Blue Hospital integrated design

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The Blue Hospital approach is a framework that moves beyond traditional green or smart hospital concepts, focusing on patient-centric care through the integration of technology and sustainability in an integrated design approach. This approach focuses on six key principles: patient centricity, employee wellbeing, health outcomes, cost efficiency, sustainability and smart hospital innovation. Like a Rubik's cube, each component interrelates with the others – for instance, smart technologies can drive energy efficiency, thus reducing environmental impact while lowering operational costs.

Initially guided by the Quadruple Aim framework – patient centricity, improved health outcomes, reduced costs and staff wellbeing – we integrated sustainability and digital transformation based on their rising importance. By addressing these principles from the earliest design stages, we help prevent budget constraints and infrastructure limitations that can arise when such considerations are delayed.

Technology and digital transformation are central to the Blue Hospital approach. The whole system-level adoption of digital health technologies, artificial intelligence, personalised medicine and smart innovations enables more efficient and effective healthcare. For example, smart hospital systems, like automated processes and data-driven resource management, enhance operational efficiency, reduce errors and minimise energy consumption. These technologies also contribute to a smoother patient experience and more efficient staff workflows.

The Blue Hospital framework strongly emphasises climate-smart healthcare by integrating circular economy principles and net-zero carbon strategies into its services, infrastructure and workforce management. Hospitals adopting this approach apply sustainable practices like renewable energy, efficient water use and waste reduction, aligning healthcare delivery with environmental sustainability goals while being resilient. These efforts not only reduce the hospital’s carbon footprint but also lower operational costs through energy savings and resource optimisation.

This framework also addresses the complex interdependencies within hospital design, highlighting how sustainability efforts can lead to cost savings and improved wellbeing. By engaging stakeholders in collaborative processes like interactive workshops, hospitals can align design strategies with user needs and priorities.

The main strength of the Blue Hospital approach is ensuring a holistic, integrated design, aiming for optimal outcomes across all six principles. The main challenge lies in fostering collaboration across disciplines to equally address all principles. As the next step, we aim to develop a structured tool and a unified package of Blue Hospital requirements, adaptable for each hospital’s specific needs.

In summary, the Blue Hospital approach offers a forward-thinking, adaptable framework for designing future-ready hospitals equipped to meet both current and future challenges efficiently and sustainably.

Learning Objectives

• Understand the urgency of a holistic approach
• Recognise the interdependency of the six principles
• Comprehend the importance of sustainability, smart innovation and wellbeing as core values in healthcare design

What matters, not what is the matter: A novel approach to empathising and understanding the third space of the healthcare waiting room

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This study applied a design-based lens to healthcare to unveil the many subtleties of the impact of physical spaces on patients' lived experiences, furthering debate on this important topic. The NHS in the UK operates under complex pressures, including budgetary, resourcing, global pandemics and an ever-ageing population. There is a need to ensure new health-setting developments meet the stated goals of world-class facilities and well-designed spaces to speed up recovery and enable appropriate treatments – which the NHS terms as prioritising "what matters, not what is the matter" (NHS, 2019).

Outside of pockets of innovation, however, a sizeable legacy remains of outdated facilities that continue to impact a significant number of patients. Notwithstanding the intentions of the architects and service designers in the original planning of health centres, the micro-level facets of the patient experience still need to be fully understood, since there lacks an emphasis on listening to the voice of the patient.

Through a deeply empathetic ‘design thinking’ approach, this research identified the multiplicity of barriers and enablers of person-centred care within the waiting spaces of a hospital in Hampshire, UK. Following a comprehensive review of literature across health, design and spatial contexts, an initial conceptual research framework was developed that included consideration of dimensions such as lighting, colour, sound and other perceptual factors such as privacy. This was considered initially via a pilot study for feasibility, before a main study was conducted through a novel two-stage exploratory design. This incorporated immersive ethnographic observation by the researcher in a real NHS setting to portray situated happenings, followed by a series of in-depth semi-structured case interviews, providing rich personal narratives and insights from the patients’ perspectives.

The results indicated a wide range of important patient considerations: while the physical characteristics (sound, décor, wayfinding) contributed, it was revealed that "what mattered" included a sense of choice, agency and dignity, and this clearly impacted wellbeing. As a result, a revised innovative theoretical framework was proposed that identified more fully the barriers and enablers of positive patient experiences within health spaces. This included theoretical underpinnings concerning hybrid identities, cultural interaction and negotiation, as well as the viewpoint that meaning is created through social interactions, using symbols such as language and gestures.

For professionals, a guide for practice emerged from this research: ‘The Health Space Design Playbook’, a discussion checklist for including multiple patient-centred considerations within potential future design/renovation projects.

Learning Objectives

• To show how design thinking and spatial theory can provide new insights into patient experiences
• To understand the importance of prioritising patients' feelings and emotions about spaces
• To convey the broad range of considerations when (re)designing spaces for patients

The role of novel preoccupancy evaluation techniques in the design of senior-friendly emergency departments

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As the ageing population increasingly utilises emergency departments (EDs), tailored design features are essential to meet their unique needs. However, the evolution of ED design reflects a fragmented approach to addressing diverse patient needs. Although guidelines for senior-friendly EDs exist, there is a lack of research on pre- and post-occupancy evaluation (PPOE) effectiveness in this context.

This literature review examines the role of PPOE in the design of geriatric-friendly EDs. Search phrases including 'pre-occupancy evaluation', 'post occupancy evaluation', 'geriatric emergency department design' and 'emergency department design' were used to identify articles of interest using Google Scholar, ResearchGate, Jstor and snowballing. The articles and books of interest were scanned for relevance to the topic of interest and maintained using Zotero.

The review highlights existing senior-friendly ED guidelines and explores methodologies for PPOE. It highlights the importance of using tools like surveys and simulation methods to enhance design decisions in healthcare settings, and underscores the necessity of holistic evaluations, incorporating quantitative and qualitative measures of success and focusing on outcomes like patient satisfaction, safety and overall wellbeing, including quality-of-life assessments for older adults.

Novel technologies such as artificial intelligence and virtual reality are being increasingly utilised in PPOE and require further exploration in the context of the needs of this patient population. The review highlights the need for targeted research to develop specific PPOE tools for geriatric EDs and explores the use of new technologies to facilitate more effective evaluations.

Learning Objectives

• To review benefits of pre-occupancy evaluation as a form of co-design of senior-friendly spaces
• To explore the use of novel technologies, such as virtual reality, to enhance pre-occupancy evaluations
• To highlight existing knowledge and expose knowledge gaps in pre-occupancy evaluation methods and the engagement of special populations

The ED physician lounge revamp project: Designing for burnout

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Physician lounges have historically provided essential respite and fostered professional connections. But in recent years, these spaces have dwindled due to financial constraints and evolving healthcare demands. This decline has coincided with rising physician burnout rates, exacerbated by increased work pressures and diminished opportunities for social interaction. This project aims to explore how redesigning emergency department (ED) physician lounges can enhance physician wellness and mitigate burnout while promoting retention, using evidence-based design principles.

The deteriorating conditions of ED lounges reflect organisational neglect, impacting staff morale and mental health. The lack of space and amenities further compounds stress levels, hindering effective rest and recovery for healthcare providers amidst the demanding ED environment.

This project seeks to address how redesigning ED physician lounges can improve wellness and reduce burnout among healthcare providers. By focusing on evidence-based design principles, the study aims to propose solutions that optimise functionality, comfort and aesthetic appeal, thereby supporting staff wellbeing and enhancing retention rates.

A scoping review highlighted the significant impact of burnout on healthcare professionals, particularly in high-stress environments like EDs. Evidence suggests that well-designed rest spaces can mitigate burnout by providing necessary respite and fostering a sense of community among medical staff. Recommendations include designing lounges that facilitate collaboration, integrate wellness-promoting features and ensure comfort through thoughtful layout and amenities. These principles aim to create environments that not only alleviate stress but also enhance the quality of patient care by supporting the mental health of healthcare providers.

Designing within a publicly-funded healthcare system presents challenges such as budget constraints, space limitations and strict regulatory requirements. These factors necessitate practical and cost-effective design choices while ensuring compliance with safety and infection control standards.

Revitalising ED physician lounges through evidence-based design offers a strategic opportunity to improve physician wellness, mitigate burnout and enhance overall healthcare delivery. By prioritising staff wellbeing and fostering a supportive environment, healthcare institutions can promote a culture of resilience and excellence among their medical professionals. Collaboration with healthcare providers and stakeholders is essential for successful implementation and sustainability of these initiatives.

Learning Objectives

• To review the principles of physician lounge design
• To explore the role of physician lounges and lounge design features that help mitigate burnout
• To design an engaging co-design pathway for ED physician lounges

Designing (mental) health and wellbeing: Student-driven exploration and interventions for healthier campus spaces

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Urban health challenges have increased reliance on healthcare systems, exposing capacity limitations and operational strains. This highlights the need to shift from solely treating illnesses to designing environments that actively promote health and wellbeing. University campuses exemplify such environments where the design of physical spaces significantly influences health outcomes, including students' mental wellbeing.

In recent years, student mental health has deteriorated, with the Covid-19 pandemic exacerbating existing issues. Despite the lifting of pandemic-related restrictions, improvements in student mental health have not met expectations. As students spend significant time on campus, it is essential to explore how the design of campus spaces can contribute to mental health improvement.

Adopting a co-creation concept, this study investigates the potential of campus design to support student wellbeing through the perspective of architecture students at TU Dresden, Germany. Students were asked to systematically analyse their campus environment, with the purpose of engaging them in an active exploration of their campus environment, identifying both positive and negative design elements affecting their wellbeing, and initiating discussions about potential interventions for improvement. This study is grounded in the understanding that university campuses are not just places of learning but are integral environments where students' holistic health is shaped and could act as health-promoting catalysts.

The results highlight specific areas and spatial elements of campus that contribute to mental strain, as well as those that foster relaxation and emotional recovery. Building on these insights, students were also asked to ideate design interventions aimed at enhancing mental health on campus. The insights drawn from the data analysis of the workshop provided a comprehensive framework of the students’ spatial and/or non-spatial needs that are to be fulfilled through design strategies to promote their health and wellbeing, particularly their mental health.

Proposed solutions highlighted the importance of providing differentiated spaces for informal studying on campus (both for group work and individual study). Special emphasis was placed on the fostering of social interaction and making connections with others. At the same time, the wish for restorative and secluded spaces became apparent and was expressed in designs and suggestions that emphasised various aspects, such as soundscapes.

This work underscores the importance of integrating health-promoting design into everyday spaces, especially as it pertains to mental health. The findings provide useful insights for architects, healthcare providers and policy makers working towards environments that foster mental and emotional resilience.

Learning Objectives

• Understand the impact of university campus design on student (mental) health and wellbeing
• Identify key design elements for health-promoting spaces within campus environments
• Explore how to apply co-creation methods in health-focused design efforts

Care for those who care: The Medical University of South Carolina’s initiative to design a space addressing substance use disorder through tailored recovery services

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Healthcare professionals face extraordinary levels of stress and burnout, which significantly increase their vulnerability to substance use disorder (SUD). Despite this critical need, South Carolina faces a shortage of high-quality residential treatment and partial hospitalisation services specifically designed for recovering professionals. This gap forces many healthcare workers and other professionals to seek treatment out of state, further complicating their path to recovery.

A comprehensive needs assessment conducted for the Medical University of South Carolina (MUSC) Health Adult Addiction Center highlights the urgency of creating a dedicated recovery centre for professionals. Key findings underscore that 8.7 per cent of employed adults are affected by SUD, yet only 1.2 per cent receive treatment, as per the 2018 National Survey on Drug Use and Health. Moreover, residential treatment admissions in South Carolina have grown at a slower rate (1.1 per cent CAGR, 2017–2022) compared to the national average of 2.5 per cent.

To address this pressing issue, we envisioned a private recovery centre in Charleston for approximately 30 clients, utilising evidence-based approaches tailored to the unique needs of professionals such as physicians, nurses, pilots, lawyers and first responders. The programme will prioritise discretion and flexibility to enhance accessibility, while fostering a supportive recovery environment.

With a design aimed at scalability, this initiative has the potential to become a regional and national destination, offering a sustainable solution to one of healthcare’s most pressing wellness challenges. Join us to explore the findings, opportunities and the vision for this transformative recovery centre.

Learning Objectives

• Addiction within the healthcare field
• Staff recovery
• Staff retention

What we did at the United Nations Science Summit, and the call to action for better brain health

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Building brain capital through design – the integration of cognitive abilities, mental health and brain-based skills – is essential for societal innovation and economic progress.

At the United Nations, Perkins&Will led impactful discussions, in collaboration with Rice University, the Baker Institute and a diverse range of panellists, to explore how the built environment can enhance brain capital. These conversations emphasised promoting brain health through design strategies such as integrating natural light, green spaces, acoustic comfort and regenerative principles to improve air quality and connect occupants with nature. We also advocated for creating inclusive spaces that address neurodiversity, accommodating diverse sensory and cognitive needs to foster resilience and adaptability. Furthermore, we advanced brain skills by encouraging the design of flexible, adaptable spaces that support collaboration, creativity and problem-solving, alongside educational environments that stimulate innovation and engagement.

To drive this vision forward, we proposed short-term actions such as piloting brain-positive projects and implementing immediate design improvements, as well as long-term goals like establishing national standards, advancing research on brain-positive design, and providing professional training. By prioritising brain capital in the built environment, Perkins&Will seeks to create healthier, more innovative communities that thrive in the face of modern challenges.

Learning Objectives

• United Nations Science Summit
• Brain health
• Brain capital

Beyond the hospital: Precinct-based approaches to health and community in Greater Randwick and beyond

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Healthcare design is evolving beyond the traditional walls of the hospital. This presentation explores the precinct approach as a framework for integrating healthcare, community and urban design in creating healthier neighbourhoods. Drawing on BVN’s experience with the Greater Randwick Urban Masterplan in Sydney, we will unpack how collaboration across sectors – including local residents, the University of New South Wales (UNSW) campus and healthcare providers – has redefined the relationship between acute care services and the surrounding urban fabric. Central to this discussion is the Prince of Wales Hospital Acute Services Building, a key anchor within the precinct, which exemplifies how healthcare facilities can serve as catalysts for broader social, economic and environmental benefits.

The precinct model extends care 'beyond the hospital', embedding wellness into everyday urban life. By considering health infrastructure alongside housing, education, green spaces and transport, the Greater Randwick project provides valuable insights into addressing challenges such as urban density, climate resilience and equitable access to care. These principles are reinforced by lessons from the BaptistCare intergenerational masterplan, also in Sydney, emphasising co-location and collaboration to create inclusive and adaptable urban environments.

From addressing healthcare inequalities to fostering community identity, precinct-based planning positions healthcare infrastructure as a driver of cohesive, sustainable neighbourhoods.

Learning Objectives

• Understanding of an overseas perspective on the precinct approach, highlighting its relevance for other countries striving to reimagine healthcare delivery
• Gain insight into how integrating acute care with community-focused urban design can support health and wellbeing
• Ability to identify strategies for cross-sector collaboration that enhance the social, economic and environmental impact of healthcare projects

What holistic healthcare could look like for our next generation

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With the recent refocus on the age-old funding dilemma of acute versus community care (at the time of writing, announcements on the expected New Hospital Programme (NHP) review were still awaited), we will use our experience from the National Centre for Child Health Technology (NCCHT) in Sheffield (RIBA Stage 5 commenced in November 2024) to identify some of the key issues and possible solutions.

