Scottish Hospital Centre

hf. 1. Nun. Sfd.

Vol. 3, pp. 105-I IO, Pcrgamon Press. lY66. Printed in Great Britain

Scottish Hospital Centre E. McNAUGHT Oj%m, ~Vu~ing

Scottith Hozpitul Centre, Crewc Road S., Edinbzqh 4, Scotland

THE Scottish Hospital Centre was opened by the Secretary of State for Scotland on 10th December, 1965. It represents a co-operative effort between the authorities concerned with hospital planning and function in Scotland. The need for a Centre of this kind was accepted some years ago at a time when the programme for new hospital building was gaining momentum, when the specialised nature of hospital planning problems was becoming increasingly apparent and the need for further study more clearly realised. The new Centre is situated at the entrance to the Western General Hospital, Edinburgh. It was designed for its purpose and built as a joint venture between the Scottish Home and Health Department, Regional Hospital Boards and the Association of Scottish Hospital Boards of Management. It contains an exhibition area where a display of hospital furniture and equipment will be maintained, a conference room, a library, and offices for the Director and the research staff. The building was designed by Mr. John Holt, F.R.I.B.A., A.M.T.P.I., architect to the South-Eastern Regional Hospital Board, Scotland, in association with Mr. Iain Haig, A.R.I.B.A. The building, together with its equipment, cost &98,000. The Centre has an independent constitution and a Council of Management representative of the Scottish Home and Health Department, the five Regional Hospital Boards and 78 Hospital Boards of Management in Scotland. Under this Council, the Director of the Centre, Dr. J. K. Hunter, and the Secretary, Mr. J. Leithead, together with a medical, nursing and architectural staff, work study officers, a librarian and a design and equipment officer will develop the Centre as a focal point for reference and research and as a forum for discussion. The work of the Centre can be defined under three main headings : 1. As a reference centre. This relates to the work of the library and the furniture and equipment section. 2. As a research unit. It is intended to promote both long and short term work into problems of hospital planning and organisation. 3. As a liaison centre for conferences, discussions and consultations on topics of current interest in the hospital planning field or on particular projects. It is also hoped to maintain direct links with aspects of hospital training. 105 A

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Library

The library provides reading space and reference facilities for anyone undertaking research into hospital planning and related subjects. It is hoped to compile a wide collection of schedules of accommodation and sketch plans of hospitals and departments planned in this country and other countries in recent years. The extent to which the library service can be developed will depend on the financial resources available. The Centre will make contributions to planning literature by publishing reports of its own studies. Furniture and equipment section

The range of hospital furniture and equipment is much more extensive than most people realise and large sums of money are involved in equipping a hospital or reequipping existing parts of a hospital. There is a need to develop a centre for the selection and indexing of items of this kind and for their display to the potential purchaser. A display area of some 2,500 ft * has been provided for this purpose and this section of the Centre’s work is under the direction of a design and equipment officer who will also develop aspects of research into the actual design of hospital furniture and equipment. Exhibitions on particular themes are supplemented by displays of items illustrating some selected topic. For example, in the current exhibition thereis an extensive display of bed area furniture for general wards and a special exhibit illustrating the difference between intensive nursing care and intensive therapy-a distinction of considerable planning importance and one which is explained in more detail below. Research

The value of a multi-professional team for research work in ward units and in most hospital departments has been increasingly realised and accepted in recent years. Hospitals are multi-professional in character and the agreed conclusion of a team consisting of medical, nursing, administrative, architectural and other officers is more likely to gain acceptance than conclusions reached by workers in a single professional field. Groups of this kind have been assembled at the Scottish Hospital Centre to undertake both long and short term studies. Each group contains a nursing officer. Long term stu&

The pilot study into the question of “supporting” or “second line” beds is being undertaken under a grant from the Nuffield Provincial Hospitals Trust, The team consists of a doctor, a nurse, and a research officer and it is expected that this review supplementary to “acute” will take about one year. The need for accommodation wards is becoming increasingly obvious but the type of accommodation, its staffing, and the range of facilities to be included remain ill-defined. There is much confusion on the various details of what is in fact a whole spectrum of medical care ranging from pre-discharge beds directly linked to “acute” ward units to long-stay accommodation for the chronic sick and an increasing number of elderly and incapacitated people. Short term research

Experience in the planning of both teaching and non-teaching hospitals has shown that in spite of the publication of much useful guide material there are many

