The coronavirus has caught the entire world off-guard. The impact of the virus is easily visible in the number of cases that are being reported around the world every day. While operating in the light of Covid-19, hospitals are concerned about the resurgence of infectious diseases in the future.
The hospitals in most countries are built with tight margins to fill the beds and have them fully filled at maximum times. This means that in an outbreak, the system is pushed to its limits. Looking at how the current situation has overwhelmed the hospitals, they don’t want to be caught flat-footed again. To prepare better for the future, it is crucial to address the configuration of hospital infrastructure.
Reaction to the Outbreak
“The new hospital design cannot ignore the concept of convertible spaces,” said Unnati Negi, ex-Chief Operating Officer, Fortis Healthcare(Mauritius). “They will be built keeping in mind what is happening during coronavirus,” she added.
Over the past few months, fast made sanitary medical spaces have proved to be an essential asset when people failed to find a place in major hospitals. This could give a direction to the construction of hospitals for the future. Modular construction, both for additional hospitals and during the crisis is a possible way to be prepared for expected outbreaks.
For instance, China built a makeshift emergency hospital in Wuhan within 10 days to treat coronavirus patients. The emergency facility is made up of two floors including several isolation wards and intensive care units and can hold up to 1000 patients. Engineers said that this could be made possible due to prefabricated units. The prefabricated elements are fabricated off-site at the same time construction is happening on-site. In other parts of the world, exhibition centres, parks, sports stadiums, and ships were used to house the patients suffering from COVID. In India, the Delhi government is converting the Radha Soami Spiritual Centre in South Delhi into the world’s largest temporary coronavirus healthcare facility with 10,000 reusable cardboard beds, which do not need sanitisation.
As the healthcare infrastructure was overburdened with the virus patients, people were wary to visit hospitals for regular tests and surgeries. Henceforth, the number of surgeries and OPDs have reduced, and hospitals have been facing losses for the last three months. While thinking of ways to reconfigure their existing infrastructure,they will for the time being need to come out with ways of striking a balance between reducing footfalls and still maintaining revenue channels.
“Hospitals will have to remember that liquidity is an issue in current times and only 15% of people are insured. How transparent they are in their pricing and what new ways can they use as an EMI offer or crowdfunding to ease the burden on the customer would also be a key factor in conversions,” said Dr. Sonia Basu, Founder, and COO, Healthfin, a Medtech start-up that offers loans to patients.
Potential Hospital Architecture
The hospitals of the future will have to be flexible as well as scalable. Expansion in terms of increasing the bed capacity and flexibility to convert the number of hospital rooms to critical care or isolation. It is true that this would increase the cost of construction, especially for a few buildings that might be used only in case of an emergency. One way to do this is by putting shipping containers to use. They can be safely stacked to significant heights, can be built anywhere, and are inexpensive. They are readily available as there are more than 500,000 abandoned containers in the world. These factors make them a strong contender for temporary health infrastructure.
Traditionally, there are two types of hospital designs—pavilion and monoblock. The monoblock is just the entire hospital infrastructure in one big tower block. Whereas, a pavilion is a collection of buildings with central courtyards and a lot of outdoor areas.
A hybrid of both styles can emerge from this pandemic. It needs to incorporate the efficiency and logic of the monoblock hospitals with the comfort of the pavilion. This could be adopted with the proper use of underground structures. The underground level of the hospital could be a large part of the infrastructure which would eradicate the need to leave the building.
Multi-story car parks can replace the traditional car parks above the ground with an underground entrance for an ambulance which would create an easy passage for emergency patients. The elevators could be used to take doctors and patients above ground to the pavilion structures. The above-ground structures will be a collection of separate structures that are connected through the underground level and occasional sky-bridge. These buildings can house patients wards, administrative buildings that are not linked to medical treatment. In a crisis like this, it can become isolation wards for the staff.
Remodeling Traditional Hospitals
Although the infection control protocols in place are to protect patients, in a crisis like this, it is equally important to protect the entire hospital staff. To limit the use of touching surfaces, one needs to leverage hands-free tools such as automation and voice activation. For instance, mobile phones could be used to operate the buttons of an elevator. Video visits and eICUs are other ways of treating patients that do not require urgent or in-person care.
Some hospitals are using smart material that is easy to maintain and resists mold. Many manufacturers are incorporating antimicrobial coatings into their interior products like floorings, paint, handrails, doorknobs, and furniture. There is also a need to work on the inner air quality products and technology that ask for sanitisation of surfaces. As some viruses grow better in low humidity, it is necessary to maintain the right level of humidity. Following this, some of the air-conditioned facilities will be replaced by open-air and designs that allow a significant amount of light into the rooms.
As social distancing has become the new normal, the new designs will have to keep adequate space in between the beds. Private rooms with separate entrances could be another potential area to look at. During the TB outbreak, hospitals introduced an isolation room for every 12 to 15 patients, the current pandemic suggests the entire hospital could become like a negative isolation room.
“Gone are the days when doctors had the luxury of coming late and having an OPD room full of waiting patients. Certain processes like discharge, diagnostics, etc which have a long waiting time would have to be re-engineered to improve efficiency so that there’s a quick in and out for anyone involved,” said Dr. Basu.
A Healthcare Revolution
Technology will play a vital role going ahead and telemedicine is expected to be the future of healthcare. The pandemic has caused the hospitals to adopt a few technologies quicker than they would have, such as the use of Skype and Zoom for patients to maintain regular contact with their families. Negi said that hospitals need to use telemedicine efficiently. There would have to be triaging of patients in terms of appointments – who could be offered a teleconsultation and who needs to be physically called to the hospital. As online appointments are still new to many, the cost structure has to be such that most people can adopt it quickly. Robots could be used to look at thermal temperature and sanitisation could be done with machines.
“I used to get questions when people saw me sanitising my phone, the same people appreciate me now,” said Negi. She believes that pandemic will raise civic sense among people and masks could become common like how Japanese people wear it as part of a sensible society.
“There is a fear psychosis currently which will probably lead to people rushing to the nearest lab to do Covid testing or consulting a family doctor immediately,” said Dr. Basu. However, this fear has also made people extra cautious and mindful to practice distancing, use of a mask, repeated handwashing and focusing on immunity building which will help prevent the spread to others.
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