Delivery of increased funding to community care shouldn’t mean a detrimental effect on delivery of acute care and, in fact, could allow for greater opportunities on existing hospital estates. The ‘left shift’ of services from outpatient departments will allow for expansion of key acute services where sites are becoming ever more constrained.
NCCHT will provide a mix of clinical, practical and collaborative innovation and workshop spaces. Two dedicated floors for consulting and rehabilitation will provide a unique mix that will allow product and service development specifically focused on our next generation’s health. Located adjacent to the Advanced Wellbeing Research Centre (in collaboration with Sheffield Hallam University), the facility will be able to bring together and develop realistic solutions for improving child health – developing ideas proposed by children themselves, through to testing prototypes and production examples.

As part of our presentation, we will focus on the following positive community benefits and intend to include an update on the ongoing 12-month delivery (start on site, mobilisation expected January 2025):
• finished building to provide a way of understanding priorities, from the point of view of lived experience experts – in this case all children;
• NCCHT‘s role as part of the wider Sheffield Olympic Legacy Park (SOLP). Show how delivery of a community model can provide increase resilience and a sustainable solution. Self-supporting through collaboration with industry;
• how to design that careful balance between safeguarding and inclusion. Community access to ground floor for enhanced collaboration – café services and chance encounters – and drop-in support;
• access to external space, both immediately adjacent and in the wider park;
• ground floor commercial test bed space for rent – industry collaboration;
• smart Building communications and functional adaptability;
• importance of prevention – early self-awareness leading to a reduced risk of ill health; educating and supporting the next generation to learn how to express concerns regarding health, both physical and mental.

Learning Objectives

• • Education: giving the next generation a sustainable support mechanism that promotes prevention rather than cure – wellness rather than illness.
• • Community integration and benefits of campus approach
• • Smart healthcare: impact of digital on design and operation – connected but separate skill sets

Co-design for enhanced access and engagement in play: Exploring solutions for children and families in paediatric palliative care

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Families with children in paediatric palliative care (PPC) and paediatric hospice care (PHC) face medical and social challenges. The provision of adapted play opportunities is vital and requires a family-centred approach to enhance comprehensive PPC/PHC.

The UN Convention on the Rights of the Child defines play as a universal right under Article 31, ensuring all children, regardless of gender, culture, or health status, can engage in play. These rights extend to children in PPC, as outlined by the World Health Organization (WHO) and the European Charter on Palliative Care for Children and Young People, emphasising that every child in such settings should have regular opportunities for play.

This project explores how inclusive play can be integrated into a PPC/PHC setting, emphasising its critical role in enhancing the wellbeing of children and families. The objectives of this study are to investigate the role and use of play in families with children in PPC/PHC. Based on the insights, the aim is to design prototypes for inclusive play environments and play solutions as part of a new children’s hospice which is currently in the planning/soon-to-be implementation phase.

The research follows the Double Diamond model, involving the collection of secondary (literature review) and primary data (survey, expert interviews, focus group) throughout the design process. The survey included 22 families with children in PPC/PHC. To complement the mixed-methods approach, a co-design workshop and a play-specific design tool (Lenses of Play) were utilised for the development of an interactive play environment/product.

The primary outcomes highlight the important role of play for children and family members in PPC/PHC, but also reveal a gap between families’ needs and the limited play options adapted to these needs. The gaps mainly affect social and outdoor play. Over two-thirds of children in PPC/PHC either rarely (27 per cent) or never (41 per cent) play with peers, often engaging in social play only with adults. Similarly, about two-thirds rarely (23 per cent) or never (41 per cent) play outdoors. A conceptual product developed within a focus group and a co-design workshop for a play environment in a children's hospice offers a potential solution to enhance social play for children in PPC/PHC and promote family interaction.

This study emphasises the importance of play for families with children in PPC/PHC. It exemplifies a co-design process for solutions that facilitate interactive play in PPC/PHC settings, such as a children’s hospice, with the aim of enhancing the family experience in these challenging circumstances.

Learning Objectives

• Role of play in PPC/PHC
• Co-design for comprehensive PPC/PHC
• Evidence-based children’s hospice design

WOmeN and cancer – a spatial DEsign approach for wellbeing in the Recovery journey

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The architecture of healthcare environments significantly impacts patient, caregiver and staff wellbeing (Alvaro et al., 2016). Yet traditional hospital designs often result in sterile, unwelcoming spaces (Sadek and Willis, 2022). This leads care environments to appear as a threat, a strangeness in the life course of patients (Periano, 2024). In Belgium, cancer care facilities highlight these challenges, with traditional hospital aisles contrasted against emerging models like wellness-integrated centres and walk-in houses inspired by Maggie’s Centres. These innovative typologies emphasise familiarity, comfort and community, signalling a shift toward more patient-centred care environments (Martin et al., 2019).

The WOmeN and cancer – a spatial DEsign approach for wellbeing in the Recovery journey (WONDER) research project examines how spatial design affects the experiences of patients, caregivers (formal and informal) and staff (PCFIS) in cancer care facilities. Focusing on women’s post-treatment recovery, it investigates the relationship between design, body image and expressions of (feminine) identity, alongside the needs of caregivers and staff.

The WONDER project addresses two core questions:
(i) What architectural factors positively or negatively impact PCFIS experiences?
(ii) How can these factors be systematically integrated into design processes, balancing desirability, feasibility, and viability constraints?

The research is structured into five interconnected work packages combining qualitative methodologies and participatory approaches.
- WP0 focuses on preparatory groundwork, including a systematic literature review, ethical committee approvals and the establishment of research fields.
- WP1 builds the theoretical foundation through a research stay at Maggie’s Dundee, enabling an in-depth study of its cancer care design principles and their relevance to the Belgian context.
- WP2 involves field observation across three distinct typologies of cancer care sites in Belgium: traditional hospital oncology aisles; wellness-integrated hospital centres (which blend clinical care with elements of wellbeing) and walk-In houses, offering community-oriented, non-institutional spaces for support and recovery. Over 18 months, participatory and visual research methods will document PCFIS lived experiences within these diverse settings and their unique spatial dynamics.
- WP3 eventually deploys co-design workshops to engage PCFIS stakeholders in collaboratively developing practical and inclusive design solutions tailored to these typologies.
- WP4 focuses on operationalising those solutions, including building code suggestions and a portfolio of adaptable design guidelines, validated through focus groups and aimed at diverse scales of implementation.

By articulating PCFIS experiences and participatory design, WONDER bridges research and practice to redefine cancer care environments. The project delivers actionable recommendations and adaptable solutions for the different typologies, fostering recovery, dignity and inclusivity in healthcare design.

Learning Objectives

• Understanding the impact of spatial design on PCFIS experiences
• Exploring traditional and emerging cancer care typologies
• Integrating participatory approaches into healthcare design

PrEP Access Navigator (PAN): Creating a comprehensive ‘application cheat sheet’ for the Trillium Drug Program

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Accessing life-saving medications shouldn’t be complicated, yet for many uninsured individuals aged 23–64, Ontario’s Trillium Drug Program (TDP) remains a barrier. The PrEP Access Navigator (PAN) aims to break down these barriers by providing a transformative, patient-centric digital tool that simplifies the TDP application process. Financial constraints, complex paperwork and a lack of digital support currently hinder access to pre-exposure prophylaxis (PrEP), leaving vulnerable populations at risk.

PAN serves as a virtual 'cheat sheet' that adapts to user responses, guiding them step-by-step through the complex TDP application. By offering personalised suggestions, PAN reduces confusion and ensures that users receive tailored support, making the application process more accessible and efficient through digital transformation.

Developed using the Translational Research Framework from the University of Toronto, PAN’s creation follows two key phases: 'Understand' and 'Act'. The 'Understand' phase involved informal research, including consultations with scholarly literature, to uncover key accessibility barriers. The 'Act' phase focuses on iterative development, with usability assessed through two rounds of feedback sessions.

In these sessions, 20 participants will test Version 1 of PAN, providing critical feedback to refine Version 2. Virtual prototyping semi-structured interviews will be conducted via Zoom to ensure data security, and participants will use mock data to protect their privacy. Thematic analysis of these sessions will guide improvements, ensuring PAN meets the needs of its users effectively. Additional metrics to measure PAN's success include application completion rate, reduction in application errors, and user satisfaction scores.

By integrating PAN with existing social service networks like the AIDS Committee of Toronto (ACT) and pharmacies, we aim to enhance patient experience and service efficiency. Streamlining the TDP application process is expected to boost PrEP uptake, ultimately reducing HIV transmission rates and contributing to improved population health in Ontario.

Beyond immediate impact, PAN offers a replicable model for other healthcare services, setting a new standard for patient accessibility, digital healthcare interventions and leveraging science and technology. By reimagining how social programmes like TDP are delivered, PAN addresses critical gaps in population health and paves the way for more equitable healthcare.

Further collaboration and partnerships for additional pilot testing and funding are required to advance our processes. We invite stakeholders to join us in expanding PAN’s impact through science, technology and digital transformation.

Learning Objectives

• Identify barriers to access
• Improve user-centred design
• Evaluate impact on health outcomes

Design for better orientation and information at hospitals during mass casualty incidents

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In extreme events, both natural and man-made, hospitals in the affected area must accommodate a large number of injured individuals and patients, exceeding their regular capacity. Hospitals also face an influx of people searching for their loved ones, adding to the complexity. The EM-DAT database shows that mass casualty incidents (MCI) can result from weather phenomena, earthquakes and man-made incidents, occurring globally regardless of location or development level.

In such events, hospitals must provide care to a much larger crowd while managing uncertainty, organisational chaos and resource shortages. Hospitals must quickly adapt, including managing allocated workforce, relocating emergency rooms and preparing large spaces for distressed families. Family members’ orientation within the hospital is a complex challenge, even in regular times, and this challenge is amplified during a disaster.

This study focuses on the MCI of 7 October 2023, where 680 severely injured individuals were brought to Soroka Medical Center in Be’er Sheva, Israel, following a large terrorist attack by the Hamas organisation. During that day and the following week, thousands of family members gathered at the hospital seeking information about their missing loved ones.

The Florence Project, part of the Bezalel Academy of Art and Design, has operated at Soroka MC since October 2021, connecting design students with on-site healthcare challenges. Following these events, the programme explored solutions to improve orientation and communication for medical teams and families during MCIs. The first solution focused on medical team orientation. A new, easy-to-operate mechanical signage system was developed to cover the existing signs, prevent confusion and ensure clarity. The system was designed to function during power outages. Additionally, modular cardboard signage columns were created, allowing dynamic redirection of people to different areas as needed. These columns can be stored in a folded form and deployed when an MCI occurs.

The second solution addressed family members searching for information. A system for sharing information between families and the hospital's information team was developed, reducing uncertainty and providing a sense of control.

The tragic event of 7 October 2023 highlighted the need for hospitals to adapt to mass casualty situations. These solutions provide tools that can support hospital systems in any MCI, regardless of location or type, and can also be used for smaller crises and daily operations.

Learning Objectives

• Assist medical teams in navigating a hospital during a mass casualty incident
• Support worried family members who arrive to search for their missing loved ones at a mass casualty incident
• Provide support for hospital staff treating worried family members who arrive to search for their missing loved ones during a mass casualty incident

An appraisal of the physical environment in organised inpatient stroke care units in Sri Lanka with comparison to European guidelines on stroke units

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Healthcare settings play a fundamental role in nurturing and sustaining vibrant communities globally. Emphasising the profound impact of healthcare facility design on patient and staff behaviour influences health, wellbeing, clinical efficiency and health-related outcomes. Stroke represents a significant global health burden as it is a leading cause of disability and the second leading cause of death worldwide. Full recovery from stroke is crucial to reducing disability. Recent studies on stroke treatment emphasise that hospital design plays a crucial role in influencing essential aspects of patient care. Thus, effective stroke unit design is necessary to fostering a sustainable community.

Improving stroke care environments is crucial, particularly in a country like Sri Lanka, which reports a significant number of stroke cases annually. Studies have found that a lack of appropriately designed stroke units delays stroke recovery. Thus, more research needs to be done on the physical environment in stroke care, which affects health and wellbeing.

We evaluated the existing stroke care units in the Southern Province of Sri Lanka, considering its high population and limited specialised stroke care facilities. The method involves a descriptive cross-sectional study, semi-structured interviews, with an open-ended questionnaire to assess seven design elements from the European stroke design guidelines. Medical officers, consultants, physiotherapists, occupational therapists and speech therapists who work in the stroke rehabilitation field were interviewed. A minimum of seven individuals were interviewed from each unit. Staff feedback regarding their perception and the degree of satisfaction was also obtained through an open-ended questionnaire from 20 individuals from each unit, including nurses and other support staff.

The main strength of the design of the existing units is co-located staff spaces. Weaknesses include suboptimal outdoor access, bed spacing, proximity to therapy spaces and disabled access, which significantly reduce social interactions among staff and patients. However, the main problem observed is the need for more planning for these units, as many of them are repurposed from existing hospital areas without being specialised for stroke care. This study highlights the absence of comprehensive stroke unit design guidelines in Sri Lanka, leading to suboptimal planning. Examining current designs and comparing them with extensively researched European design guidelines will be beneficial to improve design guidelines. The study offers insights to architects for developing building guidelines for stroke care in state hospitals in Sri Lanka and other low-resourced South-Asian countries.

Learning Objectives

• To identify the special design requirements specific to the stroke care environment in the European stroke design guidelines
• To investigate whether the stroke units in the Southern Province of Sri Lanka have been designed to adhere to specific design guidelines
• To compare the extent to which the stroke units have responded to the special design requirements in the European stroke design guidelines

Adapting healthcare spaces for the future: Flexibility and resilience in hospital design

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As healthcare systems worldwide face rapid and unpredictable changes, hospital designs must evolve to meet emerging challenges. Hospitals are long-term infrastructures, typically designed to endure 50 to 100 years, during which medical advancement, societal shifts and technological progress will significantly reshape care delivery. To remain relevant, hospitals must exhibit adaptability, resilience and the capacity to respond to diverse and evolving needs. This paper explores strategies for designing hospital spaces that embrace these shifts, positioning them within the broader healthcare ecosystem.

Hospital spaces are subject to three primary types of evolutionary changes.

1. Slow evolution: policy and economic shifts – the first type of change occurs gradually, driven by shifts in healthcare policies, economic models and patient care philosophies. These changes often require foresight in hospital design, ensuring that spaces can evolve with new medical technologies or healthcare delivery models. Designing modular spaces that allow for the reconfiguration of patient rooms and treatment areas is essential. For example, non-medical spaces (e.g. conference rooms or storage areas) could be easily converted into temporary treatment zones during periods of high demand. Hospitals must be designed with foresight to accommodate these long-term shifts.

2. Medium-paced evolution: technological and medical advances – the second category is driven by scientific and technological advancements, such as new treatments, telemedicine and personalised care. As these innovations transform care delivery, hospitals must design flexible spaces that can accommodate emerging technologies and decentralised care models. Additionally, the increasing trend toward outpatient procedures and shorter stays necessitates adaptable inpatient care areas, with rooms capable of being repurposed to meet shifting demands. Hospitals must plan for spaces that can be quickly repurposed to accommodate emerging technologies and services.

3. Accelerated evolution: crisis-driven adaptability – the third category involves abrupt changes, typically resulting from crises like pandemics, natural disasters or geopolitical conflicts. Hospitals must be prepared to rapidly reconfigure spaces in response to surges in patient volume and emerging healthcare needs. The Covid-19 pandemic highlighted the importance of designing hybrid spaces capable of transforming non-clinical areas (such as parking garages) into patient care zones. Hospitals must also integrate infrastructure that supports the rapid deployment of medical technologies, ensuring readiness for unexpected demand spikes.

Hospital design must prioritise modular, adaptive architecture, smart infrastructure and flexible layouts to accommodate these three forms of evolution. Spaces should be able to absorb change without extensive renovation, allowing for swift transformations in response to evolving healthcare needs.

