VK participates in strategic care project CARE2030 by Brussels University Hospital
VK is participating in ZORG2030 (CARE2030), a strategic care project for Brussels University Hospital. The initiators of this project, Brussels University Hospital and the Faculties of Medicine and Pharmacy at the Vrije Universiteit Brussel, have issued an initial report on the ideas and visions shared between September and the end of December 2017 on the dialogue platform www.zorg2030.be.
VK Architects & Engineers is partnering with Brussels University Hospital in several renovation and new build projects, and also wants to help think about care in the future and the related infrastructure.
Five topics have been created on the platform:
- What values are sustainable?
- Are patients the experts?
- Technological progress or decline?
- How can the quality of health, research and education be evaluated?
- Care landscape or labyrinth?
What images of care in 2030 did we find? We are publishing the results of the first report here, almost in their entirety.
After all, these insights and ongoing developments will also influence the work of designers and engineers. So we end each chapter with our viewpoint on the matter.
GET PATIENTS INVOLVED!
In the future, humans will be the genuine focus of care. They will carry the state of their health with them everywhere they go, throughout their lives, in a digital medical file held in the chip in their ID card. They will have access to it and – what is more – they will own it. Medical data will be continually updated in real time (by virtual assistants) because people will be constantly monitored. This will help care providers implement treatment as well as aiding prevention. People will receive alerts, and care providers (who are attuned to each other’s actions) will take the initiative themselves, because they also receive the same alerts.
Thus people will have a real-time image of the entire care process, on a dashboard for example, with details of their treatment and medication. A patient portal is indicated as a possible way of providing access to information about treatment in a specific care organisation, but it does need to be highly informative, comprehensible and clear enough to contribute to the patient’s health literacy.
Doctors and patients are partners who co-create the treatment based on a holistic vision of human beings. People are regarded as “expert patients” in a way that avoids condescension. After all, they are the experts in having a disease and receiving treatment. People are free to choose their degree of involvement: providing customised information and communication also encompasses the fact that patients do not always want to be aware of certain diagnoses, an element that is incidentally included in the 2002 Law on Patients’ Rights.
Patients are constantly listened to, for example through satisfaction surveys. Patients want a facilitation of the exchange of experiences with people in the same situation, certainly in the case of rare, chronic and life-threatening illnesses. The idea points in the direction of crowdsourcing in care.
The idea of a ‘patient expertise centre’ has been put forward. It appears that patients today still feel like outsiders in their own care process and in the provision of care in general. It is clear from the survey that patients have a lot of ideas, which also makes it essential for the care offered in the future to be designed along with patients. Today too much thinking is done for them.
What about the healthcare designer?
In future, architects will take more account of changing, more efficient care processes in terms of scale. It also appears that patients need to have control of their own care, that they want more independence and want to share their experiences. Whereas cancer patients bear their burden anonymously at present, it will probably be possible to create separate “co-caring spaces” in hospitals instead of a single, central cafeteria. People who share the same fate will be able to go there to exchange their experiences.
THE PATIENT’S EXPERIENCE
The care on offer must take more account of the patient’s experience, instead of being predominantly biomedically based as it is today. This partly has to do with the logistics of the care environment (patients want rooms with large windows and pleasant waiting rooms – assuming that they will still need to wait in the future). That can be interpreted as a request for a healing environment.
It is also partly related to information and to communication with the patient. These factors need to be accessible, without obstacles. The care sector in general is experienced as a complex tangle that creates a feeling of disempowerment, where care providers operate under serious time constraints (with the corresponding risk to a healthy work-life balance) and the organisational and economic interests of the care institutions are too highly prioritised.
There is a need for cooperation in all areas, both between the care providers involved in a single treatment and, for example, between hospital and home care. Patients experience the need for personal support – an intermediary throughout their care process, perhaps assisted by volunteers (with a clearly formulated status) – as well as support during consultations or hospital admissions, or in mental health care. There is a suggestion that patients’ associations could also be involved here.
Incidentally, patients note that being ill is more than being unfit for work, and that there should be a greater focus on prevention. Care providers therefore need to take a broader view of health and a care organisation should evolve further in the direction of a kind of happiness and health institution.
Patients comment that it is not easy today to evaluate the quality of care; there is a need for clear quality indicators for the care on offer, although this should not detract from aspects that are difficult to measure.
What about the healthcare designer?
The “us-them” attitude with the doctor/carer who works for an organisation on one side and the patient with their problems in the other, within a generally functional care infrastructure, needs to make way for well-considered, interconnected and/or stacked care departments that can evolve freely within a future-proof design focused on human aspects and experience. Abundant natural light, a view of nature, integration into the environment, intuitive way-finding and homeliness: these are the basic ingredients of our future centres of wellbeing.
TECHNOLOGY AS A MEANS TO AN END!
Technology is clearly viewed as a means of improving patient care and the care on offer, not as an end in itself. Besides the fact that digitisation will enable people to quantify their own health on an ongoing basis (using clear graphs or process bars), a consultation with the doctors will only occur when really necessary. This will make virtual first-line consultation and even virtual emergency medicine possible.
Digital technology will also lead to greater efficiency and increased service: all kinds of apps will facilitate communication with care providers, for example apps for making appointments and providing information about waiting times. Furthermore, big data and the use of artificial intelligence will improve diagnostics.
