LCB-HEALTHCARE Newsletter #4
In this issue of the LCB-HEALTHCARE newsletter we concentrate on the themes and outputs from the joint conference European Health Property Network (EuHPN), held in Bologna, 12-14 October:
Sustainable European Healthcare Infrastructure: innovation in procurement, planning and design for a green future.
EuHPN organises an annual workshop for its members, and for 2011 the EuHPN board agreed to collaborate with the LCB-HEALTHCARE consortium to put together an event of common interest to both networks. This is the first time that EuHPN has shared a workshop with another organisation. The host for the Bologna workshop was SIAIS – the Italian Society for Healthcare Architecture and Engineering.
As the workshop programme developed, it became clear that, while innovative procurement and low carbon health building design were still key elements, there was a need to begin the event with a thorough examination of how the global financial crisis would affect health facility planning, design and construction. Furthermore, as the LCB network matures, it was also apparent that the workshop should look at links with other networks and organisations, with a view to the future dissemination of lessons from the LCB project.
The above considerations led to an eclectic mix of speakers and participants. We welcomed health planners and healthcare architects, capital investment experts and procurement professionals, supply chain managers and academics, hospital directors and low carbon specialists, from around 15 different European countries. The workshop split naturally into three elements: an introductory, scene setting plenary session on day 1; presentations on developments in innovative procurement, low carbon technologies for healthcare buildings, and lessons from other sectors on day 2; and visits to Italian exemplars of low carbon adaptation in healthcare buildings on day 3. You can find the final version of the workshop programme here and many of the workshop presentations here.
As a quick overview of how the workshop began, here’s a Wordl representation of the keynote presentation on the first day:
Not a strictly scientific analysis, perhaps, but it does give a high level idea of the kinds of issues that were in play during the workshop. Europe’s health systems are changing, and they have to achieve successful transformation in the face of huge pressure on the availability of capital resources. At the same time, the Europe 2020 strategy expects the public sector – most certainly including healthcare – to play a leading role in achieving ambitious carbon reduction targets. How, then, to square the circle? As the opening speaker said, “We can no longer ‘buy’ progress”. The challenge from this presentation was to consider that ‘doing the same thing, but harder’ might not be enough. In other words, while energy efficiency measures and wholesale application of existing technology may be a useful component on the way to a low carbon future, we may need to see a much more radical approach, involving a large-scale transformation of where and how healthcare is provided, in order to meet the health sector’s expected reductions in CO2 emissions.
So - what could help? The workshop presentations can be grouped into a number of themes:
Use architecture and design to nurture innovation in healthcare systems
Two of the expert architect speakers on the first day of the workshop suggested that transformation in health systems can be supported by high quality design. If form follows function, and ‘function’ is to include lower carbon emissions, then health building designers have a responsibility to respond – and indeed to offer solutions that their clients have not yet explored. It was further suggested that the process for commissioning healthcare architects needs a shake up, and that more inventive responses to briefs could be encouraged through the use of open architectural competitions.
Develop accurate, reliable, internationally comparable metrics
Some speakers on day 2 of the workshop gave inspiring examples of re-evaluating health buildings in light of in-depth, detailed measurement of energy use and ‘embedded’ carbon. Some of the results presented were surprising and counter-intuitive, and clearly made the case that some facilities managers need much better information and data before making decisions about energy strategy. This message was reinforced during the day 3 study tour to Rimini, where the hospital’s managers outlined a holistic, whole-system carbon reduction strategy that marries investment in new technology with a long-term programme to change staff and patient behaviour in relation to energy use.
Re-think space requirements
A number of speakers pointed out that a carbon reduction strategy can see quick wins by simply using less space – and therefore less construction material, less energy for heating and cooling, and less resources for maintenance. Speakers gave updates on new methodologies for analysis of activity levels in health buildings, new means to plan and organise patient and staff flow around buildings, and new thinking about integrated care pathway development.
Too often, health buildings are designed for a model of care that is out-of-date before the facility even opens, and the result can be wasted space, wasted energy, and higher than necessary life-cycle costs.
Innovate bottom up, as well as top down
Large scale, strategic thinking is important, whether it’s EU commitment to carbon reduction, national policy on renewable energy, or regional strategy for collective procurement of better building solutions. But small scale projects also have an important role, especially if they are the basis for learning across a health system, and if they can persuade the supply chain that they can be scaled up. A number of speakers – particularly those representing LCB pilot projects – made the case that innovative thinking can start from modest beginnings but become widely influential if the right support and networking is in place.
Learn from others
Health systems have a tendency to be inward looking, and could benefit from lessons already learned in other sectors. For example, local and regional government in many countries has already taken steps to promote public sector procurement as a means of stimulating markets, and may be able to offer ready-made expertise to healthcare facility planners, managers, and procurers.
The EuHPN/LCB workshop organisers made a concerted effort to draw on the experiences of others, and included speakers from local government, clinical networks, universities and other networks. You can visit some of these via the following links:
• Health Care Without Harm
• CleanMed
• ÖkoKauf Wien (for German speakers, or go to the HCWH link for hospital procurement guidelines.
Make use of the Low Carbon Building-HEALTHCARE network
Speakers from LCB pilot projects touched on many of the preceding issues, and it was clear that the practical experience of running pilot projects to make changes to procurement practice is an important test bed, as well as an opportunity to learn how to make sustainable change happen.
The pilot projects who presented were:
Innovative procurement for a sustainable solution – cleaning beds, Erasmus University Medical Centre, The Netherlands.
Ultra Efficient Lighting for Future Wards, The Rotherham NHS Foundation Trust, UK. [LINK TO CASE STUDY]
In fact, all the pilot projects were represented via case study documents, and you can read about Forward Commitment Procurement at Nottingham University Hospitals NHS Trust (UK), Rawicz County Hospital (Poland) and The ‘Nye Østfoldsykehuset’ Project (Norway) here.
Having consulted with a broad range of stakeholders to inform the LCB State-of-the-Art Report, and with country pilot studies now fully underway, the LCB network has produced an informal report titled ‘Creating the Conditions for Innovation: Towards a Good Practice Guide’. This was presented at the Bologna workshop, with an appeal to the participants to contribute to creating a final version, covering the factors that support and hinder innovation in procurement of low carbon health buildings, and looking ahead to production of a final Good Practice Guide in 2012. You can read the interim guide here.
And finally …
… the EuHPN/LCB workshop was a successful partnership that drew on the expertise of professionals working in many sectors, representing many different types of organisation from many different countries across Europe. Bologna was an excellent venue, partly because it could offer visitors the opportunity to see new technologies and methodologies in practice, in hospitals at Rimini, Forli and Ferrara, but also because it has some wonderful examples of sustainability in healthcare infrastructure. Workshop participants had the opportunity to visit one of these, the ‘Teatro Anatomico’ in Bologna University’s Library - a wooden structure, still perfectly fit for purpose, unchanged since its creation in the 17th century!
