Hospital Design


The difficult work
of institution-building
 

The University Hospital, currently under construction, will be the centerpiece of an integrated medical campus in Dubai Healthcare City. Partners Harvard Medical International (PHMI) has been instrumental in planning and designing the hospital. Christopher Railey from PHMI looks at the process behind the design and discovers that there is much more than just bricks and mortar to bring a hospital to life.

When the University Hospital in Dubai opens the doors to its first patients, it will be the beating heart of an integrated academic medical community unprecedented in the Middle East, comprised of institutions dedicated to patient care, medical education, and research. In the UH, a multidisciplinary planning team led by Partners Harvard Medical International (PHMI) has worked to reimagine how care is delivered, how health care professionals coexist and collaborate within the walls, and most importantly, what the patient experience should be like from the moment they arrive.

Some of the most recognised brands in medicine have set up shop in the Middle East. Yet rather than being another branch extension or offshore opportunity, the University Hospital, at the end of the day, will be Dubai’s own touchstone for 21st century health care.

A look at the process of planning and designing the UH reveals that there’s more to bringing a new hospital to life than bricks and mortar, allocation of space, and the machines to fill it. In fact, for the revolution in health care envisioned by the Dubai government, state-of-the-art hospitals represent just one pillar of what Dubai hopes ultimately to create. The UH is the centerpiece of an integrated medical campus that will include the homes of the Harvard Medical School Dubai Center (HMSDC), Dubai Harvard Foundation for Medical Research, and other entities critical to rounding out Dubai as a regional hub for health care that can be sustained by a home-grown workforce trained to international standards.

“Through Dubai Healthcare City, the government of Dubai has made a strong commitment to developing a world-class health care environment that meets the needs of its population and is sustainable for the future,” said Andrew Jeon, MD, President and Chief Executive Officer of PHMI. “DHCC and the University Hospital are not merely putting together a new building or launching an education programme to stand alone. This isn’t about planting a wellrecognised flag in the sand. This is the difficult work of institution-building.”

While the HMSDC and the Dubai Harvard Foundation provide critical education, knowledge transfer, and professional and career development, the University Hospital – as a major tertiary care center with education of the healthcare workforce at the core of its mission – will mark a dramatic advance in Dubai’s mission to become a regional centre for health care excellence.

Background

PHMI’s involvement with the UH and Dubai Healthcare City goes back to 2003, when the organization was engaged as the chief strategic collaborator charged with assisting with the development of DHCC. Working closely with Dubai leadership, they helped transform the government’s health care free zone concept into an operating model incorporating a governance and regulatory structure – operated by the Center for Healthcare Planning & Quality (CPQ) – to ensure quality among DHCC’s providers and guide DHCC’s progress and growth as new institutions came on board.

PHMI also oversaw the development of the HMSDC, which is a postgraduate education centre, and the Dubai Harvard Foundation, an engine for research programme development in the region. PHMI continues to fulfill a wide range of strategic and operational oversight functions for DHCC, most notably through participation in its regulatory governance through the CPQ.

With DHCC up and growing, Dubai and PHMI moved forward on plans to develop a world-class teaching hospital – an idea that had been in the works since the commencement of the PHMIDubai relationship. Working in close collaboration with the Dubai healthcare community, PHMI provided the initial vision for the hospital and oversaw its design and development, including helping to develop the clinical programmes that would be offered, defining the hospital’s core operational structure, and assisting with the recruitment of executive and clinical leadership. The planning team was comprised of experts in 27 medical specialties, as well as senior leaders and administrators with deep knowledge of hospital operations and critical support services. Ellerbe Becket, an international architecture firm based in the US, was brought on board to collaborate with PHMI on the architectural design. The executive leadership team for the UH was recruited once the design of the hospital was underway.

Designing for change

Dubai’s full-on investment in health care comes at a time when the demand for worldclass healthcare services in Dubai and the greater Gulf Region is increasingly rapidly. With few exceptions, Dubai’s hospital facilities – many of them old and equipped with outdated technology and infrastructure – have proved unable to meet these rising demands. Thus many of the country’s citizens and a significant proportion of its large expatriate population continue to look beyond Dubai’s borders for their care.

Decreasing the outflow of patients was an obvious driver of both DHCC’s creation and the vision for the hospital. The University Hospital therefore would have to be developed according to international standards. But quality and world-class benchmarks weren’t the only guiding principles of the hospital’s design. The hospital’s planners also recognised that owing to the rapidly shifting demographics of Dubai, evolving patterns of physician practice in the region, and limited market data available to guide medical and facilities planning, the UH would have to be dynamic and flexible. The demand for certain clinical services would change over time. Therefore flexibility to adapt – within an individual patient room or entire clinical department – would become a central feature of the hospital’s design.

In Boston and Dubai, PHMI brought together more than 40 clinicians, faculty, and department heads from various Harvard Medical School-affiliated teaching hospitals to work with the core planning teams to integrate important advances and key trends in their specialty areas into the vision of the UH. Clinical heads from top Boston hospitals like Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center infused planning sessions with their own experiences, drew on latest published evidence, and consulted with colleagues and focus groups. Nurses played an important role as well, providing insight into room design and patient flow processes. These multidisciplinary planning sessions – with planners, architects, and practicing clinicians working side by side – aligned the aspirational with the practical, resulting in a conceptual design and plan that could be realised.

