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designing for better healthcare – the singapore
DESIGNING FOR BETTER HEALTHCARE - THE SINGAPORE PERSPECTIVE 25 SEP 2013 RUBY LAI SENIOR CONSULTANT CPG CONSULTANTS PTE LTD [email protected] Governments everywhere are asking the same question: How to provide good healthcare at lower cost Singapore’s Healthcare According to WHO •Singapore’s Healthcare system is 6th best in the world •Healthcare Expenditure 4% of GDP – (less than ¼ paid by US and ½ that of Western European countries) However, still many challenges Singapore Healthcare Designing for good healthcare goes beyond good architecture & good design of healthcare facilities Healthcare development seen as integrated and inseparable part of overall development planning for the country • Good housing • Clean water, food and air • Controlling infectious diseases • Effective sanitation and waste disposal • Development of parks and tree planting to enhance environment and living conditions Singapore Healthcare 20% of Primary Care 80% of Inpatient Care Singapore Healthcare Public Healthcare Public General & Community Hospitals Private Healthcare Centres of Excellence Alexandra Hospital National Blood Centre Ang Mo Kio Community Hospital National Dental Centre Changi General Hospital National Skin Centre National University Hospital National Cancer Centre Ng Teng Fong General Hospital & Jurong Community Hospital(under construction) National Heart Centre Khoo Teck Puat Hospital & Yishun Community Hospital Sengkang General & Community Hospitals (planned) Singapore General Hospital Tan Tock Seng Hospital 80% of Primary Care 20% of Inpatient Care Medical Centres & Polyclinics National Neuroscience Institute Singapore National Eye Centre KK Women's and Children's Hospital Private Hospitals & Medical Centres Voluntary Welfare Organisations Private Specialists & GPs Adam Road Hospital Camden Medical Centre Parkway East Hospital Gleneagles Hospital and Medical Centre Mount Alvernia Hospital and Medical Centre Mount Elizabeth Hospital Mount Elizabeth Parkway Novena Medical Center National Centre for Infectious Diseases Paragon Medical Centre Institute of Mental Health Thomson Medical Centre Raffles Hospital Westpoint Hospital Singapore Healthcare PUBLIC HOSPITALS • “Restructured hospitals” • autonomous, and run like private hospitals wholly owned by government • Infrastructure fully funded by Government, then leased to the restructured hospital • receive an annual government subvention or subsidy for the provision of subsidised medical services to the patients • managed like not-for-profit organisations • subject to broad policy guidance by the Government through the Ministry of Health • Given maximum flexibility to introduce innovative and cost effective management systems and to motivate and retain good staff • Can concentrate on research. Singapore Healthcare Challenges 1. New & Complex Health Conditions – Non-communicable diseases (high blood pressure, high blood glucose, physical inactivity, and obesity) – Emerging infectious diseases 2. Ageing Population (by 2030, 20% of population will be > 65 years old) 3. Greater Demand on Healthcare Manpower 4. Affordability Singapore’s Strategies 1 Enhancing Accessibility • Invest in specialised healthcare and research facilities • Greater emphasis on design 2 Addressing needs of Ageing Population • Differentiation to cater to different needs 3 Catering to Greater Demand on Healthcare Manpower • Increased training 4 Ensuring Affordability • Encouraging individual’s responsibility • Public / private partnerships Strategy 1: Enhancing Accessibility • Invest in specialised healthcare and research facilities • Greater emphasis on healing design INVESTMENT IN PUBLIC HOSPITALS Changi General Hospital (1997) Tan Tock Seng Hospital (1999) National University Hospital Ph 1, 2 and 3 (1985, 1997) KK Women’s & Children’s Hospital (1998) Woodbridge Hospital (1992) Increased Healthcare Infrastructure By 2020, there will be an increase of over 3,700 beds • • • • Over 1,000 beds at Ng Teng Fong General Hospital & Jurong Community Hospital 1,400 beds at Seng Kang General Hospital & Community Hospital 800 beds at Khoo Teck Puat and Yishun Community Hospitals • • Additional 500 beds at • Changi General Hospital & St Andrew’s Community Hospital The new Ng Teng Fong General Hospital & Jurong Community Hospital New National Heart Centre New National Centre for Infectious Diseases Additional nursing homes will be built Khoo Teck Puat Hospital (with RMJM Hillier) Project Data: • GFA 108,000 sq.m • 550 beds •Completed 2010 A salutogenic design – Beautiful landscape – Excellent way-finding – “Green” Building BCA Green Mark Platinum