Learning Objectives

• The need for flexibility and resilience in hospital design
• Strategies for adapting hospital spaces to changes and challenges
• Architectural innovations and healthcare design

The Erasmus MC patient room (EMPARO): A living lab to explore and design the microbial-safe patient environment

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The design of a hospital patient room is of utmost importance and should provide microbial safety and support optimal care. Microbial safety means that transmission from the environment to the patient is minimised. Designing this environment requires a multidisciplinary approach, bringing together expertise from infection prevention specialists (MV, JS), epidemiologists (AV), architects (MH), real estate experts (LvH), and expertise of nursing workflows (MvD).

Our aim is to develop an evidence-based functional and technical programme of requirements (PoR) for a purpose-built Living Lab to design the future Erasmus MC patient room (EMPARO) based on experimental studies in the Living Lab. The design of EMPARO will be fueled by this Living Lab through the study and evaluation of design components, materials and systems in order to create an optimal 'evidence-based design patient room'.

The PoR will be developed by a joined expert team to firstly create an unique full-scale Living Lab of a hospital patient room with an adjacent bathroom and anteroom. This will be constructed at Erasmus MC, providing direct access to tertiary care, education (Faculty of Medicine) and research facilities. This gives the unique opportunity to:
• perform experimental studies to develop evidence-based measures for design and care;
• test and optimise technical, functional and material requirements to be used in the patient room;
• facilitate international collaboration for infection prevention and control (IPC) and nursing research.

The Living Lab includes:
• ventilation systems: testing air change rates and pressure differentials;
• sinks: evaluating multiple designs;
• toilets and showers: flexible layouts to study microbial contamination;
• furniture: modular configurations with different materials;
• surfaces: testing antimicrobial coatings;
• disinfection systems: e.g. UVC, H₂O₂, and manual methods.

The Living Lab enables studies on:
1. bathroom layout: optimising placement of sinks, toilets and showers for contamination and fall risk reduction;
2. inventory placement: determining alcohol-based hand rub dispenser locations for compliance;
3. workflow and configuration: assessing layout impacts on care efficiency and safety;
4. sink design: identifying designs minimising splashing and contamination;
5. storage: optimising safe and accessible storage locations;
6. ventilation systems: evaluating ventilation rates and configurations for airborne particle reduction.

The PoR and Living Lab experiments will guide the final EMPARO design, contributing to evidence-based IPC strategies and evidence-based design of hospital rooms that ensure microbial safety. The findings aim to set new international standards for patient room design in healthcare facilities.

Learning Objectives

• To develop a purpose-built Living Lab enabling evidence-based design of the hospital patient room
• To learn the effect of the design, inventory and materials on microbial safety in the patient environment
• Collaboration of experts on enabling the study of the optimal design and use of the hospital patient room

Beyond the partition: Flexible, sustainable and smart healthcare interiors

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Plasterboard was invented in 1916 and still remains dominant despite being fragile, dusty, time-consuming to install and, above all, inflexible. Refurbishments and reconfigurations require demolition, disposal and replacement, and access for maintenance and updates causes significant debris and disruption. Current 'future-proofing' relies on surface-mounted solutions – electrical trunking, bedhead units, IPS panels – that segment functions, increasing the number of contractors, space requirements and costs while reducing the partition wall’s potential to a minimal role.

Our workshop highlights the sustainability and functionality of multi-trade, prefabricated interior walls that can adapt to the changing needs of healthcare environments. Hospitals, though designed with an attempt to consider the future, are swiftly rendered obsolete following the development of each unforeseen technological, regulatory or environmental advancement. Without innovation, new hospitals promised by 2030 risk perpetuating outdated practices, leading to inefficient infrastructure, inflexible interiors and increased waste and carbon emissions. To avoid repeating history, we must maximise the potential of the partition wall as a dynamic, adaptable element.

The way in which we can learn to build better, harnessing both form and function while being mindful of the future, is through the use of fully adaptable, reconfigurable and reuseable interiors, the features of which demand highly durable and performance-based materials, allowing them to offer the same level quality and operation over decades.
Prefabricated systems offer the efficiency of standardised production alongside the flexibility of bespoke design through its intelligent software. This software allows users to explore their design in rendered visualisations and virtual reality while the design is being developed, encouraging collaboration and patient- + user-centric considerations from the onset. It generates a live, fully costed bill of materials, so the impact of every change is transparent throughout the process, and it directly feeds the factory floor, giving control of the design to the people who know it best. No materials are cut until everything is signed off, reducing waste and giving certainty of design, cost and schedule.

The result is healthcare infrastructure that evolves with the needs of the users, ever-developing technology and the requirements of the patients in its care. Hospitals’ interiors become fluid ecosystems that can react to the unexpected changes faced throughout their lifetime, without generating waste or requiring costly overhauls. By embracing adaptable interiors, we eliminate fears of obsolescence, creating sustainable, efficient and flexible healthcare environments.

Learning Objectives

• Understand the limitations of traditional hospital infrastructure
• Learn the principles of adaptive, sustainable and circular design
• Discover the role of digital technology in customisable healthcare spaces

Physical environment factors influencing falls among women during pregnancy

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Falls in pregnant women are as frequent as in the elderly population. However, little is known regarding aspects of the physical environment that induce falls in this population. The aim of this study was to examine how physical environment features and attributes influence loss of balance and falls among women in their third trimester of pregnancy. Adopting a qualitative approach situated within ecological and dynamic systems theories, the study aimed to uncover patterns in the interplay between behaviours, intrinsic risk factors and physical environment features related to falls. Data were collected through weekly interviews with 13 pregnant women in their third trimester, exploring real-world incidents of falls and near falls within their home environments.

Findings revealed distinct sequences of affordances, encompassing applicable affordances to execute behaviours, dysfunctional affordances contributing to imbalance and affordances used to prevent falls. The study also identified patterns linking specific behaviours (such as putting on shoes and clothes, working in the kitchen, rising from furniture and bed, carrying a child, descending stairs, entering a bathtub and walking on a slippery floor while wearing socks) to fall risks. Environmental characteristics such as low light levels, cluttered areas, wet flooring, low furniture and toilet seat heights, and the lack of sturdy, fixed supports further contributed to the risk of falls.

While intrinsic factors could not be altered, modifications to create safer residential spaces are proposed, including closed furniture layouts, adequate and accessible lighting and the inclusion of supportive features. This research also provides valuable suggestions for product designers to develop safer and more ergonomic household items, as well as for caregivers to better assist pregnant women in minimising fall risks.

The research contributes to an enriched understanding of falls as complex systemic events shaped by multiple interacting constraints. It offers a foundation for future hypothesis testing as well as insights to guide the design of environments tailored to this population’s needs. Limitations are the potential for recall bias and limited generalisability. This study makes essential theoretical and practical contributions regarding falls among women in the third trimester of pregnancy.

Learning Objectives

• Understanding fall risks in pregnant women
• Exploring interactions between fall risk factors
• Establishing a foundation for future research

Designing with compassion: Principles for trauma-informed healthcare environments

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A 'trauma-informed' approach to care and practice within health and social services is gaining momentum as awareness grows of the pervasive nature of trauma and its prevalence within society. Trauma can exist at an individual, intergenerational, transgenerational and sociocultural level, and has significant detrimental impacts when left unresolved. However, a corresponding 'trauma-informed' approach to design is nascent. This gap exists despite the acknowledged influence of physical environments on health outcomes. The literature highlights the risk that designing environments without considering the needs of people experiencing trauma may inadvertently result in buildings that contribute to or perpetuate trauma. Originally developed in the context of homelessness, trauma-informed design has since been applied to housing for vulnerable populations, female correctional facilities, residential treatment centres for children and schools. Recently, the concept of trauma-informed neighbourhoods has also emerged.

This study examines existing healthcare built-environment research to identify themes and aspects that correspond to trauma-informed design approaches and their six fundamental human needs principles: 1) dignity and self-esteem; 2) empowerment and personal control; 3) security, privacy and personal space; 4) stress management and coping; 5) sense of community; and, 6) beauty and meaning.

The research team previously developed a conceptual framework to provide a holistic understanding of health and healing in the context of trauma. This framework synthesised a salutogenic perspective of health with insights from neurological and interpersonal neurobiological perspectives. The framework was then applied to a review of existing trauma-informed design literature in a previous study. Building on these foundations, this study examines literature at the intersection of health, healing and design through these combined lenses to further explore trauma-responsive spaces.

Derived from scientific findings and situated within a salutogenic paradigm, this investigation identifies design dimensions within healthcare environments that are sensitive to the impacts of trauma and responsive to the needs of individuals in recovery.

Grounded in salutogenic theory and informed by scientific insights into the mind-brain-body connection, the findings contribute to the limited body of trauma-informed design literature, and provide a platform for both practice and future research on the design of healthcare-built environments intended to support healing and recovery from trauma. Design dimensions are identified in healthcare environments that address the effects of trauma and cater to the needs of individuals on their path to recovery.

Learning Objectives

• To understand how the principles of trauma-informed design apply to healthcare environments
• To explore the interplay between trauma, healing and design
• To identify trauma-responsive design dimensions in healthcare

Human-scale interventions: A case study of dignity, wellbeing and belonging in a dementia-enabling environment in metropolitan Melbourne

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In Victoria, Australia, 100,000 people live with dementia – a number expected to double by 2040. There is a sociocultural shift towards personal responsibility for health in the Australian context. These two factors have informed recent aged-care residential design policy. Dementia-enabling environments that support identity and dignity for residents, person-centred models of care, and renewal and expansion of underutilised estates inform design in metropolitan Melbourne.

Meanwhile, amid global carbon reduction initiatives there is growing recognition that a deterministic approach of perfect correspondence between present need and built form risks obsolescence due to unknown (and unknowable) future contexts. With the rising prevalence of dementia, it is timely to reconsider ‘perfectly fit’ aged care within a wellbeing and ecosystem paradigm.

Research has found that cognitive ramps of dementia-enabling environments – achieved through personalisation, colour and artwork – are an important way for residents to develop (and maintain) their sense of belonging. This is recognised to benefit therapeutic outcomes and behaviour management by lowering agitation, disorientation and anxiety. While previous research explored the impact of art styles and colours, this study focuses on how the interaction of interior design elements can enhance residents' dignity by aiding orientation and wayfinding.

The case study takes a partnered approach between Studio STH (architects), Eastern Health (operator), the Victorian Health Building Authority and the peak-body, Dementia Australia. Murrenda Home (opened in 2022) is a four-level, 120-bed residential aged care development, which incorporates a small-household model of 15-bed clusters.

The project offers insight to estate planning as three disparate and geographically separate facilities are brought together into a vertical arrangement. A linkway to an existing 64-bed facility (opened in 2007) invites discussion of whole-of-life carbon of two paradigms on a single site: the new-build vertical volume and the retained single-level form. The outcome of this research is delivery of a human-scale environment that implements dementia-enabling guidelines: artwork as landmark, colour as tool for navigation and personalisation of memory boxes and household doors. These interventions are design at the human scale: they are adaptive and humanistic.

This research demonstrates that small but impactful interventions offer a way to challenge the ‘perfectly fit’ building. It indicates that personalisation is a factor for design practice to consider more fully. In addition, preventative care and social wellbeing is recognised through inclusion of a hair salon, sensory rooms, bowling green, therapy and community spaces. The next step is to consider exterior ‘human-scale’ interventions that are similarly adaptive.

Learning Objectives

• Artwork as a means of evoking curiosity and a sense of belonging
• Artwork as a tool to assist with wayfinding and orientation
• Design interventions contributing to a human-scale environment

Building the healthcare ecosystem: Leading digital transformation through an online community of medical professionals

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Transformations in digital health hold the potential to manage healthcare challenges by adopting an ecosystem approach. The opportunity to redesign healthcare services using technologies, such as telemedicine, robotics and AI systems, requires a collaborative effort to connect disciplines, organisations and industries, overcoming resistance to change and structural boundaries. An example of a collaborative model is the Digital Health Community, established by the Israel Ministry of Health in 2020 to manage the challenges of the Covid-19 pandemic and the uptake of remote care. The professional online community (OC), which includes over 1,200 medical professionals from diverse disciplines and organisations across the healthcare system, has become a platform for leading digital transformation.

In a qualitative study, we investigated the OC organisation and work practices and explored their impact on the healthcare ecosystem during and after the crisis. Based on interviews with the OC members, observations of their activities and documentation of outcomes, we studied the collaborative effort of healthcare professionals in navigating the challenges and opportunities presented by emerging technologies to redesign healthcare.

Our findings illustrate how the OC webinars and WhatsApp groups supported knowledge sharing, collaboration and innovation. Starting with professional working groups, they developed guidelines and simulation training for remote care. The OC later evolved into multidisciplinary mission task groups, a research club, service design workshops and an accelerator programme to support innovative teams. Their activities led to new models of care, professional guidelines and regulation change while fostering a network of medical professionals nationwide. Over the years, the OC shifted from focusing only on telemedicine to broader digital health transformation, aiming to facilitate a resilient, inclusive and innovative healthcare ecosystem.

The study demonstrates how the Digital Health Community provided the Ministry of Health a strategic platform to connect with working professionals in all healthcare organisations. By challenging existing notions of professional identity, the OC facilitated multidisciplinary collaboration, cross-organisational boundaries and entrepreneurship, fostering leadership in healthcare transformation and overcoming professional resistance to change. The study indicates the potential of online communities as incubators for future-oriented healthcare design and reform, where grassroots innovations can be scaled nationally to address challenges such as workforce shortages and healthcare inequalities. It highlights the need for new governance models, merging top-down and bottom-up involvement and leadership, moving from hierarchical structures to network structures across professions and organisations, and diffusing innovation and transformation to diverse stakeholders across the healthcare ecosystem.

Learning Objectives

• The potential of an online community to provide a platform for collaboration and innovation
• New governance models to connect with professionals and develop leadership
• Ways to overcome resistance to change by shifting professional identity

Co-designed personalised reusable theatre caps: Enhancing sustainability, communication, identification and comfort

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Climate change is the biggest global health threat of the 21st century. The challenges we face, however, present an incredible opportunity to do things differently – to adopt innovative, design-led approaches that will transform NHS Scotland’s health and social care ecosystem. This paper presents research that unites a wide range of disciplines, research organisations, regional and local industry, and other public sector stakeholders. Design HOPES, one of four Green Transition Ecosystem (GTE) Hubs funded by the Arts and Humanities Research Council (UK), embeds in designing, making and acting through circularity principles, to drive sustainability and change across products and services, strategy, policy and social influence to evolve design outcomes that will matter most to people and planet.

Design HOPES encompasses a rich disciplinary mix of knowledge, skills and expertise from a range of design disciplines (i.e. product, textile, interaction, games, architecture, etc.) and other disciplines (computer science, health and wellbeing, geography, engineering, etc.) that is focused on people and planet, from the micro to macro, from root cause to hopeful vision, from the present to future, and from the personal to massive populations. Design HOPES’ work involves designing and making things and testing them to see how they work driving further iteration of ideas and resolutions.

This paper describes one specific Design HOPES project that aims to eliminate the dependency on single-use, disposable theatre caps while addressing communication barriers and misidentification issues among NHS Scotland staff. Working closely with NHS Golden Jubilee theatre staff, the authors have co-designed a diverse range of options for reducing theatre cap waste (hundreds of thousands of single-use theatre caps are disposed of every year across NHS Scotland hospitals). The co-designed reusable theatre caps propose and test new material considerations, driving far greener practices while delivering better fitting, more comfortable garments.

The paper highlights that there is much that can be done to improve textile and other material products across NHS Scotland. Furthermore, the paper shares one of many creative approaches Design HOPES is taking to transform a range of NHS Scotland products and services. The co-designed personalised reusable theatre caps paper outlines a series of co-design workshops in NHS Scotland settings that empower people to define problems and to actively inform solutions by hacking, making and testing possibilities. The paper presents also presents a holistic approach to the design and development of an innovative piece of theatre staff uniform with significant environmental credentials.

