Planning of a New Children s Hospital in Helsinki, Finland

Transcription

1 Planning of a New Children s Hospital in Helsinki, Finland Pekka Lahdenne, MD, PhD, Associate Prof of Pediatrics Children s Hospital, Helsinki University Central Hospital Hospital District of Helsinki and Uusimaa Helsinki, FINLAND

2 Hospital District of Helsinki and Uusimaa Lohja Hospital Area Hyvinkää Hospital Area Porvoo Hospital Area Kerava Vantaa Western Uusimaa Hospital Area HUCH Hospital Area Espoo Kauniainen Helsinki Kirkkonummi Jorvi Hospital Peijas Hospital HUCH Hospitals in Helsinki FINLAND Oulu Turku Tampere Helsinki Kuopio Children and adolescents aged 0 to 15 years: Helsinki Espoo Vantaa All together ( )

3 Helsinki Children s Hospital and Children s Castle Children s Hospital Children s Castle Built Extensions 1986 and Gross area m m 2 Wards 11 (2 intensive care units) 4 Beds Other facilities Specialities 6+1 operating rooms, outpatient clinics, joined ER with primary health care, radiology, laboratory, physiotherapy, education, school, play unit pediatrics, pediatric surgery outpatient clinics, day hospitals, physiotherapy, school child neurology, child psychiatry

4 Children s Hospital, Helsinki Arvo Ylppö

5 Children s Hospital in bad condition too small old fashioned not able to fulfill the soft standards of pediatric care Need to centralize more pediatric care Cleft palate surgery pediatric neurosurgery ear and eye doctors for pediatric patients Children s Castle plumbing and air conditioning in very bad contition old fashioned, not suitable for hospital use Neonatal intensive care (NICU) to the Women s Hospital in 2015 needs to be close to maternity hospital and children s hospital

6 Helsinki Children s Hospital in 2012 The only comprehensive-service pediatric hospital in Finland 24/7 on-call of 15 different specialists Number of patients Admissions 8461 In-patient hospital days Outpatient visits Emergency room visits Primary care emergency visits Operations 6462 Emergency operations 2 374

7 Helsinki Children s Hospital Operational activities and responsibilities Secondary level specialized medical care for children and adolescents in the Helsinki metropolitan area National responsibility for several specialized functions Treatment of all complicated cases of pediatric heart disease Open-heart surgery in infants and other types of demanding pediatric heart surgery Pediatric organ transplantation Stem cell transplantation Examination and treatment of refractory epilepsy Training of health care professionals Scientific research aimed at improving the health of children and adolescents

8 Helsinki Children s Hospital Patients The age of patients varies from extreme prematurity up to 16 (-18) years The smallest patients weigh less than 500 g Comprehensive children s hospital = extreme interpatient variation in the services required Some annual patient volumes Approximately 350 heart surgeries 15 to 25 organ transplantations 40 to 50 new cancer patients, 150 premature babies weighing less than 1,500 g

9 Some general attributes for the New Children s Hospital majority of care is for infants and small children sufficient space for the growing population of the Helsinki metropolitan area families from long distances and for extended periods of times secures availability of comprehensive specialized care for all Finnish children facilities for tertiary functions will have growth potential possibility to take care of patients from other countries facilities for education and research agility in the face of medical development patient/family centered processes attractive place to work at infection safety high quality platform for teaching and research including post graduate training of specialists

10 Political decision making vs planning of the New Children s Hospital 11/2011 need for a new hospital recognized at political and hospital administration level > potential construction sites evaluated / Meilahti campus in Helsinki > first analyses of future operational requirements of the new hospital (e.g. estimated patient volumes in 2020 and onwards) prepared for political decision making 9/2012 Children s Hospital Working Group for functional planning appointed > detailed extensive analysis of future hospital operations and requirements; role as comprehensive pediatric care hospital for the Helsinki metropolitan area and for the whole Finland in defined fields of medicine