Award SIA NParks Skyrise Greenry Award FutureArc Green Leadership Award BCA Universal Design Award - Gold SIA Design Award Healthcare Building SIA Design of the Year Award Design & Health International Academy President’s Design Award Khoo Teck Puat Hospital (with RMJM Hillier) Ng Teng Fong General Hospital & Jurong Community Hospital (with HOK & Studio 505) Project Data: • GFA 184,000 sq m • Site Area 54,000 sq.m. • 700 beds General Hospital • 400 beds Community Hospital Core Clinical Services: • General Hospital • Community Hospital • Specialist Clinics Ng Teng Fong General Hospital & Jurong Community Hospital (with HOK & Studio 505) Every bed with a window Design Emphasis of New Facilities PATIENT- AND VISITOR-FOCUSED DESIGN Careful design of windows for patients Better ventilation View of landscape & daylight Improved privacy Toilet within each room Satellite nurse alcove PATIENT CENTRIC Design Emphasis of New Facilities PATIENT- AND VISITOR-FOCUSED DESIGN DESIGNING FOR VISITORS PROMOTING PREVENTIVE CARE • Many visitors to hospital • Hospital not only to treat illness • Role of promoting healthcare • Auditorium • Education Centre • Exhibition areas Design Emphasis of New Facilities HIGH TECHNOLOGY Improved Patient diagnosis and treatment CATERING TO CHANGING MEDICAL TECHNOLOGY • Rooms large enough for equipment • Higher structural loading • Sufficient electrical and emergency power • High IT capability Design Emphasis of New Facilities HIGH TECHNOLOGY IMPROVING STAFF EFFICIENCY 1. Integrated patient information systems (National Electronic Health Record System) 2. Staff support • Automated guided vehicles for transportation of food, linen and medicine • Pneumatic chutes for dirty linen and waste • Pneumatic tube system for specimens, etc Design Emphasis of New Facilities PLATINUM SUSTAINABILITY GREEN MARK + Use of Passive Measures use of natural ventilation where possible + Response to Tropical Climate + Energy Efficient + Green Mark (“LEED”) + M&E design Design Emphasis of New Facilities PASSIVE DESIGN SUSTAINABILITY PASSIVE DESIGN 0.68DF Sunlight Penetration 2.01DF 2.14DF 7.95DF 8.04DF Daylight Distribution in Typical Ward WARD STUDIES Translating simulation studies to architectural form and space With evidence based simulation, the design maximises the opportunity to utilise daylighting for the wards. Khoo Teck Puat Hospital & Ng Teng Fong General Hospital received GreenMark Platinum Award Design Emphasis of New Facilities LANDSCAPING HEALING ENVIRONMENT In Singapore, it is rare for a hospital to get a site with good scenery. Usually, the hospital site is located within a densely built up area. HEALING ENVIRONMENT The hospital creates it own gardens and sanctuary to compensate for the lack of scenery and views in the urban site. Design Emphasis of New Facilities ENCOURAGING COLLABORATION BETWEEN CLINICIANS & RESEARCHERS Design Emphasis of New Facilities BUILDING IN URBAN ENVIRONMENT • Land scarcity • High plot ratio • High dependence on lifts • Impact on fire evacuation and patient safety • High rise gardens Increased Research Infrastructure Construction of new research and training laboratories The Academia Singapore General Hospital Project Data: • GFA 184,000 sq m Core Clinical Services: •Research & Service Labs •Training Facilities •Vivarium Strategy 2: To Address Needs of the Ageing Population • By 2030, more than 20% of Singaporeans will be over 65 years old (3 fold increase from today) • Differentiation to cater to different needs Healthcare Needs for the Elderly Evolving Social Structure: • Smaller nuclear family • Reduced caregivers • Reduced community capability in caring for the frail • No. of residents 15 – 65 per resident 65 and above Healthcare Needs for the Elderly Emerging Chronic Diseases = More sub acute + rehabilitative care demand Changing Healthcare Demand Traditional model: Acute and Sub acute care by General Hospital Acute Hospital Illness Disabilities Community Hospital / Step-down care Home / Long Term Care Recovery Sub-Acute • More people need acute bed • More patients under sub acute care – significant overlap of acute illness and functional disability – not efficiently managed in the acute setting Evolution of Community Hospital Acute Hospital Community Hospital Medical Functional Acuity Impairment Acute Phase •First few days •Diagnostic eval •Rx initiated •Needs hi-tech Ix Sub acute Phase •D3/5 to 1-2wk •Diagnosis Certain •Vitals stable •May need basic Ix Nursing Home Residence Coping at Home Post acute Phase • Near/Complete resolution • Needs functional retraining Integration of Community Hospital with Acute Hospital Acute Hospital with Specialist Outpatient Clinics Community Hospital attached to acute