Learning Objectives

• We wish to present our design-led work to a wider healthcare audience
• We wish to learn more about the choices healthcare practitioners make in the products and services they use on a daily basis

The ‘Nature + Nurture’ concept in healthcare

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The 'Nature + Nurture' concept in healthcare projects integrates biophilic design principles and evidence-based strategies to enhance patient and staff wellbeing. This approach delivers functional, iconic, sustainable and aesthetically pleasing projects.

Based on recently completed project studies, central to the architectural design is the visual connection to the body and nature, as nature symbolises growth and healing. Research shows that natural light not only accelerates patient recovery but also enhances the wellbeing of healthcare professionals. Green design elements contribute to 15 per cent faster recovery rates, a 22 per cent decrease in pain medication usage, an 11 per cent reduction in secondary infections and an 8 per cent reduction in hospital stays. Over 92 per cent of bedded areas offer external views, complemented by a day-lit atrium.

We embarked on creating specialist hospitals dedicated to complex head and neck, spinal and vascular surgery, integrating sustainability principles to enhance healing. Traditional hospitals often have high carbon emissions due to their significant energy and water consumption. Our goal was to develop a sustainable healthcare facility that prioritises the wellbeing of patients and staff while supporting the environment and its communities.

Learning Objectives

• Integrate biophilic design principles
• Showcase human-focused applied design principles, scale and circulation
• Integrate evidence-based strategies to enhance patient and staff wellbeing

Contributing to a decade of transformation in healthcare

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Over the past decade, healthcare and healthcare design in Australia has undergone a remarkable transformation. This presentation reflects on the design and delivery of ten hospitals in BVN’s portfolio over this period, highlighting the interplay between practical experience, authentic engagement and the balance and evolution of the Australasian Health Facility Guidelines (AusHFGs). By examining projects, we will explore how lessons learned have informed not only individual outcomes but also the broader framework guiding healthcare infrastructure development.

Each hospital tells a unique story, shaped by its location, community needs and clinical ambitions. While the AusHFGs provide a robust foundation for consistent, high-quality healthcare environments, their application often requires careful localisation to meet the distinct requirements of diverse briefs. These adaptations range from considerations of cultural context and patient demographics to the specific demands of regional and urban settings.

Key themes of the presentation will include:
• authentic engagement: collaborative approaches to co-design with clinicians, patients and communities, ensuring responsive and inclusive outcomes;
• innovation in delivery and procurement: strategies for balancing speed and quality in project execution, from early planning to handover;
• resilience and adaptability: how design solutions anticipate future needs, from technological advancements and spatial expansion to sustainability goals.

Some of the projects shared will include:
• Northern Beaches, through the lens of holistic integration of services and a public/private model on a greenfield site;
• Nepean, through the lens of mental health by design and reimagining of a vertical hospital campus;
• St Vincent’s, through the lens of connecting to research, rehabilitation and recovery within the confines of an inner city campus;
• Canberra Hospital, through the lens of sustainability and future-proofing for expansion.

This retrospective examines how iterative improvements in design and process, informed by real-world challenges, have strengthened the profession’s ability to deliver innovative, patient-centred facilities. Attendees will gain insights into how these frameworks and practices can continue to evolve to meet the changing needs of healthcare systems around the world.

Learning Objectives

• Analysis of the adaptation of the Australasian Health Facility Guidelines (AusHFGs) in diverse project contexts
• Application of lessons in sustainability and future-proofing in hospital design
• Examination of collaborative co-design practices in healthcare infrastructure

Student participation in hospital post-occupancy research projects: The why and how

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Published post-occupancy evaluation (POE) studies of new or renovated hospital environments are still rare. The need for an interdisciplinary approach to understanding the complex causality of the perceived performance of new environments that may affect ‘bricks, bytes and behaviour’, is just one barrier. Often hospital organisations lack opportunities to apply findings in future projects, and also lack the resources to conduct or guide research projects needed to close the evidence-based design cycle. Similarly, POE is not a subject being taught in architectural education.

However, starting with a collaborative approach within a Dutch university medical centre (UMC), a network of collaborations with other UMCs, hospitals, universities and universities of applied science has been established recently. This innovative approach gets students, lecturers, researchers and practitioners to collaborate in order to expand the understanding of the interaction between the hospital built environment and its users. In this abstract, we explore the participation of Bachelor and Masters students in answering hospital-related POE research questions. The aim of the study is to present and reflect on how students have been involved in POE research projects for Dutch UMCs to better understand the potential of this resource, as well as looking at the preconditions to balance the interests of all stakeholders involved.

Hospitals provide case studies for student education in research methods. From 2018 onwards, students from different disciplines have contributed to POE research studies in Dutch UMCs, resulting in (Bachelor and Masters) graduation theses and (material for) scientific publications. The majority of the research projects concern qualitative research (interviews, observations), with the addition of some more quantitative survey studies. Students can contribute to data collection, analysis and presentation/dissemination as part of individual or group assignments.

Collaboration between lecturers, researchers and ‘boots on the ground’ in the UMCs is a prerequisite to successfully developing relevant research questions, organising interaction with hospital staff and offering proper tutoring of students during their research. While study results already provide value at the local level, the time and embeddedness of these kinds of research projects in a larger (potentially national) research effort seem to be serious constraints to publishing results in scientific papers.

Students may be a ‘hidden’ resource to conduct POE studies in all hospital settings. Understanding the need to facilitate education for non-medical/nursing professionals and a network of professionals with shared (research) interests enhances the chance that this resource can be deployed.

Learning Objectives

• How to engage students in POE studies in hospitals
• How to build collaborative networks with different stakeholders
• How to balance learning objectives for students with relevant research outcomes

Entwining healthcare and nature: Utilising NHS Scotland greenspace for community and infrastructural care

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Community growing is currently underdeveloped across NHS Scotland estates. While there are localised initiatives such as community gardens, comprehensive strategies that foster a strong connection between environmental health and human healthcare are lacking. It is widely recognised that time spent in nature benefits human health across various domains, including physical, cognitive and social wellbeing. There is little guidance on the duration and variety of nature engagement (Shanahan et al., 2016). Notable contributions from Cooper Marcus (1999; 2007) highlight the need for nature-based solutions to support human health. The outdoor environment is a prominent health enabler, making it crucial to explore the intersections between patients, hospital infrastructure and the wider communities hospitals reside in. This understanding is vital for addressing net-zero goals and integrating new healthcare paradigms.

This paper introduces a model for integrating flax growing on NHS Scotland estates to enhance community wellbeing, achieve net-zero goals, increase biodiversity and develop regenerative infrastructure. Flax is a regenerative crop used to create linen and other products, such as seeds and oil, that can be grown on underused NHS greenspaces. This project, part of the £4.625 million Design HOPES Green Transition Ecosystem (GTE) Hub funded by the Arts and Humanities Research Council (AHRC), aims to produce items like theatre scrubs and bed sheets for NHS use. By reimagining care delivery and sustainability in a circular production process, we can model interactions between NHS staff, patients and communities from a design-research perspective. Scotland alone has 278 hospital sites, many with land suitable for growing flax. Adopting a design-led approach, and the concept of therapeutic landscapes of wellbeing (Wood et al., 2013), we will explore how nature participation can be more closely integrated into healthcare settings to develop novel approaches to care and resource use.

Following Pretty’s (2004) trinity of viewing nature, being and participating in nature, we propose a model for preventative and therapeutic healthcare that makes productive use of NHS Scotland’s estates. This model focuses on growing, harvesting and processing flax as a community activity to promote social wellbeing. As the NHS already has several active policies to support sustainable and environmental interventions, such as ‘Good Places, Better Health’ and the ‘National Green Theatres Programme’, developing models in which the positive impacts of flax growing on NHS estates are theoretically and practically explored offers a novel strategy for ‘entwining’ the worlds of healthcare and greenspaces for improved staff, patient and community wellbeing.

Learning Objectives

• Recognise the underdevelopment of community growing initiatives across NHS Scotland estates and the existing small, localised efforts like community gardens
• Introduce and understand the proposed model for integrating flax growing on NHS Scotland estates to enhance community wellbeing, achieve net-zero goals, increase biodiversity, and develop regenerative infrastructure
• Understand the proposed model for preventative and therapeutic healthcare that utilises NHS Scotland’s estates for growing, harvesting and processing flax as a community activity to promote social wellbeing

Optimising healthcare delivery: The Mid Cheshire Hospitals NHS Trust target operating model

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Developed by Archus, in collaboration with Mid Cheshire Hospitals NHS Trust, the Target Operating Model (TOM) framework is a comprehensive and integrated approach to delivering high-quality healthcare services. A requirement for the New Hospital Programme’s (NHP) business case process, the TOM serves as a blueprint for transforming strategic goals into operational reality, focusing on operational efficiency and integration. This is to ensure that new hospitals are operationally optimised before schemes are developed.

The TOM framework offers a flexible and agile model that can be applied across different levels of healthcare delivery, transcending the traditional hospital setting. It supports the transition towards a future health ecosystem that is adaptable, patient-centric and resilient.

The development of the TOM involved several key steps:
• set-up of TOM working group: a dedicated team was established to oversee the development, with clear terms of reference;
• understanding NHP expectations: comprehensive research was conducted to understand the broader strategic environment and relevant policies;
• research and discovery: insights were gathered from policies, guidelines and best practices to inform the TOM framework;
• early drafting: an initial draft of the TOM framework was created, outlining key components and principles;
• engagement: the draft framework was reviewed and challenged by stakeholders, including clinicians, service managers and programme leads. This is a fluid and ongoing process between drafting and refinement;
• refinement: feedback was incorporated iteratively to refine the TOM framework, aiming for a model that reflects the Trust's vision and capabilities.

The TOM aims to provide a 'golden thread' that links key transformation agendas, ensuring they are interfaced, complementary and system-based rather than organisation-based. This is from both a Trust and Archus perspective. It describes how services will function in the future and the capabilities needed to deliver them, covering strategies related to clinical, digital, estates and FM (infrastructure), workforce and research and innovation.

The TOM framework, rooted in the Trust’s vision to deliver exceptional healthcare services, will foster innovation, patient-centric care and operation efficiency. This framework will help the Trust achieve optimised operational readiness in time for the new hospital being built, preventing outdated ways of working from being transferred to the new estate.

Learning Objectives

• Operational efficiency
• Strategic health planning
• Target operating model

How emerging market countries can apply international best practice in healthcare facility planning and design

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Investment in healthcare infrastructure in emerging economies is critical for promoting equity, improving quality, and strengthening health system resilience. These projects must optimise environments for high-quality clinical service delivery, integrate across health services, foster healthy communities, and apply sustainable strategies appropriately. However, compared to those countries that have continuous in public capital infrastructure, emerging economies often face challenges due to the lack of continuity in government projects, which can limit industry knowledge, experience and available resources during periods of lower public sector infrastructure spending such as healthcare.

Purpose: Emerging economies are adopting international best practices in healthcare facility planning and design. Despite affordability constraints, achieving high-quality, fit-for-purpose healthcare facilities is possible through the use of holistic, practical guidelines that can drive continuous improvement and learning.

Methods: Delivery routes often involve public-private partnerships or design-build models requiring an output specification. While funding and operating models may vary, there is significant commonality in healthcare services that allows for standardised approaches. Archus and a team of specialists, including Murphy Phillipps, Arup, and MTS, developed guidelines for the clinical planning and design of new PPP hospital facilities in emerging economies, covering:
• The clinical briefing process/functional content
• Room data sheet development
• Schedules of accommodation
• Approach to equipping
• Site due diligence
• Design brief and design deliverables lists
• Multi-disciplinary technical output specifications

Results: Consistent use of these guidelines can address:
• Incorrect assumptions about local health service delivery models, ensuring facilities are fit for purpose
• Gaps in requirements due to missing information at the feasibility stage, reducing risks of budget and time overruns
• Bespoke plans and requirements for each project, reducing inefficiencies and variable quality
• Unclear clinical and technical requirements for the market, improving bid quality and reducing risks of budget overruns and low-quality facilities
• Provide an evidence base of best practice design, continuous improvement and lessons learned.
The guidelines are currently being piloted at the project level. Success will be measured by the level of adoption and project outcomes, including cost certainty, delivery timelines, and health service feedback.

Conclusion: The implementation of these guidelines brings a level of standardisation, comparability, and international best practices that can increase certainty at each step and maximise the value from healthcare infrastructure investments, reducing risk and setting the framework to foster innovation and entrepreneurship for those working in emerging economies.

Learning Objectives

• Needs of emerging country healthcare facility projects
• Understanding the risks and pitfalls
• How to apply international best practice and approaches to maximise end value

Movement-Light-Nature-Human Connection: Strengthening Dubai’s healthcare ecosystem with preventative care

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The diabetes burden in the Middle East and North Africa (MENA) region remains alarmingly high at 18.9 per cent (11th worldwide) and is projected to increase by 96 per cent by 2045 if left unaddressed. Dubai Health recognises the need to strengthen the healthcare ecosystem. Its sustained investment in preventative care continues to advance this, and the goals of the Dubai Social Agenda 33, to promote a healthy lifestyle and enhance the quality of health.

The new Dubai Diabetes Centre of Excellence (DDC) is the next project to advance that vision. Embracing minimalism and gravitas, it is designed around a new model of comprehensive, co-ordinated, personalised, and predictive medicine – harnessing artificial intelligence alongside traditional healthcare delivery. Endocrinology, ophthalmology, psychology, nutrition, podiatry and lifestyle coaching are under the same roof, physically and digitally, enabling a seamless movement between clinical specialties. The iterative nature of this information exchange is embodied by an infinity circulation loop through the building which doubles as education/research space, promoting physical activity ‘snacks’ as short as three minutes, which are shown to lower post-prandial blood sugar. Before leaving, there is opportunity to reflect on things learned, on ways to change in the future and ways to give back to the care community one is now part of – then repeat, such is the nature of chronic disease management.

The DDC goes beyond treatment, focusing on preventative medicine and patient empowerment. Four thematic gardens featuring herbs, fruits and flowers found in Ibn Sina’s (Avicenna) 'Canon of Medicine' medieval pharmacopoeia are used in education sessions and cooking demonstrations. This thoughtful approach extends to the overall patient experience. One’s care is in the hands of the same team of professionals, every time. Over months and years, relationships form. Trust is built on the connection forged in those exchanges. You are not a number; you are among friends here.

The DDC represents a transformative vision for healthcare in the MENA region. Integrating preventative care, connection to light and nature, advanced technology and a holistic approach to patient management, it is poised to significantly reduce the diabetes burden. The design features a planning innovation – the Infinity Loop – ensuring seamless co-ordination among various specialties, fostering a comprehensive and personalised care experience. Moreover, the emphasis on patient empowerment and community engagement underscores commitment to fostering healthy communities. As Dubai Health continues to invest in forward-thinking initiatives, it sets a benchmark for healthcare excellence, paving the way for a healthier future.

Learning Objectives

• Understand the diabetes burden and preventative care initiatives in the MENA region and how learners might apply this knowledge to address this public health challenge in their home country
• Understand key features of the DDC, including its comprehensive, co-ordinated, personalised and predictive medicine model, the integration of artificial intelligence and the Infinity Loop design for seamless data exchange
• Learners will be able to assess and apply the benefits of a holistic approach, including natural light, thematic gardens, education sessions and consistent care teams, in promoting patient empowerment, community engagement and trust building

Endoscopy design study

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The demand for endoscopy procedures currently far outweighs capacity in the NHS and many trusts are undertaking demand and capacity modelling to support future planning. P+HS Architects was involved in the development of several different endoscopy schemes during 2024, and we would like to share our experience and reflect upon the design of some of those projects. The submission contrasts four of our current projects which, while derived from common design guidance, demonstrate the impact that variations in clinical model and site characteristics can have on a ‘standard’ typology. Alongside JAG accreditation, each scheme has unique priorities.

