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Sustainable hospital infrastructure

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Building a smart & sustainable hospital infrastructure and rethinking strategies required is the need of the hour 

Countries across the world are under unprecedented and volatile pressures due to the ongoing pandemic and number of challenges associated with it, casting greater responsibility on the governments to protect, nurture and provide a sustainable environment and build a pool of resources for the country. This comes on top of already-existing challenges that the healthcare sector was grappling with including growing national demand for health services, investment and funding and overall impact on the environment. Amid all this, building a smart & sustainable hospital infrastructure and rethinking strategies required is the need of the hour. Moreover, these challenges are the driving force behind adaptation of more sustainable design solutions which will not only reduce the operational costs but will also generate better health and well-being outcomes for patients.

Highlighting the challenges posed by COVID-19 and need for adopting structural changes, Akshat Seth, CEO, CK Birla Healthcare said, “COVID-19 has correctly taught us that there might not be a virus erupting every day but it is every day that we must be prepared. The structural changes introduced during COVID-19 teach us an important lesson about sustainability-hospitals have to be adaptable and flexible. The pandemic taught us that the routine medical requirements of patients should be addressed, uninterrupted. A conscious healthcare system, thus, should provide for robust design for infection control & patient safety, modular design to allow for zoning services /spaces, integrated designs to incorporate natural healing & wellness and natural healing through exposure to sunlight. Space repurposing should be planned according to the evolving social norms, facility operations and infection control measures. To put it briefly, we should aim to build hospitals without rigid walls, buildings that we can remodel to heed to the crisis and offer uninterrupted high-quality medical care.”

Sharing his views on the same, Col. Hemraj Singh Parmar, Co-founder, DoctCo said, “The lack of pre-defined clinical processes for aiding a significant number of patients falling sick at once overwhelmed our healthcare ecosystem. There were two major issues; inadequacy of infrastructure (equipment, medicines, life support equipment and trained manpower) to deal with mounting COVID positive cases and poor clinical and operational protocols. Acute shortage of life-saving medicines and medical devices only added to the woes. This situation calls for a rethink on the sustainability of healthcare infrastructures keeping futuristic requirements in mind and our ability to deal with natural or manmade disasters of this scale in future. Hospital design, therefore, needs to undergo a drastic transformation in line with future requirements.”

Stressing on the need for revamping infrastructure to suit today’s sustainable approach, Dr S. Narayani, Zonal Director, Fortis Hospitals Mumbai said, “Currently, most hospitals have centralised control units. But during the COVID19 pandemic, this aspect proved detrimental. What hospitals must do differently, is that we need to break the air-handling units into small pods, where you have the opportunity for open ventilation & an opportunity for segregating or isolating/ compartmentalising sections of the hospital. Additionally, when you plan your air conditioning systems and everything in the right and more sustainable way, you can add elements of nature. By doing so, hospitals can be at an advantage to understand wind direction and place equipment, furnishing etc., and create ambient spaces – one that does not remain heavily dependent on air-conditioning to keep your environment right. This will be an important change and progressive step towards sustainability in the long run. The second thing to do is to tackle hospital waste. It is significant for every hospital to relook at the amount of waste each unit generates in terms of biomedical waste and office generated waste. There is an urgent need to regulate hospital waste management. Moreover, hospitals use biomedical gases for various purposes, the use of which needs to be brought down.”

Sudhir Damodara, Director, Climatronics Technologies said, “The COVID19 virus and the subsequent second wave has shown how hospital infrastructure can be overwhelmed by a unexpected outbreak and there is a definite need for better healthcare for India. China also a very large country with a billion plus population has shown the right way to tackle such outbreaks earlier such as SARS, and now COVID by creating emergency isolation facilities at break neck pace.”

“The challenges remain in public delivery of universal healthcare, since Health is a state subject there has been significant variation in quality of hospitals state to state, and there is a definite need for better public health centres. Another aspect is taxation on healthcare – which is significant since the supplies are at full GST and there is a definite need to liberalise this sector and allow more players with a focus on certifications to ensure quality”, he added.

Green healthcare: Current scenario

A sustainable business is no longer just about meeting regulations – it’s about playing an active role in addressing the climate change challenge, while also creating a healthier future for communities by focusing more on and adaptation of green hospitals.

As per a green paper by Health Care Without Harm, “Health care’s climate footprint is equivalent to 4.4 per cent of global net emissions (2 gigatons of carbon dioxide equivalent). The global health care climate footprint is equivalent to the annual greenhouse gas emissions from 514 coal-fired power plants. If the health sector were a country, it would be the fifth-largest emitter on the planet.”

