Karl Redmond, BIM4HEALTH representative and Director at Bowman Riley Innovate outlines how the NHS could obtain accurate data relating to the estate which should ultimately improve care pathways…
The vision set out by the NHS Five Year Forward View, captures the drivers for the estate and patient care, which are to be undertaken to help meet the UK Government’s need to increase efficiency of the public sector estate and new/refurbishment build programs. It highlights the need to capitalise on the opportunities the information revolution presents, including the BIM process. This approach captures vital and valuable information, enhances and supports the NHS aims and objectives, delivers tangible benefits and can significantly influence all future decision making relating to any and all asset/estates strategies. The BIM process, through understanding, collaboration and culture change, can aid the broader NHS agenda by introducing a diverse solution combined with local and national leadership, facilitated and coordinated via the BIM4Health group and its core members.
BIM4HEALTH is one of many BIM task groups, bringing together expertise from industry, government, public sector, institutes and academia to drive the increase in adoption of BIM across the supply chain. Its goals are broadly to:
- Raise Awareness of Health BIM;
- Articulate the value proposition/benefits to the healthcare sector;
- Measure & benchmark Health BIM performance;
- Provide a clear understanding of the requirements of Level 2 BIM;
- Make sure the healthcare sector understands the risks of not adopting BIM;
- BIM4Health also aims to share examples of Health BIM project implementations.
BIM and the NHS
The NHS has evolved into a system that is renowned for being one of the most comprehensive domestic healthcare providers in the world. However, the size and complexity can challenge its ability to offer an integrated health care service that many perceive it should.
The implications of delivering such a sizable and complex system also means that it is one of the UK’s largest financial burdens as well as a key UK asset. However, critics have raised concern with regard to the ability of the health service to develop an integrated patient pathway. One particular challenge is to capture and understand the needs of patients and to effectively align clinical services. To meet patient needs effectively, without unduly placing additional burden on the country, requires resources to be aligned. At the moment it is suggested that the physical assets are not effectively utilised and in some cases unable to meet practitioner and patient needs.
Utilising asset data that is captured by the BIM process for new build projects is just part of the broader systems thinking required. Although the data captured via this process is valuable, if cultural and leadership issues cannot be tackled simultaneously, the significant collaborative methodology and opportunity the BIM process represents will not be realised.
The asset
My recently written paper titled: NHS asset reconfiguration with specific reference to functional use and patient pathways: A sustainable approach to asset management, presents a proposal for research which seeks to identify requirements and map the resources and use of physical assets to meet the patient and practitioner needs. The specific focus of the research identifies reconfiguration factors and reasons for under-utilisation. Through review and expert feedback a more effective asset model will be proposed and subsequently validated. The paper itself provides a review of methods used to assess the NHS building stock and highlights the need for new models which will inevitably require validation from a range of expert groups for critical feedback and further development.
The ultimate aim is to help identify an effective and ‘fit for purpose’ NHS estate, for specific Trusts, based on current infrastructure, demographic data and geographic considerations, that support an integrated patient care pathway. Integration will be aided by developing and implementing a strategy for a Trust(s), and the associated health and population systems, through an accurate asset database, complemented by graphical visualisation, understanding, data analytics and systems thinking.
However, healthcare demands are dictated by disease patterns, ageing populations, demographics, technology, public expectations and legislative standards, all of which are in a continual state of flux, providing challenges to healthcare providers and their associated buildings. Developing a software tool to capture these complexities around patient care and mapping them to the NHS’s estates has been shown to be problematic1.This is a problem because of the various data sets required, their size and the sensitivity (personal, political, legal) surrounding some of the information, all of which needs to be considered simultaneously if robust solutions are to be developed short and long term.
The need for a clear understanding of the existing NHS acute estate and the part it plays in the delivery of healthcare and improving patient outcomes has never been more important. The NHS ‘Forward View into Action – The Healthy New Towns programme’ (July 2015) states that “Some NHS organisations have large estate holdings”, with a particular interest in “organisations considering how to make better use of underutilised estates”. This type of initiative is welcome, but consideration must be given to what we as patients (we are all patients) need from our NHS now and going forward. Once assets are sold or converted into none healthcare offerings, it will be very difficult or impossible to reverse.
Through shared data platforms (including the BIM process and broader methodologies) clear links between the current NHS estate, patient needs and potential new development programs can be evidenced and articulated to all. This should result in building owners, users and occupants receiving facilities designed to support better outcomes for all.
Buildings not only designed, built and occupied for improved physical and mental health outcomes, but developed (virtually and in reality) to reduce carbon emissions and energy bills, and digitally planned to deliver a more streamlined service. Almost all objects can now be a data point, and interactions with these data points can be aggregated with outcomes and experience data. Correlations can be explored, and the data can be effectively mined to support better decision making, and ultimately, benefits for society, corporate partners, the public sector and most importantly, people/patients in terms of physical and mental health outcomes.
The development of NHS data sets, guidance notes and standards is a requirement as well as a necessity that will benefit everyone reliant on the NHS service, in short, all of us. The continuous improvement and up-dating of vital corner-stone components, as is the case with Health Technical Memorandums (HTMs) and Health Building Notes (HBNs), is not negotiable and must be proactively and vigorously maintained to ensure positive healthcare innovation is highlighted, promoted and assessed for the good of patients, clinicians and operational staff.
The BIM agenda can help with the vision of a better, more efficient, and effective national healthcare service built on solid, robust and innovative guidance and standards as well offering flexible, future proofed designs that can be adapted to the changing needs of the patient. The sharing of current data, guidance and best practice would be an on-going process maximising and expanding the knowledge base through independent post occupancy evaluation work, which would inform and enhance the HTM and HBN documents. The increasingly robust and evidenced-based documents would be utilised to support procurement practices, especially life cycle procurement programs (rather than short-term capital focused cheapest wins programs), link capital and operational expenditure and support the Digital Built Britain initiative, the BIM process and Big Data agendas.
1 Cruz, C.O., Marques, R.C., (2013), “Integrating Infrastructure and Clinical Management in PPPs for Health Care”. Journal of Management in Engineering, Volume 29, No 4.
Karl Redmond
BIM4HEALTH representative and Director at Bowman Riley Innovate
Tel: 07725 785543
karl.redmond@bowmanriley.com