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aspects of hospital planning which require clarification from both functional and design points of view. A team consisting of a doctor, a nurse, an architect, a work study and an administrative officer, all of whom have had experience in the field of hospital planning, will concentrate on problems of this kind, of which there are many examples. Early attention is being given to the requirements and the design of changing accommodation for non-resident staff, residential accommodation for junior hospital doctors, the implications on planning for hospital maintenance and repair work to be undertaken by direct, as against contract, labour. Other examples of work of a short term character requiring study includes the space requirements for central sterilisation in operating theatre suites, technique in the use of mock-ups in hospital planning, facilities for the admission of patients, a review of experience’in hospitals where provision for flexibility and adaptability were required in the architect’s brief. . As their first major study the team is examining the most effective methods of improving or “upgrading” existing ward units. Although the hospital building programme in Scotland is gaining momentum and is expected to spend about ~110,000,000 in the next ten years, many wards of an older type will require to remain in use for a considerable period. The study of these wards involves a systematic study of the different designs already in use in hospitals and detailed examination of plans for proposed schemes. It is hoped to assess the degree of improvement in the level of amenity for patients and the functional advantages, particularly for the nursing staff. In addition, the costs involved will be analysed and, as part of the study, the team will design the upgrading of an open ward as a practical exercise. This will be subjected to the same form of analysis. Conferences and discussions

It has become clear that one of the principle functions of the Centre is to act as a forum for the discussion ofplanning questions, in relation to particular projects, and to arrange conferences to discuss topics of current importance in hospital planning and organisation. It is intended to hold one major conference of this kind each month. The first conference considered the “upgrading” ofexisting ward units; the second had hospital infection as its subject. Further conferences will examine questions for medical staff”, “the planning such as “bed usage”, “residential accommodation implications of the prevention of fire”, and “disposal systems in hospitals”. There are many other subjects of this type on which an authoritative exchange of views should be stimulating and helpful. Training

It is hoped that the Scottish Hospital Centre will be associated in future with the training of administrative staff and already there have been considerable links with nursing interests. Classes of nurses undertaking the Hospital Administrative Course at the Royal College of Nursing have attended at the Centre for talks and groups of senior nursing staff have taken part in courses of lectures and discussions. These have extended over several days and have covered a wide range of current hospital planning and organisational problems. The importance of nurses’ requirements in many areas of hospital planning has been more widely recognised in recent years and it is encouraging that nurses are becoming increasingly aware of the responsibility which

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participation in hospital planning entails. Too often in the past opinions based on general experience have proved an inadequate substitute for the more detailed study of planning requirements, especially in the patient-care areas and the related nursing ancillary rooms. It may be of interest to describe in more detail a few points which have been emphasised or have arisen from discussions of the kind mentioned above. Intenske nursing care and intensive therapy It has become increasingly clear that there is a need to define more precisely the

difference between these two elements of what is commonly included in the single title “intensive care”. In the course of a series of studies conducted in ward units of different design, the opportunity was taken to assess the conditions of the patients and their dependence on nursing and medical staff and/or special equipment. From these studies it was possible to determine the type, size and location of the accommodation necessary to meet the needs of patients requiring constant care and supervision. These patients could clearly be divided into two categories-those requiring intensive therapy and those requiring intensive nursing care. The planning requirements for each category are different and these can be seen on Table 1. TABLE 1. INTENSIWX CARE

Intensive nursing care

Intensive therapy

1. NURSES DOCTORS

24-hr nurse stalling Doctors on call

24-hr nurse staffing 24 hr medical staffing

2. PATIENTS

12%-20% of patients on an acute ward. This amounts to 8-12 beds in a 72-bed floor

1%-2% of total number of patients in acute wardsin the hospital.Thisamounts to 6-10 beds in a 600-800 bed hospital

3. ADMISSION and DISMISSAL

Admission to and dismiil unit on nursing decision

from the

Admission to and dismissal from unit on medical decision

4. EQUIPMENT

Type of equipment used is controlled and operated by nuning staff, e.g. drainage apparatus: I.V. apparatus.

Controlled and operated by medical staff or technicians, e.g. ventilators

5. STAFF

Interchangeability of staff possible with nurses in other units on same floor, e.g. intermediate care units

Separate staff. No interchangeability with staff on other units

6. CO-ORDINATION

Good co-ordination of patient-care if unit is on ward floor and under the supervision of administrative sister responsible for all the bed areas

Patients require to be passed to another nursing team on dismissal from unit for continuation of their care. This leads to more difficult co-ordination of care

7. LOCATION

On each “acute” ward floor

8. ANCILLARY ROOMS

The essential “nurse-working” rooms, e.g. preparation and disposal rooms, should not be shared with any other bed area on the same floor

One unit for whole hospital and located adjacent to but ~1 part of the operating theatre suite A separate set of ancillary rooms should be provided for the unit

zzzTIENT

The interpretation of architects’ drawings

Informed scrutiny of architects’ plans is extremely important in relation to new hospital projects and also in connexion with the commissioning of new units. If those

