How healthcare design would change post-COVID
Hospitals of the future would need to look at flexibility of design and use of more anti-bacterial material and automation
Are our hospitals infrastructure safe and resilient to withstand disasters and pandemics? What are the strategies used by hospital to ramp up their bed strength for COVID -patients. How are hospitals creating isolation centres and scaling them up? How the current pandemic that infection over 85,000 patients change the way hospitals of the future would be built.
The webinar, 'Hospitals Preparedness for Managing COVID-19' held on 8th May and organised by Healthcare Radius attempted to find answers to these questions.
The panelists were Dr Ashutosh Raghuvanshi, MD & Group CEO, Fortis Healthcare; Dr DS Rana, Chairman, Sir Ganga Ram Hospital; Ted Jacob, PE, President, Ted Jacob Engineering Group (USA); Peyman Askari Nejad, Founder, President, PAN Partners (UK); Shawn Basler, Co-CEO and Executive Director, Perkins Eastman (USA); Reza Kabul, President, ARK Studio INC (USA). The discussion was moderated by Bibhor Srivastava, Publishing Director, ITP Media, and co-moderated by Sanjay Bhan, Director, ITP Media.
On asked how hospitals were putting their resources and machinery together to fight the pandemic, Dr Ashutosh Raghuvanshi, MD & Group CEO, Fortis Healthcare, said, “From historic times, we are aware that a pandemic or an epidemic can hit us any time and from 2002 it has been very eminent. Subconsciously, everyone to some extent was wondering as when this would happen and not whether this would happen or not. The questions was when. From December and January, it became obvious that this was coming to us as well. From early February, we started planning and the first thing that we worked on was our supply chain as we felt that might be disrupted and our needs might change dramatically in terms of PPE, etc."
He added that he felt that the infrastructure was not prepared for handling a large of patients who are infected. "And that adequate number of isolation beds were not there. And then there are people related challenges. For instance, the frontline workers are at severe risk and that could seriously impair how your functioning is going to be. We divided the team into sub segments, so that we don’t put all of them at work together," he added.
Dr DS Rana, Chairman, Sir Ganga Ram Hospital, added,“We started to prepare to fight the crisis from mid March and we have prepared ourselves successfully in the last six weeks. We have joined hands with the Government by preparing two of our hospitals for COVID-19 patients, by following ICMR guidelines.”
Asked about how the new projects would be post COVID-19, Peyman Askari Nejad, Founder, President, PAN Partners (UK), said, “Today a traumatic event has affected the built environment. When we glance through history, it was the Cholera of the 19th century that prompted the introduction of a sewage system with roads to be wider and straighter above them and required a new zoning law to avoid overcrowding. Then there was the plague pandemic in 1855 in China which introduced drain pipes to building foundations, drastically changing the design aspect of the whole systems due to the rats. And now we have this pandemic, and now the design industry should look into the new strategies as to how to face the new dilemma.”
He suggested to mull over the time when we would return to the offices post quarantine, whether we would need to live in isolation or should be work in equilibrium with the design. “As designers, we embrace solutions that have capability and knowledge to safeguard the building users and inhabitants. Hospitals or buildings, we as designers have to look into better ways to mitigate this pandemic,” said he.
He informed that his company is working on using smart material that is easy to maintain, and resists mold. Many manufactures are incorporating anti microbial coatings into their interior products like floorings, façade, paint and furniture. He emphaised on the need for working on indoor air quality as well for products and technology that ask for sanitisation of surfaces. He asked to leverage anti microbial material such as copper.
He also said that more of handwashing and sanitisation, as well as improved cleaning protocol have to be focused on, as well as one needs to improve on indoor air quality and lower transmission of infection through HVAC system, maintain optimal right humidity (40 to 60% humidity) as the virus grows better in low humidity. He said that one needs leverage hands-free tools, automation and voice activation- as one has to think of building more sustainable and small buildings- limiting the need to touch things in the work environment and reduced exposure to germs.
Shawn Basler, Co-CEO and Executive Director, Perkins Eastman (USA), said, “The healthcare infrastructure was not prepared for this pandemic. We are going to see a complete change in healthcare design and systems to be able to tackle this pandemic.”
He said that hosiptals of the future has to have flexibility and scalability in healthcare design. “By scalability, I mean healthcare systems need to quickly expand in terms of converting parts of the hospital to increase bed capacity or within a community to increase the bed capacity. But there needs to be flexibility, so that one can quickly convert the number of rooms within a hospital to critical care or isolation. And that is what we are doing with many of our clients in the US.”
Post pandemic, he said, many hospitals would focus more on flexibility and scalability. He also pointed out that there is a change in how people use the healthcare system, due to anxiety of going to the hospital. So, there would be more of spokes and out patient surgery centres to serve the community.
Reza Kabul, President, ARK Studio INC (USA), said,“The nature bed capacity in public hospitals in India is 7,00,000 and that means 0.55 beds per 1,000 people. So there is a shortage of beds in India to tackle the pandemic. We do have not enough testing facilities, no proper quarantine for COVID patients as well as shortage of beds and ventilators and even trained staff to handle the situation. India has the requirement of 1,500 square feet per bed, while in the US it is 2,500 per bed. In the third world countries, it is 1200 square feet per bed.”
The new designs have to have social distancing in mind and for that hospitals need to give more space between beds. He suggested that instead of 1,500 square feer, one might need to go for 2.000 square feet per bed. "We will have to look at more anti-bacterial material, and even for elevators we may not have touch buttons but use our phones- so that there is less of human contact, Even hand rails and door knobs should have anti bacterial coating going forward," said he.
Ted Jacob, PE, President, Ted Jacob Engineering Group (USA), said, “We have seen epidemics like Tb, SARS and Ebola in the past and now the new pandemic has monumental impact on the healthcare industry. With Tb, we had hospitals introducing a one isolation room for every 12 to 15 patient rooms and with the new pandemic the entire hospital should be in negative isolation room.”
Earlier, only 20% of the hospitals required ventilators with medical gases but now it looks like the entire hospital should have these support. “We will also see changes in terms of architecture in terms of dealing with how the progression of patients to OR and ICU and other areas happen,” said he. He also suggested given the surge of patients, parking lots in hospitals can be converted to containment zone.
Look for the entire coverage of the webinar in our June edition.