As per the paper, “United States, China, and collectively the countries of the European Union, comprise more than half the world’s total health care climate footprint (56 per cent). The top ten health care emitters make up 75 per cent of the global health care climate footprint. The United States health sector, the world’s number one emitter in both absolute and per capita terms, produces 57 times more emissions per person than does India. While India has the seventh-largest absolute health sector climate footprint, it has the lowest health-related emissions per capita of all 43 nations. China’s health sector produces six times more greenhouse gases per person than India’s does. But China’s health system also emits one-seventh the greenhouse gases per capita as that off the United States, one-third that of Korea and just under one-half per capita that of the European Union.”

Talking about the steps that hospitals can take to reduce their ecological footprint and reduce waste, Vinay K Mayer, Director – Market Research & Consulting, Asia Research Partners said, “The principles of environmental sustainability can be applied to healthcare systems in several ways, including the reduction of paper waste through the use of electronic health records (EHRs) and electronic medical records (EMRs). The system must empower the workforce to play an active role above all by educating them on the issues at hand. Also, it is critical that they are able to communicate their needs and desires as well as implement any changes that may occur. Solidifying medical waste can prove to be an energy intensive process, having the potential to release noxious fumes that cause fatalities upon inhalation. Healthcare providers must consider moving towards greener ways of disposing of their solidified medical waste, such as autoclaving, chemical treatment, and microwaving.

“Saving energy can be difficult in some cases when hospitals, for example, try to reprogram their heating and cooling plants. On the other hand, re-engineering air handling systems and upgrading lighting systems may seem like an impossible task at first, until you start with small steps like conserving water or making sure that lights are turned off by finding innovative ways to bring about positive change in the world around us”, he added.

Talking about the green initiatives in hospitals in India, Dr Narayani said, “There are a lot of green initiatives being undertaken, especially in the field of anaesthesia and OT infrastructure. Hospitals are certainly adopting green OTs and moving towards the concept of green buildings. Many hospitals have already applied for Green OT Certification. In these cases, we are trying to change the way we induce a patient, and the kind of anaesthesia we use, aiming to minimise the amount of bio-medical gases and number of medication, in a manner which is good for the patient and is more sustainable for the environment. Some hospitals also have options of solar panels for energy conversation. Now that can be a challenge for some hospitals who have lesser space. Developing solar panels may require more space, in that case, there is an option for adopting wind power.”

“From an industry perspective, I feel hospitals should be incentivised to adopt green initiatives. Institutes that are already adopting unique ways for environmental sustainability should be recognised & rewarded and be allowed to help others in creating such green healthcare spaces, setting golden examples of progressive change”, she added.

Trends & technologies in designing sustainable hospital infrastructure

Hospitals are already making efforts and adopting the sustainable and green initiatives. The pandemic played a role of a catalyst in fast-tracking the process of this adoption.

Highlightening the trends and technologies in designing sustainable hospital infrastructure, Mohanbir Singh, Founder, Director, Creative Designer Architects said, “Healthcare infrastructure, which is known to be one of the most latent and resource-intensive spaces, is one vital area for probe and optimisation. Some prevalent trends in this area include designing for the climate and economy, including slashing the infrastructure’s energy footprints and planning for occupant health and well-being at odds with rising air pollution, temperature, and humidity. Secondly, sustainable healthcare design should explicitly focus on health equity and communal well-being. This is the only systemic feature that has the capacity to possibly wither an outbreak as overwhelming as the COVID-19.”

“Further, health providers’ emphasis on health-user experience must continue to intensify. The pandemic has propelled the transition of healthcare providers and users towards a digital telehealth ecosystem which will significantly impact facility design in times to come. Therefore, designing for flexibility and adaptability with technology becomes a crucial guide rail in designing sustainable healthcare infrastructure”, he added.

The second wave which was a major learning for Indian healthcare system as far as hospital infrastructure is concerned highlighted the need for technology integration while designing the sustainable hospital model.