11 Political decision making vs planning of the New Children s Hospital 12/2012 preliminary decisions on funding of the hospital planning and building by the Executive Board of Helsinki Hospital District > additional financing (i.e. government participation and private donations) besides regular funding mechanisms of the hospital district needed/accepted >the new children s hospital project is carried out via a Foundation, which allows large-scale fundraising and high class expertise involvement 3/2013 and 6/2013 Approval of Phase I project plan and the letter of intent with the Foundation by the Executive Board of Helsinki University Hospital District > committed to donate 40 million Euros to the foundation 4/2013 Government of Finland > committed to donate 40 million Euros to the foundation (estimated total budget 160 me)

12 Concept planning of the New Children s Hospital prediction of growth of the pediatric population in the area / Finland prediction of medical services and care given in the future hospital current metrics of the hospital estimates of future patient volumes by specialists responsible for specific areas in pediatrics, pediatric surgery, and child neurology estimates of patients coming from abroad (2014 onwards free choice and movement of patients in European Union) prediction of evolving medicine perspectives from the medical staff covering all fields of pediatric care

13 Simulation model in the planning of the New Children s Hospital the change factor for each patient group was calculated using a formula that incorporated the future birth rate estimate and a combined factor on the burden of relevant disease and patient groups predictions on disease burden included the estimated change in the insidence and prevalence of given diseases, potential changes in the treatment modalities, potential changes in the centralisation of the care of certain patient groups, and change in the production of care strategically selected by the hospital the workloads of the nursing staff in the wards (based on daily numbers of in-patients) and the utilisation of the allocated rooms in the outpatient clinics (based on the number of visits) were analysed.

14 Defining a change factor for each patient group The effect of birth rate = A The effect of other factors = B change in incidence/prevalence - example diabetes change in the way of practice - example individualized vs. standardized follow-up visits change in centralisation do we want to market this specific service - strategic growth do we want to some one else take care of this specific patient group Total change = A*B

15 Tammi Helmi Maalis Huhti Touko Kesä Heinä Elo vos4 Syys Loka Marras Joulu K1 K2 K3 K4 K10 S10 Present situation variation of occupancy rates in hospital beds and work load of nursing staff Maanantai Tiistai Keskiviikko Torstai Perjantai Lauantai Sunnuntai Tammi 58 % 62 % 70 % 69 % 64 % 48 % 54 % Helmi 69 % 68 % 70 % 74 % 62 % 51 % 55 % Simulation of different combinations of wards together Maalis Huhti Touko Kesä Heinä Elo 72 % 70 % 78 % 78 % 69 % 48 % 56 % 59 % 60 % 67 % 70 % 58 % 40 % 44 % 71 % 69 % 70 % 72 % 71 % 57 % 57 % 61 % 67 % 69 % 57 % 53 % 43 % 48 % 55 % 56 % 51 % 46 % 41 % 37 % 40 % 69 % 65 % 69 % 68 % 63 % 53 % 51 % Syys 81 % 67 % 77 % 69 % 61 % 52 % 65 % Loka 55 % 60 % 70 % 66 % 54 % 50 % 56 % Marras 75 % 69 % 75 % 72 % 66 % 58 % 63 % Joulu 56 % 57 % 63 % 63 % 54 % 39 % 50 %

16 Comparisons of alternative (4) ward block units - occupancy rates - distribution of different age groups toteutunut nettokuormitus (ka) päivien %-osuus kuormitusprosenttiarvosta arkipäivä viikonloppu/pyhä laskentajaottelu >70% >80% <50% >60% <40% K4 siko, 0-1 pvk8 25 % 2 % 3 % 8 % 8 % K3 K10 S10 17 % 0 % 0 % 0 % 13 % K1 K2 K5 33 % 5 % 5 % 25 % 8 % Husuke K6 Neuro 58 % 23 % 12 % 0 % 42 % teho 0 % 0 % 23 % 8 % 17 % keskiaarvokuormitus 27 % 6 % 9 % 8 % 18 % Simulating age distribution of the patients in different combinations of wards

17 Simulation model in the planning of the New Children s Hospital setting standards for the expected level of the managerial performance 80 % occupancy rate of hospital beds utilisation of out-patient rooms set to 30 patient visits/room/week calculations of space and room allocation to different hospital functions generic modules (patient rooms, ORs, out-patient consultation rooms etc) changes in the organisation of the hospital units 15 in-patient wards -> 4 combined wards with modules priority for out-patient care and day hospital

