Designing for wellness – the digital hospital of 2022

“Salutogenic” may sound like yet another obscure term thought up to describe a bodily function by molecular biologists, but it is in fact a sociological term used to describe a different way of thinking about health and ill-health.

For some time now it has also been applied to principles underlying the design and construction of healthcare facilities, particularly hospitals, to promote wellness rather than the opposite. Salutogenic design is about designing the built environment for wellness rather than disease.

It is also a major topic at next week's Digital Hospital Design conference, one of several satellite conferences being held in conjunction with the Health Informatics Conference (HIC) in Sydney, kicking off on July 30. This is the third Digital Hospital Design conference and it is again being organised by the DHD special interest group of the Health Informatics Society of Australia (HISA), organiser of HIC.

Brendan Lovelock, leader of the healthcare team at Cisco and co-organiser of the conference, doesn't claim to be an expert on salutogenic design but he does believe that its principles, allied to the growing ability of ICT to transform healthcare, are radically altering how we plan and build healthcare facilities as part of a community, rather than the stand-alone entities we all know and dislike.

The new Royal Children's Hospital in Melbourne is a case in point. “It is honestly a wonderful experience; you walk in there and it's beautiful with sculptures and a two-storey fish tank,” Dr Lovelock said. “It's a very sophisticated design, looking at how to make children, and their parents, feel more relaxed.”

One of the fundamental principles of salutogenic design is that if you can make people feel better about themselves, then they'll actually get better quicker, he said. “It started 40 or so years ago when a designer looked at the recovery of people in hospital rooms with windows and without windows. They found that patients recovered quicker and experienced less pain when they had a window with a view.

“In the past, hospitals became more about the delivery of mechanistic care and now they are understanding that the patient is a critical element in their own recovery, so how can we make them feel better, to assist them in their own care?”

Most of the beds at the Royal Children's Hospital are in single rooms, with 80 per cent built with a window looking over parkland. Most are also equipped with a patient entertainment system and with sofas for parents that can pull out into an overnight bed. “That is another element of salutogenic design,” Dr Lovelock said. “With the parents in there, the child feels better and if the child feels better they recover quicker. There are all of those elements about changing the way hospitals deliver care.”

The theme of this year's Digital Hospital Design conference is “building the healthcare system of 2022”, looking at what the healthcare environment will look like in terms of needs from both a public health and an acute care point of view, and what ICT will be needed in those facilities to enable them to support that environment.

“With the ageing population and the increasing cost of care, those resource restraints will be mean that we will be sicker when we go into care and we'll stay there for a shorter time,” Dr Lovelock said. “As a consequence, the community is going to have to take care of a sicker population of people outside of acute care. We'll have to turn acute care resources inside out and link them with primary care and community care and care in the home, to actually deliver the most appropriate care in the most appropriate place.

“It then comes back to what do we do now as a consequence. We are building infrastructure right now – there are about 19 major hospitals that are in the building or delivery phase at the moment – and the government has made significant investment in the healthcare sector. We've got the PCEHR, we've got the NBN, we've got all of the telehealth activities, so now we have the major building blocks to actually create that environment that needs to support that population of patients in the community.

“The question is how do you take those building blocks – the hospitals, the PCEHR, the NBN – and actually bring them together to deliver that future, because we know it's going to be a multi-year journey. That is the next big objective in terms of healthcare.”

While the emphasis is on the acute care sector, the hospital of the future is going to have to become more a part of the community than a stand-alone monolith that barely interacts with primary and community care. The consumerisation of IT, however, is going to radically alter that relationship, Dr Lovelock said. “We are beginning to conceive of hospitals as part of the community and how the hospitals merge in with all of the other community resources.

“I think ICT provides a really important enabler to be able to say you don't need all of your resources to be geographically located in the one spot. One of the big issues we have in Australia is the scarcity of skilled resources in healthcare. You can help free the geographic constraints with ICT, but once you are free of that and can deliver care remotely that is reliable and high quality, then as a consequence you can ask how is care delivered in the community, in the home, in general practice? What will the GPs look like? Will they still be stand-alone small business entities as they are now?

“One of the big trends is the consumerisation of health IT and as a consequence of that the availability of devices and information that allows consumers to take better control of their own healthcare. Not only consumers but the families and the social environment around the consumer, the support of the patient – being able to provide the information on the device to be able to support them means that we have new ways of delivering care and will be able to support them in the ways that they want to be cared for.

“It is about delivering those things in a way that the patient wants it delivered rather than having a more formalistic approach. I see ICT along with physical design as being able to contribute to designing for wellness.”

The Digital Hospital Design conference has sold out and there is now a waiting list for those wanting to attend. Also being held at the same time at HIC are two other satellite conferences – Nursing Informatics and Indigenous Informatics. The latter will concentrate on how the Northern Territory's pioneering electronic health record for indigenous people is now leading the nation.

The Aged Care Informatics conference is being held as part of HIC on August 1. See the HISA website for more information.

Posted in Australian eHealth

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