Healthcare Architecture in the Post-Covid-19 Era
UAE Healthcare Architecture in the Post-Covid-19 Era
?When the pandemic of the novel coronavirus (COVID-19) hit in early 2020 with a seismic wave of infected cases globally, our region was not spared, with more than 168 million confirmed cases and over 3.4 million deaths were recorded around the globe as of 25Th May 202,
In the United Arab Emirates (UAE), the first cases of positive coronavirus were discovered in early 2020 for a visiting family from China UAE, to date, there were over 557 thousand confirmed cases and a total of 1,654 deaths in the UAE as of 25th May 2021.
The rapid spread of the Covid- 19 and its inevitable health and socioeconomic impact had led to the implementation of serious measures across the globe. Putting all counties' infrastructure especially the healthcare sector into a test. Inadequate capability, supply shortages, the need for treatment redesign, and financial accrue due to the pandemic for healthcare design and delivery organizations. According to complexity science, healthcare delivery organizations are viewed as dynamic adaptive structures that function in highly complex and unpredictable settings. According to this viewpoint, much of organizational existence is unknowable, unknown, or unpredictable and cannot be standardized or regulated.
?Between 2018 and 2022, private-sector healthcare spending is expected to rise at a cumulative annual growth rate (CAGR) of 9.5 percent, compared to 4.4 percent for government contributions. The emergence and support for PPP, as well as the growing demand for care and hospital beds among an aging population, are driving growth in the UAE.
?In the meantime,
?The spread of the disease and its unavoidable health and social consequences have prompted serious steps to be taken around the world. Border closures, flight suspensions, full and partial lockdowns, quarantine, physical separation, and public respiratory hygiene measures were all used to achieve this. During the UAE's countrywide lockout, which lasted from mid-March to July 31, 2020, residents were told to remain at home except for essential personal movements. Furthermore, as part of the national disinfection initiative, the government closed non-essential businesses implemented telework and distance learning, strengthened distribution systems such as providing medications to critically ill patients, and sanitized cities at nightfall.
?Businesses and economic operations were reopened after the lockout ended in early July 2020, but with stringent preventative and restriction measures in places, such as overnight curfews, local movement bans, physical distancing, and the wearing of face-covering in public spaces.
?Historically, quarantine has been used to control the spread of infectious disease outbreaks; however, it is an unpleasant experience for the general public.
?The COVID-19 lockdown and quarantine had a significant social and psychological effect on the whole population; the pandemic triggered cultural changes as some families faced tensions and turmoil as a result of the restrictions imposed during the outbreak.
The medical communities were concerned about an influx of affected patients, a lack of beds, a lack of medical equipment, and understaffed hospitals, to name a few issues.?
?The current crisis can be seen as an opportunity to revitalize the country's healthcare systems. The following suggestions can be used to accomplish this and enhance the healthcare design as a total:
?I.???The increasing importance of primary care
Primary care, as the patient's first point of contact, is critical for assessing an initial diagnosis – preferably before basic disease patterns become complicated and/or life-threatening.
It has become a critical building block in healthcare systems around the world in recent decades, prompting countries to invest more heavily in the necessary infrastructure.
?Primary treatment has a variety of purposes:
The World Health Organization has rightly deduced that an all-inclusive, reliable & efficient Primary Health Care or PHC is the cornerstone to making any progress towards the overall healing of humanity in the current crisis.
?The UAE's primary care system is still in its early stages of growth, but given recent rises in lifestyle diseases, improved primary care services have the potential to greatly boost overall health.
There are few reasons why we should enhance the primary care in the UAE and be our top priority:
?The following elements will make up the ideal primary care model:
?
II.???Planning of Space
To address the problem of cross-infection in hospitals, it is necessary to rethink spaces that facilitate healthy socialization by creating neutral zone or buffer zones. On the other hand, The Outpatient Department (OPD) and Integrated Project Delivery (IPD), shall be put first, followed by the public waiting or administrative units. To ensure the optimal protection of the patients/visitors, critical spaces such as intensive care units (ICUs) and Operating theaters (OTs) must be separated. Moreover, the number of people in contact with each other and their interaction decreases with each zone and the Travel distance between commonly used locations must also be minimized in spatial planning.
