trends and pressures in dutch hospital design
TRANSCRIPT
TRENDS AND PRESSURES IN
DUTCH HOSPITAL DESIGN
Menno Hinkema
THE ORDER OF THE DAY
TNO and healthcare infrastructure
The Dutch healthcare system: an introduction of sorts
Hospital responses to systems change pressures
Current and future trends, challenges and threats
What’s next: planning your 2020 field visit
Summary and questions
Trends and pressures in Dutch hospital design
TNO AND HEALTHCARE
INFRASTRUCTURE
TNO IN A NUTSHELL
Trends and pressures in Dutch hospital design
Trends and pressures in Dutch hospital design
TNO IN A NUTSHELL
STRATEGY TRANSITIONS
Industry
Safety & Security
Urbanisation
Healthy Living
Energy
CONCEPTUAL APPROACH
Trends and pressures in Dutch hospital design
TNO PRIORITIES IN RESEARCH AND SERVICES
Trends and pressures in Dutch hospital design
THE DUTCH HEALTHCARE
SYSTEM – AN INTRODUCTION
OF SORTS
SOME KEY (BUT BORING) FACTS
Trends and pressures in Dutch hospital design
Bismarck system: funded through mandatory health insurance
premiums
Total expenditure 2015 circa € 72 billion
Health services delivery is negotiated with providers on behalf of
patients by private health care insurers
All healthcare organisations are private trusts
All health care real estate is privately owned
System management and governance is highly decentralized
Hospital care and primary care consistently score well in
international benchmarks
Long-term care very expensive
Capital costs for health estate investments have to be covered
from production-based fees
Trends and pressures in Dutch hospital design
PRESSURES
ON INFRASTRUCTURE
USE AND DESIGN
LEGISLATION BALANCE OF POWER
PRICING
BUDGET CUTS
URBAN DEVELOPMENT
AND SUSTAINABILITY
Deregulation of healthcare
building projects
Loss of financial safeguards
>70% DRGs subject to free
price negotiations
Relaxation of obligation on
health insurers to contract
with all providers
Tougher energy performance
targets
Redevelopment schemes on-
site and off-site
Hospital vs hospital
Hospital vs health insurer
Hospital management vs
medical staff
Overall budget cap
Individual product prices
Trends and pressures in Dutch hospital design
HOSPITAL RESPONSES TO
SYSTEMS CHANGE PRESSURES
RESPONSE TYPOLOGIES
Trends and pressures in Dutch hospital design
Coping strategiesConstantly changing cognitive and
behavioral efforts to manage specific
external and/or internal demands that are
appraised as taxing
Strategic positioning
Performance management
Infrastructure
Just plain silly
Trends and pressures in Dutch hospital design
STRATEGIC POSITIONING PERFORMANCE MANAGEMENT
New wave of mergers between mid-size
acute hospitals
Reduction of number of hospital
organisations to 30-40, each servicing
300.000 – 500.000 people.
Primary motivation: create regional near-
monopolies to strengthen negotation
position with health insurers
Other motivations: economies and
necessities of scale and scope
WHAT ÁRE WE SEEING IN
INFRASTRUCTURE RESPONSE?
“THE BAD LUCK OF THE DRAW”
Trends and pressures in Dutch hospital design
THE PROBLEM
Large hospital plans often take a very
long-time to progress: often >10 years
from first ideas to opening of new facility
Opportunities to influence future
performance diminish rapidly as the
design process progresses
A number of hospitals conceived in the
early 2000’s were built on models and
assumptions that are proving hard to
sustain under new systems conditions
“THE BAD LUCK OF THE DRAW”
Trends and pressures in Dutch hospital design
EXAMPLES
Isala Ziekenhuis - Zwolle
Orbis Medical Park - Sittard
Vlietland Ziekenhuis - Schiedam
WHAT WENT WRONG?
Jeroen Bosch Ziekenhuis
Den Bosch
“Lag” in service delivery models.
