Hospitals of the Future In partnership with Mott MacDonald we are exploring how hospital design will change in the next decade. Building on insights gained from multiple healthcare expert workshops around the world, this is an initial perspective that share some key thoughts on how and where we may see most change. Starting with context on shifts in healthcare more generally, from slide 28 onwards it includes 22 proposals for future design focus. These range from hub and spoke ecosystems and post-Covid reconfiguration to more flexible spaces and the impact of digital theatres. As part of a global Open Foresight programme, we are now sharing these views to gain feedback for inclusion in a more detailed point of view that will be published later in the year. If you would like to add in your opinions on which issues will be driving most change in hospitals of the future, we would welcome input either directly to us by email (tim.jones@futureagenda.rg) or via this short survey: https://www.surveymonkey.co.uk/r/J9S8SB6 Many thanks in advance for your collaboration on another key topic for future change.

1. Future of the Hospital
A Selection of Insights from Multiple Expert Discussions
September 2020

2. The Future of the Hospital
As healthcare needs and systems evolve, the format, role and features within
hospitals is changing. This is an initial view of shifts that may occur by 2030 and
is designed to stimulate further debate ahead of a more detailed report.

3. Multiple Discussions
The insights in this presentation have been gained from multiple expert
workshops around the world with researchers, regulators, doctors, HCPs,
providers and payers, as well as health systems and public health specialists.

4. Contents | Two Sections
This presentation shares emerging trends that may impact the future of hospital
design. We begin with macro healthcare shifts and then, in more detail, explore
future hospital design trends. It is the start of further open dialogue.

5. PART ONE: MACRO HEALTHCARE SHIFTS

6. Commitment to Universal Health Coverage
In 2019, the UN adopted a Political Declaration on Universal Health Coverage
including financial risk protection, access to quality healthcare services and the
provision of essential, effective and affordable medicines/vaccines for all.

7. Common Drivers for Change
There are several global ambitions that drive how healthcare systems are being
reconfigured. There are also additional regional challenges that are variously
impacting different healthcare models.
Improving Patient Experience
Improving HCP Experience
Improving Outcomes
Improving Efficiency
Global Ambitions Additional Regional Challenges
Overcoming Workforce Shortages
Improving Remote Access
Simplifying Complex Processes
Reducing Variation

8. New Paradigm Shifts
There are four underlying systemic trends that are driving healthcare
transformation. These align with the global priorities and have varied impact
across different healthcare systems and regions.
1: Wellbeing
• Focusing on
prevention and
wellbeing and a
shift from sick-care
to health-care
2: Value-based Care
• Changing the
pricing model from
‘cost-plus’ to value-
based driven by
social impact
assessments
3: Care Closer
to Home
• Providing more
services outside
hospitals to offer
convenient
healthcare support
where people live
4: Connected
Systems
• Smarter, integrated
infrastructure
linking healthcare
system to the social
determinants of
health

9. Four Tiers of Healthcare Delivery
Globally many see four models for healthcare delivery gaining momentum as
common solutions. With current trends towards community care, the role of the
hospital will change, providing more specialised services for complex cases.
In Home Care
• Remote diagnostics and monitoring via smartphone and in-home sensors
• Telemedicine support with HCP and wider system
• Increased use of online platforms (e.g. Good Doctor)
Polyclinics
• Ambulatory out-patient care primary care
• Convenient location in transport hubs, shopping malls
• Virtual / video consultations with experts in other locations
Community Hospitals
• Standard procedures such as maternity, knee operations and step down support
• Shared resources across networks
• ER / A&E with separate access and facilities
Super Hospitals
• Regional centres of excellence linked to universities
• Major trauma centres with extensive ICU facilities
• High volume of complex procedures with areas of speciality (e.g. cardiac)
Drivemajorityofhealthcaresupportlocal
Concentrateexpensivecomplextreatment

10. New Patient Journeys
Many agree the future hospital experience should be better configured around
the patient - not just the healthcare system. New patient journeys are in
development. Some involve incremental change: others are more radical.

11. Complex Ageing Populations
The challenge of an increasingly elderly population with
more comorbidity is however introducing greater complexity.
As demographics shift, hospitals will need to cater for more holistic treatment.

12. More Patient Data
Improved electronic records and the wider availability of proxy data provides
access to more, improved patient information. This drives greater transparency
on the impact of interaction at home, in the community and in hospital.
Growth in VolumeMore Variety

13. Evidence Informed Practice
Multiple digital / technology innovations and the ability to use emerging
evidence of what achieves good health outcomes, are driving a change in way
clinical services are organised. Many focus on greater sub-specialisation.

