FUTURE OF Healthcare Ecosystems
Preventive Anytime, Anywhere High Tech and High Touch
Bespoke for All Catalyst for Urban Regneration Diffusing the Monolith Behind the Scenes FUTURE OF Preventive Anytime, Anywhere High Tech, High Touch
The scope of healthcare services looks likely to Technology is transforming the ways in which As healthcare becomes embedded into almost every shift to a more preventive model that accounts for healthcare professionals provide their services Healthcare aspect of our lives, technology will continue to the wider determinants of health. This change is and how patients access them. Rapid advances in drive increased convenience and better outcomes. driven by a rise in chronic illness, environmental mobile as well as wearable and hearable technology, Physical and emotional needs remain as strong as risk factors, personalised approaches to life-long the increased emphasis on operational and cost Ecosystems ever, so digital advances will need to be met with health and economic pressures. New approaches efficiency, shifts in behaviour and lifestyle patterns, increasingly inclusive and human-centred solutions to healthcare will seek to achieve health by or and changing business models are redefining when, and experiences. through design, with a greater emphasis on mental where and how healthcare services are delivered health and wellbeing, a balance of physical and and accessed. digital solutions and better understanding of the role of green urban spaces.
Read more Read more Read more
Bespoke for All Catalyst for Urban Diffusing the Monolith Behind the Scenes Regeneration Improved access to both physical and digital In a future when healthcare systems in cities will be The operation of future healthcare systems will information and a better understanding of individual By 2030, 1 billion more people will be living in urban characterised by the need to provide on-demand, high inevitably become more complex, driven by the health needs means that the days of ‘one-size-fits- areas than in 2020 . While rapid urbanisation poses a tech, high-touch, bespoke and preventive services, the demands of personalised medicine, greater numbers of all’ healthcare solutions are over. Revolutionary challenge for the operational capacity and efficiency role of the built environment and its buildings will be touchpoints – both on- and off-line – climate change- new medical approaches and a greater appreciation of healthcare and city systems, the opportunities it more important than ever. The ‘monolithic’ physical driven environmental extremes, and global health crises of demographic and cultural needs are supporting provides to embed health and wellbeing into new form of conventional hospitals will need to adapt to that will make safe, accessible and consistent services the delivery of bespoke solutions. At the same time, urban developments are two-fold. Better-designed an increasingly health-aware population, and an urban more challenging. The human and digital systems tailored services in intelligent, adaptable spaces buildings, spaces and places can improve resident context where traditional boundaries between modes that underpin healthcare systems’ performance will have the potential to deliver better outcomes whilst health and wellbeing and overall quality of life. At and activities, public and private, and inside and outside evolve to deliver improved access and outcomes while reducing costs. the same time, hospitals and healthcare facilities can are no longer fixed. At the same time, they will need the capacity to respond to sudden demand will surge, support the long-term economic growth and social to remain equipped to respond rapidly and locally to enabled by advances in logistics, resilient infrastructure, cohesion of local communities. health crises. automation and communication technologies. Read more Read more Read more Read more INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
Healthcare affects us all. For many, This report considers the long-term Our environmental projects, whether Foreword the events of 2020 have made the threat future of healthcare as a collaborative, providing new renewable energy or and consequences of ill health more multi-disciplinary endeavour – one that water treatment systems, also reflect our apparent than ever; for others it has extends far beyond physical healthcare commitment to the UNSDGs and the underlined the importance of staying assets to include transport networks, unequivocal link between planetary and healthy, and the support networks we public spaces, residential and human health. all need to do this. commercial design, urban planning and more. Our research focuses on With its global outlook, we hope this Pandemics like COVID-19 are part the built environment, but considers report illustrates the potential for of the new normal, accelerating a a broader set of drivers, trends and inclusive, sustainable and efficient changing approach to healthcare that innovations that could support more healthcare across multiple contexts, accounts for the wider determinants efficient, effective and inclusive and the opportunities within our grasp. of health and follows a more healthcare systems. It is intended for developers, architects preventive model. The breadth of and designers as much as policymakers challenges we face – whether adequate Recent Arup projects indicate this and healthcare providers, managers and nutrition, antimicrobial resistance emerging approach, and the pace operators – indeed, anyone with a stake or the effects of climate change – is of innovation. These include patient- in the future of healthcare. daunting, and change will take time, centred environments at the Alfred investment and coordinated effort. Hospital Intensive Care Unit, Yet philosophically and financially Melbourne; guidelines for ‘plug- in’ there can be no going back. modular hospital capacity, developed by our team in Dublin; and our work with Matternet to create an effective drone logistics system for healthcare facilities.
MAGGIE’S CENTRE Leeds, UK
This recovery centre offers a calm space for cancer patients and visitors. Natural DAVE PITMAN materials, bespoke amenities and plants Director, UKIMEA Healthcare embedded into the structure create a Business Leader, Arup respite from clinical spaces. Click to read ©Hufton+Crow more on Arup Inspire.
3 INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
The first half of 2020 showed in stark healthcare environments can positively The graphics in this report aim to convey Introduction terms the direct relationship between contribute to local people’s physical and some key themes within the future human health and human settlements, mental health and wellbeing, as well as of healthcare. Blue was chosen for its TYPOLOGIES OF HEALTHCARE and the defining influence of different galvanising economic and social benefits. SETTINGS AND THEIR INTERACTION associations with trust and stability, economic, social and political contexts. WITH THE URBAN CONTEXT key ingredients for healthcare in a Our understanding of health and Addressing innovation, it explores how digital age. This becomes gradually lighter wellbeing has evolved significantly as a convenience, cost and efficiency pressures chapter by chapter, indicating result, along with our expectations of are driving greater digital adoption – the future decentralisation and diffusion healthcare systems. including Artificial Intelligence (AI), of healthcare. telemedicine and wearables – at the same Healthcare systems globally were under time as strategies that account for and Each chapter is represented by a simple growing pressure to change and innovate engage human emotions and senses. abstract gif using universal shapes and even before the COVID-19 pandemic. It also considers the potential for services a sound effect, intended to immediately In many countries affordability of and spaces to engage with the needs convey the chapter’s focus. Lastly, the healthcare services in relation to national of different demographics and use of linework suggests the increasingly healthcare spending, ageing populations, cultural groups. DIY and self-made nature of healthcare, and a rise in lifestyle-related and chronic a deliberate move away from polished diseases have forced a rethink about how Future of Healthcare Ecosystems impersonal-style renders or vector graphics. and where healthcare services addresses these themes across seven are delivered. This is set against a chapters, exploring a variety of scales backdrop of global urbanisation and from the urban to the individual. The climate change, as well as the pursuit of report ends with a focus on the outlook social value and inclusive growth. for systems that underpin the smooth operation of healthcare environments, DIAGRAM Future of Healthcare Ecosystems before concluding with the overarching Typologies of healthcare settings explores the trends, drivers and contexts implications of the research. Each section and their interaction with the shaping the future of healthcare, and the contains best practice case studies and a urban context innovations affecting change. Fundamental plausible vision for the future. to this is a shift towards preventive Hospital buildings are moving from an models, and a philosophy that accounts for Planning, designing and building future inpatient focus towards more balanced the wider determinants of health. healthcare ecosystems will require an space typologies as healthcare services integrated, multi-disciplinary approach – shift to prevention-based models. Critically for the built environment, one that considers healthcare as a diverse These sites can accommodate a wider the adoption of preventive approaches and dynamic ecosystem of actors, from range of acute, non-acute and preventive must go hand in hand with the evolution the microbial to the planetary. This report services and activities. At the same time,
of the hospital from a hermetic space considers what a sustainable and effective Acute services Non-acute and preventive services Urban context hospitals are moving away from the urban for diagnosis, treatment, healing and healthcare ecosystem could look like, our fringe to become prominent city-centre recovery to one that is diffused across its prognosis for the future of the sector and structures, activating their surroundings urban context. This report considers how the vital services it provides to all of us. and diffused across the city.
