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Meeting future demand by improving existing healthcare infrastructure, redeveloping, and building new facilities

Infrastructure as the key to healthcare improvement

Adj. Prof Russell Harrison

Chief Executive

Western Health (Vic)

At the recent Healthcare Infrastructure event, we heard from Prof Russell Harrison, Chief Executive, Western Health (Vic) as he dived into how infrastructure is the key to healthcare improvement. In this article he explores:

  • Reconfiguring existing buildings to provide seamless infrastructure now and into the future
  • Ensuring efficiency, cost reduction, sustainability and a reduced carbon footprint, and most importantly improved patient care

Better infrastructure leading to better patient care

Healthcare is generally all about looking after patients in the best possible manner. This of course can be done anywhere and is mostly dependent on the healthcare professionals, but is enhanced if the care is provided in world-class facilities. Adjunct Professor Russell Harrison, the Chief Executive of Western Health in Victoria, says that ultimately, hospital infrastructure is about “ensuring we get a better patient and staff experience in our facilities.” In the western catchment area of Melbourne, where Western Health operates, it is a very exciting time for infrastructure development because “we’re seeing a significant amount of investment in the west of Melbourne, something we may never see again.” Western Health is leveraging the opportunity and ensuring that they come out of it with a number of new and revamped “capital projects.”

The oldest of Western Health’s sites is Williamstown Hospital. “The foundation stone was laid in 1892, and it was opened in 1894.” It has been in continuous use for 127 years, though of course has had many upgrades since, with some “of the older parts knocked down and renovated for better patient care.” Another relatively old facility is Footscray Hospital “which opened in the 1950s.” From the outset it was a state-of-the-art facility because at the time, “it was the first hospital in Victoria that was fully air conditioned.” It had major upgrades in the 1970s and now looks “pretty tired.”

Of the three major hospitals under the auspices of Western Health, the newest is Sunshine Hospital, “which opened in the early 1980s, but replaced some older facilities on a different site.” In many ways, this is the jewel in the crown because it is “an acute service building with five ward blocks.” In May 2019, the Joan Kirner Women’s and Children’s Hospital was added to the site to “meet the specific demand in Melbourne’s west,” whilst the almost completed emergency department redevelopment will add yet another dimension. Together, these developments and modern buildings “provide greater opportunities for better patient care in newer facilities.” In fact, there are plans to “almost totally rebuild” the oldest parts of the site over the course of the next 20 years, “because the demand is so significant.”

COVID-19 as a catalyst for a changed approach

Healthcare was clearly the industry most affected by the pandemic, though it affected the physical premises as much as the care of patients. For instance, if all the buildings in their facilities had been modern with the latest gadgets, it would have made treating patients easier, “but that’s not the reality we live in.” As such, the staff really needed to be “agile and very adaptive,” especially because the facilities of Western Health became “the epicentre of the wave two in Melbourne. We cared for well over 500 positive COVID positive patients in our ICU facilities that really weren’t designed for that.” The staff had to be particularly agile in the way they worked “to protect themselves and their patients.” Even now, COVID is still a factor, whilst the ICU and other facilities have “become drop in areas, transit lounges and are used for day services.”

““The Melton Hospital is an entirely Greenfield site. It will be the first tertiary level acute hospital to be built in Victoria not replacing something else, in 40 years. It is allowing us to put in place all of the lessons learned from all of our buildings, including some interesting stuff coming out of the pandemic.””

The pandemic showed, in the most definitive of ways, that though “our buildings last 50 years or more, the clinical pace of technological disruption moves at a much faster pace.” Western Health therefore “learned significant lessons” in how to design new buildings and create greater flexibility. For instance, the newest hospital in Melbourne is likely to be the Melton Hospital[1] (within the catchment area of Western Health).

On top of that, in 2019 it was announced that a new Footscray Hospital would be built. The current building “has served the community well but is moving just down the road.” It will open in 2025[2] and though construction began before the pandemic, some of the lessons regarding flexibility and agility are being incorporated into the design too, in order to serve the growing community.

[1] http://www.buildmeltonhospital.com.au/

[2] https://www.vhba.vic.gov.au/news/introducing-your-new-footscray-hospital

Lessons for the future

With two new projects and others constantly being upgraded, Western Health has some “key takeaways and lessons” that others might find useful when thinking about healthcare infrastructure:

  • Always push for environmental sustainability – “For all our new buildings we do the most we can in terms of environmental sustainability, and we are trying to retrofit our existing buildings. We want to be real leaders in this field. Our staff are really passionate about it.”
  • Consider different models of care – “The buildings are very different, so the models of care have to be different.” For instance, some of the rooms at the new Footscray Hospital will be four times larger than the current rooms, so this needs to come into consideration when providing care.
  • There are increased costs – Not only are the “buildings increasing in size,” but the “running costs continue to grow.” This means working with government and other partners to develop new efficiencies so as to “push for environmental sustainability whilst the costs increase.”
  • A push for natural light – “Every patient room has a window that faces daylight. Natural light has a real benefit for clinical and patient spaces that shouldn’t be underestimated.”
  • Promote a flexible environment – “We know we will use rooms differently in 5 to 10 years than the way we use them at the moment, so we ensure that we’ve got lots of flexibility built into that.”
  • Technology enablement – With virtual care and other modes of care, each room needs to be set up so that it is enabled for any eventuality, and “so that we can essentially run a model of a hospital without walls. This is really important to us.”
  • Invest in change management – “The management processes and leadership skills of our team are most important.”

Each of these lessons has come from “around Australia and internationally, and is about how to do things better so that we have facilities with great flexibility.”

“We can always have great staff in poor buildings, but building a brand new shiny building doesn’t guarantee that you get great staff. So there’s a huge amount of work to do in terms of change management around supporting the workforce transition to new buildings, and taking a great culture to those buildings to continue that development.”