14. COVID-19 Pandemic Impact
The COVID-19 pandemic is accelerating some key emerging trends,
halting others and questioning whether there will be wider
reinvention of healthcare in the years ahead.

15. PART TWO: EMERGING HOSPITAL DESIGN TRENDS

16. A New Healthcare Philosophy?
Many see that by 2030 we may be experiencing a new approach to healthcare -
with significant innovation in hospital business models and design.

17. Significant Change Ahead
Experts see more change in hospitals by 2030 than in the last 30 years as
physical and virtual trends align with digital delivery and early prevention.

18. 22 Potential 10-year Shifts
From our discussions with multiple experts around the world we see 22
potential areas for 10-year shifts that will impact future hospital design thinking.

19. Patient-Centric Hospitals
Including patients and key stakeholders in the design of new hospitals
and the wider ecosystem creates a more human-oriented environment.

20. Connected Hospitals
The next generation of hospitals will be a part of a connected community heath
ecosystem. Enabled by pervasive 5G networks all elements will be interoperable.

21. Hospitals as Part of the City Ecosystem
With the focus increasingly on prevention, hospitals are better integrated with
other urban activities such as transport, education, leisure and the workplace.

22. Digital First Approach
In order to integrate technology across the full hospital lifecycle, digital
technologies are included up-front in the initial planning of hospital design.

23. Hub and Spoke
Successful adoption of hub and spoke ecosystems in India are provoking others
to rethink the structure and interconnection between different hospital assets.

24. Adaptable and Flexible Estates
To accommodate changing future demands, many consider that more flexible
approaches to hospital facility layout, structure and use will be essential.

25. Resilient Hospitals
As critical infrastructure, hospital location and design are rethought. Resilience
to storms, frequent flooding, extreme temperature and wildfires is a priority.

26. Net-Zero
As leading cities all aim to be net zero by 2050, hospitals are designed to
achieve radical reduction in carbon footprints and lower overall energy use.

27. Post COVID-19 Hospital
In the wake of Covid19, the balance between public and private healthcare is
challenged. Some see a long-term shift in funding priorities for public hospitals.

28. Check In vs. Check Out
Post-COVID-19 there is separation of hospital admission and discharge as well as
theatre entry and exit. This leads to the redesign of patient and HCP flows.

29. Proof of Immunity
Access to some health facilities is driven by a combination of digital identity,
proof of immunity and proof of no infection – all validated before entry.

30. Distinct But Flexible Zoning
Increased separation of patient admission, treatment and automated ancillary
activities define more distinct zones. These can be flexed as need.

31. Pods Not Wards
The adoption of more flexible spaces enable patient assessment, diagnosis and
even treatment to become more personalised, relaxed and convenient.

32. Flexible Supervision
Networks of connected nursing stations with real-time monitoring allow
flexible, overnight stay supervision to be the norm.

33. Self-Cleaning Materials
Aware of the rising risks from contagion, designers specify materials that
are increasingly self-monitoring and self-cleaning when needed.

34. New Room Thresholds
There is a focus on separating patient, family and nursing access so that
healthcare professionals can support patients without personal compromise.

35. Accelerated Recovery
To reduce expensive time after the ICU, patient recovery is migrated outside the
core facility - but is supported by increased remote supervision and analysis.

36. Separation of Emergency Department
Some regions talk about creating different facilities for emergency response to
prevent cross-infection from patients and separate health resources and staff.

37. High-Rise Hospitals
The benefits and risks of building high-rise facilities are hotly debated: It requires
a balance between access, cost, footprint, colocation and contagion risk.

38. Digital Theatres
An increase in technology enabled surgery adds theatre complexity but also
drives a growing dependency of input and supervision from an extended team.

39. Robotic Surgery
The use of robots for high precision, repetitive surgery impacts cleaning
standards, remote supervision as well as the required levels of human support.

40. AI and Unstructured Data
As self-learning AI develops, the ability to deal with unstructured data delivers
major improvements in diagnosis. AI is embedded into many clinical decisions.

41. QUESTIONS

42. Your Perspective
As we build the informed global view on the future trends for hospital design,
we would very much welcome your perspective on three key questions.
Impact
• Which of these trends will have greatest impact on hospital design by 2030?
Innovation
• Which areas will see the most innovation and change and why?
Gaps
• What else will drive significant change in future hospital design?
Please complete the survey on https://www.surveymonkey.co.uk/r/J9S8SB6

43. Future Agenda Limited
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www.futureagenda.org | @futureagenda
Mott MacDonald Limited - Dubai
Festival Tower, 2nd Floor Dubai Festival City 11302 UAE
www.mottmac.com | Yara.Aboelwaffa@mottmac.com