As past chair of Architects for Health (UK) Chris provides a valuable forum for exchanging ideas and promoting excellence in design of healthcare settings.
If you'd like to learn more about the AHDC, please connect with us on our website www.aushdc.org.au or on LinkedIn at linkedin.com/company/aushdc.
As past chair of Architects for Health (UK) Chris provides a valuable forum for exchanging ideas and promoting excellence in design of healthcare settings.
If you'd like to learn more about the AHDC, please connect with us on our website www.aushdc.org.au or on LinkedIn at linkedin.com/company/aushdc.
[00:00:00] David Cummins: G'day and welcome to the Australian Health Design Council podcast series, Health Design on the Go.
[00:00:19] I'm your host David Cummins, and today we're speaking to Christopher Shaw, founder of medical architecture and past Chair of Architectures for Health in the UK is founder of the Health Design Company, Medical Architecture.
[00:00:31] Chris works at the interface of the two worlds of health and architecture. As a past chair of Architects for Health, Chris has been able to be at the forefront of innovation and ideas exchange for the healthcare settings. I'm excited to learn more about Chris today and hear more about his thoughts on the future of health.
[00:00:47] Welcome Chris. Thank you for your time to be here.
[00:00:50] Christopher Shaw: Hello David, it is great to join the podcast and good evening to you from bright and sunny London.
[00:00:56] David Cummins: Bright and sunny London... Um, what's your definition of bright and sunny in London?
[00:01:01] Christopher Shaw: Well, London, as everybody knows, is a city that's built for drizzle, so it's rather unusual to have a bright spring day in London.
[00:01:08] David Cummins: So keeping that in mind, when it does come to the world of health design and knowing, certainly in Australia, water ingress is always a problem. Do you have to account for that as a designer in the world of health architecture, in especially clinical-sensitive places in the UK do extra resources and extra innovation go into that?
[00:01:28] Christopher Shaw: Yes, of course. We're all working on design for climate change at the moment. That's a common global theme in healthcare design and this realisation that the impact of climate on health is immense.
[00:01:40] It's something that concerns us all but at a micro-level, just making the best use of your environment is a sort of 101 for designers, making sure that the experience of arrival at a health setting, navigating getting into the health setting, feeling a connection between the environment outside, being able to see the passing of time.
[00:02:05] It's very important in mental health, the change in the weather, whether it's day or whether it's night, reinforcing those circadian rhythms, that's all part of deal and part of the enjoyment I think , of design and planning healthcare settings.
[00:02:18] So in a city area (I'm bang in the middle of London at the moment) the challenges are around really weird things like air quality I mean, we couldn't open windows at one of the hospitals we were designing in the middle of London because the air quality outside was so much worse than the air quality inside.
[00:02:35] So, there are all those sort of little niggles and interesting challenges that come, but all the way through that, you're trying to make the user experience, whether you are a clinician, patient or just a visitor, make that whole experience just a lot more pleasant.
[00:02:51] And that's a fairly low bar, but it can be a challenging thing in a very intense functional environment such as a hospital.
[00:02:57] David Cummins: One of the things you touched on there, and I do know certainly your company and your past history has really, really emphasised the need for good research and the good for lessons learned, and you just reeled off so many lessons learned and so much research then such as biophilic design, air quality, user groups...
[00:03:15] what do you think we can learn from other countries in reference to the future of health? How can we, as probably more developed nations, learn from other nations when it comes to the future of health?
[00:03:27] Christopher Shaw: I think that's right, bringing research into design. I'll just touch on the issues around research and design, because it's something that needs to be moderated and balanced in the way that one approaches it.
[00:03:38] There's a huge body of research available. If you spend a bit of time on the internet, you can find vast amounts of evidence-based design around environments and healthcare outcomes.
[00:03:48] But it does need a degree of intelligence and interpretation applied to it because A: some of the research isn't very good and you need to be able to judge whether it is substantial or not, and secondly you need to be able to apply sort of experiential lair to it.
[00:04:06] People have been designing cities for about four and a half thousand years, and there's a huge body of cultural ways of doing things that can be applied and layered over the top.
[00:04:15] Whether you are working in a big new acute hospital or a community setting, you just need to apply that sort of common sense attitude as well as drawing on some of the aspects of research.
