Infrastructure resiliency could ensure hospitals are prepared for future challenges

By Natasha Elsner, manager, and Wendy Gerhardt, senior manager, Deloitte Center for Health Solutions, Deloitte Services, LP

If the COVID-19 pandemic has taught us anything, it is that the future is likely to bring new challenges that will increase the need for a more resilient health care system. From climate change to natural disasters to new pandemics, clinicians and medical facilities should be prepared for situations that are difficult to imagine today.

Our Deloitte Center for Health Solutions research on both the Physician of the Future and the Hospital of the Future sheds light on how to build resiliency to manage these imminent challenges.

As part of the research, we interviewed several health care experts, including hospital executives, physicians, scientists, futurists, and technologists. We asked these experts about the types of challenges that might stand in the way of progress. They agreed that the health care sector needs to reduce disparities and make care more equitable. They also highlighted several infrastructure challenges that health care organizations should be prepared to address:

• Energy continuity: With greater dependency on technology, an uninterrupted energy supply is more important than ever. One of our respondents noted that “robots and computers must have power all the time, they can’t skip a meal like a human doc.”
• Natural disasters: Climate change can cause more extreme weather, which could cause health care needs to surge. Natural disasters can also increase the risk of power losses and disrupted internet connectivity.
• Evolving pathogens: Antibiotic resistance, climate change, and ever-evolving infectious diseases could contribute to future pandemics. “Physicians today are growing up thinking they will be mostly concerned about dementia and diabetes, but really we could get hit by some astonishing infectious diseases that none of us are prepared for,” one respondent warned.

Our interviewees offered some solutions and ideas for responding to these challenges that involve flexibility, sustainability, and interoperability.

Interoperability: Infrastructure for digital technologies, scientific advances, and data

Big data and artificial intelligence (AI) are seen as critical tools for forecasting future surges in patient volume. Predictive analytics that incorporate data from multiple sources could support early detection of infectious disease outbreaks, future pandemics, natural disasters, and other risks, as noted in an April 2 Health Forward blog. This can help hospital clinicians and staff predict when additional space might be required or when other precautions need to be made. Such technologies can also be useful in determining demand for supplies and staffing.

Scientific advances and digital tools could also help with interventions and treatment. Genomic tools such as CRISPR can help fight (and perhaps, one day, eliminate) viruses and bacterial infections.^{1, 2} A digital twin—a digital representation of a physical object, person, or system—could also help health entities test the potential impact changes could have on their organization, community, or individual patients. A digital twin for a community, for example, could help organizations evaluate emerging health trends and changes in demand for specific services. A digital twin for a person could help clinicians digitally assess and triage patients and direct them to appropriate care before they even walk through the hospital’s doors.   

Flexibility: Modular space

We expect that future hospital design will allow for space that can be flexed up or down depending on demand. This will likely require modular, flexible space-designs and smaller, more mobile equipment and diagnostics. For instance, ICU oxygen could be rolled into a temporary room instead of being built permanently into the walls and ceilings. Our interviewees described how treatment and diagnostic technology could come to the patient in the future, which could eliminate the need for the patient to be moved to the room that is equipped with the requisite technology. In the future, hospital waiting rooms, communal spaces, outpatient clinics, virtual-health clinician work rooms, and larger patient rooms could be easily transformed into temporary, ready-for-volume-surge rooms.

Access to the buildings could also flex. Multiple entry points could be built into the ER entrance and other critical entry points. Instead of relying on single entry points (where multiple potentially contagious people can contaminate others), virtual triage could reduce traffic and exposure risk by directing patients to different entry points.

Sustainability: Green facilities and reusable resources

We expect that all aspects of hospital operations will be sustainable. In the future, buildings can be smaller and have fewer beds. More clinical care will shift to the home, virtual, outpatient, and other alternative settings.

Hospitals could reduce their environmental footprint through the use of underground parking garages, rooftop gardens, refurbished and reused furniture, and by increasing green space where possible. Medical and other waste might be recycled and reused wherever appropriate. Multiple-use items (e.g., medical tools, instruments, and gear) can help reduce the amount of medical and non-medical waste, like cups and straws.

Energy efficiency and continuity of energy will also be important. We expect to shift from today’s back-up generators and direct procurement of renewable energy from local utilities to greater use of microgrids that could serve large buildings or hospital campuses. While still connected to the central grid, microgrids can make energy generation and transmission more efficient and offer protection from cascading central grid failures. Moreover, smart utilities could increase a building’s efficiency and sustainability. Lighting could be ambient and triggered by movement. Monitoring could automatically predict when heat and air conditioning need to be turned on or off across multiple rooms and facilities or adjusted based on patients’ activity level or sleep cycle.

As care delivery becomes increasingly technology-driven, the continuity and reliability of the internet connection will be critical. While there are no solutions for ensuring strong connectivity during natural disasters and power-supply failures, interviewees were optimistic that advances in networking technologies could lead to solutions in the near future.        

Space designed to be an inclusive experience for all senses

Instead of building a space that can fit a certain number of beds and services, spaces designed for healing, treatment, or rehabilitation should also be built to appeal to the patient’s senses. The building, furniture, equipment, lighting, and its surroundings should all be visually appealing. Ambient sounds could be used to help patients feel more at ease. Smells are also important because they can help with emotional connections. There also should be more communal spaces that give patients a place to lightly exercise, socialize, and be comfortable outside of their rooms (where they spend the majority of their time today).

“Investing in this [pro-social design] is actually going to save you money,” one interviewee suggested. “The experience and emotional mindset of the person is better, and the person will get well faster.” Our research highlights two global hospitals that are focused on sustainability and design, using features that naturally align with human-centered design principles.

• Karolinska University Hospital in Sweden is largely a glass structure that maximizes natural light to promote healing. The hospital is also designed to be much quieter and calmer than a typical hospital (see The digital hospital of the future).
• Australia’s Royal Adelaide Hospital is one of the first large-scale hospital complexes in the country to obtain a “4-Star Green Star—Healthcare as Built” rating. Rainwater harvesting, natural-light optimization to boost energy efficiency, and high-efficiency fixtures for water recycling will help reduce greenhouse gas emissions by 50% (see Is the hospital of the future here today?).

Preparing today’s hospitals for the future and for the challenges ahead

Health care organizations already do a great deal of emergency preparation and have heroically treated (and are still treating) surges of COVID-19 patients using innovative therapies. The future brings new challenges that are difficult to imagine. In designing the hospital of the future, organizations should prepare for enduring features and strategies that can ensure resiliency no matter the challenge. Flexibility, sustainability, and interoperability are three areas that can help hospitals move toward that end. 

Endnotes

^{1.        Is CRISPR the next antibiotic?, The New York Times, October 28, 2019}

^{2.        Scientists program CRISPR to fight viruses in human cells, Scientific American, October 23, 2019} 

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