Facing tomorrow's challenges and complexities demands hospitals that keep pace, blending cutting-edge design and digital tech. With this goal, Italy kicked off the Next Generation Hospital project to craft the blueprint for tomorrow's hospitals.
What will future hospitals look like? It’s a fair question, especially since these places touch the lives of millions. For instance, based on “2021 Report on hospital admission activity” – by the Italian Ministry of Health, announced in october 2023 – Italy saw over 7.3 million hospital discharges in 2021, up 7.4% from 2020. The urgency is felt more in Italy, where 70% of hospital buildings are over 50 years old and half of the physical infrastructures are not fit for today’s healthcare and organizational models [Source: INAIL and IRES].
We need to rethink hospital infrastructures for the updated care needs, more so after the pandemic highlighted the need for safe, efficient, and resilient hospitals. This led to the birth of the Joint Research Platform Healthcare Infrastructures (JRP HI), a project by the Politecnico di Milano – Department ABC (Architecture, Building Engineering, and Built Environment) and the Politecnico di Milano Foundation. This initiative aims to unite companies and institutions to imagine, plan, define, and develop the hospital infrastructures for the future.
Launched in 2022, the JRP HI research platform first scoped out the needs and current best practices before setting two goals: to envision a next-gen hospital and to stress the importance of measuring all aspects related to the physical space.
TAKEAWAYS
The shape of future hospitals
Healthcare’s shift and defining what future hospitals look like are guided by three main ideas from JRP HI: rethinking hospitals after the pandemic; setting up a local network to back up future healthcare; and planning out the steps for hospitals that are safe, eco-friendly, and tech-savvy.
On this note, they’ve pitched a first design model, the Next Generation Hospital, which includes all the performance needs sorted into specific areas to help design hospitals ready for what’s next.
After two years of work, they’ve come up with a functional model and a performance model, plus the first UNI standard for a shared terminology with 410 terms that’s going to be published this year.
In the functional model, hospital infrastructure is split into 15 big areas and 55 functional ones (like Emergency Departments, Operating Rooms, etc.). The performance model lists 95 must-dos to make sure the hospital meets certain performances, aiming to bring to life a hospital model for the future across seven areas: location, design, adaptability, green practices, risk management, digital upgrades, and putting users first.
What comes out of this big picture is a fresh take on hospitals: places that are safe and healthy, welcoming and comfy, practical and adaptable, loaded with digital and tech features, connected to their communities, green, and up to snuff. The idea is for the infrastructure to be flexible and to reflect a bunch of important issues, with the digital and tech part becoming more and more key.
Digital innovation at the heart
The hospital of the future needs a vision that captures smarts (smart hospital), green practices (green hospital), and the ability to bounce back (Covid hospital).
Digital innovation is set to be a game-changer in future hospitals. As the 2022 report already pointed out, it’s looked at through how much bang you get for your buck, in both planning and running stages, «especially looking at integrated systems to make the physical and digital hospital more efficient, and digital tools for the right sizing and fitting new techs».
From what’s being offered, a bunch of new tech can be woven into how care is given. This includes more use of artificial intelligence models, robotics, as well as more precision medicine, telemedicine, genomics, along with 3D printing, augmented and virtual reality. These techs are being picked up not just because they’re cool or can cut costs and make things run smoother, but also for the long haul, «aiming for more precision, fewer goof-ups, and better results» as mentioned in the report.
From what people want, new tech has changed expectations. «More and more patients are hoping for healthcare services to be quick, easy, and feel more normal. So, the whole way of giving care is shifting, and these changes are likely to speed up. Hospitals, which have always been at the heart of healthcare, are now figuring out or having to rethink their place».
Just like in smart cities, where everything gets a techy upgrade, future hospitals need to blend new tech into their design and daily operations to make things better for everyone, not just within the hospital walls but as part of a bigger healthcare scene, where hospitals play a big but not the only role.
Future hospitals and the value of data
Digitalisation is an indispensable element for an efficient healthcare management model. Having access to patient clinical data, while safeguarding privacy and cybersecurity, results in a general improvement in treatment capability and operational efficiency. It assists healthcare professionals in diagnosis, risk identification, and equipment selection.
Moreover, relying on data facilitates more targeted and effective decision-making, benefiting the care process, the quality of services, and enhancing patient well-being, in addition to optimising costs.
In the digital innovation journey, among others, the use of certain remote electromedical equipment, as well as the deployment of IoT sensors, must be considered to allow hospitals to ensure a personalised and dedicated experience for each user by monitoring their comfort and satisfaction levels. Furthermore, virtual and augmented reality tools and solutions must be an integral part of this, with their potential impact on patient care, treatment processes, and the configuration and use of spaces.