4 INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
Preventive
The scope of healthcare services looks likely to shift to a more preventive model that accounts for the wider determinants of health. This change is driven by a rise in chronic illness, environmental risk factors, personalised approaches to life- long health and economic pressures. New approaches to healthcare will seek to achieve health by or through design, with a greater emphasis on mental health and wellbeing, a balance of physical and digital solutions and better understanding of the role of green urban spaces.
5 INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
CHANGING EMPHASIS AN APPLE A DAY? Healthcare is typically considered a The role that technology plays in reactive system, serving to cure or preventive healthcare is double-sided: treat an issue rather than preventing it on the one hand the proliferation from occurring in the first place. of technology has resulted in a Yet the precursor of Western medicine, widespread adoption of digital and ‘on- the ancient Greek ‘Asclepeion’, the-go’ lifestyles across generations. acted as a space to promote healthy For some, this has contributed to living rather than somewhere to a wider issue of reduced time for treat patients.1 Today, with 40% of exercise, self-care, or physical premature deaths in the developed social interaction. Further, the CASE STUDY world occuring due to unhealthy constant flow of information provided Forward Health behaviours, poor diet, and inactive by smart devices has fuelled instant San Francisco, USA lifestyles, governments are recognising gratification, which can both that such conditions are avertable.2 positively and negatively impact Launched in 2017, Forward uses AI to help people’s lifestyles as they begin to patients manage their health, focusing This comes at a time when costs favour convenience. The absence of on preventive and proactive care and of treatment are increasing, and instant gratification and convenience, using powerful user-experience design. it would be cheaper to pay to stay however, can also trigger anxiety Operating like a gym membership, the healthy rather than being treated. and contribute to poor mental health monthly subscription gives members Yet currently only 3% of healthcare – an issue that has been shown to unlimited visits to the clinic as well as budgets are attributed to preventive exacerbate physical and chronic illness the necessary equipment to track their services.3 However, initiatives and is costing the UK’s National own health, including a health app and including the Well-being of Future Health Service (NHS) an estimated £8 in-clinic equipment. When attending an Generations Act in Wales, and New billion a year alone.5 appointment, a body scanner measures Zealand’s ‘wellbeing budget’ suggest an individual’s height, weight, body a new approach, one that encourages While technology is responsible for temperature and heart condition in Only 3% of healthcare and enforces more preventive models. some of the negative impacts on 45 seconds. Blood and genetic testing, Launched in 2019, New Zealand’s people’s physical and mental health, it wellness and nutrition counselling and budgets are attributed to wellbeing budget aims to leverage can be used to reverse these effects by ongoing monitoring from wearable preventive services. This advances in technology that empower offering responsive care services both sensors are also available. Data and comes at a time when people to lead healthier lifestyles as physically and digitally. results collected are displayed on a large well as use design and planning to digital screen during each consultation, costs of treatment are facilitate and encourage new choices.4 emphasising the value of the data and increasing, and it would fostering dialogue between doctors be cheaper to pay to stay and members. Forward demonstrates the demand in the US for clinics that healthy rather than the © GoForward© incentivise on-going health – a cheaper cost of being treated. alternative to being treated after falling ill.6
6 INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
CASE STUDY Marmalade Lane Cambridge, UK
Co-living has been put forward as a potential solution to the housing crisis, providing communal space and amenities that also foster interaction between people. Such schemes might offer a viable alternative at a time when younger people are struggling to make ends meet due to expensive city rent for minimal space, and with some experiencing the effects of isolation. The Marmalade Lane co-housing scheme in Cambridge is a mix of varied size homes ranging from one- to four-bedroom houses and apartments. The scheme also prioritises wellbeing and socialising, with a central common area that offers a space for gathering and eating. Amenities are also shared, including a communal
laundry, gym, meeting rooms and garden – © David Butler all managed by residents.7
7 INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
Some tools can also give individuals PLACES OF PREVENTION the power to monitor and opt into Digital-led approaches alone however healthier everyday choices, as well are not enough to drive healthier as affecting how people navigate lifestyles, but rather need to work in through spaces, such as diet apps or tandem with physical infrastructure, exercise trackers. In the last few years, urban space and carefully designed several tools have also incorporated buildings to deliver a truly ‘gamification’, using rewards and preventive model. The average US instant gratification to encourage more citizen spends 90% of their life inside physical exercise. For example, studies buildings,9 making it essential for of Nintendo’s AR app PokemonGo designers, architects and planners to
showed that the game increased the create environments that can sustain CASE STUDY proportion of people who walked over mental and physical wellbeing. Xiamen bicycle skyway 10,000 steps a day (4km) from 15% to Consideration needs to be given to Xiamen, China 28% and reduced sedentary behaviour indoor air quality, sound and lighting of its players by 30 minutes a day.8 to alleviate levels of stress and poor This 8km cycle skyway in Xiamen, China, mental health, while more active was completed in 2017 by Danish Technology has the potential to design and provision of facilities architects Dissing + Weitling. empower people to take control and such as gyms at work can reduce Hovering five meters above street level co-create their health. This is also barriers to exercise. The physical and the congested roads, it connects five visible in the way digital technology distancing guidance and hygiene key residential quarters and three business is driving the emergence of more recommendations for workplaces centres in the middle of the city. This has preventative health clinics. In the in the wake of COVID-19 likewise promoted greener, more sustainable and US, such schemes can fill a gap emphasise the spatial impact of a active transport. In turn, more users have in provision, improving avoidable preventive approach. consciously decided to ride a bike to avoid health problems through lifestyle traffic jams and have also noticed health changes before more costly doctors’ benefits. The majority of the 8km skyway appointments are needed. is positioned vertically between ground level and an existing elevated bus rapid 500 metres transit (BRT) expressway. The BRT route those living within 500m of accessible provides shelter for the skyway, further green space are 24% more likely to do encouraging its use as an alternative to 30 minutes of physical activity per day. private vehicles. Shared and dockless bicycle pick-up points are also positioned along the route to encourage casual use by visitors as well as residents. The £8bn/year skyway also connects urban districts
the cost of poor mental health on the DissingWeitling © to green spaces surrounding Xiamen, UK’s National Health Service (NHS). providing additional health benefits.12
8 INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
Additionally, with 11 million deaths practices such as forest bathing attributable to dietary risk factors, (Shinrin-yoku). It is more important studies have suggested that aspects of than ever – particularly for those living built and food environments have a in cities – to reconnect with nature role to play in shaping healthier eating where green space is limited. habits to prevent chronic illnesses.10 Yet proximity to urban parks or gardens Identifying and redesigning such is uneven, a factor that became apparent obesogenic environments,11 for in the UK during the initial lockdown example where unhealthy food phase of the COVID-19 pandemic. options predominate or where walking In addition, the way people transition is impeded, should be at the heart of between spaces, their commutes or preventive healthcare. other journeys could become daily opportunities to improve fitness and The role of recreational outside spaces wellbeing by dedicating more and is another significant factor, given better connectivity for active forms of that interaction with the outdoors is transport, such as cycling and running. an increasingly important aspect of healthier lifestyles. A study by the The built environment is perhaps best UK Heritage Fund shows that living positioned to play a significant role in in greener areas and close to forests alleviating mental and physical strains is associated with less sedentary time on people through the design and and reduced risks of obesity.13 planning of urban spaces to encourage healthier lifestyles, which – like Other studies have shown that green the Asclepeion – support a holistic environments help prevent disorders approach that individuals can choose and speed up healing, with countries and shape. Digitally-led approaches including Japan adopting therapeutic alone are not enough to drive healthier lifestyles, PARSLEY HEALTH rather they need to work New York, USA in tandem with physical Parsley Health offers its members infrastructure, urban 24/7 access to medical practitioners, space and carefully personalised care and nutrition plans designed buildings and personal medical data, and includes lifestyle factors as part of a to deliver a truly © Trevor Tondro © Trevor preventive approach. Click to read more preventive model. on Arup Inspire.