Lincoln endoscopy
Located at Lincoln County Hospital, this new-build facility will incorporate 12 patient pods, enhancing the patient experience by offering both audible and visual separation for improved privacy and dignity.

Poole endoscopy
P+HS and Premier Modular have assisted with the design development of a modular build for the expansion of endoscopy services at Poole Hospital. The scheme will expand capacity, enabling the service to maintain waiting standards and provide timely and safe diagnostic endoscopy services. The location and modular construction methods have been chosen to best meet the time and space requirements of the brief.

Cumberland Infirmary endoscopy
North Cumbria Integrated Care NHS Foundation Trust is aiming to improve its endoscopy service through the provision of a new five-room endoscopy unit designed to support both outpatient and inpatient flow. The design utilises a hybrid approach to recovery spaces with multi-bedded recovery bays and en-suite pod spaces, which provide flexibility for dealing with the needs of more sensitive patients. To ensure the unit is operational as quickly as possible, modern construction methods are being utilised. Completion is targeted for March 2025.

Leicester endoscopy
University Hospitals of Leicester NHS Trust is constructing a new-build facility to provide six new procedure rooms. Aiming for a net-zero, carbon-neutral, sustainable design, the scheme is on target to achieve BREEAM Excellent.

As the Government strategy for improving NHS services shifts reactively to national programmes of prioritised upgrades (community diagnostic centres (CDCs), urgent and emergency care, Cavell centres, elective surgery, etc.) and the New Hospital Programme (NHP), it is important to understand the potential scope and limitations of standardised design. Our experience shows that the inherent site characteristics and operational policy can push designs in very different directions, limiting the potential for rolling out standard solutions to something that appears to be a common clinical brief.

Learning Objectives

• Outlining design principles relating to example schemes
• Outlining design principles relating to example schemes
• Review learning from projects and feedback received

Hybrid model of care for high-risk pregnant women: Immersive design between the hospital and home

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Healthcare organisations are developing models of care between the hospital and home, using remote technologies for monitoring and communication. Most programmes for hospital at home / virtual wards support intermediate care, such as chronic management or rehabilitation programmes, while acute care often requires hybrid models, integrating physical and virtual care at the hospital and the home.

This study investigates a novel hybrid model for pregnant women with severe maternal or foetal complications of pregnancy. The model provides an alternative for prolonged hospital admission indicated for maternal and/or foetal intense monitoring, which often lasts weeks or even months before delivery. The hybrid model allows high-risk pregnant women hospitalisation at home, integrating telehome monitoring and daily remote visits of the physician and midwife with twice-a-week physical visits of the women to the hospital unit. Remote care at home leverages cutting-edge telemedicine technologies to replace the standard hospital daily assessment, including vital signs, glycaemic control, foetal heart rate monitoring and ultrasound assessment, performed by the woman with the remote guidance of the caregiver. When visiting the hospital twice a week for on-site check-ups, the women are treated in a designated unit within the medical ward by the same caregivers.

The ongoing qualitative study, based on observations of and interviews with patients and staff, examines the design of the new healthcare service, focusing on the intersection between the social, technological and built environments. Preliminary results illustrate transformation in all three environments of care. The hybrid model shifts relations between women and caregivers, changes professional practices and processes, and empowers women by growing involvement, responsibility and a sense of choice. Telemedicine technologies for self-monitoring at home, which requires learning and patience, were reported to give women greater control over their situation. Staying at home allows women to maintain family life and motherhood and often continue their work or studies, which is challenging, or impossible, to proceed with during traditional hospital admission. Women reported that the home environment reduced stress and supported better sleep than the hospital ward, and the hybrid unit provided a VIP experience.

The study also indicated the potential to use remote technologies for inpatient care, empowering women at the hospital while managing the lack of professional caregivers. It demonstrated challenges in managing and scaling the service, highlighting the need for more research to explore the potential and limitations of hybrid models and their implications on the design of future hospitals and healthcare services.

Learning Objectives

• The development of hybrid models of care between the hospital and home
• Advantages of remote care at home for high-risk pregnant women
• Implications of remote care and hybrid models on the design of hospital wards

Implementing a robust social value strategy: Designing for underserved and vulnerable populations

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As more health systems and healthcare organisations begin to align with the United Nations commitment to the 2030 Sustainable Development Goals (SDGs) to end poverty, protect the planet and ensure prosperity for all, it is imperative for designers to leverage a robust social value strategy to ensure that the communities being served by a new medical facility receive maximum benefit. It is also essential that the social value strategy reflect the cultural context of the community, so the design of the facility reflects what matters the most to both those who receive and those who deliver care within that community.

In this session, participants will explore how one organisation has implemented a robust social value strategy throughout the design and construction of a new 1.2 million square foot tower expansion at the Lyndon B. Johnson (LBJ) Hospital in Houston, Texas, which serves as a safety net hospital in the United States that provides care for some of the nation’s most underserved, vulnerable communities. Hear from global community engagement experts, patient and family advocates, designers and visionary leadership from one health system on what it takes to transform the community by honouring the voices of those they serve.

The team will share how a comprehensive community engagement process, which included bus tours, town hall meetings, community outreach events and surveys, was used to foster trust and build consensus within the community. Attendees will also hear about a rigorous experience strategy effort that engaged, patients, families and staff in the design process, to ensure the design of the new facility meaningfully improves the patient and staff experience and positively impacts the community in ways that matter most to them. The team will also discuss strategies for giving back to the community through volunteer efforts to help provide jobs, food and clothing to members of the community.

To date, over 91,000 touchpoints with the community have occurred through a more than 90 community outreach events and bus tours that touched 169 neighborhoods and zip codes and engaged over 1,100 minority participants in the design process. From this engagement, 21 non-negotiables for design were identified. Of those 21 non-negotiables, 17 have been meaningfully addressed through the design and the remaining four are currently under review.

Implementing a robust social value strategy during the design process is critical to ensure maximum benefit is received by the community through the development of healthcare infrastructure.

Learning Objectives

• Learn how one health system is leveraging a robust social value strategy to transform how they provide care for some of the most underserved, vulnerable communities in the USA
• Discover how designers can play a crucial role in supporting the United Nations commitment to the 2030 Sustainable Development Goals
• Explore how to implement a comprehensive community engagement process that can help foster trust and build consensus within the community

The benefits of joining up mental and physical health services

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This paper presents the development of a new rehabilitation centre at Western Community Hospital in Southampton, which aims to transform rehabilitation services across the UK’s south-east region. The redevelopment has allowed the integration of all levels of rehabilitation, from Level 1 to Level 3, into one location, providing a centre of excellence for patients requiring intensive inpatient rehabilitation. The project is led by the Hampshire and Isle of Wight Healthcare NHS Foundation Trust, with the goal of delivering expert care to patients and improving overall service efficiency.

The rehabilitation centre brings together specialist neurological, physical and mental health rehabilitation services, offering a streamlined and comprehensive experience for both patients and staff. Transformation of the estate provides the potential to enhance recovery times and enable the admission of patients with greater acuity, including those directly from ICU. Accelerating the transition to rehabilitation improves patient outcomes and helps free up acute care beds more quickly. This paper will examine the synergy between clinical services planning and building design, exploring how these elements support improved patient outcomes and how their impact can be measured.

Clinical services planning
This paper will outline the framework for managing higher-acuity patients, including the innovative use of community beds for flexible care, enabling faster step-up and step-down between acute and rehab settings. A new community hub integrates urgent response teams, virtual wards and outreach services to proactively manage frailty and long-term conditions, ensuring care is delivered closer to home.

Building design
The design of the facility complements the holistic approach to rehabilitation by focusing on reducing patient stress, enhancing interaction with nature and promoting social connection while maintaining a safe and visible clinical environment. Key architectural features, such as light-filled corridors, green walls, sensory planters and safe outdoor spaces, support both physical recovery and mental wellbeing. The design fosters a healing environment, encouraging movement and social engagement, which are crucial to the recovery process.

Results
The development of robust clinical pathways has led to improved care efficiency and effectiveness. Preliminary feedback indicates that the design has positively impacted patients, with many who were initially reluctant to leave their beds now mobilising, interacting with others and engaging in their recovery. Based on these early outcomes, the paper will discuss the potential for post-occupancy evaluation to quantify the benefits of the integrated clinical services and the therapeutic environment.

Learning Objectives

• Clinical pathway planning for rehabilitation services
• Building design for physical and mental wellbeing
• Fostering synergy between clinical and design professionals

Equity, dignity and culture of care: An evidence-based design approach

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Over the past 40 years in healthcare, as buildings, products and services, and the roles they play in our lives and the environment, have become more intricate, the focus of design in health has changed to include data and research-driven processes (Chong et al., 2010; Nicholas et al., 2024; Wang & Groat, 2013). Healthcare services and spaces created through these patient-centred, evidence-based processes are models of recovery, reflection and reimagination. This case study research paper will present several project-based examples that undertake health and design research to implement novel solutions for improved care. These examples include a proposed dementia-friendly hospital room, a dementia-friendly mobile exam space and an older adult family caregiver kit for hospital stays. This work has arisen from over six years of collaboration with a large local teaching hospital, capped off with 18 months of participation as a part of the American Hospital Association’s (AHA) Age Friendly Health Systems Action Community. Inculcated in these projects is the AHA’s 4Ms of care: medication, mentation, mobility and what matters to the patient (Penn State Nursing, 2024).

Central to this paper and the projects presented here, is a community-driven culture of care for both patients and caregivers (Evan & Fischer, 2022; Fuentes, 2020; Lightburn et al., 2005; Robert Wood Johnson Foundation, 2020). Considered an emerging approach in corporate and health environments, a 'culture of care' requires that the human necessity for dignity be the leading concern when creating solutions for those in need at all levels of engagement (Evan & Fischer, 2022).

Due to the complexity of design practice, especially in the healthcare space, these human and patient-centred approaches to design are increasingly necessary and are often developed through empirical design research (Chong et al., 2010; Frayling, 1994). Much work in this lab is underway to undertake physical, virtual and augmented reality simulations to develop spaces and solutions in this way, and the projects discussed here put patients at the centre of the care through both a service and space-driven approach.

Learning Objectives

• This presentation will assist attendees to consider how culture of care and design might create solutions for existing hospital environments to augment care
• Attendees will learn how evidence-based design can assist with hospital retrofits
• Attendees will learn about an empirical culture of care design approach

Evaluating existing pain assessment tools in paediatric emergency care and barriers to adherence

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In order to give paediatric patients the best care possible, trauma centres are required to follow evidence-based recommendations. Studies have revealed that adherence to these guidelines is still subpar, despite research claiming that compliance to these recommendations improves patient outcomes. The evaluation and treatment of pain in children who have experienced trauma is a major topic. For this vulnerable population to receive an accurate pain diagnosis and suitable care, standardised pain assessment instruments are crucial. However, little is known about the reasons for the inconsistent use or adherence to these strategies in practice. Using a translational research approach that actively incorporates key stakeholders in the process, this study aims to uncover the facilitators and barriers affecting adherence to standardised pain assessment methods in trauma clinics.

The study seeks to address a number of important issues with the methods currently used for pain evaluation in paediatric trauma care. First, what procedures are currently in place for evaluating pain in kids who have been hurt, and how well do they satisfy the demands of the young audience? Second, are trauma centres utilising standardised pain assessment protocols? If not, why aren’t they? What obstacles do healthcare practitioners experience when adhering to the protocols? If they are being used, what enables them to do so successfully?

This is primarily a qualitative study that includes interviews with administrators, healthcare professionals and other pertinent stakeholders to collect data for the study. The information will shed light on the variables that affect the use of pain assessment instruments, including organisational culture, training, awareness, resources and the protocols' perceived applicability to paediatric care.

This study intends to support the development of solutions to enhance adherence to best practices by evaluating the challenges to, and facilitators of, implementing standardised pain assessments. By pointing out regions that require interventions to improve the quality of pain management, the findings will also benefit the larger field of paediatric trauma treatment. By making sure that standardised, evidence-based pain assessment instruments are applied successfully across trauma centres, this study ultimately aims to enhance the standard of care for paediatric trauma patients.

Learning Objectives

• Develop strategies for meaningful stakeholder engagement with healthcare providers to enhance research and care outcomes
• Understand and apply qualitative research techniques such as interviews to determine their appropriateness for studies on pain assessment in children
• Critically evaluate existing pain assessment tools for validity and reliability and identify opportunities for their enhancement in clinical settings

Towards user-centred healthcare architecture: Teaching post-occupancy evaluation in design education in Delft and Vienna

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In architectural education and practice, the evaluation of a building’s functional, psychosocial and social performance – its ability to meet user needs – is often neglected (Brown, 2018). Post-occupancy evaluation (POE), a systematic approach to assessing whether buildings fulfill their design intentions and respond to both explicit and implicit user needs, offers a promising solution to this oversight (Lehane, 2022). Despite its potential, architectural education often prioritises conceptual design, with project evaluations heavily influenced by subjective opinions of professors, visiting critics and peers. This approach leaves students with limited insight into how their designs perform in real-world contexts (Duffy, 2008). Research indicates that integrating POE into architectural training can help students better understand design effectiveness and prevent recurring design flaws (Hay et al., 2017; Brown, 2019). Furthermore, architects trained to apply POE methods are better equipped to create spaces that meet user expectations over time, thereby reducing the likelihood of premature building modifications (RIBA, 2017).

This paper presents how two courses teach POE to their students, one at the faculty of architecture at Delft University of Technology and the other at the faculty of architecture at Technische Universität Wien. We illustrate how students in these courses are taught to apply POE, focusing on healthcare environments through a structured research process. The courses at both universities teach students to conduct POE in real-life healthcare settings, such as Klinik Floridsdorf and Erasmus MC. Students are introduced to a research question and trained to develop appropriate data collection techniques, including observations and interviews. They gather both quantitative and qualitative data, which they then analyse by integrating findings from multiple methods. The process emphasises linking user feedback with observations of building performance to foster a comprehensive understanding of the relationship between physical design and user experience.

The structured POE training process enabled students to develop a deeper understanding of how design impacts users over time. By applying POE methods, students gained insights into the practical implications of designs and learned about user needs in healthcare environments. We will discuss the potential benefits of integrating POE in architectural training for students, faculty and the architectural profession as a whole.

Learning Objectives

• Recognise the importance of user-centred design
• Develop skills in conducting POE
• Apply POE in the context of healthcare environments

Point of entry – filling the gaps for improved outcomes

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The healthcare 'continuum' is full of interruptions that impact the outcomes of individuals and families. Leland Kaiser was a futurist and inspiring systems thinker. He talked about using systems thinking as the context for describing the future of hospitals and healthier communities. Now more than ever, there is a need for a systems approach to integrate care within supportive built environments that focus on the care populations being served and the fulfilment of service and care co-ordination that is often lacking.

By mapping the built environment with the relevant staff and care population, we will identify the gaps that can be filled with improvements to the built environment, operations, technology use and training and education. Each scenario presented begins with understanding the demographic accessing care and services and their needs from a community-based perspective. Person-centred approaches include following individuals through various situations and circumstances that include the decision-tree trifecta: care, the built environment and positive outcomes.

Join us to discuss case studies that evaluate several point-of-entry scenarios demonstrating gaps that, once filled, can be supportive of a true continuum of care. Looking forward to seeing you there.

Learning Objectives

• Discover gaps in the care continuum from an individual patient perspective
• Learn through case studies and scenarios how to identify gaps in the care continuum
• Use a mapping exercise to demonstrate a systems approach to fill gaps in the care continuum for improved outcomes

Introducing the Silent Hospital: Reducing noise on wards to improve patient and staff experience

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Imagine a quieter, calmer postnatal ward, where mothers and babies can rest and recover without constant interruptions. At the Royal Cornwall Hospitals NHS Trust (RCHT), we have been making this a reality with the Silent Hospital Pilot evaluation project. The initiative aims to reduce noise and alarm fatigue on the hospital’s postnatal ward by silencing traditional call bells and replacing them with a digital alert system. By routing patient calls quietly and directly to smartphones carried by midwives and nursing staff, RCHT has created a more peaceful and supportive environment for both patients and staff.