[00:04:26] And research can be just asking yourself and asking those around you fairly dumb questions. That qualifies as research. One of the areas that I've been watching with interest is the development of healthcare systems in Africa at the moment because they're evolving in an interesting way, which I think we can learn from.
[00:04:43] In Australia, in Europe, in North America, we have healthcare systems, which are to some degree state systems or large mature private systems with whole infrastructures associated with those. If you're sitting in Ghana, there's a colonial residue of those systems.
[00:05:00] They have acute hospitals and so on, but I think what's really interesting is how they're starting to develop health systems based around micropayment systems on mobile phones that can be used to get advice for a few cents, and then that that can lead to ordering pharmaceuticals and getting treatment at a local level with fairly low skills.
[00:05:23] And I think that that is incredibly economic compared to the sort of edifices that we've all built around our systems in the west. Whether you're in Australia and Europe or in North America, all our health systems are under incredible financial stress at the moment.
[00:05:38] And I think that looking at how other systems work, perhaps from unexpected areas, is well worthwhile and very interesting. That, I think has an impact on the that we might plan our future health systems, the distribution of facilities, and it ties in with the piece I think that none of us have really got to grips with, which is digital health.
[00:06:02] We're dealing with a hospital system and the layout of hospitals, which to be honest, is mostly designed on social relationships. In other words, departmental planning and the movement of paper and goods and materials.
[00:06:16] And when we start to consider the opportunities in digital health of care at home, much more flows in hospitals and organisation of hospitals much more based on patient's needs, rather than departmental planning.
[00:06:29] That starts to give us a few lessons. We can start to feed in what's happening in Africa on those health systems, how that might work with integrated care systems. They'll have done the hard work for you and there's a lot to learn from that.
[00:06:43] Certainly, I think the potential is to change the way that we structure health systems.
[00:06:49] David Cummins: You touched base, certainly at the start about sustainability, and part of that sustainability is utilisation of existing assets.
[00:06:56] You also just talked about how some of these old buildings, the automatic response certainly in Australia is to knock it down, but what more do you think we can do, keeping in mind sustainability, the future of health, knowing that some of these buildings are quite old.. what can we do more to utilise these old buildings whilst also keeping in mind sustainability?
[00:07:15] Christopher Shaw: I think there's a whole new discipline in here. I mean, what I've described as 'reverse health planning'. If you're fairly experienced, you understand what people are trying to achieve in terms of the organisation and flow around a hospital.
[00:07:28] Often you'll find that a department in a hospital is quite inadequate and it's costing a lot of money and it's got inefficiencies associated with the buildings but just next door to it is this piece of office accommodation, which is fairly low spec in terms of engineering, but hey, it's got a nice 7 metre grid or something like that.
[00:07:46] I suppose the process that I'm talking about is looking at the buildings that you've got and seeing what can work best within those buildings, and your limitations will often be around structure, quite often around the vertical flow capacity or elevators and so on.
[00:08:03] But I think, being able to step back, look at what you're trying to do, look at your existing infrastructure assets that you've got, and start to remap a bit of that. I think everybody does it because you kind of have to. We've all done those kind of refurbishment schemes and so on, but pulling that away and starting to professionalise that.
[00:08:20] Say, you're dealing with embodied carbon in a much more efficient way, you're starting to simplify the level of innovations, the disruption to existing processes is going to be much reduced cause you're not knocking things down and building and you're just moving things around.
[00:08:35] We need to think about making that more sexy, making that something that is more aspirational. Look at the chaos that is most hospitals when you go and, when you walk around the sort of assembly of ward buildings that somebody's thrown up in a car park, all of that doesn't make any sense.
[00:08:50] But if you start to analyse it and see where things might work best and better and use the digital piece, you don't actually have to be next to each other, you can be much more distributed using the digital piece and start to really make that work for your estate.
[00:09:05] That also means it's going to save huge numbers of dollars if you start to do things that way. It can be seen as a pragmatic response, but that doesn't mean you're looking down at it. You really should be seeing that as real positive.
[00:09:16] But also, you get really great results. There's this really neat thing that you get when you've retrofitted a building, because things don't quite fit the way that they would in a new building where you've squeezed your efficiencies and value-engineered it to death.
[00:09:30] You get the opportunities... "oh yeah, we can put a coffee station there, or"... you can do all the sort of opportunistic stuff as you're developing that and it's really great and you get great results.