9 INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
Truly preventive healthcare will go integrate nature, introduce more natural A vision for an far beyond the traditional model of a light, softer sounds, more communal single designated space for reactive spaces for events and eating to incentivising medical treatment. Instead, our encourage interaction, and quiet areas future healthcare ecosystems will or furniture that encourage breaks. healthcare tackle the maintenance of health and wellbeing in the context of where we Streets will promote active lifestyles ecosystem eat, work, how we sleep, play and by creating mobility routes for cycling travel – rendering health and all or running, hand-in-hand together with our immediate environments cleaner urban air. Building facades will inherently linked. remove pollution while also hosting urban climbing walls. Being healthier office access to The built environment will be also calls for more personalised and nature recognised as having the power to targeted spaces that foster a sense prevent illness and promote healthier of community and belonging. These lifestyle choices, experiences and emerging trends will drive healthcare outcomes. This will be enabled beyond the walls of hospitals and urban food production by design decisions that consider care facilities – bringing treatment to office natural lighting everyday experience and with an the community instead of the patient and ventilation understanding of mental processes, seeking it. This increases access and
augmented by wearable devices. convenience and unlocks the true climbing wall Buildings and their urban context will potential of preventive healthcare. facade
spaces to socialise
green space
outdoor gym outdoor seating
active travel
10 INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
Key recommendations
HEALTHCARE PROVIDERS AND OPERATORS Explore digital platforms and tools, such as gamification, and devices, such as wearable and hearables. These will connect patients outside the hospital and promote and monitor healthy lifestyles through regular exercise, self-care and nutrition.
DEVELOPERS, ARCHITECTS AND ENGINEERS Adjust building programmes and masterplans to prioritise access to nature and natural light as well as activities and modes that promote physical and mental health and wellbeing – from walking to conversation.
POLICYMAKERS Regulate towards lower emissions and acoustic levels in urban centres and increase the requirements for active transport infrastructure in existing and new spatial plans.
11 INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
Anytime, anywhere
Technology is transforming the ways in which healthcare professionals provide their services and how patients access them. Rapid advances in mobile as well as wearable and hearable technology, the increased emphasis on operational and cost efficiency, shifts in behaviour and lifestyle patterns, and changing business models are redefining when, where and how healthcare services are delivered and accessed.
12 INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
TELEMEDICINE SEE ALSO In the UK, NHS doctors and nurses are that would make someone visit their Genie Connect using Skype to help older people get primary care physician. Through the Robot companion for independent faster care, reduce avoidable ambulance app, users can also get their medicine living call-outs and help people stay out prescriptions delivered directly to of hospital.14 Between 2017 and 2019, them.18 While the app is currently only Changi Airport solving problems via Skype resulted being piloted for Amazon employees Contactless immigration trial in 2,000 fewer GP appointments, in the Seattle area, it is a sign of what prevented 3,000 avoidable visits to a just-in-time delivery model for
A&E and saved the NHS £1.3 million, healthcare services could look like. CASE STUDY signifying the huge potential of using 3D-printed Polypill Skype and similar telemedicine tools THE MANY FACES OF WEARABLES Nottingham, UK to connect patients with healthcare In recent years, the popularity of professionals.15 The integration of smart wearable devices has opened many A ‘polypill’ is a single tablet or capsule speakers and artificial intelligence (AI) possibilities for healthcare applications. that combines different types of is also making it easier for those who In the UK alone, the number of medication in order to treat or prevent are unable to search for health advice wearable users is expected to rise to chronic conditions. Combining different on the internet, including the elderly 7.1 million by 2024 – a steady increase pharmaceutical ingredients into a single and blind, with specific new services from 6.6 million in 2020.19 From pill reduces the number of tablets that designed to be accessed by virtual smartwatches monitoring heartbeat a patient needs to take, simplifying assistants.16 Some medical devices and rhythm, physical activity and sleep treatment and reducing the medical integrate the technology directly, such patterns, to wireless earbuds filtering administration associated with as the Livio AI hearing aid connecting noise and doing near-instantaneous multiple prescriptions. Researchers at to Amazon Alexa. translation of foreign languages, the University of Nottingham have taken wearables have the potential not only the polypill concept a step further In addition, advances in voice to collect physical and mental health by 3D-printing a pill to treat £1.3m recognition technology including data but also record it straight into cardiovascular disease. The printed saved for the NHS between 2017 and speech and vocal pattern analysis are medical records. This can reduce ‘multi-active tablet’ contains five 2019 from offering healthcare services used for earlier diagnosis and treatment the need for hospital or GP visits by compartmentalised drugs with two via Skype, signifying the huge of diseases like Parkinson’s disease. helping doctors spot ‘early warning’ different release times: immediate for potential of using similar telemedicine By reducing diagnosis and treatment signs and act as personal assistants some and sustained for others. tools to connect patients with times, these advancements can improve helping people live better. With the The 3D-printed polypill approach could healthcare professionals. patients’ quality of life and help number of connected wearable devices open the way for more complex illnesses professionals understand more about worldwide expected to rise to 1.1 to be treated by a single pill, improving diseases and their evolution.17 billion by 2022 (compared to 325 administration efficiency in locations 90% In the US, Care, a telemedicine platform million in 2016),20 the opportunity to where access to medication is limited. the uptake in electronic medical also developed by Amazon, functions form a first line of patient testing and It could also improve outcomes, with the records nationally by the Australian via virtual or in-person care as a ‘first monitoring without requiring physical © CC0 Adam Nieścioruk increased ease of a single pill improving Digital Health Agency. stop’, covering most of the situations interaction is significant. drug adherence by patients.