??III.???Flexible and Adaptable Spaces in Design
Flexibility in spaces and modular design needs to be at the forefront to make hospital designs adaptable as well as flexible and meet the vastly increasing patient and equipment load. Grid system designs can be used to construct long-span spaces that can accommodate a large value of patients as well as allow the flexibility to subsist with the changing patient expectations, new treatments as well as medical advances. The swift changing needs we are seeing prove the importance of designing buildings to have alternate lives beyond their original design intent. Our buildings are becoming the first barriers to the rapid transformation needed today. This is game-changing for everything for how we design.
Architects and designers generally using their abilities to solving existing issues that they can see, when in reality, we need to widen our design thinking to look ahead and predict issues that need to be solved before they happen. It will take compiled understanding of healthcare providers, architects, designers, engineers, services providers, medical simulation modelers, construction experts, and medical manufacturing industries to assemble and to look ahead.?To predict how to face the next rampant, we must be looking. The flexible spaces will be essential for every facilities’ planning strategy from where a tent can be erected to where a mobile unit can be delivered. In addition, each healthcare system will be thinking creatively about their current real estate outside of the hospital box itself; including accompanying buildings, near hotels, clinical spaces, parking spaces structures, infrastructure, etc. These will all be used during planning. Decisions shall be made regarding what and how spaces can be converted to accommodate certain astuteness levels.
?IV.???Conversion of the available Spaces;
领英推荐
Healthcare was uniquely positioned to deal with this current epidemic because it is the most regulated industry in the country. Regulations completely failed to consider the scale of the problem. As a result, many facilities are recognizing that they are ill-prepared to handle the demand increases they are currently experiencing. These facilities are especially unprepared when it comes to retrofitting existing spaces to temporarily serve increased use. The greater the acuity, the greater the impact on which spaces may be converted more readily. Parking structures, conference rooms, and lunchrooms aren't as good at rapidly converting to critical treatment spaces or surge areas as we would have hoped. Infrastructure such as HVAC, power, and plumbing can make or break a startup's success. They can be easily converted into non-COVID holding or observation units, but they are not readily convertible into all observation or holding functions. An important factor limiting success is the lack of free real estate. Because of the shortage of space, temporary "tent structures" or make-shift structures are rising in number. The facilities that were forward-thinking in terms of anticipating future needs and planning for resiliency, capacity, flexibility, and the well-being of staff have seen tremendous benefits. While it's impossible to have every good thing we could have wanted, some of these nice-to-haves will appear in code and Guideline’s language.
?V.???Technologically-inclined systems;
Growing demand for "touch-free" controls has driven an increase in the demand for systems that utilize new technology. A more sophisticated approach to lighting, temperature, and other building systems can help reduce the incidence of infection in the high-traffic areas of a building. To help patients stay connected, these health centers may also integrate popular technologies such as video chat and virtual reality headsets. Waiting rooms will have a role to play in the use of technology. Using digital patient management tools, patients can check-in online, making it possible for medical personnel to prepare ahead of time, and mobile devices can have patients arrive when the medical team is ready for them. This has the added benefit of decreasing check-out wait times. The result is that ‘pause spaces' (i.e., waiting spaces) replace ‘waiting' spaces, helping to minimize the overcrowded waiting room problem. RTLS (real-time locating system) for patients is still in its infancy, but we expect that it will become a more common treatment method shortly. Facilitating better patient management, the capability to keep track of all patient locations in a patient care environment will enable staff to know where each patient is and should be, helping to relieve the frequent gathering of patients and aiding in distance control. The UAE's healthcare regulators are taking into consideration new, smart technologies that will assist with the modernization of the country's healthcare ecosystem. Expected to contribute USD 182 billion to the economy by 2035, as AI adoption grows at a faster rate, further helping the country fulfill its goal of becoming a leading global healthcare technological hub. However, forecasts are always subject to uncertainty since the spread of the pandemic cannot be predicted.
?VI.???Anti-Microbial Building Materials:
Some surfaces, such as copper, are more or less hospitable to microorganisms. The use of these materials can reduce the risk of surface transmission. E-switchable privacy glass, known as e-glass or smart glass, is currently used in some hospitals.