It's all part of our digital estates plan to evaluate smart communication technology in preparation for our new Women and Children’s Hospital. The New Hospital Programme wants to see significant digital transformation across trust estates as part of its plans. At RCHT, we collaborated with DNV Imatis and Wandsworth Healthcare to silence the call bells. Engagement with Kernow Maternity Voices Partnership and ward staff and patients was essential, so they participated in the design and needs very early on. Information leaflets were circulated to patients on the ward, and a training pack was produced for staff, using a train-the-trainer and superuser model.

The project was introduced on the postnatal ward where the technology could be assessed by receptive patients and staff alike. The idea is to quieten down the ward, helping patients to get better quality sleep and rest, and for staff to not endure 'alarm fatigue'. We took acoustic measurements and response time data logs on the ward, pre and post 'switch on'. We conducted surveys with staff and patients, pre-pilot and throughout the trial, to gain qualitative data. We employed a patient leader for the project who undertook detailed data analysis around noise reduction, patient length of stay, call response times and staff productivity, as well as the wellbeing of patients and staff.

Patients and staff alike have really embraced the modern technology and are keen to continue to trial extended digital capabilities on the ward. Mums reported that they and their babies were more relaxed and enjoyed better sleep quality. Staff reported a vast improvement in the work environment with far fewer interruptions and a much quieter ward. Now, we are on our way to proving that these factors enable faster recovery and reduce patients’ average length of stay by half a day.

Learning Objectives

• To reduce noise levels and understand the impact of noise reduction on the postnatal ward
• To understand the impact of the new technology on patient and staff experience and wellbeing
• To establish any correlation between a quiet ward environment with recovery and length of stay

Bayers Lake Community Outpatient Centre: Redefining outpatient care

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The Bayers Lake Community Outpatient Centre (BLCOC) represents a transformative approach to healthcare design, emphasising population health, the intersection of design and clinical medicine, and the role of art and architecture in promoting prevention and keeping patients healthy. Located near Halifax, Nova Scotia, Canada, BLCOC is part of a broader initiative to decentralise healthcare services and make care more accessible to residents of the Greater Halifax Region. This new facility not only delivers critical outpatient services, such as primary care, diagnostic imaging and specialised therapy, but also integrates advanced technologies and architectural innovations to support wellness and improve patient outcomes.

Initially, the presentation will focus on population health and describe how the BLCOC moves beyond a traditional focus on illness to create a wellness-focused ecosystem. The presentation will demonstrate how flexible space utilisation, digital appointment systems and telehealth integration offers personalised and efficient care. By allowing for virtual consultations alongside in-person services, the facility maximises the reach and effectiveness of healthcare delivery, fostering healthy communities by breaking down geographical and technological barriers. The integration of services and technologies ensures that patients receive care in a seamless, timely and compassionate manner.

Secondly, the presentation will explore how the facility exemplifies the intersection of design and clinical medicine, particularly through its human-centric architecture. The Great Hall, a central feature of the facility, is a double-height glazed space that serves as a welcoming and restorative environment for patients, families and staff. The building’s modular design, with adaptable clinical spaces, allows for the flexibility necessary to meet changing healthcare needs and technological advancements. This adaptability is crucial in an era of evolving medical practices and patient expectations, offering both functional and humanistic solutions to clinical service planning.

Lastly, the presentation will walk through how art and architecture play a pivotal role in promoting wellbeing, dignity and identity within the BLCOC. The thoughtful design incorporates natural light, soothing colours and views of the surrounding Birch Cove Lakes Wilderness Area to enhance emotional healing and recovery. The careful selection of materials and attention to detail in spaces dedicated to patient privacy contribute to a sense of dignity and respect. Communal spaces foster social interaction and emotional support, while evidence-based design principles ensure the facility is functional, accessible and safe.

BLCOC sets a new standard for healthcare architecture, blending cutting-edge technology with an empathetic, patient-centred design that prioritises the holistic needs of both patients and staff.

Learning Objectives

• Understanding the role of architecture in population health
• Exploring the intersection of design and clinical medicine
• Evaluating the impact of art and design on wellbeing and dignity

Designing spaces for medically-assisted deaths

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Medical assistance in dying (MAiD) is increasingly becoming legal in countries across the world. Within Canada, where MAiD became legal in 2016, patients can receive care in any care area, save a few. Within British Columbia, faith-based healthcare facilities can opt out of supporting MAiD. A request to receive MAiD within those facilities requires the patient to move from where they receive care to an alternate clinical space with a secular healthcare provider. To limit the movement and clinician manifestations of being moved at the end of life, adjacent spaces were created. These spaces are close to faith-based facilities, and most allow for patients to remain in their bed while being transferred. This adjacent space creation has been different for a variety of reasons, both in its conceptualisation and in its creation. For design, the process can elicit questions such as “what is considered a good death and how can design support that aim" and “how is designing for MAiD different than other healthcare options”.

The answers to these questions do change. The clinical team has supported the creation of five spaces, thus far, and more are being considered. With each iteration of the space, learnings from the previous creation are brought into the new build; these learnings include the requirement to not share the space, and the essential need for the space to meet the cultural needs of all patients and their families. Creating these spaces presents a design opportunity to support and honour the clinical care option taking place, while also trying to meet the needs of patients from a wide variety of backgrounds while they experience the death of a loved one.

Additionally, it has been noted that creating these spaces is different from other builds. Design and clinical teams have not only experienced the need to support collaborators through the ethical consideration and justification as to why these spaces are clinically necessary, but also have had to alter designs and processes in order to address concerns about the deceased patient being seen. These additional complexities are unanticipated labour that can slow or halt a project if not addressed sensitively.

As MAiD becomes legal in a more and more countries, these design experiences and their implications need to be explained, examined and discussed.

Learning Objectives

• Examine elements of design that are essential in spaces that support MAiD
• Examine the unique ethical issues that are present when designing spaces for MAiD
• Discuss how personal experience and perspectives might play into design

The expansion in the transition towards community healthcare – a global perspective

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As our global healthcare systems continue to evolve and transition, within Arcadis we are seeing some global trends emerging in the work that we do. Our client base across our European and North American regions vary – from healthcare systems, academic healthcare systems to contractors and local authorities – yet whether the healthcare system is public or private, we are continuing to see, through completed projects, a continued transition of care away from the acute setting.

Through examination of a series of exemplar case studies, our presentation will present effective ways in which this is being achieved, alongside key issues which each individual scheme is further responding to, because of its regional context.

In the UK, our work in Wales, such as the Bevan Health and Wellbeing Centre in Tredegar, reflects the ambition of the local health board to transform its clinical futures, supporting the population health of the local community. The development, built in the hometown of Aneurin Bevan, the founder of the NHS, opened in January 2024, and respects the sustainability objectives of the Well-being of Future Generations (Wales) Act 2015. This example demonstrates how an aligned healthcare system can focus on community healthcare investment to reduce activity in an acute setting, while providing a greater level of community support.

In North America, our work with academic healthcare systems, in both Miami and San Diego, follows a similar trend, whereby the co-location of a variety of healthcare specialists work collaboratively to support individuals’ health and wellbeing. Service offerings are bespoke to each facility, reflecting the needs of local communities and providing access to key service lines, with the added academic overlay of creating research opportunities into community health and wellbeing.

Common design themes around flexibility, reflecting opportunities to continue to flex and vary services over time, human experience, efficiency in operation and a drive to increasing the level of sustainability are evident in all of these schemes.

Learning Objectives

• Improving preventative health
• Sustainability
• Investment

A village apart

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This research paper was produced as part of a written thesis for a Master’s degree apprenticeship in architecture at Northumbria University. Through continued research into the topic of later-living housing, it became apparent that most, if not all, of the purpose-built ‘retirement’ developments (including extra care facilities and sheltered housing) currently being designed and built today are age-exclusive, intended only for residents aged 55 and over.

With the divide between ages continuing to grow within the country, research was conducted to investigate possible age-integrated retirement communities – and the results yielded were minimal, leading to the following research questions.
- Why are current retirement communities within the UK age-segregated?
- Is creating age-segregated communities harmful to the wider context?
- How do residents within retirement communities feel about living in an age-segregated environment?
- What are the benefits of intergenerational approaches within retirement communities?
- How can we design communities with a more intergenerational lens?
- Could intergenerational living become a positive preventative measure, reducing hospital referrals and admissions?

The research ‘A Village Apart’ aims to explore the concept of age segregation and the effects it has on wellbeing, social integration and links to ageism while evaluating the impact this has on retirement communities within the UK, and to investigate whether we should be looking more deeply into intergenerational approaches in order to design and create more holistic and sustainable environments for people to age in, thereby reducing the strain on the NHS.

Several interviews were conducted with a range of experts from different sectors, including healthcare professionals, council members and housing developers, alongside current residents within age-exclusive retirement housing, in order to better understand attitudes, opinions and potential barriers to intergenerational living.

The overall results of this paper intend to demonstrate the benefits of intergenerational connection and hopefully inspire architects, designers and policy makers to adopt a more intergenerational lens in future schemes.

Learning Objectives

• To study the physical and mental health impacts of age segregation
• To address how intergenerational connection can benefit the wider society
• To understand how architects can design with a more intergenerational lens

Consent to organ donation. The places of communication sensations and perceptions between architecture and neuroscience

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In Italian hospitals, the rooms where the staff communicate the end of life and the request for organ donation to the patient's family members are inadequate. Often, this conversation takes place in a medical examination room or in a doctor's office, where, for the family, knowing about the death of their loved one is already a cause of trauma. However, it has been shown that, if the place is 'human', welcoming and comfortable, and people are prepared, the dialogue between healthcare staff and family members and the final decision are facilitated, allowing a mourning experience without adding further stress.

This research concerns both the topic of organ donation from an architectural perspective – the need to invest in the quality of communication spaces – and the role of neuroscience, which studies the brain activities that come into play when people experience critical moments. The aim of this research is, therefore, to create architectural spaces and environmental features that can support healthcare staff and family members in the process, also considering that, according to neuroscience, the memory of this circumstance could correspond to a biographical rupture in the subjects' lives, a turning point that could change radically their habits.

The case study, at the San Bortolo Hospital in Vicenza, concluded with a design hypothesis for a room, exemplary but not exhaustive, but which aims to be a model of 'humanisation', capable of improving empathic communication and spatial perception. To support the study, a virtual figure, Jack, who guides the user through the project in a video, was introduced. This virtual figure not only helps visualise the architectural model, but also provides the experiential dimension of the space, expressing feelings and emotions that we could also feel in delicate contexts such as that of death or organ donation.

The study generated a set of design parameters available for designers to test on future projects aimed at supporting those who give and receive information about the end of life. Taking into account the principles of humanisation and, therefore, considering the patient as a person and not only as a sick subject – at the centre of care with not only material, but also psychological and spiritual needs – these guidelines are only the beginning of a path that aims to give a concrete answer to the shortage of Italian hospitals and become a requirement of hospital design regulations, of which humanisation is already a mandatory requirement.

Learning Objectives

• The role of spaces for end-of-life communication and organ donation requests
• What empathic human-environment communication is and what a space that supports that is
• The path to follow to change the regulations of hospital design

Sound and music as integral elements of the healing process in hospital design: Analysis of the case of neurorehabilitation inpatient care

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Healthcare environments are essential places for physical care and the restoration of people's wellbeing, but they often present significant problems, some of which are invisible at first sight. Among these, noise is one of the most relevant – and acoustics plays a central role. If not properly managed, it can become a source of great discomfort, increasing the vulnerability of patients and the stress of staff. At the same time, music, already used in the therapeutic field to relieve pain, activating different brain areas, can represent a powerful tool to accelerate rehabilitation processes and improve the quality of life. However, are hospital spaces really ready to welcome this precious resource?

This research explores acoustic improvement and music integration as an inherent part of architectural project, designing them in the early stages of the process and not retrospectively, aiming to improve the effectiveness of care but also not to waste it. In addition to the psychological aspect, a small reduction in hospital stays in expensive departments generates significant savings when large budgets are involved. With the final goal of shaping the hospital of the future as a place respectful of the dignity of the person, the research aims to transform it from a stressful place to a place of calm and wellbeing.

The idea of transformation has been applied to the neurorehabilitation department and spinal unit of the new Padua Hospital, a 963-bed project to be completed in 2031, currently under development by Politecnica, who conducted this research. The integration of music therapy, in particular neurologic music therapy (NMT), was analysed in this department, outlining practical solutions that consider functional, constructive and economic aspects, as well as spatial implications related to light, materials and geometry.

Building on previous successful trials, the application of innovative music technologies to the design of the new Padua Hospital has proven to be feasible. Conceived as a pilot project, with the idea of extending its guidelines – which do not claim to be exhaustive, but constitute a solid basis – to future facilities, the integration of music and acoustic improvement represents a significant initial investment, but the long-term benefits will repay the effort. However, the main added value is human: music contributes to making the hospital experience more respectful and people-centred, for all users.

Learning Objectives

• Information on music therapy and acoustic improvement in hospitals
• Reasons for minimising hospital stay times in the neurorehabilitation department and spinal unit
• The implications of the use of music in improving the effectiveness of care

Towards inclusive learning spaces using affordable MEMS-based environmental monitoring and students’ perceptions

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This research explores the impact of environmental factors – such as lighting, temperature, sound, air quality and spatial layout – on students’ concentration, wellbeing and overall learning experiences. Recognising that students have diverse sensory needs, both diagnosed and undiagnosed, the study aims to support the inclusive design of educational environments that cater to all learners.

The primary aim is to identify and evaluate how these environmental conditions affect students with and without sensory sensitivities, with the goal of enhancing concentration and promoting wellbeing. By incorporating participatory design principles, the research seeks to place students at the centre of the conversation, ensuring their perspectives inform practical and inclusive improvements.

Key objectives include identifying effective methods for measuring environmental factors using accurate and affordable MEMS-based sensors, developing tailored questionnaires to capture students’ subjective experiences, and prioritising the most significant environmental challenges impacting their daily learning. A mixed-methods approach – combining quantitative environmental data with qualitative input – will be employed to gather a comprehensive understanding of students’ needs.

Ultimately, the study aims to deliver actionable insights for educators, designers and decision makers, enabling the creation of optimised learning spaces that support academic performance, holistic development and inclusive educational practices.

Learning Objectives

• Identify and analyse the environmental factors that affect students' concentration and wellbeing
• Explore effective methodologies for measuring environmental factors
• Design an interview schedule to capture students' perspectives on how environmental factors influence their sensory experiences and wellbeing

Impact of peer health navigators supported by clinician ‘health coaches’ on hospital resource utilisation for high-risk adults

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The Northern Patient Watch (NPW) programme was designed to reduce hospital admissions and bed days by patients identified to be at high risk of subsequent readmission by providing proactive monitoring and support through peer health navigators working with health-qualified professionals. Internationally, peer health navigators have been shown to reduce inpatient resource utilisation. This study aimed to assess the impact of NPW on hospital admissions, bed-day use, emergency department presentations and outpatient non-attendance, compared to propensity score-matched controls drawn from the same eligible cohort.

A propensity score matching design was used to compare NPW enrolees with controls over three-, six-, and 12-month follow-up periods. Hospital resource utilisation was the primary outcome, with secondary outcomes including outpatient appointment non-attendance rates. Data were analysed using statistical methods appropriate for normally and non-normally distributed variables, with adjustments made for potential confounders.