13 INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
CASE STUDY 5G Surgery, Hainan, China
In 2019, a patient with Parkinson’s disease received 5G-based remote surgery in the Chinese city of Hainan while his surgeon conducted the operation from the city of Beijing, 3,000km away. Leveraging the benefits of fast connectivity (zero video lag and remote-control delay), the surgeon managed to acquire all the necessary visual, auditory, tactile and other real- time information, manipulate the surgical instruments with micron precision on a computer and successfully implant a deep brain stimulation at the optimal target site.21 This breakthrough operation signified the beginning of the next step in Chinese telemedicine, moving from just remote monitoring and consultation to operation. In the future, advances in telemedicine and telesurgery will further augment the capabilities of doctors and surgeons allowing them to offer specialist services from anywhere in the world. At the same time, they will allow access to
operations for patients who live in remote MAD.vertise/Shutterstock.com © areas, away from specialist hospitals.22
14 INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
HEALTH ON THE GO
But this is not the only first line Australia has made headway with of healthcare tracking, testing and the first of these challenges, with the monitoring that technological Australian Digital Health Agency advances are able to contribute to. leading a 90% uptake in electronic During healthcare emergencies, medical records nationally, the world’s leveraging the ability of mobile devices highest participation rate for a novel to function as powerful health tools national health record system.29 CASE STUDY will allow fast and efficient health In Singapore, the Government Digital Livio AI checks and tests on the go, including Service works to produce and improve Minesota, USA remote temperature checks, biometric online access to government services, monitoring and contact tracing. This including healthcare. Its products have Livio AI is a hearing device that combines becomes increasingly important during included the ‘TraceTogether’ contact sensors with AI. Functioning as a hearing a pandemic, particularly in spaces with tracking app designed to prevent the aid, Livio AI can improve the clarity of high volumes of pedestrian activity spread of COVID-19 while protecting speech through selective noise filtering such as public transit hubs or sedentary user privacy,30,31 as well as tools to and by reducing or eliminating sounds environments (offices, retail stores, improve access to local public that cause annoyance. It can also waiting rooms, etc.). The experience health clinics.32 carry out near-instantaneous translation of the COVID-19 pandemic highlights of 27 languages and transcribe the role of this technology; from live conversations. Beyond hearing temperature mass screening in transit and speech, the device tracks physical areas such as airports and stations, activity and cognitive health, such to biometric wristbands tracking the as how much the user is talking and emergence of potential cases,25 to engaging with others and the wearer’s contact tracing using built-in features heart rate, and features a fall detector of smartphones like location data During healthcare and an alert system in case the user and Bluetooth Low Energy.26,27 emergencies, leveraging does not respond after a fall. It can also Mobile digital devices and systems the ability of mobile connect directly to an audiologist who can act as an additional measure for can provide real-time remote adjustments pandemic outbreak preparedness devices to function as and updates. By connecting to Amazon and control. powerful health tools Alexa and other devices on the Alexa allows fast and efficient platform, the device is also part of a Alongside the many opportunities bigger ecosystem of hardware that technological advances bring health checks and tests and software. Livio AI demonstrates to the healthcare ecosystem there on the go, including how hearing aids and other wearables are inevitable challenges, including remote temperature are gradually turning into personal digital infrastructure and system checks, contact tracing assistants that not only augment users’ © Robert Przybysz/Shutterstock interoperability, data privacy and the senses but also help them live better.23,24 ability of physical space to adapt.28 and biometric monitoring.
15 INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
The ever-evolving role of technology Wearable and hearable technology A vision for as an enabler of access to healthcare will further augment human senses will enhance existing and create new and act as a personal assistant a ubiquitous digital solutions and systems which, that helps people live better33,34 by when integrated into and supported by empowering them to take control healthcare physical infrastructure platforms, will of their physical and mental health allow patients to access care services and wellbeing. In addition, advances ecosystem without having to visit the hospital or in robotic technology will drive the leave their home. Faster, 5G-enabled next generation of care robots and connectivity will result in an even more proliferation of 3D printing, while seamless interaction between patients self-test home kits will add care to and doctors, allowing the expansion the list of activity modes a home of VR technology from education and will accommodate (care from home). training to immediate care purposes. AI, Machine Learning (ML) and cloud At the same time, faster connectivity computing will allow pharmaceuticals medicine home delivery will drive the next phase of and technology companies to develop telemedicine and telesurgery aiming drugs and vaccines faster and more to tackle the inefficiencies (surgery efficiently.35 This omnipresent layer waiting times, staff shortages, etc.) of technology will result in increased which many healthcare systems face. and better prevention and quicker responses at scale – especially during health crises – while underpinning a light-touch, pervasive model of health- monitoring and surveillance.
AI hearing aid
virtual doctor consultation
wearable diagnostic device
voice-enabled, home care robot virtual assistant
16 INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
Key recommendations
HEALTHCARE PROVIDERS AND OPERATORS Ensure digital infrastructure interoperability between public, private and third-party platforms and systems to maximise speed, convenience and data value.
DEVELOPERS, ARCHITECTS AND ENGINEERS Future-proof building assets through support of multiple digital layers, such as 5G-ready hardware and software, alongside physical spatial design.
POLICYMAKERS Legislate transparency in the recording, storing, sharing and management of user data, both by government and private platforms, especially during pandemic outbreaks or other healthcare crises.
17 INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
High tech, high touch
As healthcare becomes embedded into almost every aspect of our lives, technology will continue to drive increased convenience and better outcomes. Physical and emotional needs remain as strong as ever, so digital advances will need to be met with increasingly inclusive and human-centred solutions and experiences.
18 INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
DIAGNOSING DEMAND WATCHING OUR HEALTH
The possibilities created by ubiquitous A rise in chronic diseases will pose access to healthcare information, significant challenges for healthcare advice and services combined with systems worldwide. Monitoring and the rapid increase of personal health prevention could be critical to data from smart devices, wearables improving health outcomes and reducing CASE STUDY and sensors will fundamentally change costs: 88% of healthcare providers in Sheffield Children’s the relationship between healthcare the US are investing in Remote Patient Hospital professionals and patients, supporting Monitoring (RPM) technology to Sheffield, UK increased autonomy and control. support the management of high- risk chronic patients.39 Current RPM The Sheffield Children’s Hospital uses Driven by increasing preference solutions have been shown to reduce art and child-friendly interior design to for participatory and preventive hospital re-admissions, emergency improve children’s hospital experiences. care, patients are asking to be department visits, and overall healthcare Through Artfelt, the Children’s Hospital part of medical decision-making, utilisation, benefitting patients with Charity art programme, the hospital empowered by easily-accessible conditions including diabetes, congestive provides free art materials and music, online information and new heart failure (CHF), chronic obstructive art and craft workshops for patients aged opportunities for self-health ‘DIY’ pulmonary disease (COPD), asthma 0-16. These sessions help to provide management.36,37 This information and hypertension.40 entertainment, creative expression and will need to be interpreted and distraction for the young patients during evaluated in dialogue with healthcare The promise of the next generation of what can be a stressful time, as well as professionals to agree upon the most RPM technology, enhanced by AI with helping them to make friends with effective treatment for the patient. machine learning, is to make treatment other patients. Artfelt, in collaboration Advances in user- plans that are personalised to the with Avanti Architects, designed the Alongside this growing awareness and individual and increasingly effective. interior of the hospital’s new Safeguarding experience and user- quantification of personal health data In the form of AI health and wellbeing Support Unit, which provides space interface design, as is a rise in long term illness. Currently assistants (or coaches), and together for assessment, treatment and play. well as the evolution almost half the US population, 133 with a connected healthcare provider, Combining high tech with high touch million, have at least one chronic these advances can empower patients elements, it includes interactive light of new wearable, disease, which are responsible for to proactively manage their own health, installations, digital projections, and hearable, implanted seven out of every ten deaths.38 Yet this effectively shifting traditional healthcare brightly coloured artworks. Other spaces and ingestible devices, is not restricted to wealthier economies towards a more preventive model (see in the hospital are suited to specific age and will increase as populations grow chapter 1). Advances in user-experience groups and are designed by specially- will make personal and age globally. In the developing and user-interface design, as well as the commissioned creatives. The design health management world, urbanisation and a growing evolution of new wearable, hearable, strategy and programme as a whole seamless, adaptable middle class are also expected to lead implanted and ingestible devices, will are intended to provide an engaging, to a steep increase in sedentary and make personal health management welcoming and safe environment for and embedded in our unhealthy lifestyles, and subsequently seamless, adaptable and embedded in our young people, helping patients feel calm Avanti Architects for Sheffield Children’s Hospital © SimonKennedy everyday lives. a rise in chronic and lifestyle diseases. everyday lives. and reducing anxiety.