??VII.???Staff Areas
There is a global shortage of healthcare workers, which is contributing to the rising demand for healthcare services. All over the world, resources in hospitals and other healthcare providers are exhausted.?A shortfall of about 18 million health workers is expected by the year 2030.?A large number of medical students have come to the UAE because of the number of medical universities in the country. Hospital staff breaks rooms and rest areas, which are just as important as public areas, are crucial to our health care workers to provide them with a safe place to rest between shifts.
?VIII.???Mobile Clinics
One of the significant problems faced during the H1N1 pandemic was the significant strain placed on resources due to an influx of patients into major cities.?For minimal cross-infection, portable digital clinics that use advanced technologies are relatively portable, and they can be a primary step in the direction mentioned above. We additionally must design and create smaller healthcare facilities in Tier-II and Tier-III cities to meet the needs of the additional functions and facilities.
?IX.???Increased Isolation Spaces
Overall, increased isolation spaces are needed in addition to dedicated isolation rooms and units for pandemic preparedness. Separate entry and exit points to these areas can assist in segregating patients and reducing the transmission of pathogens.
?X.???Managing Hospital / Patient Flow
?The main challenge for hospitals is keeping visitors' flow to the right service line for care under control. Due to the traditionally front-door nature of the emergency department, triage and assessment occur at the same time when patients present. An administrator from a nearby hospital and facility management confirmed that individuals infected with COVID-19 will show up at campus entrances and walk around until they are assisted. It's noteworthy to point out that medical campuses have too many uncontrolled access points, and the emergency department requires an expansion such as telemedicine, a concept in which emergency room patients are diagnosed, treated, and evaluated via remote screening facilities outside of the emergency department. A patient-centered waiting room design strategy to aid in creating an improved patient experience. When you visit the doctor, your stress should go down, not up. We expect to see a significant change right away with the introduction of the concept of “social distancing” into all waiting rooms for healthcare. Waiting rooms that can accommodate hundreds of people at a time could be a thing of the past. There will be small waiting spaces in emergency departments that separate those with health issues from those who are well. There will also be private spaces where you can wait as a caregiver in an office of a pediatrician or family practitioner. An outside “waiting room” with a shade canopy and enhanced natural ventilation may be an effective method for accommodating waiting customers in temperate climates. I believe that one result of this plague will be the idea of separating our caregivers from the general public utilizing more physical barriers. As we finish checking out, we see acrylic screens at the grocery store. We will have to consider the emotional impact of everyone involved, including us nurses and nursing staff, who will have to go from having open stations to enclosing them in glass bubbles. Is the personal safety of our staff a higher priority than openness in the workplace? My answer to that is loud and clear. A ‘physical barrier' debate has a ‘demoralizing effect' on nursing professionals because it erodes the compassionate care environment that has been a defining feature of the profession. Concepts such as low-volume air curtains will hopefully evolve so that we can provide the separations with fewer physical barriers while keeping patients and staff safe.
?XI.???MEP Services:
First and foremost, our hospitals need to improve the air quality and guarantee a stable and secure environment for our patients. So, all of the steps above are critical to the continued health of our healthcare system, still, it’s important as patients get well with their surroundings. Natural light and ventilation can help reduce the time a patient needs to recover.?While the additional emphasis is placed on ensuring a physical and visual connection to nature is present for patients in the form of open spaces and healing gardens, which assist in their recovery, stress is also reduced.?We have highlighted open spaces as a key aspect of our upcoming projects because of the layout plans for the hospital complex. Natural treatments and herbal gardens that provide ample green spaces for natural treatments and health promote rejuvenating healthcare experiences for patients. Other than the necessity of having medical facilities, these institutions help to advance and encourage the development of new medical practices.
