1,100 beds in four hospitals, will be self-sufficient, with its own mosque, parks and restaurant.
Another element of the patient-centred approach to design and technology is the -growing use of telemedicine – delivering medical information by telephone or over the internet – and distance learning. A higher level of chronic diseases among Gulf citizens – diabetes rates are forecast to rise from 1.5 million cases in 2000 to 4.1 million in 2030 – means patients need to be treated by specialists who are often in different locations. As a result, traditional hospital -information systems have changed to provide information across a range of locations and to better manage their sources through a single IT system.
A patient’s records can now be sent between hospitals using electronic medical record technology. This information can be sent directly to a surgical theatre, so treatment can be managed wherever the patient is.
The development of other health information technologies will contribute to -better patient care in the region’s hospitals. Clinical physician order entry systems enable medics to order laboratory tests while documenting the actions they have taken for the patient. Pharmacy information systems provide instant inventory updates.
As the Gulf becomes home to larger hospitals and patient volumes increase, issues such as managing health records provide an opportunity for technology companies.
“We have recently installed the Philips iSite Pacs image management system in Sheikh Khalifa Medical City, which integrates with a hospital’s in-house hospital information system,” says Zeven. “The technology makes it easier for clinicians to manage the large volume of information and images that need to be safely stored and accessed wherever and whenever needed.”
The development of health information systems is of particular use in the Gulf. It is currently difficult to recruit and retain the best medical talent because of the relatively small size of the market – for example, there is often not the critical mass of patients to justify a specialist surgeon’s career move to a Gulf hospital. But having telemedicine technology installed means the best surgeons from around the world can be consulted.
The Cleveland Clinic’s interior design also incorporates a hi-tech tracking system using radio frequency identification. This tracks clinical instruments, machines, beds and even staff, so equipment is used more efficiently and medical staff can spend more time with patients.
The need to track equipment and medical records is universal in healthcare, but Gulf patients have specific cultural needs that have influenced hospital design. Space, for instance, is very important in the region’s hospital designs. Patients are often accompanied by large, extended families, and both private and public space has to cater to this need. Family zones have been built into the design of new hospitals across the Gulf.
USarchitect Perkins Eastman designed Dubai’s Al-Maktoum Accident & Emergency Hospital for Dubai Health Authority, which, when completed, will become the emirate’s first such dedicated facility. Incorporating the latest in design and technology was a core goal in the project, says Nadia Tobia, principal in charge at Perkins Eastman.
“We had to cater to a brief that required state-of-the-art healthcare design and technology, and at the same time maintain world-class design using a non-institutional approach,” says Tobia.
Part of this approach is the provision of public spaces for accompanying family groups. The design for the 300-bed hospital complex includes a large atrium with eating and shopping facilities.
The atrium, or ‘spine’, of the building provides direct access to all medical departments, which is crucial for the circulation of people and equipment. An ambulance reception area is directly linked to a surgical trauma operating room and a diagnostic imaging unit with MRI, CT and X-ray scanners.
Good environmental management is also a feature of the new generation of Gulf hospitals. Despite the challenges presented by the region’s hot climate, architects have been briefed to design buildings to strict environmental standards, and many are seeking Leadership in Energy & Environmental Design (Leed) accreditation.
The Leed system rates buildings on their site development, water savings, energy efficiency, materials selection and indoor environmental quality. The Al-Maktoum hospital is aiming for a Leed silver accreditation, although it still has to go through the application process.
The Cleveland Clinic is aiming to be the first hospital in the GCC with Leed gold accreditation. The design addresses the harsh Abu Dhabi climate by means of a dual wall, serving as a ‘respiratory system’ for the building, according to Wu. Air is circulated between the glass walls to insulate the building from the hot climate, thereby helping to reduce the need to cool the building using energy-intensive air conditioning. Grey water – wastewater generated from domestic processes such as dishwashing and laundry – will be reused to reduce the building’s dependency on expensive, desalinated water.
“In terms of architectural design, we are seeing a real revolution,” says Wu. “I think the clinic will be a benchmark hospital for the new wave of hospital design. Other hospitals in the region and beyond will be looking at it to see how it is designed.”
Tobia says designing with the environment in mind is more difficult for hospitals than for conventional, residential structures. “The volumes of energy consumed by a hospital, infection control measures and clinical standards are particular challenges in healthcare design,” she says.
Airborne particles and contaminants, for example, need to be controlled by sophisticated filtering systems.
Abu Dhabi’s 25-year-old Al-Mafraq Hospital is being replaced with a building that also aims to reduce the institution’s environmental impact. The new hospital, with 690 beds, will also recycle grey water, reduce the use of electricity using fibre-optic interior sunlighting and use solar panels to generate power.
Hospital technology and design are inseparable. While the benefits of new technology in terms of diagnostics and support systems are obvious, good hospital design can contribute to better healthcare delivery. Gulf governments have set themselves the goal of having some of the best healthcare in the world. Abu Dhabi Health Authority, for example, has a stated goal of creating a world-class healthcare system funded primarily by employer insurance schemes. This means the region’s hospitals are likely to become examples of how the latest technology and design can work together.
“What is happening on the cutting edge of medical research as far as construction is concerned is innovation in energy conservation, sustainability and patient care environments,” says Norman Soto, director of UAE healthcare at Burt Hill.
The Gulf’s multi-billion-dollar spending programme not only represents an opportunity for the region’s 34 million people to be treated to a high standard in their home country, but also represents potential business for companies in a range of sectors.