This process can rely on multiple supports, from wearable devices to monitor patient status to robots for various services, and the use of drones for the delivery of medicines and other items.
Additionally, work must be done to reduce paper-based health and administrative documentation and its digital and cloud transposition to repurpose storage and warehouse spaces for other functions, including server rooms.
The JRP HI itself highlights that digitalisation can «always reduce process times and especially compact and shorten the phases».
It does not forget to consider that true digitalisation can only be achieved by exploiting the combination of methodologies and technologies in both the strictly medical domain and the physical hospital structure, effectively implementing OT (Operating Technology) – IT (Information Technology) – MT (Medical Technology) convergence.
The designed and constructed buildings «must have distributed intelligence at various levels and an intrinsic ability to interact with the building’s users. They can no longer be considered just a ‘physical asset,’ but a fundamental asset of the healthcare organisation and an intrinsic part of the entire healthcare delivery process».
In this digital scenario characterising the hospitals of the future, digital twins will play a part, allowing for the real-time monitoring of building performance, thus enabling the formulation of new value-added services for healthcare service managers.
Glimpses of Futures
Planning today for future hospitals is crucial for many reasons: there’s a need to renew the existing property portfolio, much of which is outdated and inefficient, with secure, modern infrastructures capable of offering the highest levels of care and managing all aspects of hospital life, not just for the benefit of patients and their families but also for medical and healthcare staff.
As the work of JRP Health Infrastructures has shown so far, hospitals need to be “physical and digital places, local and in the cloud, real and virtual, but also safe, comfortable, and resilient.”
We have to consider the aging population, but that’s not all: by 2030, there will be a global shortfall of 10 million healthcare workers, especially in low and lower-middle-income countries [Source: WHO].
Using the STEPS matrix, we now attempt to anticipate future scenarios, analyzing the impacts that such a change could have from a social, technological, economic, political and sustainability point of view.
S – Social: Future hospital structures will have to account for increasingly long stays. According to a study published in Plos One, there will be a 42% increase from 2013 to 2050, going from 4.66 to 6.72 million days of hospital stays. The most significant change will concern the population over 70. Also, managing home care paths will become more complex, considering the demographic decline, especially in Europe and Italy, and the shrinking family network: by 2041, one in four families will be made up of a couple with children, more than one in five will have none [Source: ISTAT]. For this reason, hospitals will have to manage an increasingly elderly population, less self-sufficient and also less supported by the family fabric.
T – Technological: The use of digital technologies will perhaps be the most defining element of future hospitals, as highlighted by JRP HI itself. It will help to improve various aspects: for example, the adoption of AI models will streamline health, administrative, and logistics processes; cutting-edge facility solutions can enhance the quality of environments, from indoor air to monitoring environmental parameters, thus reducing the risk of nosocomial infections.
E – Economic: Having more efficient and high-performing hospital structures allows for significant economic savings. Just considering the economic impact in terms of energy, the real estate sector accounts for about 44% of Italian consumption, “buildings with a hospital use have one of the highest annual kWh/m² consumption rates relative to gross floor area,” specifies the 2022 report by JRP HI. More energy-efficient structures, both structurally and in terms of systems, reduce this impact. Moreover, digital management, with monitoring tools for consumption, allows for targeted use, reducing waste.
P – Political: Hospitals have a significant political impact on various aspects of society, including access to healthcare and its quality, costs and funding, technological innovation, and emergency health management. Political decisions regarding hospitals can deeply influence people’s lives and the health of communities. Having efficient, modern, safe, and resilient structures can be an important element in improving the quality of life and ensuring the health and well-being of all, as required by goal 3 of Agenda 2030.
S – Sustainability: The healthcare sector is one of the most impactful in the world in terms of emissions. A study conducted by Arup found that healthcare’s climate footprint is equivalent to 4.4% of net global emissions. If the healthcare sector were a country, the same study notes, it would be the fifth-largest emitter on the planet. In addition to working on improving the environmental sustainability of the sector, it is also necessary to promote advancements in terms of social and economic sustainability. This aim can be achieved by investing in the energy retrofitting of hospitals, among other measures. For example, as JRP HI itself illustrates, “the hospital of the future employs a Lean, just-in-time, and automated logistics system. Such an efficiency in logistics reduces the size of the warehouses, centralizes stock, optimizes storage, and improves the distribution of products, leading to savings in spatial, economic resources, and time taken to carry out activities.”