hospital Nursing Home / Hospice Outpatient Clinic HUB & SPOKE CONCEPT Integration of Community Hospital with Acute Hospital Community Hospital built together with Acute Hospital – ensures continuum of care. Proposed Jurong Community Hospital built together with Ng Teng Fong General Hospital Core Clinical Services: (CPG with HOK & Studio 505) Mobility Park • 400 beds • Outpatient clinic • Rehabilitation facilities Healthcare Oriented Developments Master planning of healthcare campuses around an acute hospital • Outram Medical Campus around Singapore General Hospital • Health City Novena around Tan Tock Seng Hospital Outram Medical Campus Master Plan (CPG together with Perkins & Will) Strategy 3: To Address Needs for Greater Demand for Healthcare Professionals • Increased number of medical and allied health schools • Increased provision of training facilities within hospitals • Healthcare Manpower Development Programme (sending doctors overseas for training) Increased Healthcare Professionals 20,000 more healthcare professions by 2020 HealthCare Manpower Development Program Expansion of Yong Loo Lin School of Medicine at National University of Singapore • • Centre of Translational Medicine, NUS MD1 – Faculty of Medicine MD1 Faculty of Medicine GFA 37,600sqm Completing 2014 Medical education, research and additional campus amenities Centre of Translational Medicine GFA 42,000sqm Completed 2011 Laboratory & Teaching spaces including Vivarium Increased Healthcare Professionals New medical schools • Duke NUS Graduate Medical School • Lee Kong Chian School of Medicine Duke NUS Graduate Medical School, Situated at Outram Medical Campus (with RMJM Hillier) Project Data: •GFA 24,000sqm •Completed 2010 Core Services: •Research & training labs •Vivarium Duke NUS Graduate Medical School Strategy 4: To Address Problem of Affordability a) Balance between individual’s responsibility and state support Avoid “over-indulgence” and “entitlement mentality” b) Private / public partnership c) Improve health and fitness Singapore Healthcare Challenges a) Striking the right balance between individual responsibility and state support – encourage self reliance 1. Government subsidizes up to 80% of healthcare costs in hospitals 2. Medisave – compulsory saving (7 – 9.5% salary) for payment of hospital bills and chronic disease management programme 3. MediShield – insurance for catastrophic illnesses 4. Eldershield – severe disability insurance for long term care 5. Medifund – to cover healthcare costs for those who really cannot afford to pay 6. Use of Means Testing to level the playing field www.moh.gov.sg Public - Private - Community • Leasing of beds from private hospitals for subsidized healthcare • Community Health Assist Scheme (Approved Private GPs providing subsidized primary care) • Government funded nursing homes run by voluntary welfare organisations Promote Good Health and Reducing Illness 1. 2. 3. 4. Encourage preventive screening Active anti-smoking campaigns National Healthy Lifestyle Campaigns Senior Health Ambassador Programme 5. Senior Activity Centres Adding Life to Years HEALTHCARE SCENE IN SINGAPORE New wave in infrastructure development within next 5 years: • 2 new public acute hospitals with attached community hospitals • 3 new community hospitals for existing acute hospitals • 1 new private hospital • 1 Infectious Disease hospital • New School of Medicine and expansion of existing training facilities • Further upgrading of existing hospitals and specialist centres • 10 new nursing homes • 21 Senior Care Centres • 45 Senior Activity Centres Moving Forward New infrastructure will cost over $2 Billion • Increasing accessibility to healthcare by building more facilities • Means Testing - Patients who are better off should shoulder higher burden • Finding more innovative ways to meet patients’ needs by diversifying facilities and partnering private sector • Increasing approved usage of Medisave, and increased subsidies fo nursing homes, etc Emphasis on Medical Education & Research • Making sure healthcare system is staffed with highly competent, highly trained staff for improved efficiency & effectiveness • To make economic progress by making Singapore a world class research centre – encouraging Health Tourism Moving Forward • Everyone has to do his part to achieve good affordable healthcare • It is important to stay healthy • Provide as much information as possible to enable patient to decide – publishing of hospital bills on website • Increased use of Medisave for chronic diseases • Co-payment to discourage waste • Help for the needy • Collaboration between Government and the private sector TOWARDS BETTER HEALTHCARE IN SINGAPORE [email protected]