19 INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
In diabetes management, for example, The emergence of AR/VR and gaming- systems like Abbott’s ‘Freestyle based interventions is also opening-up Libre’ use smart sensors on the skin to new medical possibilities for assessment, continuously monitor blood glucose, with rehabilitation and therapy. Game-based data accessed and shared in real-time for VR interventions with stroke survivors discussion with healthcare professionals. showed a significant advantage of 10.4% Similarly, ingestible sensors embedded over standard treatment methods.44 In the into pills can reduce the consequences field of traumatic brain injury, the number of mismanaged drug intake: only 25- one cause of neurodisability with no 50% of patients globally take medication current available pharmacological therapy, CASE STUDY correctly, errors which cost the US VR is seen as a game changer.45 VR and National Academy for health system US$300 billion annually, AR interventions have also been effective Social Prescribing or 16% of total US healthcare costs.41,42 as a distraction technique, for example London, UK Sensor-embedded pills developed in chemotherapy or to reduce anxiety by Proteus Health can monitor in stressful hospital environments.46,47 Social prescribing is advice given by medication intake and effect; and During the COVID-19 pandemic, AR was medical professionals to their patients to compartmentalised, low-power also used by doctors at Imperial College engage in organised social events and microchips by etectRx can transport London to reduce the number of medical community activity to alleviate symptoms. messages to and from sensors located staff needed on the coronavirus ward. Rather than a conventional prescription in the body and manage drug release, A Microsoft HoloLens headset allowed a for medication, social prescribing might significantly reducing human error. single doctor treating patients to interact include volunteering, art classes, or with remote colleagues’ holograms, as cultural or outdoor sporting activities, Today, smart health devices are well as medical notes and X-rays. and are intended to help with mental predominantly enabled by GPS trackers, health and psycho-social problems heart rate monitors and our smartphone Beyond improved treatment efficacy and such as loneliness, anxiety and stress. cameras. In the future, interfaces, patient experience, these new technologies By utilising existing local assets and 88% monitoring and interactions will be can reduce cost and staff time in the groups to improve outcomes, the of healthcare providers in the US are driven by voice technology, smart care of acute and chronic patients by approach ultimately reduces the cost investing in Remote Patient Monitoring contact lenses, implantable chips, sensor enabling independent therapy at home. of treatment. The concept has seen (RPM) technology to support the embedded clothing, and even smart In buildings, sensing environments could uptake in the UK, The Netherlands management of high-risk chronic nanodevices circulating in our systems support nursing, care and assisted living and Ireland, with the UK Government patients. will both monitor and treat health by monitoring vital signs and physical establishing the National Academy for conditions, proving increased autonomy and mental wellbeing amd detecting falls, Social Prescribing in October 2019. and improved health outcomes. This meaning family members and healthcare The independent, non-profit organisation 50-75% ‘Internet of Bodies’43 will provide a providers could be more connected and aims to create a network of social of patients globally take medication rich source of health data, supporting remotely involved in the care of their prescribing partners, fund community- incorrectly, errors which cost the US preventive rather than reactive family members despite living far away, based programmes, coordinate research, health system US$300 billion annually, approaches, albeit privacy concerns with incidents detected and addressed Images/Shutterstock.com Business Monkey © and develop a network of advocates to 16% of US healthcare costs. will need to be addressed. in real-time. better embed social prescribing nationally.
20 INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
THE HUMAN CONDITION The expansion of the Medical Internet and patient experience. Functionality, of Things (MIoT), automation and strict hygiene requirements and efficient robotics in healthcare to support operation have been driving decision- mundane and repetitive tasks could making, but a greater understanding see the reallocation of human staff to of the interplay of patient wellbeing, more high-value, ‘high-touch’ roles. comfort and experience and patient A focus on core responsibilities and recovery are reshaping priorities. uniquely human competencies will see A market shift towards ‘value-based healthcare professionals spending more healthcare’ and the (debated) ‘patient time directly interacting with patients, as a customer’ models is further
CASE STUDY improving productivity, quality of influencing the transformation of the Chelsea and Westminster care and enhancing patient and design and operation of hospitals and Hospital visitor experiences.48 practices to focus on quality and patient London, UK experience (see also chapter 4). The tactile and physical nature of The redeveloped labour and maternity healthcare professions, as well as At its most basic this includes the wards at Chelsea and Westminster the increasing need for valuation ability for patients and healthcare Hospital in London are designed to create and interpretation data, will make professionals to communicate. a welcoming, calm and natural space. healthcare jobs less susceptible to Language barriers can be common A key part of the scheme is its lighting full automation. Instead, healthcare in cities with diverse communities, strategy, researched and designed by professionals will be supported in their where many – often vulnerable – Arup, which aims to reduce fatigue and roles by robotic and AI assistants.49 patients may be unable to speak the improve sleep. The bespoke system VR applications such as ‘We are local language, presenting a serious eliminates flicker and glare, as well as Alfred’, which put the user in the place risk to patient safety. In healthcare providing dimmable lighting so that of an extremely ill elderly individual, facilities the provision of translators patients can control the brightness of their will help medical and nursing students and materials in multiple languages own environment. This human-centred develop interpersonal competencies by can reduce barriers, as well as training approach forms part of an overall strategy learning to empathise with patients on non-verbal communication tactics. to improve experiences and comfort and conditions.50 Communicating in the communities levels. This includes brightly-coloured themselves is also key. In the early mosaic tiling, bespoke artwork and the Further, the reallocation of resources stages of the COVID-19 pandemic the use of natural materials such as wooden more broadly could help to meet translation team of the Western Sydney furniture and textiles. In addition, recliner demand for ‘high-touch’ mental health Local Health District, where 49% of chairs in each room can lie fully flat to services where demand far outstrips the residents speak a language other than provide a temporary bed for birth partners. supply of care.51 This shift to a more English at home, produced resources Combined, these tactics help to provide a human-centred role of the healthcare in 26 languages so that residents more personalised, adaptable and home- Gardner CW+/Gareth © professional also manifests in new were aware of the latest information like hospital environment. approaches to healthcare environments and guidance.52
21 INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
A ROOM WITH A VIEW An increasing body of research is Hospitals are leveraging these benefits showing the impact of environmental by adopting light and open design and design factors in improving patient approaches and by integrating natural outcomes and staff performance, landscapes such as parks into the including a reduction in medical architecture of their buildings to ensure errors, falls and infection rates.53 ample natural light, fresh air and open The level of control over and reduction views throughout all spaces.57 of environmental stressors by improving acoustic and visual comfort, The approach taken by San Diego orientation, a sense of privacy, view Medical Centre has been to focus its and exposure to nature and daylight can improvements of patient experience significantly improve patient wellbeing around the element of control and and shorten recovery times.54 A greater customisation: temperature and room consideration of these design factors microclimates can be adjusted to in hospital and care environments has medical requirements and patient the potential to significantly improve preferences, and lighting is designed quality and efficacy of treatment around circadian rhythm while and patient recovery, leading to allowing for individual adjustments shorter duration of stays and reduced by the patient. Nurses’ stations have medication and operating costs. been relocated outside of patient rooms to make care more patient- A greater consideration For example, patients with a window centric and accessible.58 This approach of design factors in with a view of nature compared to blends integrated technology with a those with a view of a brick wall had sensitivity to emotional experiences, hospital and care shorter post-operative stays and supporting human-centred healthcare. environments has the took fewer potent pain drugs.55 potential to significantly Natural materials such as timber used within interior spaces have also been improve quality and shown to reduce stress.56 efficacy of treatment and patient recovery, HOSPITAL CABINS subsequently leading Oslo, Norway to shorter duration Two woodland cabins work as extensions of stays and reduced of local hospitals, allowing patients to spend rehabilitation time around nature cost of operation and in a therapeutic space. Click to read © CC0 Evan Leith and medication. more on Arup Inspire.