[00:09:41] Some of the most pleasurable buildings that have been around have been where somebody's taken something and just completely stripped it out, refitted it, and it has a kind of maturity about it, it fits in the surroundings a heck of a lot better than some of the new stuff that might start off being really great. But by the time the budgets have been looked at realistically, it just becomes less and less of a positive thing.
[00:10:02] And often those buildings themselves don't have the great lifestyle. Here in Europe there are some really great Victorian buildings that are over 150 years/120 years old that not only can, but are being used really well and actually perform a lot better because you've got great floor-to-ceiling heights, you've often got good natural ventilation.
[00:10:22] All those things that we were tearing our hair out over Covid. "Oh, they work quite well in this scenario" and Australia really isn't any different. If you look around the world, everybody has their little cycles of health building development which went on in the sixties, the seventies, the nineties.
[00:10:38] We've all got those and they may not be loved, certainly if they've been around for 20 or 30 years they won't be working very well because you will have hit the end of cycle for all of the main engineering system replacements. But boy, look at them again and make looking at them again top of the pyramid task.
[00:10:55] It's really important and I think that that's a trick we're missing.
[00:10:59] David Cummins: It's quite interesting talking to you because John Temple, who's on the Board of the Australian Health Design Council almost quoted you verbatim about the need for flexibility and adaptability in future design, which as you clearly pointed out, 150 year old buildings in the UK still have that flexibility.
[00:11:15] Certainly healthcare from the sixties, seventies here didn't have that. So that was his big message, to be flexible, be adaptable, build for the future without knowing what it is. It's really quite eerie to hear you both say the same thing.
[00:11:27] Christopher Shaw: Well, John and I cut our teeth together at the medical architectural research unit.
[00:11:32] David Cummins: Well, there you go. Yeah.
[00:11:32] Christopher Shaw: Shouldn't be that surprised that the messages are the same. It doesn't make it less powerful or less authentic I think though, that's a good message to have.
[00:11:39] And I think the problem is that it's not a message necessarily that a major contractor, or a large firm of architects want to hear. Because they're not geared you know.. in a way... suddenly, it becomes hard stuff, you're talking about the difficult stuff.
[00:11:51] Well, I'm sorry! You've got infrastructure, you've got these assets, you've got to make the best use of them and use top skills to do that, and top skills on the construction engineering and design side. I think that there's good work to be done there.
[00:12:04] David Cummins: I totally agree.
[00:12:05] You touched base earlier about the need for Artificial Intelligence and technology and also the way of the future. How do you see the world of AI technology, innovation, helping with the future of design and the future of healthcare as the future of treatment?
[00:12:22] How do you see that happening now in a time, long after you've retired?
[00:12:27] Christopher Shaw: It's happening now, but it's happening in the kind of wrong way. So I'll give you the great engineer Buckminster Fuller, great American engineer once brought a crit to a standstill by saying, "yeah, it's a really nice building, but tell me how much it weighs".
[00:12:39] It's asking those sort of awkward questions. We've got great BIM programs these days that people design buildings on. They produce really good information.
[00:12:49] And it all ends up being an absolutely fabulous render and video fly through and there's all this AI stuff that you can do there. But what we're not doing is what I call is 'really good simulation'. And I think that as designers, the opportunity around AI is more around option appraisals and simulation.
[00:13:08] Really looking at, if you're going to do this, let's simulate how this is going to work and use process simulation in a 3D environment to see how that goes. And there's some really good work that has been done on that. But with the advent of AI and particularly Chat GPT, there's some really good ways that we can start to look at avatars within that environment.
[00:13:29] So, if you can imagine an emergency department where you've got clinical leads, you've got nursing assistants, you've got patients coming in, you've got your ambulance staff, you've got these really complex, urgent interactions, and you can imagine simulating that in a sort of Sim City type of way where people come in and looking at alternative layouts and there are some classic systems that you can start to use to do that.
[00:13:53] And things like Chat GPT you can arm each of your avatars, each of your actors in that sort of environment with artificial intelligence. This will need a bit of work, but because the interactions will be quite complex as human interactions are.
[00:14:07] But to do that at an option appraisal level, when you're looking at alternative layouts, we've got really good data on a lot of this stuff, we all know how flows work in hospitals. Hospitals are really good at producing the data. As designers, we don't really use it in the simulation model, and I think that we have got the opportunity as designers to start getting much more into sim simulation around different options.
