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Updated: Developing World Class Hospitals in China: Lessons from All Corners of the World

by Karen Prosser

Publisher‘s Note: It is difficult to know the number of major hospitals around the world. North America houses close to 9,000. China has more than 20,000. There are many thousands in Asia, Europe and over 500 in the GCC. But for the rising Dragon, here are lessons that may assist their people so as to not make the same mistakes others have made. May this also provide insights to the rest of the world and improve their healthcare sectors for present and future generations. Kindly read the update at the end of this article.

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August 11, 2012 (TSR) – As populations and life expectancies increase, spending on healthcare follows. Standing at only five percent, healthcare spending in China has been relatively small per capita as a ratio of GDP compared to western countries,  but investment in health has almost doubled over the last six years and is expected to continue growing at double-digit rates for years to come.

The large rise in the elderly population is also expected to impact health spending. By 2020, nearly 12% of the population is predicted to be older than 65.  This defines China as having an “ageing population”, according to the National Bureau of Statistics of China. With studies in Japan showing that around 80% of healthcare spending is for patients older than 65, there is a real need to develop hospitals that enable doctors and clinical staff to deliver the highest standards of medical care.

FOR FUTURE GENERATIONS

“The key is to blend the best ideas, developing the right system and approach for each hospital to meet
the health needs of the community.”

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If hospitals in China are to deliver the very best in healthcare outcomes for their patients, there are several areas that need to be considered when assessing what is needed within any community.  These areas include, among other things: demand management or forecasting of clinical services that will be required; planning and strategy around the hospitals which need to be developed; and efficiency of operating the building, including how space can be used more effectively.

Using our international experience we have identified the following areas of best practice to help deliver better healthcare outcomes more efficiently.

DEMAND MANAGEMENT AND FORECASTING

In many cases, hospitals focus on the early part of the journey when the design is being considered and base it on short-term needs rather than long-term expectations and planning. This routinely leads to costly and disruptive changes later in the process, particularly when they occur after the facility is built. In turn, this then causes delays in the ability to fully use the hospital and results in wasted time and money.

With populations growing and people living longer as a result of technological and pharmaceutical breakthroughs, the need for medical care increases year after year and forecasting the needs of these growing populations is crucial to making hospital building and management a success.

When planning for medical care facility needs, developers need to take into account such things as the age profile of a population, specialty needs, clinical disease incidence, the number of collaborating sites within the area, and what services they provide.

This planning work will provide a clearer picture of the kind of clinical service demand that may arise in the future and can limit disruptions or high costs associated with required changes after a medical facility has been built.

PLANNING AND STRATEGY

Consultative involvement is important to enable clear plans to be made as to how busy a hospital will be and therefore what size and type of building is required to meet this need. It is normal in China for patients not to visit a primary care physician but to go directly to the hospital, even for the most minor illness. This means that hospital emergency waiting rooms routinely clog up with potentially 2000 patients per week awaiting treatment – for ailments ranging from broken bones to a common cold – in rooms that were initially designed to hold much fewer.

Too often, organisations are in a rush to build the hospital without developing a benchmark against which to measure future success. For China, which has embarked on a huge build program, investing more than USD 133 million over the next three years, careful planning and strategising must be undertaken to ensure that the money is spent wisely and that high-quality hospitals can be built, avoiding among other things, building hospitals where emergency waiting rooms’ capacity are far too small.

When projects are poorly-managed and planned, it invariably leads to buildings that don’t meet the needs of medical staff who then complain and want areas to be redesigned to enable them to deliver high quality patient care. Involving clinical staff, medical professionals or consultants with experience during the planning phase avoids this kind of issue.

With the costs of hospital projects worldwide ranging from USD 2,642 to USD 7,482 per m² and for clinics between USD 1,200 and USD 4,000 per m² (derived from our sample of 18 worldwide schemes in 11 countries) , there are many issues to overcome in appraising the project costs/space of similar hospitals.   

Whilst part of the difference in cost comes down to labour, location or specialty-based costs, much of the difference can be explained by other factors and cultural influence. These factors include: national government/statutory standards; town planning and engineering resilience; accreditation; strategy around procurement of equipment, quality of external and internal environment; and expectations from patients and their relatives.

It is in the interests of all stakeholders to ensure that at an early stage, hospitals and clinics are clear what standards they want and  why they want to apply them. The key is blending ideas to ensure each m² provides value and has a clear long term usage, but in our experience many facilities could achieve 10% reductions in gross floor area by taking a more commercial view of asset usage and delivery. This can be done by bringing procurement, clinical and non-clinical uses together and reworking activity and processing.

CONCLUSION

Simply picking one country’s methodology and replicating it isn’t going to achieve the best results for building and managing the region’s healthcare facilities. The key is to blend the best ideas, developing the right system and approach for each hospital to meet the health needs of the community and get ‘buy in’ from clinical staff as to how healthcare will be delivered.

Whilst healthcare is a specialist industry, evidence from other countries has shown the benefit that can be achieved through international best practice. This form of evidence based design is an emerging science and striving to achieve excellence, ensures that health organisations can move forward by creating a new model for health facilities building and development that can lead to better outcomes for patients.

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AUTHOR: Karen Prosser

Karen Prosser is a Partner at EC Harris and leads Equipment Services across the public sector business.  Her role involves providing consultancy to both private and public clients as well as procurement and equipment audit services. She specialises in developing solutions for health and education clients, having done so on a number of major PFI projects within the UK, as well as providing advice in relation to high technology equipment services across Europe.  She also has extensive bid management experience. Prior to EC Harris, Karen worked as a radiographer for a number of teaching and acute Hospitals within the NHS and the Private Sector.  Her experience in the NHS has provided her with a sound understanding of the requirements of the Health sector and how clinical services can be delivered working in partnership with the NHS. Karen is now based in Hong Kong.

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On September 17, 2012, China released a positive response to our recommendation in their state media, Xinhua:

Chinese government plans to encourage more private investment in the country’s hospitals, Health Minister Chen Zhu said Monday.

In 2011, there were 3.81 hospital beds for every 1,000 Chinese people, which is a high rate among developing countries, Chen told a press conference.

He said public hospitals would see moderate development while more room would be made for growth of private investment in the sector.

Qualified private investors would be given priority to new hospital constructions, he said.

Efforts should be made in planning and management of medical resources to secure orderly development for private health care institutions, Chen said.

The minister pointed out that the government would also encourage private funds to invest in construction of rehabilitation hospitals, nursing homes, geriatric and chronic disease hospitals. Chen also called on private hospitals to improve their service quality and efficiency.

At the end of 2011, there were around 22,000 hospitals and 918,000 grassroots-level clinics across the country. The number of medical practitioners for every 1,000 residents increased from 1.47 in 2002 to 1.82 last year, Chen said.

The accessibility of health care services for residents has improved, the minister said, noting that hospitals and clinics nationwide had received 6.27 billion outpatients and 150 million inpatients in 2011.

China currently has more than 6,000 private hospitals, making up one third of the country’s total, but the numbers of beds and patients received at these hospitals only account for 10 percent and 9 percent, respectively, of the total, he said.

The proportion rates of hospital beds and patient volume provided at private hospitals should double by the end of 2015, as the country pledged for both rates to reach 20 percent during the 12th Five Year Plan period (2011-2015), according to Chen.

At the press conference, the minister expressed his appreciation over the commitment of medical workers of the Hong Kong Special Administrative Region on the mainland.

Medical workers from Hong Kong worked with their mainland peers on a number of projects, including one that has helped 100,000 impoverished cataract patients restore their sight through free eye surgery, Chen said.

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