Important elements of the functional
brief proved superseded once the
hospitals were operational
Ambition and prestige were important
determinants in decision making
processes
Designs and business cases based on
unrealistic growth figures and market
assumptions
Bad luck: built during the financial crisis
Result: these new builds have been
heavy burdens on operations and in
some cases have led to near-bankruptcy
situations.
THE HOSPITALS THAT NEVER WERE
Trends and pressures in Dutch hospital design
RTIC - Heerhugowaard
Gemini Ziekenhuis – Den Helder
ADRZ - Middelburg
TOO EARLY TO TELL
Trends and pressures in Dutch hospital design
Medisch Spectrum Twente
Enschede
Hospital type: tertiary acute hospital
Floor area: 78.000 m2
Beds: 620
Completed: 2015
Architect: IAA Architecten
Constructive design: Bartels Ingenieurs
Engineers: ARUP
TOO EARLY TO TELL
Trends and pressures in Dutch hospital design
Reinier de Graaf Gasthuis
Delft
Hospital type: acute hospital
Floor area: 56.000 m2
Beds: 475
Completed: 2015
Architect: EGM Architecten
Constructive design: Corsmit
Engineers: Deerns
SOME HAVE BEEN DOING A
RATHER BETTER JOB….
THE LAYERS MODEL
Trends and pressures in Dutch hospital design
LAYERS ORGANISATION
Trends and pressures in Dutch hospital design
“Hot floor” environment
“Hotel” environment
“Office” environment
Meander Medisch Centrum
Amersfoort
Hospital type: acute hospital
Floor area: > 100.000 m2 (includes non-
hospital functions
Beds: 584
Completed: 2013
Architect: Atelier Pro
For an overview of the design and
construction team and plenty of
images of the completed project,
check out:
http://www.atelierpro.nl/nl/projects/32/
meander-medisch-centrum#.Vt6t-
U0UXIV
LAYERS ORGANISATION
Trends and pressures in Dutch hospital design
Ziekenhuis Bernhoven
Uden
Hospital type: acute and regional hospital
Floor area: circa 54.000 m2
Beds: 380
Completed: 2012
Architect: de Jong Gortemaker Algra
Constructive design: Aronsohn
Engineers: Royal Haskoning
LAYERS ORGANISATION
Trends and pressures in Dutch hospital design
Gelre Ziekenhuizen
Spittaal location
Zutphen
Hospital type: regional hospital
Floor area: circa 32.000 m2
Beds: circa 200
Completed: 2010
Architect: Royal Haskoning
Constructive design: Dura Vermeer
TAILORED FLEXIBILITY - LIFETIME
Trends and pressures in Dutch hospital design
Reinier de Graaf Gasthuis – Delft. TNO Masterplan
TAILORED FLEXIBILITY - LIFETIME
Trends and pressures in Dutch hospital design
Reinier de Graaf Gasthuis – Delft. TNO Masterplan
TAILORED FLEXIBILITY - LIFETIME
Trends and pressures in Dutch hospital design
Reinier de Graaf Gasthuis – Delft. TNO Masterplan
TAILORED FLEXIBILITY - LIFETIME
Trends and pressures in Dutch hospital design
Reinier de Graaf Gasthuis – Delft. TNO Masterplan
TNO produced a study into lifetime flexibility for 35-year
lifespan. Focus on expansion flexibility (concern because
of tight site); reallocation of floor area; timely replacement
of technically complex (hot floor) facilities. Planned
replacement/demolition of surrounding buildings factored
in to scenario.