22 INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
Technology promises to improve our resources, as well as more sensitive A vision for health, whether through embedded and therapeutic medical spaces. a humanised devices that will monitor and treat If challenges posed by the security of chronic conditions, richer data technology innovation, data ownership, natural analysed by AI to inform personalised ecosystem partnerships and funding materials healthcare treatment, or by the use of gamified VR can be overcome, future healthcare and AR treatment. But this ecosystem ecosystems will be digitally enhanced, ecosystem will also benefit from the increased centred around the patient experience one-on-one personal care we will and will incorporate environmental receive as a result of automation and design elements to improve patient the reallocation of previous human wellbeing and recovery.
welcoming artwork
view of nature
human interaction
Augmented Reality (AR) interface
natural light © Based on Urban Hospice NORD by Architects Image © Adam Mork’
23 INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
Key recommendations
HEALTHCARE PROVIDERS AND OPERATORS Integrate intelligent, digital technologies and automation in hospital operations to free staff from mundane tasks to focus on quality, human-centred patient interactions.
DEVELOPERS, ARCHITECTS AND ENGINEERS Include environmental design elements in the design of healthcare spaces with known positive effects on patient wellbeing and recovery and staff performance.
POLICYMAKERS Maintain inclusive age-friendly access to digital healthcare to support ageing populations by humanising user interfaces and experiences.
24 INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
Bespoke for all
Improved access to both physical and digital information and a better understanding of individual health needs means that the days of ‘one-size-fits-all’ healthcare solutions are over. Revolutionary new medical approaches and a greater appreciation of demographic and cultural needs are supporting the delivery of bespoke solutions. At the same time, tailored services in intelligent, adaptable spaces have the potential to deliver better outcomes whilst reducing costs.
25 INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
PRECISION MEDICINE New AI-enabled processing technology As well as better patient outcomes, combined with a greater quantity this would free up significant time and and accessibility to genetic data have money for more research and innovation, kickstarted a wave of genomics research commercialisation and diffusion and personalised treatment. A genome initiatives, creating an overall positive is an individual’s complete set of feedback loop delivering further improved DNA: understanding this can reveal a health outcomes and costs savings and, person’s risks to specific diseases and ultimately, a more sustainable system. likely response to drugs. As the cost of technology continues to fall, it will In addition, an individual’s increased CASE STUDY place genomic sequencing technology access to their health data, including their Kindbody at the heart of realising more precise, genetic sequence, could support a greater New York City, USA affordable and outcome-based care.59 degree of autonomy, DIY care and choice. It is anticipated that by 2040 all new- This would further bolster emerging Kindbody aims to provide more affordable borns will be DNA sequenced,60 outcome-based healthcare models, and holistic women’s health services. presenting huge opportunities for how which prioritise patient autonomy and end For US$10 a month, members have an individual’s health is managed across results rather than interventions. access to services including annual their lifetime and supporting precision Given the financial crises of public gynaecology check-ups, same-day urgent medicine with treatments tailored to healthcare systems and the looming care, contraceptive counselling, on- a person’s specific genomic makeup. insurance challenge of ageing populations demand virtual appointments, and pre- The impact of these shifts on medical with multiple chronic illnesses, this conception counselling. Services like these facilities could be to prompt a more presents the possibility of both a more provide members with the peace of mind spatially-distributed healthcare model cost-effective and personalised ecosystem. they need, but which they may be unable with smaller, cheaper and specialised to receive from multiple conventional local clinics equipped to diagnose and HUMAN-CENTRED SPACES clinic visits due to cost barriers. Members To manage life-long administer therapies less often, rather To manage life-long health holistically, the also have access to discounted general health holistically, the than individuals needing regular or future of bespoke care must look beyond wellness care as well as bolt-on services acute treatments at larger facilities. conventional understandings of ‘outcomes’ for fertility testing, egg freezing and IVF. future of bespoke and be more sensitive to the broader needs Targeting women aged 25-45, the clinics’ care must look Newly-developed unbiased treatments that and experiences of individuals. This is interiors challenge conventional medical beyond conventional account for differences in patient gender already manifesting in varied spatial environment design, creating a sense of and ethnicity alongside shared patient data approaches to different demographic security and comfort with warmer lights understandings of will result in more informed decisions needs, such as age or gender: Kindbody, a and materials, organically-shaped interiors ‘outcomes’ and be more and vaccines that could eliminate US network of women’s clinics, responds as well as integrating abstract art. Above sensitive to the broader unnecessary treatment, combatting the to women’s experience of healthcare all, the space aims to create a sense of current estimate suggesting that 20% environments with spaces and specific place that fosters conversation and gives needs and experiences of healthcare spending is wasted on material choices that prioritise security, Studio Islyn © women a sense of companionship not of individuals. ineffective interventions.61 comfort and trust.62 found in traditional clinics.
26 INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
SEE ALSO Urban hospice Copenhagen hospice for palliative patients
Maggie Centre Leeds Charity centre for cancer patients
CASE STUDY St. Michael’s Hospice Hereford, UK
The design of St Michael’s Hospice seeks a balance between the necessary requirements of a professional healthcare environment and the sense of a warm, more domestic space that integrates nature-based solutions. The design team engaged early-on with patients, practitioners and hospital teams to help create bespoke spatial configurations that satisfied their respective needs and aspirations. Nurses’ stations, for example, are positioned to provide full visibility of the rooms they are caring for while also ensuring privacy and comfort for patients. This discreet observation is enabled by a spatial configuration that moves from the current model, whereby rooms are positioned adjacent to corridors, to a layout where clusters or wards of rooms are connected to the main axis of the building. The design team also satisfied patient needs by maximising outdoor connections: each patient room has an external view and private patio,
providing a sense of place and comfort Dennis Gilbert© rather than of clinical treatment.
27 INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
In Chiba, Japan, a clinic for elderly the value of the complementary and patients is designed to be informal, alternative medicines market expected to with bright but discreet treatment rooms reach US$271.8 billion by 2024, up from contained in house-shaped buildings US$192 billion in 2018.66 Non-Western that provide a domestic alternative to approaches are often underestimated, hospital visits;63 and in the grounds of especially with applications in the Oslo University Hospital, Norway,64 prevention and management of lifestyle- Snøhetta-designed ‘cabins’ are sited related chronic diseases, in meeting the close to woodlands (see chapter 3). health needs of ageing populations, and These respond to patient needs for space managing the psychological aspects that respects everyday life by providing of pain. Some countries and insurers an informal environment for family are slowly expanding coverage of such visits, as well as the therapeutic benefits services amidst rising patient expectations CASE STUDY of outdoor space. Palliative and end-of- and costs. In Hong Kong, the first Chinese Hospital of Traditional life care too have their own practical medicine hospital is set to open by 2024 Chinese Medicine and emotional needs, with hospices and providing the city’s first space where Weihai, China organisations such as Maggie’s providing Western and Chinese healthcare practices space beyond the hospital that balance co-exist and complement each other.67 Situated on the coast and within a observation, privacy and comfort. black pine forest, this hospital offers The emotional effect of alternative comprehensive healthcare, including Healthcare systems and spaces that are therapeutic spaces is already influencing space for healing and preventive care. tailored to demographic characteristics the design of healthcare environments, The architecture reflects traditional of age or gender may still be at odds with with the potential to complement the Chinese typologies and is imbued with an individual’s cultural characteristics. more technology-led approaches explored and surrounded by nature (trees and This includes spiritual beliefs and in chapter 3. This includes the greater waterscapes) offering patients and language (see chapter 3), but also integration of daylight, natural materials, visitors calming and picturesque scenery. extends to the medical approach as a planting and an awareness of the impact Multiple courtyards and gardens connect whole, for example Traditional Chinese of sound. Likewise, smaller, domestic- various sections of the building and Medicine. Such factors are not restricted scale spaces are part of this shifting focus. feature unconventional programmes, to geography or ethnic group, with A more physically-distributed spatial including showrooms, gymnasiums, 65-80% increasing global connectivity, migration model that prioritises patient experience eating areas and classrooms. The two of the global population use holistic and travel supporting a greater awareness could be supported by a centralised axes running north-south and east-west naturopathic medicine as a primary of different cultures and religious data infrastructure, enabled by 5G. choreograph patient and visitor journeys form of healthcare. practices and their varied therapeutic Combined, these trends suggest a across the site, creating a sense of approaches. Indeed, between 65-80% healthcare system that will need to be layers and routes through the hospital. of the global population uses holistic more flexible and accommodating to This facility demonstrates the changing US$271.8bn naturopathic medicine as a primary differences, supported by diverse smaller nature of hospital typology, shifting from the value of the complementary and form of health care.65 Adoption of such spaces that enable shorter, tailored and ©GLA©Li Yao Design a processing ‘machine’ into a rich alternative medicines market by 2024. practices globally is increasing, with varied forms of treatment. spatial experience.