NPW enrolees demonstrated reductions in hospital bed days usage across all time points compared to matched controls. The effect size increased over the follow-up period, with NPW enrolees utilising statistically significantly fewer bed-days at the 12-month follow-up compared to matched controls (median 2.00 [0.00, 8.00] vs. 4.00 [CI 1.00, 14.00]). Admissions and emergency presentations were generally lower in the NPW group, although these differences were not statistically significant. Outpatient appointment non-attendance rates were significantly lower in the NPW group at 12 months (107 [44.8 per cent] versus 133 [55.6 per cent]), indicating improved engagement with healthcare services.

The NPW programme involving risk-based eligibility and assessment, clinician induction and team-based follow-up was associated with reduced hospital bed-day usage and improved outpatient appointment attendance. These findings suggest that peer health navigators can play an important role as team members working alongside health-qualified professionals to reduce inpatient resource use and enhance patient engagement. Further research is needed to explore the features of the at-risk population and to evaluate the long-term sustainability and broader clinical impact of such interventions incorporating health navigators working with health-qualified professionals.

Learning Objectives

• Identify high-risk cohorts
• Understand the importance of systems of care and targeted services
• Identify roles for non-health-qualified health navigators as part of front line

Digitising health: A global perspective

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As healthcare systems evolve, several key trends are shaping the industry's future as we approach 2025. Michèle Wheeler, International health and life sciences director at Lexica, highlights significant trends expected to impact healthcare in 2025 and beyond. Globally, healthcare systems are adopting digital solutions to ensure sustainability and affordability in an increasingly complex sector. Disruptive innovation has the potential to transform traditional, expensive, hospital-centred care delivery.

Health policy makers are debating ways to consolidate fragmented health services. Governments and healthcare providers must collaborate to create efficient systems that prioritise patients. Challenges include outdated legacy systems, lack of digital awareness and reluctance to fund critical digital transformations. However, the benefits include a more efficient, resilient and cost-effective healthcare system.

Post-Covid-19, remote monitoring and virtual care have become standard practice. Healthcare providers are investing in advanced remote monitoring platforms for continuous patient observation and early intervention. Recognising the potential of digital technologies to improve accessibility, quality and affordability, the World Health Organization (WHO) urges member states to enhance the use of digital technologies for health. They should consider integrating these technologies into existing health systems to promote people-centred health and disease prevention.

Many economies and regions have developed strategies to accelerate the adoption of digital solutions in healthcare. Digital healthcare is seen as crucial for maintaining economic strength and global competitiveness in an information-driven era. This paper will explore similarities and differences across various global economies.

Success will depend on effective implementation, stakeholder engagement, public-private partnerships and continued investment in healthcare infrastructure.

Learning Objectives

• Understanding digital health: define digital health and identify its components, including smart devices, AI, big data and the internet of things (IoT), and explain how these technologies improve healthcare accessibility, quality and affordability.
• Recognising barriers and benefits: discuss the barriers to digital transformation in healthcare, such as outdated systems and funding reluctance, and describe the benefits, including cost savings and improved system efficiency and resilience
• Innovation and implementation: outline the role of digital health innovations, such as AI in diagnostics and remote monitoring, and understand the importance of collaboration between healthcare and ICT sectors for successful implementation

Best-laid plans: Balancing strategic investment and overplanning in healthcare estate planning

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How did we go from ‘look before you leap’ to decision paralysis? How did we reach a point of agonising indecision because we embraced the wisdom that a hospital planned today must accommodate technological advances, innovations in medical practice and new ways of working that will undoubtedly emerge in the years to come? If an NHS trust that has been ‘planning’ a hospital redevelopment for a decade, while circling around RIBA stage 1 or 2 for years, was handed a construction budget today, how soon would it get its scheme on site? It could conceivably go fast and might even produce a good outcome in five years or so.

Our presentation will explore the critical balance between robust investment planning and overplanning in healthcare estate development. We will consider imperative steps such as setting clear vision and goals, establishing clinical and operational principles and priorities, and addressing knowns versus known-unknowns and the unknowable. Additionally, we will discuss the need for resilience, future readiness and adaptability.

Costs associated with extensive research, meetings and revisions can escalate without necessarily improving outcomes. Bureaucratic inertia can stifle innovation and responsiveness. Overly detailed plans may limit flexibility, preventing organisations from seizing new opportunities in a rapidly evolving field. The UK has long attempted to create standard solutions, such as those of the Best Buys programme, but Nucleus designs ended up being heavily criticised for being undersized, functionally lacking and environmentally poor.

Through analysis of case studies and best practices from international healthcare systems, we aim to provide healthcare estate planners with insights and strategies for delivering resilient health facilities and campuses that remain high functioning well into the future.

In healthcare estate planning, strategic investment is crucial for ensuring that resources are allocated efficiently to achieve long-term goals. Effective planning helps mitigate risks, optimize resource use, and enhance stakeholder confidence. However, over-planning can lead to decision paralysis, where the sheer volume of information and options overwhelms decision makers.

Our goal is to identify the 'sweet spot' where conscientious, rigorous planning contributes to robust investment without becoming an impediment to progress. We will look at standardisation and guidelines that can help elevate the quality of healthcare planning and design, ensuring that healthcare facilities can meet the needs of their communities both now and well into the future.

Learning Objectives

• Critical balance between investment and planning
• Review of modern case studies
• Standardisation and guidelines

Reimagining healthcare environments in Italy: Artistic and architectural interventions as tools for care and human flourishing

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In the evolving landscape of healthcare design, art and architecture are increasingly recognised as transformative tools capable of improving both patient care and caregiver wellbeing (Ulrich et al., 2008; Chatterjee & Noble, 2013). This paper focuses on the Italian context, presenting a systematic mapping of emerging projects and practices that integrate artistic and architectural interventions to humanise healthcare spaces. The research highlights how art is no longer perceived as a decorative element but as a strategic tool to foster healing, emotional support and cultural identity (Montgomery, 2016).

Methodologically, this study combines an analysis of real-world case studies with an innovative pedagogical approach. A central pillar of the research is the Medical Humanities course at the University of Siena, where future healthcare professionals are trained to rethink hospital environments by adopting human-centred perspectives rooted in the arts and humanities. The course emphasises:
- empathy-driven design: developing spaces that respond to the emotional needs of patients and staff (Chatterjee et al., 2017);
- art as intervention: practical exploration of site-specific artistic projects that transform healthcare facilities into places of beauty and dignity (Case study: Fondazione Don Gnocchi, Milan);
- community engagement: involving patients, artists, architects and healthcare workers in co-design processes (Brown & Wyatt, 2010).

The Italian mapping showcases a series of initiatives – from the inclusion of curated art installations in oncology wards to architectural renovations designed to harmonise form, function and wellbeing (E. Bomardieri et all., 2021). These examples illustrate a gradual yet significant shift toward holistic, patient-centred care models where art, architecture and healthcare converge.

This paper argues for a broader implementation of such approaches across healthcare systems. By combining research, education and applied case studies, it provides a replicable methodology for reimagining healthcare environments as living ecosystems that nurture healing, foster human flourishing and address contemporary challenges in care delivery (Gesler, 1992).

Learning Objectives

• Healing environments
• Artistic interventions in care
• Medical humanities

Improving the home environment of people living with mental illness in the community

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People living with mental illness (PLWMI) discharged from wards often move to inadequate homes, with poor conditions affecting their health and leading to rehospitalisations. Despite research on psychiatric wards and the central role of the built environment to deinstitutionalisation and social reintegration, little is known about the built environment after the discharge from the psychiatric ward and how PLWMI’s living conditions affect their health, including clinical outcomes, wellbeing and social reintegration. This cross-disciplinary research brings healthcare architects, clinicians and psychologists, aiming to highlight the importance of the built environment as an integral part of a comprehensive rehabilitation plan.

The research is examining the home environment needs of post-hospitalised PLWMI in independent living accommodation in the community, to prevent relapse and encourage psychosocial reintegration. Methodology includes a systematic review on the needs of PLWMI related to their home built environment and the development of a checklist for evaluating the home built environment to support PLWMI. To validate the checklist, we employ site visits to recently discharged PLWMI living in the community to perform the checklist and conduct semi-structured interviews. The research is underpinned by the sustainable consumption and production (SCP) theoretical model of environmental provision.

By adopting this cross-disciplinary approach, this research is addressing the issue from a 360-degree perspective, both from the built environment and the psycho-social aspect. Findings comprise improvements for the living conditions and support the psychosocial reintegration of PLWMI into the community, targeting social services and government policies on housing and facility conditions for social care, strengthen social workers' skills to assess premises in an informed way and evaluate living conditions, especially in reaction to the environment.

This research project supports that psychosocially supportive environments promote independence for PLWMI. The project findings and validated checklist could be used to inform policy makers, urban planners and housing providers, enabling them to make more informed decisions and develop policies and design guidelines that prioritise the needs of PLWMI. This will help create more supportive and inclusive home built environments, to improve community integration and improved health and wellbeing and, ultimately, benefit PLWMI, carers, health authorities and health and social policies.

Learning Objectives

• The home built environment of PLWMI in the community is central to deinstitutionalisation and their social reintegration
• Build environment factors such as the location, stressors or lack of access to services in the surrounding area, and the environmental conditions inside and around the dwellings, could cause PLWMIs to relapse
• The active involvement of PLWMI and health professionals and social workers in shaping and reviewing the built environment and deinstitutionalisation policies, including Care Quality Commission (CQC) guidance, is imperative

Thinking on a new hospital – our keys for Pisa, hospital of the future

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The New Santa Chiara Hospital in Cisanello (NSC) in Pisa (Tuscany, Italy) is under construction (www.e-chiaracresce.it) as Pisa University Hospital (AOUP). The hospital has approximately 1,100 inpatient beds. The AOUP has 5,000 employees and currently in two hospital facilities – both pavilions. They will be brought together in a single location at the Cisanello Hospital where new buildings will connect to existing ones in an horizontal monoblock. Works will end in 2026, followed by the setting up, moving and redistribution of the activities. This impactful structural change involves transition from the current hospital organisation.

The transfer requires commitment at all levels from today. The company is now focused on managing the change for all workers, as well as for patients and caregivers. The new structure, new spaces and contiguity will change the care processes and organisation, with shared spaces in new settings. This requires a staff training and change management process and a solid smart hospital, including digitalisation at multiple levels, co-ordinated from a command centre.

Research, change management and smart hospital are our key drivers for the move to the future.

First is change management. All healthcare organisations target safe and successful care delivery, pursuing excellence in quality and safety while improving patient and family satisfaction. The NSC project will bring deep structural and technological innovation, leading to new responsibilities, roles and organisational and care delivery models in the new hospital layout. Our approach for change management is to engage the participation of workers with a bottom-up approach, believing innovation must be shared and communicated.

The 'e-Chiara' project will allow the transition of the hospital into a smart hospital model, moving from a digital maturity-level assessment towards a complete transformation of processes into an interconnected and integrated ecosystem. The NSC hospital aims to be an healing environment, patient-centred, fully connected and flexible.

The process we are undergoing, of moving from an old to a new hospital of such dimensions and such high clinical complexity, is not very common. However, we believe that our model of change, based on change management and digitalisation, can represent a winning path to results. The work is managed by a limited group of professionals. However, we have extended the involvement of all interested internal and external stakeholders with a bottom-up approach, giving perspective to all the operators involved on the opportunity for change.

Learning Objectives

• Innovation
• Change management
• Facing new architecture

Bringing care buildings, green space and the urban city together

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In the heart of Malmö, we are designing the Southern Hospital area for Region Skåne. This general consultancy assignment is a collaboration with LINK Arkitektur, Wingårdhs and Sydväst. The project will provide facilities for both children and adults in psychiatry, mobile care teams, specialised palliative care, habilitation and units for vision, hearing and deaf services in approximately ten years. The primary objective is to enhance both transparency and participation during the feasibility study and programming phases. Our goal is for the three parallel processes – urban design, building scale and operational planning – to be closely aligned, with progress easily trackable throughout. This approach has resulted in the creation of a co-produced programme phase report that serves as foundation for decision making across the entire project lifecycle.

This report, completed at standard level, establishes key principles and strategies and aligns all stakeholders around a shared vision. Standardised care clinic and care wards are developed, ensuring flexibility and adaptability in the building's continued dimensioning and evolution.

The project features active dialogue with the City of Malmö regarding the development of the hospital area. We work closely with all stakeholders to design spaces that will support their operations and effective collaboration. The core question is how to create a space that serves the needs of the region's healthcare system, while simultaneously integrating the surrounding urban environment and green spaces. The programme phase report was developed collaboratively by the architectural team and the developer, serving as a key reference point for decision making throughout the design process. It remains a living document, evolving in response to the project's ongoing phases.

One of the most motivating aspects is making healthcare visible within an urban, green space. We continually test requirements through 3D sketches to ensure both functional and safety standards. For example, patient safety is a key requirement, particularly in relation to the separation of flows. We translate these requirements into physical design elements and assess the degree to which they should be implemented. This process allows us to balance functionality, vision and budget, ensuring that the project remains both feasible and aligned with the region’s goals.

This is an interdisciplinary endeavour, with close collaboration between all consultant teams and the client’s skilled organisation. By using standard levels and conducting pressure tests of requirements, we can validate solutions that are sustainable, efficient and practical for long-term implementation.

Learning Objectives

• Standard level
• Co-creation
• Transparent process

Stakeholder collaboration in the NHS Golden Jubilee National Treatment Centre programme

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NHS Golden Jubilee provides regional and national services in Scotland. As the largest single-site elective orthopaedic centre in Scotland, it receives patients from all over Scotland and, with the recent increase in theatre availability, performs over 30 per cent of all Scottish hip and knee replacements. There will be a significant growth in demand for elective surgical care over the next 25 years to meet this demand – and NHS Golden Jubilee has been tasked by the Scottish Government with planning additional elective care requirements.

The Surgical Centre is connected to the existing hospital building at nine connections across three levels. It features:
• five orthopaedic UCV theatres, each with a lay-up prep room and an anaesthetic room;
• five endoscopy procedure rooms and 14 individual patient pods;
• a surgical day unit with 38 patient pods;
• a central sterile processing department;
• storage and supporting accommodation.

The project team worked closely with all key stakeholders ensuring that there was representation from design conception through to operational commissioning. Initial engagement focused on the key attributes and qualities that the facility should include to meet the needs of patients, staff and visitors and third sector colleagues. The brief for the design was to develop an innovative environment that supports the principles of safety, privacy and dignity and also patients who may be anxious ahead of surgery, while reducing reliance on pre-medication ahead of surgery.

As a centre providing high-volume activity, it was also key to improve the process by which patients are admitted for surgery, specifically:
o to reduce patient waiting time between admission to hospital and being taken to theatre for their procedure;
o to develop a design that supports improved patient flow and reduces distance travelled by staff and patients between admission, theatre and recovery.

The introduction of patient ‘pods’ allows the option to improve patient privacy, dignity and confidentiality, and additionally since the pandemic assisted with the prevention and control of healthcare-associated infections (HAIs) while also negating the need for separate clinical rooms. The pods allow the choice for patients to be accompanied by a relative/carer, providing an an environment which supports a more personalised approach to patient care, and enabling family involvement in aspects of care and decision making. There was a a level of anxiousness about introducing pods; however, having stakeholders, including patients, as part of the decision-making process helped, along with the use of virtual reality, and reduced the need for changes at commissioning.

Learning Objectives

• Communication and collaboration
• Engagement with technology
• Setting the direction

An integrated framework for improving healthcare services in chronic disease management: A case study on diabetes management in Saudi Arabia

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Type 2 diabetes mellitus (T2DM) is becoming a serious health issue worldwide. The projections indicate that prevalence could rise to 700 million by 2045. In Saudi Arabia, the situation is especially concerning. Recent data from the International Diabetes Federation shows that the prevalence rate of T2DM is 20.5 per cent, significantly higher than in many other countries. Identified risk factors that lead to T2DM management include age (specifically individuals over 45), lifestyle choices (such as physical inactivity and unhealthy eating patterns), obesity, psychological stress and social determinants of health. An integrated approach that encompasses physiological, psychological and social factors is crucial for understanding and managing T2DM effectively. Thus, this research presents an integrated framework for improving T2DM management by combining social and technical factors.

