The importance of clinical involvement in healthcare building projects
Jo Makosinski speaks to Fiona Halstead and Alison Cann about why involving clinical staff in building projects is crucial to designing healthcare buildings which work for all
Alison and Fiona frequently speak at industry conferences and events to explain the importance of clinical involvement from the earliest stages of a building project
“People do not appreciate how well thought out modern healthcare buildings should be, and with the ones that are great, how hard it was to get there.”
This stark observation comes from Alison Cann, clinical compliance specialist at Barts Health NHS Trust, who, along with colleague, Fiona Halstead, is leading a charge to imbed clinical advisors in all healthcare development project teams.
“The problem is there’s a lot of clinical people who do not understand buildings and a lot of architects who do not understand the intricacies of healthcare delivery”, Halstead adds.
“They have a huge vision, quite rightly, but to get that into a building is very difficult.
“Creating a healthcare building which truly works is about flows and processes, and you have to look at that.
“It is all very well giving an architect a brief for a new ward, or a new room on a ward, and they do that very well. But it might not flow well and support patients and staff, and that’s where we come in.”
A brave move
Barts’ clinical compliance team was born 23 years ago when Jilly Bowen, the deputy director of EFM (capital), made the ‘brave’ decision to bypass external consultants and put together an in-house team made up of senior clinical staff whose job it would be to ensure the needs of patients and staff were acknowledged, and acted upon, when building projects were developed.
Halstead and Cann are both RNs and were drafted in from operational management and clinical nurse management roles to lead this team.
And the results have set a new benchmark for the design, construction, and operation of healthcare developments, both at Barts and across other healthcare operators in the UK and further afield.
“There’s a lot of things we can do by going by the book, but we can’t understand a lot of it without using each project as an individual entity, and that’s where we can act as the lynchpin”, said Cann.
“Clinicians have great ideas, and so do architects, and we help to marry them up.”
Halstead adds: “We are the link between the clinical users and the architects, who are at two ends of the spectrum. One doesn’t always understand drawings, and the other doesn’t understand clinical flow, and we understand both.”
One of the projects Alison and Fiona were involved with was the creation of new theatres at Newham Hospital in east London
Early intervention
To maximise the positive impact of this role, they advise trusts to create clinical advisory panels, and get them involved in all building projects at the very-earliest opportunity.
Halstead explains: “In the very-early stages we should be involved – just as the project is being morphed and when they have an idea of what they want because they might be looking at the wrong space or a space that does not link with other correct services.”
An example of this is the creation of standalone surgical units, an increasingly-common development within the health sector as it struggles to cope with an increase in patients and a backlog of procedures.
Cann said: “If it’s a standalone building like a surgical unit the only way to get a patient to ICU is to call 999 and send an ambulance.
“It is such a ridiculous waste of resources and as a nurse I cannot say that it is in the patient’s best interest.
“In this case, I would want a link corridor running between both buildings written into the plans at the earliest stage.
“While it might also seem simple on paper to get patients in for surgery, when you start to factor in all the support spaces ie.staff changing rooms, nursing stations, and clean and dirty utilities, these can be overlooked and then the department does not work in the best way for staff or patients.
Developing skills
“As a team we think about this all the time and there are certain things we have developed unusual skills in which are helping to inform more-efficient healthcare facilities.”
Another key attribute for those on the team, and another role they play, is forward thinking to ensure that all developments meet the needs of patients and clinical staff both when they open and in the future.
“What happens a lot is they choose the wrong building, without thinking about how different a service might look in a few years”, said Cann.
“Part of our job is to look at future demographics.
“When we were building an A&E unit in London the (then) consultants wanted to have it all curtains with no solid walls so in the event of a major incident they could use it like a field hospital.
“We thought it was a horrible way to look after people, not to mention the lack of confidentiality, privacy and dignity and noise.
“We insisted on hard walls, while some had curtains in the front, and we got support from our infection prevention and control team.
“And that was a good move when COVID hit.
“Looking to the future, we are likely to have another pandemic and it is also our job to look at things like that.
Using their clinical and management knowledge, Fiona and Alison ensure buildings work for both staff and patients
The little things
“We also are very keen on single rooms and we get the same comments that they are not good for nursing, but if you design them well, there is no difference.
“These are great for confidentiality, privacy and dignity and for managing patients with infectious diseases or those who need to mobilise after surgery.
“It’s the little things like that which people do not think about it until they have thought about it!”
Halstead adds: “Flexibility is critical and part of our role is in the background to look at new projects and developments in technology, what other people have done, and to read healthcare magazines so we know what the future looks like.
“As a manager I understand the needs, not just from nursing, but all staff and patient flows etc.
“And we have to be negotiators as you work with some difficult personalities who do not want to be told what to do, and might not see the reasons why we are doing it.
Meeting needs
“Having management on board, as well as clinical staff, is advisable too because they see things from a different perspective and a good manager who can manage their staff can be a real asset as there is a lot of delicate weaving to be done.”
In conclusion, Cann said: “People do not realise how complex an environment a clinical space is.
“If you have done your homework, and have considered the needs of staff, patients, and managers, you can create lovely environments which improve patient outcomes and are places staff want to work in.
“I think if we don’t design our healthcare buildings with clinical input we will not meet people’s needs.”