Talking about the technology evolution and integration of sustainable hospital infrastructure, Mark Matthew, COO, NF Healthcare India said, “While India thrives on quick innovation, we now have a perfect replacement to reduce dependency on these oxygen cylinders & liquid oxygen plants – PSA oxygen plants. These in-hospital equipment takes in atmospheric oxygen and produces medical graded oxygen with 93 per cent purity which is then fed to life support systems like ventilators, Bi-Pap machines etc. Another advantage of these plants is that their oxygen output can be adjusted according to requirements from hospital. The only thing that hospitals need to ensure is continuous electricity supply. These inexpensive plants give an ROI within 1.5 to 2 years depending on oxygen usage. Currently, certain state governments have mandated for any 50+ bedded hospital to have an in-hospital oxygen supply system. Due to high initial costs some hospitals may find it difficult to install such systems, hence, both government and corporates can step in and support such hospitals.”

“As technology advances, many companies are working on integrating these oxygen supply systems with AI/ML technology to directly alarm a doctor’s phone in case there is something wrong with the oxygen supply systems. This would also mean faster output and self-adjustment of machine to match hospital requirements”, he added.

Talking about hospital modernisation, Dr Sharada Rao, Vertical Head-Delivery, Life Sciences, Birlasoft said, “E2E digitisation of the healthcare system – right from onboarding to diagnostics to surgery to post-operative care experience are critical elements to hospital modernisation where healthcare cloud adoption, devices and services, modernisation of HIS enterprises, IoMT, and bots form the underpinnings of futuristic platform solutions.”

Investment and partnership: Need of the hour

Healthcare investment has always been the subject of intense focus in the competing demands, whether from the public or private sectors. The same stands important while investing in sustainable hospital infrastructure.

Talking about sustainable healthcare design and innovative long-term partnerships, Kirtiman Sinha, Project Head-Healthcare Spaces, Edifice Consultants added, “Sustainable healthcare design shouldn’t be an afterthought. Sustainable approaches can result in cost-effective and better healing environments that contribute directly to a country’s healthcare coverage. In India, the public healthcare system is bearing most of the weight of healthcare sector for its population. Today, private healthcare sector has emerged to provide majority of secondary, tertiary care in metros, tier – I and tier – II cities. Innovative long-term partnerships between public and private healthcare sector can bring about major change in the system especially during an unanticipated crisis like COVID-19.”

“In future facilities, we need to consider how to build flexibility in order to manage the sudden influx of patients which we had seen during pandemic-Design that maximises infection control, integration of ICU/Critical care bed capacity in the layout that quickly converts regular beds to crucial care beds during emergencies. Future hospitals will likely have prosocial design for patient and staff wellbeing such as customised patient rooms, attractive visitor’s lounges, views of green surroundings like healing garden that help reduce patient anxiety and expedite healing. Smart furniture layout is an important consideration – the possibility of a flexible arrangement that breaks the monotony and accommodates visitors with social distancing norms and safety. This can help in reducing the walking demand and employee stress at hospitals”, he added.

Stressing the areas of investment, Dr Mradul Kaushik -Senior Director – Operations and Planning, Max Healthcare said, “The pandemic exposed the fault-lines in both Public as well as the private health systems with the resultant near collapse of the healthcare delivery mechanisms. The impact of the pandemic was not limited to hospitals alone, it amplified the issues of inequity, accessibility, affordability, supply chain, infrastructural and operational gaps that are required to mount an effective response to COVID-19. We saw the hospital bursting at seams during the pandemic, the lack of ICU beds was a huge challenge that none anticipated and this was made worse by knee jerk reaction of both public and private sector especially during the second wave which came almost like a tsunami. This certainly emphasises the fact that the health systems should create sustainable ecosystems which take care of the future emergencies.”

“This requires significant planning and investment in not only the existing health systems but also for creating new and novel systems. In my humble opinion the digitisation, infrastructure augmentation and operational efficiencies remain the most important challenges and opportunities for hospitals and health systems and this is where the most opportunities also lie”, he added.

Talking about the role of community ownership, Sameer Mehta, Vice Chairman, Dr Mehta’s Hospitals said, “Over the last few years, the writing has been on the wall to evolving customer centric and outcome centric way of life.  Most good hospitals now share best practises, drive to improve clinical outcomes through qualities standards (NABH, CAHO, AHPI, QAI, JCI et al).  We will also see more community ownership by hospitals and providers.  By working in communities, you could reduce specific risks, by working in community you could improve our collective health. So perhaps it is the time for the dawn of the community centric hospital.”

Now, in the wake of the COVID-19 pandemic, there is an increasing interest in reform in healthcare delivery, so that systems and infrastructure are capable of being responsive to pandemics, and meeting shifting consumer appetite and preference towards more sustainable hospital facilitates.

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