?XII.???Sustainability & Supply Chain
Going forward, our priority must be to develop hospitals that are environmentally sustainable while also increasing operational efficiency and cutting costs. Motive: This initiative is aimed at moving the system toward a place where health care facilities serve as a catalyst for better health and motivate residents to engage in healthy habits and overall well-being. A healthcare infrastructure nexus that fosters community resilience. If the outbreak is properly handled, it offers an opportunity to identify existing weaknesses and foster improvements in our built environment. To ensure all of our healthcare facilities have personal protection equipment (PPE), we'll need a supply chain. Facilities in which a system's group of hospitals keep all of their surge supplies may become more popular and effective when it comes to distribution.?An increasing number of large facilities are beginning to implement 3D printing services in-house, and these are being reconfigured to manage PPE and other equipment such as ventilator parts shortages.?With this out-of-the-box thinking, supply chain operations could be completely transformed in the future. this pandemic has shown us that we have resiliency concerns that we haven’t face before, and chief among them is our use of disposable items when a crisis occurs.?The in-house sterilization and material reuse we have today will have implications for central sterilization, materials management, and planning for the future. Examples of innovative approaches to facility issues that have emerged in the current epidemic. This topic includes much non-architect work on the built environment concerning future pandemics that may have merit. Biologists have recorded the newborn microbiome's development. For the first time, researchers have recorded the changing microbiome of a building that is under construction. they researching the data to see how the building's microbial character has changed because of human presence, and whether the microbial environment has returned to the humans. This research and technology are “out there,” but we hope to see a day where hospitals and interior designers work together with microbiologists to create facilities that use microbes to create healthy microbes that could help combat new pandemics or old ones.
?XIII.???Medical tourism and wellness tourism:
For the period between 2013 and 2019, the global health tourism industry is estimated to have generated USD 32.5 billion in revenues, which represents a CAGR of 17.9 percent. the expected growth rate of 21.1%, evolving in an expansion of USD 207.9 billion by 2027. According to the World Health Organization, rapid growth is mostly due to increasing middle-class populations globally (particularly in Asia) who can travel to other countries for medical treatment. Medical Tourism Index Ranking places Dubai and Abu Dhabi in the 6th and 8th positions when it comes to the world's leading medical tourism destinations. In addition to the country's extensive tourism and travel infrastructure, including numerous attractions, hotels, entertainment, the provision of world-class, internationally extensive aviation services, and strong transport logistics, the UAE has immense potential as a medical tourism destination.
?Societies are looking for the next era of healthcare architecture. Previous design approaches include Building Information Modeling (BIM), Evidence-Based Design (EBD), Integrated Project Delivery (IPD), and the newest approach is the Model for Embedding Behavioral Design (human behavior) in Health Care Since One major reason for this is that there’s still a crucial element misplaced from the design of healthcare and services which is the consideration for the role of human behavior.
?Where the Model for Embedding Behavioral Design Just looking at the decisions and actions that both healthcare providers and patients encounter highlights the criticality for the design the health care to work better for behavior. healthcare providers should constantly comprehend plentiful information and use their attention, memory, and judgment to make countless decisions in fast-paced settings each day; they should build trust with patients and repeatedly share vital information to people from different backgrounds who may be disoriented, and they must do all this in a taxing work environment requiring long hours, coordination across teams, and significant red tape. On the other hand, patients shall understand and remember their medications, take the right one at the right time, avoid the bad foods, persevere pain and discomfort, and more. Enhancing patient health and healthcare delivery depends not only on quality medicine, treatments, and advancements but also on the decisions these two groups make and regardless if they follow through. Behavioral insights can assist them to do just that.
??XIV.???Conclusion
COVID-19’s spread exposed cracks in the healthcare sector, but also opportunities in this sector for AEC firms.
This is a Time for Change in Healthcare Design. While we expect that the last quarter of 2021 shows more signs of normalcy & back to pre-covid19 status; there some things that will become permanent in the future such as - Telehealth (mobile healthcare), Increasing demand for behavioral healthcare services, optimized use of energy & space.
Once all the data is gathered & studied concerning the pandemic & its aftermath, an actionable execution strategy can be initiated in terms of design & structure.
Lists of assets to be recommissioned or repurposed are built followed by developing projects based on the deficiency recommendations and costs.
We as Architects continue to look for the most suitable Design methodologies in the AEC sector that enhance holistic health & are progressive in trends. Thankfully, UAE offers a great opportunity for us to showcase our talent and implement it in the right direction.
?
M.REZK