In the third of a three-part series focused on the Dunedin Hospital rebuild, health reporter Eileen Goodwin travels to Christchurch where hospital designs differ "radically" from the past.
Parts of the new $215 million Burwood Hospital, in Christchurch, resemble a modern shopping precinct or swanky office building more than a traditional hospital.
Surgeons write up patient notes in a "hot desking" open office, and the reception and cafe area have a concourse or airport lounge feel.
Burwood, in a quiet part of Christchurch well away from the main cramped Christchurch Hospital district, is designed for longer-stay patients.
Communal areas are designed to lure patients out of their single rooms, particularly for meals.
But that is nothing compared with the $445 million acute services building under construction on the Christchurch Hospital site.
"The design coming out of that is radically different from anything in the world," Canterbury chief executive David Meates says.
Nearly 15,000 people visited the DHB’s Design Lab and their thoughts led to a profound rethink of the design.
"The big error of our generation is building huge single-room hospitals.
"If you’ve got cancer patients they don’t want to be by themselves."
"Our community told us that what was more important to them was interaction.
"It was too radical for the ministry [of Health] to get their head around. But all the reviewers have said: ‘Oh my God, you’ve got to do this’. I would hope that Southern spends a bit of time understanding what we’ve done here."
Wards are built on a standard, general model, other than areas that need specific design, such as haematology.
Multi-bed wards have been designed using sliding glass partitions, which can afford more privacy if patients choose.
The mantra is "long life, loose fit".
"Language is important in health. If you’d said we’re going to design a generalist ward, we would have had our clinicians totally up in arms." Mr Meates says.
The word ‘‘generalist’’ caused consternation in Dunedin when the Ministry of Health suggested the new hospital might be built on those lines.
"The way it’s been designed we have built ultimate flexibility. People in the Design Lab are saying it’s exactly what they imagined."
Tucked away in industrial Christchurch, the Design Lab is quite a contrast to the frantic Christchurch Hospital site.
Over the years, it’s been the place concepts and designs have been played with and tested.
Mock wards have been constructed with every possible detail so as to road-test them as thoroughly as possible.
When the Otago Daily Times visits it is largely empty apart from a model house of the typical patient, who, according to Canterbury’s health mantra, is at the centre of everything it does.
There’s also a stack of tiny beds printed with "$250,000 per year" to illustrate the cost of keeping people in hospital.
It will be a "wasted opportunity" if the SDHB does not engage the community and the health workforce in the Dunedin rebuild, he says.
Mr Meates says health boards often get community engagement wrong and end up "talking at the community".
As well as having apractical purpose, participation in the Design Lab makes people feel involved and informed.
Communication is also critical on the Christchurch Hospital site because of all the building activity under way.
By the end of next year, every clinical service would have shifted on average four times since the quakes.
It seems incredible so much can be happening in a relatively small space, but it has become normal.
The acute services building is under construction beside the working Christchurch Hospital and will be completed in 2018.
It will have 12 operating theatres and procedure rooms, an intensive care unit, a radiology department, an emergency department, and a rooftop helipad.
And work is about to start on the $72 million outpatients’ building on the other side of the working hospital.
In Christchurch Hospital itself, earthquake-strengthening and other work is under way.
Clinicians are involved in decisions that affect them.
In one example, a department was allowed to choose whether some particularly noisy work happened over a shorter more intense period, or over a longer period.
They opted to get it over with in a shorter timeframe.
Surgeons sometimes ring construction heads to tell them to stop drilling because "I’m going into the head".
"That’s abnormal but we’ve made it look really easy from the outside," Mr Meates says.
The ODT asked Southern DHB commissioner Kathy Grant what the board had in mind to involve the community in the redevelopment of Dunedin Hospital.
Mrs Grant released a statement in response: "The commissioner team has gone to significant effort to engage with our communities to get an understanding of what really matters to them, including through the Southern Future listening sessions.
"They have told us they want a healthcare system that puts patients at the centre, is more integrated, closer to home and has better communication across different sectors.
"They also told us about the importance of a hospital’s physical environment, such as the need for calm and quiet, especially at night, and appropriate spaces for whanau and friends.
"This will absolutely inform our work to determine delivery of healthcare services and the redevelopment of Dunedin Hospital.
"Patients and their representatives are involved in current activity around detailed service planning, and to shape models of care, for example in the patient journey workshops.
"We recognise the critical importance of their involvement, particularly as the project proceeds into the design phase, and will ensure we have appropriate measures in place to facilitate this.
"The Design Lab set up in Christchurch is one example of how that could be done," the statement said.
• Monday: Neurosurgery in upheaval
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Comments
Open plan patient rooms are not for everyone. I have had several bad room-share experiences in hospital: a large amount of someone's noisy instrusive visitors when I had a migraine after anaesthesia (grandpa visitor's back was even against mine through the curtain while I sat on a commode. The room, previously noisy, fell silent as they waited for me to produce a tinkle in the pot), another patient with a loud gasping breathing - I thought she would choke to death and I could not sleep as I might need to call a nurse for her; I had severe nausea and the patient next to me had a new colostomy that burst with very smelly results. There needs to be options for solitude.