Here, likewise, it is emphasised that digital tools must be developed with the active participation of patients. Patients and IT developers speak different languages, however, and it has been suggested that an intermediary layer should be created so that patients’ needs can be understood and implemented correctly by the IT experts.
Privacy is also a concern: if all the care providers directly involved require access to a patient’s medical file, where is it stored and who manages it? Care organisations need to be transparent about this.
In turn, care providers can increasingly use technology for their training and for care, in fields such as artificial intelligence, augmented reality, exoskeletons, aids for organ failure and virtual assistants. Patients are hesitant about robots replacing people, because they still prefer human contact, certainly in illnesses that have a great impact on the patient’s life and those of their friends and family.
What about the healthcare designer?
The architect will always continue to be an integrator of all the current technology to some extent, both in terms of the building and the equipment. At VK, the interdisciplinary approach we have applied for decades in the healthcare sector is a gigantic bonus. Pioneering in care technology will only strengthen this.
LESS FREEDOM OF CHOICE, MORE FLEXIBILITY!
Whereas patients demand greater involvement, care providers expect their care process to be more coordinated, with less freedom of choice for patients. There will be hyper-specialised core hospitals, plus several general hospitals – sometimes mobile ones – and many local and outpatient neighbourhood and home care providers for first-line care. The care offered must become a single, transparent, coherent, clear, attuned and coordinated whole (incorporating hospitals, rest homes, home care, fitness centres, diet centres, child support services etc.), thus responding more effectively to the holistic and preventative care needs that people request and require.
The care on offer should also evolve towards greater fairness: for example, doctors should no longer be allowed to charge extra fees, there should be no difference in these fees for patients in single or double rooms, and language should not make any difference to care (something that does probably happen with Dutch-speaking patients in Brussels). Both patients and care providers want an honest debate on the distribution of resources, with all tasks covered by a single budget. They envisage improved insurance, with fewer minor costs being reimbursed, and a fair payment system where it is worth keeping people healthy. People want financial transparency.
What about the healthcare designer?
This flexibility will also need to be incorporated into the design of buildings. The life cycle of a hospital will have to enable certain areas to be repurposed during that lifetime, without too many structural changes. In other words: there is a need for internal and external flexibility. This approach is expressed in the new Grand Hôpital de Charleroi, for example: the largest hospital in a new generation in Wallonia, where both the building model and a life cycle cost estimate were applied for the first time.
ZORG2030 also discusses changes in medicine, such as the personalisation of care by means of genetic profiling and improvements to prevention through genomics. This also leads to an ethical debate: does every patient want to be informed proactively when they are genetically predisposed to a given condition, and how can we determine who does or does not want to be informed?
Many patients are critical of how rare diseases are dealt with, especially when the diagnosis has not been confirmed or a disease has not yet been formally recognised. Evidence-based guidelines must not become a straitjacket, obstructing an individual diagnosis, and there is a plea in favour of a combination with more experience-based medicine. It was suggested that a platform for rare diseases be set up at European level with confidential information for specialists.
There was also a clear plea for sufficient attention to be paid to developing measuring systems and criteria for psychological suffering, to prevent patients being failed by the system. Whereas medicine itself is evolving in the direction of personalised medicine, patients report persistent pigeonholing and compartmentalisation.
All the aforementioned trends lead in the direction of radically different training for doctors, evolving towards health medicine and focusing on interdisciplinary cooperation and a profile of the care provider that goes far beyond the biomedical. Furthermore, that training would include continuing education, including training related to new technologies.
What about the healthcare designer?
Is the architecture of care a separate discipline? Technology will most likely affect every level of society, but when it comes to eHealth, mHealth, telemedicine etc., technology will probably bring about a transformation in the global care economy and create enormous savings. We are looking at better prevention thanks to early detection with sensors, fewer consultations and hospitalisations, an increase in complex home care and home hospitalisation, remote interventions (certainly in the care of the elderly and mental health care) and so on. All these developments need to be assessed as accurately as possible by the architect of care to turn the most complex building in the world into an integrated health-promoting lifestyle campus at the heart of our community.
- Whereas care providers are focused on medical care, human beings are focused on experience and wellbeing. Care in the future demands a combination of the two.
- Whereas care providers think about the future, patients – and especially chronic patients – are struggling with the problems they are facing right now. Short term improvements are also necessary.
- Patients want to be in control.
- We are witnessing a shift from the care of the sick towards health care, from curative to preventative medicine. What patients really want is to stay healthy, whereas hospitals focus on treatment. The financing is also splintered (between federal and regional authorities), creating extra barriers.
- Communication and privacy are opposing forces.
- The reactions make it clear that there is a fear that excessive technology would detract from the human aspect of care. It will therefore be important to find a balance in that area and ensure that humanity is present where it is essential.
- Evidence‐based and experience‐based care need to be combined.
- Volunteers are experienced as important, but it is not their role to compensate for the shortage of care providers.
This provisional report is based on 424 suggestions made between mid-September and the end of December 2017. 81 of them were entered directly into the dialogue platform ZORG2030, 172 are the result of the dialogue day with Dutch and French-speaking patients, and 171 are the result of the dialogue day with care providers and other stakeholders.
Ideas can still be posted to www.zorg2030.be until the end of March. The final report will be published before the summer.