This study employs design science as a research methodology to investigate how patients, their families and healthcare professionals can incorporate both social and technical factors that impact T2DM management. Data collection involved purposive sampling based on data saturation, targeting older T2DM patients, their family members and various healthcare professionals from multiple hospitals in Jeddah, Saudi Arabia. A mixed-methods design research approach was utilised, integrating qualitative and quantitative methods. Each participant engaged in semi-structured interviews designed to extract information on socio-demographic variables, behavioural and psychological attributes, social support networks and barriers to management. Interview sessions were audio-recorded, transcribed from Arabic to English, and subsequently analysed using NVIVO software.

Analysis of the data revealed several key determinants of adherence, including emotional eating, work-life balance, sleep quality and the frequency and duration of physical activity. These findings have informed the development of a structural equation model to elucidate the relationships among these variables.

Based on these analyses, we are proposing an integrated framework to enhance T2DM management. We firmly believe that proposing this framework will serve as a valuable guide in the development of support interventions aimed at clarifying the critical uncertainties associated with the management of T2DM. We hope that the insights gained from this research will significantly enhance the understanding of various factors influencing T2DM management in Saudi Arabia and ultimately contribute to the generation of new, pertinent data within the field. By addressing these uncertainties, we aspire to pave the way for more effective strategies and improve overall patient outcomes in T2DM management.

Learning Objectives

• Understand the key socio-technical factors influencing type 2 diabetes mellitus (T2DM) management
• Explore the application of design science methodology in advancing healthcare research
• Analyse the integration of social and technical factors to develop an integrated framework for enhancing T2DM management

Robot-human cohabitation: A framework for people living with frailty

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Europe and the UK are promoting innovation for people living with frailty (PLWF) with robots at the forefront. Yet, the adoption of robots in care environments is limited to devices such as voice assistants, even though the robotic industry races to break the commercialisation barrier. Our research, by bringing together expertise from healthcare architecture, population health, human-computer interaction and clinical practice, uncovered a link between robots being tested in labs bearing little resemblance to actual built environments as a barrier to the adoption of such technologies. This discontinuity leads to care environments not designed for robots or the needs of people living with frailty and to not-fit-for-purpose robots for home use, even robots could support PLWF with activities promoting mental and physical agility. Findings led to the creation of a framework for human-robot cohabitation and smart technologies within the built environment.

Methodology included meetings with allied health professionals, visiting the Robot House, home visits including auditing eight lived-in residential properties of PLWF in sheltered housing at Gloucester City Homes. 3D scans of all properties and CAD floor plans were made. 3D scan images were produced to recreate plans of actual lived-in extra care environments simulating the robot’s function within the home environment, using personas for different case scenarios.

Based on data collected, the team produced a multi-level framework that can lead to future research exploring robot and PLWF cohabitation in real homes. It incorporates three levels that triangulate the resident’s needs, the built environment and robots/technology. Level 1 refers to 'Identifying user needs, preferences and social cohesiveness', Level 2 to 'The architectural structure and built environment features' (e.g. how does the built environment need to be designed or adjusted to fit the requirements of the robots to be implemented), and Level 3, 'Technology considerations for the robotic system', to the various types and functionalities of robots.

Currently, most available robots would not adequately fit in an independent living accommodation. This framework encompasses a vision where inclusive residential design supports ageing through facilitation of the use of technological advances and can be used to aid the planning of homes for living with, and technological support for, an ageing population with diverse and changing needs, with the intention of minimising relocation due to those needs. By unifying these three essential aspects, it enables a range of stakeholders, such as planners, architects, housing providers, etc., to consider aspects of those factors that may have hitherto been overlooked.

Learning Objectives

• The cohabitation of humans and robots presents substantial spatial limitations, which impede the effective implementation of robots in caregiving roles
• Most currently available robots would either be ill-suited or pose tripping hazards in independent living accommodations, including care homes
• Robots should be considered as one of the users of the care built environment

Building evaluations and the comprehensive electronic health record for occupant health

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Have you ever wondered why doctors do not include their patients’ built environment in their analyses? After all, the average person spends 60 to 90 per cent of their time inside buildings; why are these not included in healthcare analysis? Current research into the exposome and environmental exposures suggests that the built environment may play an essential role in the etiology of disease. However, there needs to be more data about a patient’s building, and how it can impact their health, that doctors and healthcare professionals can access.

The Architectural Medicine System and the ARxMD software provide a platform to complete this cycle, from a doctor's initial request for building evaluations to the results for architects and building professionals to provide solutions. The long-term impacts of building health are recorded and added to the electronic health record, which becomes a comprehensive health record that includes building data. Data analysis, as building informatics, provides insights into the short- and long-term impacts of indoor environmental quality (IEQ). These evaluations include inspections related to indoor air quality, building materials, gases and toxins (i.e. CO, CO2, NOx), moulds and fungi, lighting issues, sound and noise, thermal inspections, and a range of other inspections focused on occupant health in buildings. These inspections include energy efficiency and topics relating to planetary issues, from climate change to the carbon footprint of buildings.

If no data is collected and analysed on these topics, how can changes be promoted through evidence-based design and evidence-based medicine? This presentation will define the systems required for these professions to work together and show the system functions using the ARxMD software platform. Providing an actionable with theory about health in buildings can be supported by systems and software that record building data. These evaluations can provide insights into patient health beyond the common clinical informatics and provide a direct focus on occupant and planetary health. The Architectural Medicine System process provides solutions beyond the hospital. It supports a health ecosystem for individual patient health and better public health, utilising these datasets for large-scale analysis.

Learning Objectives

• Understand how doctors can use building data for patient health
• How utilising building informatics can provide a bridge to better health in architecture
• Learn about the gaps that currently exist between architecture and healthcare and how to bridge them

Carbon footprint cure: Addressing embodied carbon on healthcare projects

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As operational carbon is rapidly reducing in healthcare projects, the focus is expanding to include the elephant in the room: embodied carbon. Recent regulations, changes to certification systems and client/company sustainability commitments have prompted design teams to undertake embodied carbon analysis in an effort to lower embodied carbon and associated greenhouse gas emissions that contribute to climate change.

A whole-building life cycle assessment was undertaken for a new medical clinic and opportunities were identified and implemented to reduce embodied carbon in the structure and enclosure by 36 per cent. Adaptive reuse of an existing building was pursued for a medical office building to deliver substantial embodied carbon savings. A preliminary comparative analysis was performed for a new hospital that identified key embodied carbon reduction strategies early and predicted their impact on overall embodied carbon for the project.

There are numerous embodied carbon reduction measures and opportunities available for any healthcare project, even with hospital-specific structural design and project constraints. There are also multiple pathways for identifying, implementing and measuring the positive environmental impact of these measures.

Healthcare projects often have massive structures with large carbon footprints – even the lowest-hanging fruit of embodied carbon strategies can have huge carbon emission reduction or avoidance implications. Embodied carbon reduction measures must become the norm in the healthcare industry. There is still work to be done in standardising and streamlining embodied carbon measurement tools and processes to generate more consistent data and make the process more accessible. Additionally, embodied carbon measurement and reduction currently mainly focuses on structure and enclosure – more work from the industry is needed to expand this scope to mechanical, electrical and plumbing (MEP) systems, finishes and furnishings, and site works.

Learning Objectives

• Learn about embodied carbon, why it's important to design teams and owners, and methods available to measure and reduce it in healthcare projects
• See three healthcare design projects that undertook embodied carbon analysis, how we reduced embodied carbon on the project, how embodied carbon is represented in certification schemes such as LEED and BREEAM, and steps to implement it on your next project
• Find out about the limitations and future of embodied carbon analysis and the importance of its role in the total carbon story

Crafting excellence: The art and science of patient experience at UHN Toronto Western Hospital’s new surgical and patient tower

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As healthcare technologies advance at an unprecedented pace, a key question arises: how can we design facilities that accommodate complex medical care while fostering environments that comfort, heal and inspire? The new surgical and patient tower at Toronto Western Hospital serves as a model for achieving this balance through human-centred design.

This session delves into how the integration of space, light, nature and technology transforms the patient journey in a large-scale, urban healthcare setting. From dramatic public areas and community spaces to private patient rooms, healing outdoor environments and cutting-edge clinical facilities, the design elevates every aspect of the experience. Presenters will share how University Health Network (UHN) leadership, along with the DIALOG design team, reimagined healthcare spaces to rival the world’s finest civic environments, setting new global standards for patient experience and redefining the intersection of healthcare and design innovation.

Attendees will learn strategies for harmonising bold architectural expressions with the creation of intimate, patient-centred spaces, and discover innovative techniques for integrating biophilic materials and enhancing access to nature to promote wellbeing for patients and staff while maintaining optimal medical functionality.

Learning Objectives

• Discover design strategies that elevate healthcare environments to world-class standards
• Gain practical insights into stakeholder engagement processes that drive better design outcomes in complex healthcare projects
• Discover innovative techniques for integrating biophilic materials and enhancing access to nature to promote wellbeing for patients and staff while maintaining optimal medical functionality

Integrating country-led design and sustainability in healthcare: The new Shellharbour Hospital development

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The Illawarra Shoalhaven Local Health District (ISLHD) in NSW, Australia, operates on the lands of the Dharawal and Yuin nations, who have lived in the Illawarra Shoalhaven region for millennia. Their cultures, laws, ceremonies and connection to the land and waterways are strong and First Nation people make up 3.4 per cent of the ISLHD population. Steensen Varming has been collaborating with Health Infrastructure NSW and ISLHD on the design of several healthcare facilities within the district, including the new Shellharbour Hospital development. Country-led design and Aboriginal engagement have been pivotal in the design process, led by Yerrabingin as Indigenous facilitator and supported by lead designers Cox Architects and STH Healthcare Planners. Steensen Varming worked with the design teams, client teams and wider stakeholders to establish the sustainability strategy for the new hospital.

The Local Health District (IHD) had high sustainability aspirations for the project, prompting us to host a series of workshops with many project stakeholders and team members to explore sustainability opportunities. Attendees included management and operations staff from the existing hospital, the ISLHD capital projects team, Health Infrastructure NSW and the wider project teams. The workshops examined various aspects of sustainability, helping establish the LHD's priorities and leading to a clear set of goals for the project. Additional workshops were held at each design stage to assess how the aspirations were embedded into the project. These sessions mapped out strategies onto the site, explaining the implications for design in terms of spatial impacts, costs and benefits to the site, patients, staff and alignment with the country-led design process established by the lead architectural team.

Our paper will explore the collaborative approach that led to the development of the sustainability strategy for the new hospital, including:
- early engagement process: input and collaboration with traditional owners;
- establishing broader design principles and the relationship between the hospital and community health promotion;
- educational workshops and co-ordination that helped develop the project sustainability strategies;
- development of building massing and optimisation for daylight, views and interaction with the landscape;
- electrification analysis to enable net-zero operational carbon;
- establishing key sustainability priorities through discussions with, and education of, LHD, stakeholders and design teams;
- discussion of the interrelationships between strategies and key design decisions that promoted positive benefits to patients, staff, the environment and the wider commmunity.

Learning Objectives

• Sustainable healthcare cesign
• Connection with country
• Education of stakeholders and clients

Developing design and legislation in tandem

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Archus was commissioned to develop the clinical services programme, functional programme and business case for the first mental health wellness centres in Alberta, Canada, in response to the needs of a new proposed Act. The Act would give police and family members or legal guardians of drug users the ability to refer adults and youth into involuntary treatment if they pose a risk to themselves and others. The first policy of its kind in Canada, if passed, it is part of the wider model of recovery and treatment, while reducing harm reduction resources such as supervised consumption sites.

Alberta experiences a well-documented opioid crisis, with 1,565 opioid related deaths in 2023. The Government is committed to implementing the ‘Alberta Recovery Model’, adopting a recovery-orientated approach for addiction and mental health, and has already begun to implement many of the recommendations of the ‘Toward an Alberta Model of Wellness’ report, published in 2022, including:
• publicly-funded addiction treatment spaces;
• Virtual Opioid Dependency Program;
• substance use surveillance system;
• recovery communities across the province, providing long-term residential addiction treatment, including on First Nations lands.

In acknowledging that conventional self-directed approaches have been ineffective in more severe cases of addiction, it is recognised that there is a need for expanded treatment supports and pathways for those who are at risk of harm to themselves and others because of their substance use.

Due to the new nature of the concept (only Portugal and California have something similar), this commission required the co-working of parallel workstreams to develop legislation, the clinical programme, the operational model and the design. While much of the legislation was developed in isolation, there was significant degree of co-working in order to understand how the clinical and functional programmes impacted the legislation and vice versa.

The initial programme is to provide adult and youth facilities, and there is already interest in other provinces in the concept, its roll-out and impact.

The presentation will explain in greater detail:
• the developing mental health and addiction model in Alberta;
• the approach to the parallel workstreams;
• the challenges and opportunities that arose;
• the clinical programme, including addressing the ethical concerns of what is a 'new concept';
• the functional programme and design, including 'clinical, not correctional' design and how to address demand vs capacity;
• the business case, including the limited standardisation of an approach to business case delivery in Canada, and the different expectations from the organisations involved about what a 'good' business case should include.

Learning Objectives

• Clinical and functional programmes and impact on legislation
• Recovery-oriented approach for addiction and mental health
• Co-working of parallel workstreams

The wider community benefits of a major capital investment in a new hospital

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Monklands Replacement Project (MRP) is NHS Lanarkshire’s exciting vision for University Hospital Monklands (UHM) and the community it serves, proposing major investment in Lanarkshire’s hospital estate by rebuilding the hospital on a new site at Wester Moffat, near Airdrie. A new, state-of-the-art, net-zero carbon UHM will support the required clinical model to meet objectives set out in NHS Lanarkshire’s healthcare strategy 'Achieving Excellence'.

The decision to relocate the existing hospital will create a ripple effect that responds to desired healthcare outcomes and addresses the region’s stated socio-economic needs. Lanarkshire’s local authorities have carried out extensive community engagement activities and work with local organisations to develop their Locality Outcome Improvement Plans (North) and Community Improvement Plan (South). This extensive and detailed work has been harnessed by the MRP project and utilised to establish wider regional objectives to address community needs, social outcomes and foster a new regenerative identity.

This major capital investment is a transformative event that brings benefits to the wider community. Beyond improving healthcare services, it will stimulate economic growth, create jobs, promote social equity and foster public health initiatives. Additionally, such an investment will drive infrastructure development, enhance environmental sustainability and contribute to medical education and research. As a cornerstone of community wellbeing, the hospital will serve as both a symbol and a driver of progress, offering long-lasting benefits that extend well beyond its walls. The new Monklands hospital has the potential to become the foundation for a longer-term vision for healthcare delivery in Scotland. Its traditional procurement route has allowed the NHS Lanarkshire clinical team far greater control over the detailed development of the design. These clinical components – rooms, suites, cores, equipment – are transferable, available as an up-to-date library, driving updated guidance.

This case study outlines the considerations and components that are forming a new future health ecosystem for Lanarkshire with the new Monklands hospital at its centre. It will explain the economic stimulation the project will foster, the improved access to quality healthcare for the whole region, the broader ‘sickness to wellness’ health promotion and disease prevention shifts, the focus on community hubs where various social services are integrated, the rebirth and repurposing of the existing Monklands site as a key future component in the wider healthcare ecosystem and, finally, the catalytic effect of the new hospital on the development of improved infrastructure and national healthcare design standards.

Learning Objectives

• Population health
• Health planning and investment
• Climate-smart healthcare