18 New Children s Hospital: Ward blocks cardio/ortho immunosuppression inf / uro / general surgery infant / neuro PICU

19 The evolving format of pediatric care in Helsinki Children s Hospital visits, procedures, inpatient days of care 2012 prognosis 2020 change% Day surgery % Day evaluation and treatment (child neurology, cleft lip and palate center, child psychiatric consultations) % Recovery room % Operating theatre % Day hospital % Outpatient clinic (elective) % Outpatient clinic / immunosuppressive (cancer, organ transplantation) % Emergency room % Helsinki city pediatric emergency health center % Inpatient days of care (wards) %

20 Concept planning of the New Children s Hospital Conclusions Clear vision of the national and local role/responsibilities Strategic choices of developing the hospital profile Strategic and adaptive development of the ways how care is delivered Increasing the cost-effectiveness of space and staff Utilize the construction process to carry out significant development/changes in the processes of care Return of Investment - better, more economical and more sustainable care of uncompromized quality

21 After concept planning of the New Children s Hospital WHAT NEXT?

22 Planning the new Children s Hospital in Helsinki 2017 a superior Children s Hospital will be opened for children and their care providers...

23 Standards for pediatric hospital care (NOBAB Nordisk förening för sjuka barns behov) (Nordic society for sick children s need) Standards consist of 10 articles that are based on UN Convention on the Rights of the Child. They take into consideration the emotional and developmental needs of hospitalized children at different ages Standards have been harmonized and adopted in 16 European countries To ensure the quality of pediatric care, these standards should be implemented not only in recommendations and instructions but also in legislation

24 Standards for pediatric hospital care - NOBAB and European Association for Children in Hospital Charter 1. Hospitalization only if there is no other way to treat 2. Child s right to be accompanied by parents at all times. 3. Accommodation should be offered to all parents and they should be helped and encouraged to stay. 4. The right to be informed in a manner appropriate to age and understanding 5. The right to informed participation in all decisions involving their care 6. Children shall be cared for together with children (not on adult wards) 7. Environment designed, furnished, staffed and equipped to meet the needs of children (play, recreation, and education) 8. Staff whose training and skills enable them to respond to the physical, emotional and developmental needs of children and families. 9. Continuity of care should be ensured by the team caring for children. 10. Treating with tact and understanding and privacy shall be respected at all times.

25 What next after concept planning? Perspectives to be taken into consideration during all stages of subsequent planning and design of the New Children s Hospital 1. High quality processes of treatment and care of all patient groups 2. Perception/experience by the child 3. Perception/experience by the family 4. Perception by the staff = Hospital as working environment 5. Hospital capacity / Efficiency = Logistics of production 6. Safety - for example: making a mistake / negligence is done as difficult as possible (flight security) 7. Technical sustainability 8. Adjustability / Flexibility (evolving medicine) 9. Energy efficiency 10. Role in the society / community

26 High quality processes of treatment and care of all patient groups Development of new treatment modalities: requires clinical research New medicines, e.g biological agents New technology, e.g. remote monitoring, remote care, telemedicine, robots... New processes of care New kind of division of work and collaboration (specialized medical care vs. primary health care or doctor vs. nurse)

27 Perception/experience by the child Visual environment and sounds Communication with a child Play, age-sensitivity Painlessness Diminishing child s fears Hospital school (world s best school system according to PISA studies) Children s opinions

28 Perception/experience by the family Presence of the parent Facilities for parents, staying overnight, sanitary facilities Peer support for parents Communication and collaboration with the staff Collaboration with the school Supporting the hobbies of a child Collaboration with patient organizations

29 Role of the New Children s Hospital in the society / community national responsibility to treat the sickest renewal of the social and health care: integration of the specialized medical care and primary health care responsibility to train new generation and to research in order to develop new treatments regional and nation prosperity; reference site for new innovations significant employer for many professions, subcontractors takes into consideration multi-culturality

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31 2017