28 INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
People’s experience of healthcare will without hindering the risk of infection A vision for be increasingly personal, with a large and quality of care. Spaces will be proportion of the world’s population more domestic, creating a place people a personal collecting and knowing their own feel more comfortable in, improving health data and genetic make-up, conversations between practitioner healthcare aiding diagnosis and personalised and patient. These accommodate treatments. Rapid access to this data individual lifestyle and demographic ecosystem and to individual medical histories factors, as well as patients that are by healthcare professionals will empowered to choose their care based reconnecting also increase the effectiveness of on greater knowledge. with nature interventions, resulting in fewer hospital visits and time spent in These smaller facilities will also help healthcare facilities. create a community, where people don’t feel alienated by the spaces Large acute hospitals will they visit to get treated in or to complement a growing number of prevent illness. This combined with smaller, tailored and alternative new business models where healthcare healthcare facilities not previously will operate increasingly as a service included in standard insurance or as an outcome-based system or health system coverage. These will ensure that services are more access to hospital will use design and nature to foster affordable, with greater focus on the bespoke experiences that challenge outcomes of the patients. personalised medical facility design conventions cabin facilities
acoustic design
therapeutic environment
29 BESPOKE INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION FOR ALL ANYWHERE HIGH TOUCH REGENERATION MONOLITH SCENES
Key recommendations
HEALTHCARE PROVIDERS AND OPERATORS Address the patient data privacy and protection challenges of personalised medicine with early investment in data infrastructure and security protocols
DEVELOPERS, ARCHITECTS AND ENGINEERS Consider a more holistic understanding of healthcare, with the emotional impact of materials and design a key component of therapeutic spaces, particularly as they become more culturally- or demographically-tailored.
POLICYMAKERS Explore different organisational forms and delivery models that will be needed to respond to demand for a more personalised and preventive healthcare ecosystem, including subscription models and DIY care.
30 INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
Catalyst for urban regeneration
By 2030, 1 billion more people will be living in urban areas than in 2020.68 While rapid urbanisation poses a challenge for the operational capacity and efficiency of healthcare and city systems, the opportunities it provides to embed health and wellbeing into new urban developments are two-fold. Better-designed buildings, spaces and places can improve resident health and wellbeing and overall quality of life. At the same time, hospitals and healthcare facilities can support the long-term economic growth and social cohesion of local communities.
31 INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
MIXED-USE DEVELOPMENTS RETAIL HEALTH ON THE RISE With preventive care models bringing The healthcare sector is taking lessons healthcare directly to communities, from retail and hospitality, engaging with hospitals are no longer the only way to patients in innovative and meaningful access healthcare. Instead, they become ways by connecting with them where places that attract people from surrounding they live, work and play.72 Retail health communities to come in for regular clinics are gradually becoming the check-ups, empower them to take control physical embodiment of this delivery of their own personal health and promote model, resulting in decentralised, flexible CASE STUDY behaviours that favour prevention, and accessible urban healthcare facilities, New Ground Cohousing not intervention.69 the strategies of which (both online and London, UK offline) resemble those of a retail shop. This new model of healthcare service These urban facilities also help to alleviate New Ground Cohousing is the UK’s first and delivery will transform healthcare some of the challenges that national senior cohousing project for women. infrastructure. Hospitals will be healthcare systems face related to access, Located in Barnet, London, the complex transformed from monolithic, secluded quality and cost.73,74 Retail clinics are comprises 25 apartments arranged structures within the urban fabric (see a popular first-stop choice for patients around shared facilities including a chapter 6) to hubs of economic activity and a valuable extension to, rather than garden, cooking space and a laundry that generate further investment for replacement of, primary care services for room. One third of the units are social adjacent uses and spaces (residential, traditional healthcare systems.75,76,77 At the rent with the remainder being leasehold. commercial, leisure, etc.). At the same same time, in low- and middle-income The majority of residents – women time, they place healthcare at the heart of countries with few or no pharmacies between the ages of 50 and 90 – were a wider economic ecosystem, components or retail drug stores have, they have actively involved in the design process Real estate developers of which are human health research and been a major source of healthcare and played a major role in determining development institutions, healthtech and and medicines.78,79,80 the sustainable and community-driven recognise that biotech start-ups, and pharmaceutical and character and layout of the project. The consumers who visit a high-precision manufacturing companies While healthcare providers recognise development is completely resident- medical clinic will also and facilities. the need to treat patients as consumers, run, and through mutual support and real estate developers recognise that inclusivity aims to keep its residents be shopping, eating and Hospital-anchored mixed-use development consumers who visit a medical clinic will healthy, happy, independent and active. drinking, and seeking in cities that put medical facilities and also be shopping, eating and drinking, and It also aims to reduce demand for social entertainment nearby. campuses at the forefront of their offering seeking entertainment nearby. The next and healthcare services. The site layout highlight the potential of health-centred decade will see developers building upon allows direct interaction between the The next decade will placemaking. These spaces not only serve this momentum to attract development to housing development and the adjacent see developers building the medical needs of their patients but complement healthcare. main street. This helps to reduce isolation upon this momentum to also suit the diverse needs of a multi- by connecting the project and its residents generational demographic, elevate the user with the surrounding community and attract development to (patient, visitor, employee) experience, Seligmann Galit © enabling them to forge meaningful complement healthcare. drive local growth and regenerate areas.70,71 local relationships.
32 INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
SEE ALSO Cavendish Square Underground health and wellness commercial centre
Ohio Urban Healthcare Campus Steam plant redeveloped as medical headquarter
CASE STUDY Elderly Housing in Norway The Balozi Project Housing scheme that encourages East Africa community interaction
North Star Alliance is a non-profit, public- private partnership developing a network of roadside health clinics at major transportation hubs across Africa. The organisation has established 90 locations in West, Southern and East Africa, of which 19 operate as ‘Blue Box’ clinics that target the health of mobile workers. Within this, an initiative in East Africa called the Balozi Project aims to build a strong knowledge base and a community-driven approach to improving education, health and safety at a local level. Long-distance truck drivers are trained to act as peer health outreach workers, creating a valuable network of health advice, with the Bridge the Gap project further expanding this programme to include the sex worker community. By engaging with target groups and community champions, the Balozi Project works to facilitate overall community development, delivering services that are inclusive and fostering processes and partnerships that empower people and Portraitor CC0 © benefit long-term community growth.
