For the 550-bed, 1,100,000-sq.-ft. Khoo Teck Puat Hospital, communicable disease response focuses on isolation against unknown pathogens and decontamination facilities against large scale threats. Following Singapore's serious bout with SARS in 2003, the Ministry of Health revised operational guidelines for isolation. Patients and visitors entering Khoo Teck Puat's accident and emergency departments will undergo passive thermal scans as part of a triage area that separates flow into two paths — one for non-infectious individuals, another for those potentially infected. The latter will be directed to an isolation zone within accident and emergency.
At a large teaching hospital in New Jersey, the focus is more every day on the coming and goings in the project's 100+ exam and procedure rooms. Working together with staff, we're considering same-handedness, where all rooms of a given type have the same internal layout from the point of entry. Pioneered in patient bedrooms, the project team believes extending the principle of unconscious predictability to outpatient areas will reinforce good behavior regarding gloving, gowning and hand washing and lower incidence of infection.
Practice reorganization
How can we make healthcare simultaneously more personalized and more efficient? By changing to a patient's-eye-view of healthcare interactions and considering new technologies. Practice reorganization aims to do both.
Toyota's Kaizen approach was chosen by Khoo Teck Puat Hospital staff to begin their programming and planning effort. For a full year before we were engaged, each department examined all types of patient, staff, goods and information flow. The result was a combination of spaghetti diagrams that charted flow, decision-tree charts that examined interactions from the patient's point of view and three-dimensional models made of Lego bricks and clay. Armed with this practice reorganization self-generated knowledge, staff were much better prepared to partner with us in the design phase to evaluate whether our ideas would achieve their objectives.
At the University of South Alabama Mitchell Cancer Institute, almost complete in southern Alabama, we've applied practice reorganization to the process of translational medical research. Transparency is the theme; patient clinical care areas, educational facilities and research laboratories are connected by a multi-story entry and lobby space. The result emphasizes the direct connection between research and treatment, creating an atmosphere of urgency and hope.
Design for staffing
When the American Association of Retired Persons recently published their study, “Who Will Care for You?,” they granted public recognition to a problem hospitals have been dealing with for years — shortage of qualified staff able to be assigned to the right place at the right time with the right training.
Not only are staff in short supply, but the growth in team-based medicine and growth in non-invasive treatments results in the frequent change in patient status even during a short stay. With patients potentially transitioning from critical-to-stable-to-good within 18 hours, resources are no longer available to staff complete stand-alone units whose occupancy fluctuates daily.
Yong Loo Lin vertically combines research, teaching and clinical care facilities with the aim of improving the efficiency of Medical School staff. Battling the horizontal layout within the adjacent University Hospital, physicians waste time moving from patient care areas to labs to lecture theatres across the street. Yong Loo Lin's MD6 building stacks these three functions, particularly the two-floor Virtual Hospital for teaching and two floors of Clinical Trials facilities, including a National Imaging Centre.