TAILORED FLEXIBILITY – GENERIC SPACE
Trends and pressures in Dutch hospital design
Deventer Ziekenhuis - Deventer
TAILORED FLEXIBILITY – LEGO STYLE
Trends and pressures in Dutch hospital design
Martini Ziekenhuis - Groningen
TAILORED FLEXIBILITY - USAGE
Trends and pressures in Dutch hospital design
Orbis Medical Centre - Sittard
TAILORED FLEXIBILITY - SITE
Trends and pressures in Dutch hospital design
Martini Ziekenhuis - Groningen
BUSINESS MODELS – HYBRID USE
Trends and pressures in Dutch hospital design
Maasziekenhuis Pantein - Boxmeer
BUSINESS MODELS – DB(F)MO
Trends and pressures in Dutch hospital design
Zaans Medisch Centrum – Zaandam (under development)
The Zaans Medisch Centrum entered into a
strategic alliance with BAM Utiliteitsbouw and
its project development daughter company
Vitaal Zorgvast. These organisations have
signed a long-term contract for design,
construction, technical operation and
maintenance of the new hospital. The new
hospital is currently being constructed. The
Zaans Medisch Centrum is the first hospital
project in the Netherlands showing this degree
of strategic long-term collaboration.
BUSINESS MODELS – INNOVATIVE PROCUREMENT
Trends and pressures in Dutch hospital design
The Erasmus Medical Centre in Rotterdam
procured a robotic bedwashing facility, using
an innovative procurement format
characterised by early engagement of
potential bidders in pre-competitive and
competitive dialogue, and by performance
instead of solution specifications
Erasmus Medical Centre - Rotterdam
SO WHAT CAN WE EXPECT
TOMORROW?
DESIGNS FOR NEW TYPOLOGIES
Trends and pressures in Dutch hospital design
NHS NORTHERN IRELAND STRATEGIC
INFRASTRUCTURE VISION
DESIGNS FOR NEW TYPOLOGIES
Trends and pressures in Dutch hospital design
EVIDENCE-BASED DESIGN
Trends and pressures in Dutch hospital design
EVIDENCE-BASED DESIGN: REACTIVATING HOSPITAL
Trends and pressures in Dutch hospital design
Inpatient wards
From
To
Pilot project with Dutch
hospital and SME suppliers
SMART ENERGY MANAGEMENT AND DESIGN
Trends and pressures in Dutch hospital design
LOW-COST INTERVENTIONS
Trends and pressures in Dutch hospital design
CHALLENGES AND THREATS
LIFE ON A BUDGET
Trends and pressures in Dutch hospital design
Hospital buildings have to be kept operational
beyond their projected cast-off date
Pressures on investment and maintenance
budgets are severe. How to allocate funds
wisely?
Hospitals, architects and engineer need to
travel a learning curve on identification and
management of critical risks
Research is showing up new routes to
establish organisational performance
equivalencies to technical performance
criteria
EXTERNAL THREATS
Trends and pressures in Dutch hospital design
The Netherlands are not known
for spectular geography.
Nevertheless…
VU Medisch Centrum Amsterdam
Burst water main
Man-made and natural environmental
disasters require a rethink on disaster
preparedness. Water resilience is a
priority topic
YOUR NEXT STUDY TOUR (WELL, IN A FEW YEARS
TIME….)
Be sure to check out the Meander and Bernhoven hospitals. Their methodical layers approach to
functional lay-out is interesting. And if there are any drawbacks, these should become clear after a few
more years’ operations.
Go see the new regional hospital facility in Scheemda (Northern Netherlands). Construction is about to
start right now.
The Erasmus Medical Centre should have completed it building project portfolio in one or two years
time. It is by far the biggest single hospital project ever carried out in the Netherlands (> € 1 billion
investment). And you’ll just have time before they need to start refurbishing the oldest bits….
Trends and pressures in Dutch hospital design
IF YOU CAN’T WAIT THAT LONG….
Trends and pressures in Dutch hospital design
The City of Groningen, The Netherlands
1-4 June 2016
Game changing concepts for Healthy Ageing and the
built environment
• Over 50 lectures, workshops, mini-
seminars and special events
• From high tech healthcare design to
healthy urbanism and sustainability,
also stopping at genetics research and
big data
• See you there!
OVER TO YOU!