trends and pressures in dutch hospital design...jeroen bosch ziekenhuis den bosch “lag” in...

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

STRATEGY TRANSITIONS

Industry

Safety & Security

Urbanisation

Healthy Living

Energy

CONCEPTUAL APPROACH

TNO PRIORITIES IN RESEARCH AND SERVICES

THE DUTCH HEALTHCARE

SYSTEM – AN INTRODUCTION

OF SORTS

SOME KEY (BUT BORING) FACTS

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

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

HOSPITAL RESPONSES TO

SYSTEMS CHANGE PRESSURES

RESPONSE TYPOLOGIES

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

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”

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”

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

RTIC - Heerhugowaard

Gemini Ziekenhuis – Den Helder

ADRZ - Middelburg

TOO EARLY TO TELL

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

Reinier de Graaf Gasthuis

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

LAYERS ORGANISATION

“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

Ziekenhuis Bernhoven

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

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

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

Deventer Ziekenhuis - Deventer

TAILORED FLEXIBILITY – LEGO STYLE

Martini Ziekenhuis - Groningen

TAILORED FLEXIBILITY - USAGE

Orbis Medical Centre - Sittard

TAILORED FLEXIBILITY - SITE

Martini Ziekenhuis - Groningen

BUSINESS MODELS – HYBRID USE

Maasziekenhuis Pantein - Boxmeer

BUSINESS MODELS – DB(F)MO

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

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

NHS NORTHERN IRELAND STRATEGIC

INFRASTRUCTURE VISION

DESIGNS FOR NEW TYPOLOGIES

EVIDENCE-BASED DESIGN

EVIDENCE-BASED DESIGN: REACTIVATING HOSPITAL

Inpatient wards

Pilot project with Dutch

hospital and SME suppliers

SMART ENERGY MANAGEMENT AND DESIGN

LOW-COST INTERVENTIONS

CHALLENGES AND THREATS

LIFE ON A BUDGET

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

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….

IF YOU CAN’T WAIT THAT LONG….

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!

trends and pressures in dutch hospital design...jeroen bosch ziekenhuis den bosch “lag” in...

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