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who have the duty to comment on the planning of a proposed new building are to do so in a way which ensures that their experience is channelled effectively, it is essential at a stage when a project is represented by the set of architect’s drawings that these are understood. Experience has shown, however, that useful advice is lost because of difficulty in understanding the range of information which drawings may or may not contain and a lack of appreciation of the main conventions employed by architects. It is intended to prepare a publication which will be a guide to the uninitiated in these matters. The functional

analysis of ward plans

After detailed survey work, the Scottish Home and Health Department published Hospital Planning Note, No. 1, Ward Design H.M.S.O. (1963) and this was supplemented by Room Data Sheets in 1965. Recent planning of ward units in Scotland has been based on the premise that the room relationships affect the nurses’ work more than any other category of staff. In examining ward plans to assess their functional efficiency, it is essential to consider the basic sequence of nurses’ work and to assess the degree to which the proposed accommodation would provide a satisfactory level of amenity for patients. It is important to examine such plans in a systematic manner with reference to those groupings ofrooms and areas to which priority must be accorded in order to make it functionally efficient. A publication on this subject is being prepared. The Scottish Hospital Centre is in some respects an experiment. It represents a new approach to the collection of reference material, the study of hospital planning and hospital organisation, and provides a new forum for the discussion and analysis of problems facing the hospital service. It has not yet had time to develop its full potential but already an interesting and promising start has been made. Acknowledgement-1 am grateful to the Director of the Scottish Hospital Centre, Dr. J. K. Hunter, for his advice in the preparation of this article.

RCsumC-Le Centre hospitalier tcossais fut inaugure le 10 dtcembre 1965 par le secrttaire d’Etat pour 1’Ecosse. Ce centre reprksente le rbultat d’un effort de cooperation entre les autorites diverses responsables de la planification et de la fonction hospitalitres en Ecosse. Le nouveau centre se situe P l’entree du Western General Hospital, a Edinbourg; il fut concu pour remplir les fonctions envisagtes et il comporte une aire #exposition pour la presentation d’ameublement et d’equipement hospitaliers, une bibliothtque, une Salle de conferences et des bureaux pour le directeur et le personnel de recherche. Ce centre posstde sa constitution propre; il est dirige par un conseil d’administration representant le Dtpartement tcossais de 1’Interieur et de la Sante publique, les cinq bureaux hospitaliers regionaux et les 78 conseils d’administration tcossais. Le programme des travaux comprend les activites 1 la fois de reference et de recherche relatives Q la planification et a la fonction hospitalitres. Le centre servira tgalement en tant que forum pour les conferences et discussions sur des themes d’actualitt; ses activitks seront l&s aux projets de formation. Des tquipes multi-professionnelles comportant des infirmitres travaillent A des projets de recherche. Une attention toute particulitre a ttt port&e, db le debut, sur la question de l’amtlioration des services d’hospitalisation les plus anciens. 11 y a participation directe aux cows de formation des infirmitres et, parmi les probltmes en dtcoulant, on note la n&es&t de faire une distinction entre lcs exigences de la

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planification concernant la therapie intensive et les soins infirmiers intensifs. En plus de ses autres dches, le centre prepare actuellement des publications sur I’interpretation des dessins architecturaux et sur l’analyse fonctionnelle des plans ds services d’hospitalisation.

Resusnen-El Centro Hospitalario Escocts fut inaugurado el 10 de diciembre de 1965 por el Secretario de Estado para Escocia. Representa un esfueno de cooperation entre las autoridades encargadas de la planificacion y funcionamiento de hospitales en Escocia. El nuevo Centro esd situado a la entrada de1 Hospital Fut diseiiado para su proyectada funcidn y General Occidental de Edinburgo. contiene un area de exposiciones para exhibition de mobiliario y equip0 de hospital, biblioteca, sala de conferencias, y oficinas para el Director y personal investigador. El Centro tiene estatutos independientes, y un Consejo de Direction que representa al Departamento Escoc& de Sanidad y Hogar, a las cinco Juntas de Hospitales Regionales, y a las 78 Juntas de Direction de Escocia. El programa de trabajo incluira actividades normales y de investigation conjuntamente, en relation con la planificacion y funcionamiento de hospitales. El Centro actuara tambitn coma sede de conferencias y deliberaciones sobre problemas de inter& general, y habrA conexion con planes de formation. Equipos pluriprofesionales, incluyendo enfermeras oficiales es& encargados de proyectos de investigation. Se estP concediendo atencion inmediata al problema de mejorar las viejas salas o unidades. Ha habido participaci6n directa en curses formativos para enfermeras, y entre 10s asuntos derivados de 10s mismos figura la conveniencia de tener en cuenta las necesidades de planificacion para terapeutica intensiva, y para cuidado intensivo por parte de las enfermeras. Entre otra labor, coma la exhibition de articulos de mobiliario o equip0 para hospitales, se preparan pubiicaciones sobre interpretaci6n de pianos de arquitecto y andlisis functional de planos de salas.

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