The Hospital Machine

Today's veterinary hospitals are so technologically complex that they can be considered machines. Unfortunately, just like a computer, these hospital ‘machines' become obsolete more quickly than they wear out. In fact, medical technology changes so fast that some predict the useful life of equipment in human medical facilities may soon contract to as little as three years. (Richard L Miller, AIA, Ear S Swensson, AIA, New Directions in Hospital and Healthcare Facility Design, McGraw-Hill, New York, 1995, pp34-35.) How do you make smart choices about equipment allowing your building to have a long and useful life?

You are making a big investment to build a new hospital. Heaped on top of that investment is the additional 5-10 percent that you may spend on new equipment and technologies. It pays to understand the trends driving technological decisions.

• The Electronic Age. Many veterinarians resist going ‘paperless'. However, the future hospital will be far beyond paperless; it will be a fully integrated electronic environment. For example, digital technologies in procedure rooms allow doctors to transmit and receive images and upload information to the patient's chart. Even if you do not wish to utilise the currently available electronic technology, it is best to have the electronic infrastructure set up so these technologies can be integrated at a later date.
• Specialisation. As specialisation becomes more pervasive in the veterinary industry, room design becomes less general and more specific. In the recent past, surgery rooms were used for multiple purposes and were general in design. Today's surgery rooms are designed more specifically for their purposes and for the equipment that will be used. Some rooms are smaller or larger as a result. For example, orthopaedic surgery rooms may be larger to accommodate imaging and medical equipment. In order to avoid building your spaces too large or too small, define a specific purpose for each room and work with your designer to maximise efficiency.
• Building for the Client. Many of your decisions about where to locate equipment will be driven by what is best for the psychological wellbeing of your human clients. In some cases, it helps to bring technology "up front", so your clients can be educated participants. This may be as simple as adding computers to your exam rooms, or you may take this concept further. Your hospital could become a ‘medical mall', where the available services and technologies are visible from public spaces. This design lessens anxiety about the unknown and allows clients to become familiar with all of the services you offer.

Rule Number 2: Make Smart Purchases

Before you make any major equipment decisions, it is important to understand the big picture enough to know what you are doing and why you are doing it. Technology is a catalyst for increasing your level of service, but you must make your purchases based on what your practice can support. For example, a linear accelerator is not a piece of equipment that is purchased without:

• A referral practice that can afford such an investment.
• A market for oncology.
• A commitment from a doctor or doctors whose reputations can support the equipment.
• A client base willing to pay for the treatments offered.

Rule Number 3: Plan for Expansion, Expect Change

Medicine is in constant flux. Technology itself is a driver of change. For example, MRI is a technology that is constantly evolving. As MRI machines appropriate for veterinary use are developed, they are more likely to find their way into veterinary hospitals. You should expect your hospital to become more technologically complex over the course of its lifetime. Here are some rules of thumb for designing for expansion and change:

• Build in more electrical service capacity than you currently use.
• "Stub out" power, gas etc in the direction of possible expansion.
• Think modular with your HVAC design.
• Organise power and date into raceways above the ceiling.
• Leave room on your site for future expansion and design your hospital strategically.
• Invest in interstitial space to facilitate future renovations.

Rule Number 4: Do Not Over Complicate

• Equipment purchases are complicated enough without worrying about unimportant details. These are some tips for keeping it simple:
• Use equipment that is tried and true in veterinary medicine and be very sceptical of human medical crossovers. 
• Spend your time focusing on equipment items that require complex coordination with your team and try not to worry too much about equipment that is more straightforward.
• Ask your colleagues about the equipment being used before. Learn from others to avoid reinventing the wheel.

Rule Number 5: Assemble your Construction Team

Despite your knowledge of medicine, you are unlikely to anticipate all of the pitfalls that you may encounter when you purchase and install specialty equipment. In human medicine, equipment coordination is a profession. Unfortunately, this is not the case in the veterinary market. Begin with the mindset that you will be the leader of a team effort and will delegate responsibilities to make thins work.

• Owner. It is your job to make a list of everything you need in each room, to select manufacturers, and to follow equipment items through the design and construction process to ensure that each item is integrated. You will find it helpful to develop a matrix for each equipment item that contains the following information:

-         Who purchases.

-         Who installs.

-         Mounting height.

-         Custom features and accessories.

-         Lead time for ordering if ordered by owner.

• Vendor/Manufacturer. The vendor or manufacturer of a piece of equipment is a great source of information. Make a habit of asking the vendor everything he or she knows about integrating complex technologies into your new building.
• Design Professional. It is your design professional's responsibility to design for the physical needs of each piece of equipment, including power, data, ventilation, structural requirements, water and gas. He or she should also verify that each piece of equipment can be brought into the building and that adequate clearances are maintained to operate and service the equipment.
• Your "People". You may be surprised to learn that construction contracts typically exclude many items that you will need to coordinate. For example, anything low voltage, such as telephone and data, is typically coordinated directly through the owner, which means that you will need to retain qualified people to assist you with your telephone/data/systems. Your telephone/data systems may interface with some of the medical equipment. You are also typically responsible for hiring a nuclear physicist to perform a shielding study for any equipment that needs x-ray shielding. While this may sound daunting, most shielding studies are simple and inexpensive.
• Contractor. Decide ahead of time with your design professional which items of equipment are to be purchased by you and which are to be "included in the contract" or purchased by your contractor. Before construction begins, sit down with your contractor to designate items that need specific coordination during construction. For example, many contractors feel intimidated by medical gas systems and need the support of the manufacturer and the owner during installation.

Rule Number 6: Follow Through

You may be exhausted with all of your technological decisions once the design is complete. Take a little vacation and get refreshed, because construction is the time to pay close attention.

• Do a "box walk" to visualise locations of power and data before walls are closed up.
• Review all relevant equipment shop drawings with your designer or contractor. Ask if you do not understand something.
• Talk to your contractor about items that need mounting height or location coordination, such as x-ray view boxes or surgery lights.

It can be difficult to find time to visit your construction site, but every visit is important. If you are concerned about being overwhelmed, you can designate a staff member to help you with some of the tasks, such as equipment ordering, but continue to stay in the loop.

Summary

You and your team may be the only ones to know of the miles of wires, cables, conduits, and pipes that create the machine that is your new hospital. Make smart decisions today and your machine will serve you well into the future.

Source:  Heather E Lewis Hospital Design Conference 2009