Judith Mitchell, AIA, PHMI’s Director of Planning on the UH project, said, “The guiding philosophy behind the design process was to consistently strive to make decisions and create solutions that resulted in an environment where patients want to go for care and where top healthcare professionals want to practice and teach.” Mitchell added that the integration of clinical and educational components in the UH has been done in a way that is unprecedented in the region.

The UH is a 400-bed facility occupying 1.45 million square feet of clinical and laboratory space, faculty offices, and amenities for patients, families and staff. The hospital’s clinical programme plan is organised around clinical service lines (rather than silo departments) designed to foster the development of integrated care teams. The service lines cover both inpatient and outpatient services, advanced imaging and surgical capability, stateof- the-art clinical laboratories, and level two emergency care. The hospital will offer signature clinical programmes and research across a wide range of specialisations, including Centers of Excellence in diabetes, oncology, women’s health, cardiovascular medicine, musculoskeletal health, and the neurosciences.

Cutting-edge advances

One of the most innovative components of the University Hospital is a fully integrated interventional suite designed to accommodate the full spectrum of surgery and interventional diagnostics safely and effectively while providing the flexibility to meet the shifting demands of Dubai’s dynamic health care marketplace. A very large footprint allows general surgery, interventional radiology, minimally invasive surgery, endoscopy, and the post-anaesthesia care unit to be located together in a single integrated environment.

A recurring theme of the University Hospital’s clinical plan is the integration of diagnostic and treatment modalities throughout ambulatory and inpatient areas. “By breaking down the traditional barriers between specialties, the University Hospital creates pathways for multidisciplinary care and has the flexibility to adjust with the demand for services,” said Mitchell.

The design anticipates increasingly complex procedures being performed in an outpatient setting – a trend that is already reshaping care and influencing hospital development in parts of Europe and the United States. In Dubai, the need to manage costs and the changing expectations of patients are likewise increasing demands on clinics and expanding the scope of services provided in the outpatient setting. The design also reflects a critical role for imaging, not only in diagnostics but in treatments utilising image-guided interventional procedures.

The need for flexibility drove all aspects of the physical design from master planning decisions to detailed room design. Universal rooms will allow inpatient units to shift from intensive care to general medical surgical care. Modular clinics have been designed to allow outpatient services to expand and contract, and soft space embedded within the clinics and interventional floor will provide additional flexibility to accommodate unforeseen needs.

To understand the specific requirements of patients and physicians in the hospital settings, focus group sessions including patients from a variety of backgrounds were held in Dubai. These focus groups revealed a wide range of needs reflecting the broad population they serve. The need to accommodate large family groups led to generous consultation spaces and the need for more private patient-doctor discussions apart from their family was also required. By intermingling generouslysized consult rooms within exam modules, the hospital design allows a variety of private and family interactions to help the hospital’s visitors feel as comfortable as possible.

Center for education

Education and access to information will be a defining feature of the University Hospital. The ambulatory clinics will feature patient resource centres offering information to patients and families about their health care. The hospital will also be physically connected to the new home of the Harvard Medical School Dubai Center, construction of which is nearly complete.

The UH will also house the Consumer Health Patient Education Center – the first of its kind in the region – which has been designed to provide educational services to patients and their families. No other hospital or medical centre in the region has made the commitment or dedicated such resources to meeting their patients’ needs for health information and education. An extension of the Al Maktoum Harvard Medical Library located within HMSDC, the patient education centre will offer patientoriented programmes such as prenatal classes, smoking cessation, and management of diabetes. Librarians and educators will be on hand to help visitors find the information they need, and will also work with clinicians to provide the resources and programmes to meet their patients’ needs.

In addition to providing excellence in patient care, the University Hospital aims to be a centre of excellence for nursing leadership and education from day one. The acute nursing shortage in the Emirates has required a new approach to attract and retain top quality nurses. In the early stages of planning the hospital, it became clear, said Mitchell, that the UH was an opportunity to not only develop an elite nursing service based on world-class standards, but also to help transform the nursing profession on a region-wide scale.

To accomplish this, the UH nursing leadership team has worked with nurse leaders at PHMI and Massachusetts General Hospital (MGH) to develop a professional practice model based on the principles of nursing excellence outlined in the Magnet Recognition Program of the American Nurses Credentialing Center. Hospitals with Magnet status are recognised as adept at maintaining a nursing environment that has a visionary nurse leader as part of the overall hospital leadership team, keeping nurses and patients more satisfied, and having a track record of better patient outcomes.

Elizabeth Brown, RN, MSN, MBA, a nursing and clinical services expert at PHMI, said, “Nursing is the common thread that is interwoven throughout the fabric of the integrated hard and soft infrastructure of the University Hospital. The early stages of planning for the UH took into consideration two important factors related to nursing: one, that nursing would comprise the largest workforce in the hospital, and two, that the existing nursing situation in the UAE would present both challenges and opportunities.”

By instituting such a strong commitment to nursing at the outset, the UH could potentially raise the bar for other hospitals in the region to enhance the nursing profession, attract capable professionals to the field, and improve overall quality of care.

● Christopher Railey is Director of Communications & Marketing, Partners Harvard Medical International, Boston, Massachusetts, United States.

 Date of upload: 10th Dec 2009