Vision Formers

Unprecedented changes in health service delivery are creating a future where healthcare assets must be able to comprehensively adapt and change without significant cost impact or major interruptions to service delivery.

The challenge is in the formulation of innovative approaches to create a new generation of physical spaces that can easily be transformed to prevent “built in” obsolescence. These spaces will need to be supported by asset life cycles that do not require major intervention or treatment in order to also adapt.

Although we can not underestimate the complexity in comprehending how the future built environment will need to change from today’s clinical models, what we do know is that where possible, space will need to be flexible, androgynous and multifunctional. Clinical spaces will need future proofing and must be easily adaptable to support ever changing health service delivery models. To exacerbate the problem, environs will also need to continually adapt to accommodate additional, constantly evolving, technological functionality and equipment.

One issue is that restrictive budgeting where initial “affordability” tends to drive the tightest possible building envelope with ”user groups” specifically tailoring spaces. An impact of this action is that future cost prevention is “value engineered” out. This inevitably has the potential to speed up obsolescence and create a future cost time bomb. We cannot afford to ignore the long term diagnoses that healthcare will be unaffordable. If we continue to accept future high change costs, driven by initial cost cutting, then healthcare will be unquestionably unaffordable.

Understanding the whole property portfolio, including opportunities through decentralisation, co-location and sharing “back shop” and “front line” services is a vital first step in ‘transforming’ primary and community services where clinical activity is located in the right place and on the right cost terms.

New Zealand’s health services already have strategic clarity that incorporates the concept of prevention being more cost-effective than treatment. This is reflected in the six initiatives:

• Better Diabetes and Cardiovascular Services
• Improved Access to Elective Surgery
• Shorter Stays in Emergency Departments
• Increased Immunisation
• Shorter Waits for Cancer Treatment Radiotherapy
• Better Help for Smokers to Quit

So why is this philosophy of prevention, not treatment, not applied fully to the built environment?

One silver bullet is to establish a new era of property portfolio efficiency where long life cycle, flexible spaces can be easily adapted to support constantly changing clinical pathways and models of care. This would require new strategic thinking in areas such as multiple occupancy, co-location of services, back shop support, life cycle cost management and value analysis.

Transformation of community and primary services requires extensive integration to formulate the right property portfolio with multifunction spaces for all community and primary providers of clinical services. Aligning clinical service and the property portfolio is as essential as the right type of property in the right place and is a key enabler for clinical delivery innovation. Conversely, the wrong property in the wrong place is a major and potentially expensive barrier to future change.
Over the last decade there has been a massive investment in New Zealand’s health economy, which has created new hospitals, primary care facility improvements and new clinics and community health facilities. Over the next four years the health sector will receive $1.7 billion new operating and $40 million capital funding. District Health Boards will receive an additional $1.6 billion to manage price and demographic pressures and widen access to newly subsidised medicines.

However, data analysed in the United Kingdom (UK) demonstrated that nearly 3% of their National Health Service (NHS) property was completely surplus to needs and that 12% was defined as ‘not used.’ (Data source; ERIC reporting 2008/09).
The NHS with more than 29 million m2 of gross floor area and a declared asset value of some £40 billion has approximately 4.35 million m2 unoccupied. It was therefore unsurprising that the NHS Operating Framework 2008/09 called for better use of underutilised and surplus property to provide the opportunity to save £3 billion.

Direct comparisons based on annual expenditure suggest that if underutilisation is of the same magnitude in New Zealand then there are potential savings of between $300 and $350 million through developing appropriate property strategies. However, due to the lack of single source data one can only speculate that this is highly probable.

The Building Intelligence Group can provide professional strategic expertise and technical knowledge developed within New Zealand and the UK by working with healthcare providers both internally and commercially. We are able to work with clients to develop bespoke solutions and options to support the difficult decisions ahead. We can share international best practice with clients and transfer knowledge and understanding whilst using our leading edge thinking to innovate and offer new ways of working.

Once a strategic direction has been established, the identification of realistic and practical options for the short, medium and long-term futures with clear measurable milestones is essential. This helps form a strategic programme to align the property portfolio with service delivery, clinical efficiency and quality plans. This must be reflected in an investment strategy where key goals and objectives are built into a long term capital investment plan for the property portfolio. This plan, when developed, should form the foundation for a long-term property portfolio development plan which is linked to clear clinical performance measurement and efficiency targets.

“...If underutilisation is of the same magnitude in new zealand then there are potential savings of between $300 and $350 million through developing appropriate property strategies.”
Brian Midgelow-Marsden - Project Director
The Building Intelligence Group

In addition, our project management services benefit from the breadth and depth of our internationally developed technical knowledge and experience. This perspective combined with our detailed understanding of project methodology and market leading thinking, enables us to get ‘under the skin’ of projects quickly and effectively whilst mitigating and managing risk effectively. Key to successful project delivery is ensuring the project is aligned to the provider’s strategic ambition and is managed at the heart of the provider, i.e. at Board level.

A property portfolio strategy that is fit for purpose and aligned to clinical needs will:

• have a fully developed and measurable plan for change
• generate best value and potential cash releasing savings from the property portfolio
• provide assurance and compliance during change management
• be benchmarked to ensure best in class standards
• have a strategic context for assessing business cases for capital investment
• be able to demonstrate commitment to sustainable development and environmental targets
• contain a detailed risk strategy that controls, manages and monitors a targeted investment strategy.

This approach can effectively support the development of a long-term, strategic, property portfolio programme specifically modelled to provide an improved patient experience and facilitate excellent service delivery from efficient, fit for purpose accommodation.

If you’d like to know more about the ideas shared in this article by our Project Director, Brian Midgelow-Marsden then please call Brian on 09 300 9984 or email him on b.midgelow-marsden@tbig.co.nz

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