[00:14:28] And I think that that is a whole, again, a new discipline. We need to be careful about the sort of historic disciplines of, ":I'm an engineer or I'm an architect", or I'm a constructor", or "I'm a health planner".
[00:14:40] I think that there are emerging disciplines around process simulation and simulating the future. And that sort of stuff fits really interestingly into the idea of the digital twin because people talk about the digital twin having that you can know the X, Y, Z coordinates in every ceiling tile in your hospital and isn't that great!
[00:15:00] Well, it becomes much more interesting if you're looking at processes, starting to look at the "well, this is how we thought the process was going to work" and the flows and the amount of people in the waiting area and the receptionist, this is what's actually working we need to look at how we can change our model.
[00:15:14] And you can also then start to implement changes in the way that the hospital is run and managed in your simulation model first. So if you wanna change, I don't know, from two sessions to three, look at what that does to your staffing salary, look at what the risks are around that, and you to see how the digital twin and the idea of the digital twin when viewed as part of this process simulation or extension of process simulation becomes a much more potent tool.
[00:15:43] And I just think that's really where we should be putting a lot of energy into at the moment.
[00:15:47] David Cummins: What you are saying is amasing. But I'm a very simple mind, and I generally do that with stick figures and with coloured coding and all that stuff. Does that technology exist in the UK now?
[00:16:00] Christopher Shaw: No, well bits of it do
[00:16:01] David Cummins: I was thinking it was, and I was like, "what a great idea".
[00:16:03] Bits of it do but you've got to think ahead. This is where I think we'll be in five years time and this is about the future. The idea that we've got really good BIM tools, we've got really good ways of bringing augmented reality into what we're doing.
[00:16:17] But we're tending to augment the visual stuff, not the process stuff. And when we start to augment the process stuff as well as the kind of visual stuff and the other sort of physical attributes, then it becomes really interesting.
[00:16:29] I've got students doing PhDs on some of this stuff, and it's been absolutely fascinating seeing how you can game it. How you can start to game the design in a completely different way.
[00:16:40] That is absolutely fantastic. I think that type of innovation, that type of care, that type of technology is something that there is such a thirst for because automatically you can see the cost benefits, the operational benefits, the staffing benefits. Automatically you can see the design benefits for having that level of detail with ebbs and flows of a weekend or a public holiday or a quiet time of a Easter break or a Christmas break.
[00:17:06] Just before we go, what do you think is one of the main things designers today need to look for, designing for the future in healthcare, knowing that the feasibility that is done today, especially for large scale public hospital projects won't actually get into commissioning until five to seven years time.
[00:17:24] What is something that we should be looking at today to help with the health of the future about patient care?
[00:17:30] Christopher Shaw: Well, I think that the idea of indeterminacy is really... I was talking to the project manager for a large hospital in Denmark and he said "Chris.. By the time we build this thing", and working in Denmark's great, they have beautiful designers, lovely sites, a whole culture that is built around design is great. He said "70% of what we think is going to be, in terms of the technologies, the equipment, the clinical processes will have changed by the time we walk in on day one".
[00:18:00] When you're thinking about, not only design, but the change-management associated with the design and the flexibility and adaptability around design, you need to game that in your head. What happens if this completely changes? What can we use it for? What's the alternative plan? What's the alternative alternative plan?
[00:18:17] Again, within the culture of construction and getting things built, you can be seen as being a real annoying person if you take that but it's really important. It's really important to sit as close to the people who are going to be managing the commissioning of the building on day one as possible. And just make everybody aware that things are going to change because they will, and treat that as a positive.
[00:18:39] David Cummins: That is absolutely fantastic news.
[00:18:41] I'm so grateful for your time and so, so lucky to have been able to interview you. You do have a global name and certainly your background and your education and your continued desire to educate younger people and younger generations is paramount.
[00:18:56] I'm just so, so lucky that we have someone like you in the world to help create better future and better healthcare for patients and for staff and for those years of healthcare.
[00:19:04] So thank you so much for all your work in this field.
[00:19:06] Christopher Shaw: That's very kind. Thank you.
[00:19:08] David Cummins: You have been listening to the Australian Health Design Council podcast series, Health Design on the Go. To learn more about the AHDC, please connect with us on our LinkedIn or website.
[00:19:17] Thank you for listening.