Deregulation in the healthcare sector has given hospital directors more freedom of choice concerning their new building projects. But what criteria should their decisions be based on? PhD student Johan van der Zwart explains.             

For his research, Johan van der Zwart examined new building in Dutch hospitals in the period 2004 - 2012 and talked to directors and project managers. In his dissertation Building for a Better Hospital he concludes that improving the opportunities for innovation is one of the most important aims. Johan: "Hospitals want their building and their processes to be adaptable to new technologies, for example to accommodate larger, or maybe smaller, medical equipment. Hospital organisations also want to be more flexible, for example by offering more medical care to patients at home." Elderly patients in particular can often receive treatment for chronic conditions outside the hospital setting and this is an important consideration in view of the ageing population. Demographic developments also make it desirable that hospital buildings should be able to be used, either wholly or in part, for other purposes in the future.

Johan van der Zwart used a priority list from the hospitals he consulted to prioritise and define added values to hospital real estate. These form the core of the toolbox.
He then examined the ways a building can contribute to achieving the organisation's goals, such as productivity and patient satisfaction. Sometimes productivity can be improved with a few simple calculations. For example, in one completed new hospital building, the directors found that the remote location of the staff restaurant led to higher costs as staff lost a lot of working time walking to and from the restaurant before and after their break. Johan: "These are things you need to know before you start building. In a hospital building where a lot of walking takes place, you need to calculate the effect of walking routes beforehand."

Creating a 'healing environment' for the patient also affects the cost of business operations. After all, happy patients recover more quickly. It is important that the patient has a view of greenery, sufficient daylight and a minimum of noise nuisance. Privacy, and ensuring a suitable place for doctor-patient communication are also shown to increase patient satisfaction. These are aspects that Johan researched in the architectonic design based on floor plans of an existing hospital.

The toolbox can help to resolve many, although not all, real-estate decisions that need to be made. In any case it provides hospital directors a useful tool to help them make well-considered investment decisions, feels Johan van der Zwart. Particularly when extra investments are required to achieve a higher quality final product, it is useful to be able to substantiate the potential benefits. "The best thing is if you can make adjustments while still at the design stage, and this research contributes to making that possible." 

Published: October 2014

More information

• PhD thesis 'Buiding for a better hospital'