33 INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
UNLOCKING THE VALUE OF UNDERUTILISED ASSETS At the same time, the changing nature and wellbeing (see chapter 1), such of healthcare delivery in cities leaves schemes can contribute positively to behind underutilised medical facilities, local economies by maintaining their often centrally located. For building residents’ economic activity, either by owners and operators, patients, employing them in community-related CASE STUDY users and surrounding communities, jobs or through community-organised, Illinois Medical District this presents a unique regeneration re- and up-skilling initiatives. Chicago, USA opportunity.84 Through adaptive reuse One example, the Humanitas care home and redevelopment, legacy healthcare in The Netherlands, offers students The Illinois Medical District comprises infrastructure can be renovated or free rooms in return for 30 hours of 2.3km2 of medical research facilities, labs, repurposed to house workplace, volunteering per month, to be spent a biotechnology business incubator, four residential, hotel or other healthcare engaging with the 160 elderly residents hospitals, two medical universities and uses and continue delivering value to of the nursing home. The types of more than 40 health-related facilities. their communities. engagement vary and include regular With 29,000 employees and 50,000 conversation and connection to reduce daily visitors, it generates US$3.4 billion The redevelopment of Chicago’s isolation and loneliness as well as in economic opportunity.88 The District Cook County General Hospital is a teaching of new skills.86 is surrounded by some of Chicago’s characteristic example. After sitting most deprived communities and is vacant for 17 years, redevelopment As the global population ages, the engaged in diversifying the character of on the 1914 building started in late ability of communities to accommodate the area, reducing the existing health and 2018 following the announcement of a the needs of senior residents will income disparities and strengthening the transformation scheme which includes play an increasingly important role in surrounding communities. One of a mixed-use complex containing office shaping local societies and economies. these initiatives is the redevelopment Through adaptive reuse space, a hospital museum, retail space Senior co-housing projects, such as of Cook County General Hospital, and redevelopment, and two hotels.85 the New Ground Cohousing project in which had stood vacant for 17 years. Barnet, London, for people who do not Past failed redevelopment attempts legacy healthcare CO-LIVING AND REVITALISATION wish to move into a care home, have sought to develop the surrounding area infrastructure can be The potential of inter- and intra- the potential to support their members first before tackling the hospital building; renovated or repurposed generational co-living to galvanise in ways that ensure that they find this latest initiative focuses on unlocking the community-led regeneration in cities is meaning and purpose through old age, value of the underutilised former hospital to house workplace, also significant. Beyond the immediate feel socially connected with their local first in order to catalyse the regeneration residential, hotel or other health benefits that co-housing has community and included in the long- of the surrounding area. The 32,000m2 healthcare uses and on residents, especially with regard term prosperity of the places that they mixed-use development will provide office to isolation and wider mental health feel happy living in.87 and retail space, a hospital museum and continue delivering value a 210-room hotel, as well as employment © CC0 Sawyer Bengtson to their communities. opportunities for local residents.
34 INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
The future healthcare ecosystem will To achieve this, healthcare providers A vision for a galvanise the economic and social will need to act in a complementary and benefits of its diverse spaces, as well unified way, building on the variety and regenerative as their medical function. Supported diversity of physical healthcare entry by greater preventative care and points in neighbourhoods to maximise healthcare patient autonomy, such spaces will access, optimise efficiency and improve become hubs of regular, casual overall quality of service. ecosystem activity, supporting active, healthy and prosperous communities. Old and Simultaneously, developers, planners new hospital buildings, retail clinics, and designers need to keep putting inter- and intra-generational co-living healthcare uses at the forefront of mixed-
schemes and buildings will act as use urban (re)development masterplans intergenerational anchors for mixed-use developments and leverage the potential of both co-housing and agents of urban regeneration. existing and new assets. In the future, a healthy neighbourhood will be the pillar for social cohesion, economic prosperity and cultural resilience.
affordable housing
retail offering health-anchored mixed-use development
healthy food choices
ground floor activation outdoor public space
35 INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
Key recommendations
HEALTHCARE PROVIDERS AND OPERATORS Build on integrating physical healthcare access points (hospitals, retail, urgent care clinics) to maximise reach, quality and efficiency.
DEVELOPERS, ARCHITECTS AND ENGINEERS Use healthcare facilities at every scale as springboards for community revitalisation and transformational change of areas and their surroundings.
POLICYMAKERS Enhance socio-economic policy frameworks that allow health-centred development initiatives to emerge and thrive as hubs, boosting the economic activity of areas (through employment, innovation, medical tourism hubs, tax revenue generation, etc.).
36 INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
Diffusing the monolith
In a future when healthcare systems in cities will be characterised by the need to provide on-demand, high tech, high-touch, bespoke and preventive services, the role of the built environment and its buildings will be more important than ever. The ‘monolithic’ physical form of conventional hospitals will need to adapt to an increasingly health-aware population, and an urban context where traditional boundaries between modes and activities, public and private, and inside and outside are no longer fixed. At the same time, they will need to remain equipped to respond rapidly and locally to health crises.
37 INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
RETHINKING THE HOSPITAL Medical and surgical processes The Woman Mother Child Centre in usually determine the form of hospital Maxima Medical Centre in Veldhoven, buildings; loyal to the architecture The Netherlands, uses an integrated principle of ‘form follows function’, model of care covering all stages of hospitals have allowed flows and pregnancy and childbirth (prenatal, procedures that saved lives to shape labour and delivery, postnatal, their spatial configuration. A general breastfeeding support and discharge). CASE STUDY focus on in-patient wards, while In practice, this means all stages of Arup CareBox responding to clinical and technological the process take place in one room, Dublin, Ireland developments, was and still is reducing the hospital footprint and prominent in hospital building layouts. freeing up space for other medical and CareBox is a series of design guidelines non-medical uses. This patient-centred for scalable, modular and rapid solutions In the future, developments in approach also keeps families together to solve the problem of intensive care and preventive care and telemedicine will and connected throughout the process.91 ward bed shortage during a pandemic transform usage patterns and reduce the outbreak. It can be quickly transported, number of people requiring treatment in In London, Guy’s Hospital Cancer deployed and implemented to provide traditional hospital environments. Centre (see case study) also follows a additional capacity in a range of settings. At the same time, utilising the benefits patient-centred design strategy. Its 14 These include healthcare campuses, where of AI, bespoke care and treatment plans storeys are split into three ‘villages’ CareBox can be attached to existing will result in faster, more effective each with their own medical focus, infrastructure to provide a ‘plug-in’ hospital, therapies that reduce the time patients clinical and non-clinical spaces, and connecting healthcare practitioners with spend in hospitals. discrete stairs and lifts helping to bring medical gases and other vital treatments a human scale. and services. It can also bring health While the number of patients treated services to buildings such as convention As well as rethinking in the UK has increased significantly HEALTHCARE EVERYWHERE: THE centres or sports halls, converting them NEW LOCALISM the typology of existing over the past 30 years, the number of into efficient-to-operate healthcare and new hospitals NHS beds has more than halved, from As well as rethinking the typology of venues. It could likewise enable additional around 300,000 in 1987/88 to 141,000 existing and new hospitals to better wards in vacant commercial premises to better align with in 2018/19,89 the result of strategies align with emerging healthcare delivery in city centres, locations where there is emerging healthcare to reduce hospital admissions and models, diffusing the monolith means limited external space for conventional delivery models, diffusing faster release times. The same trend is changing the distribution of healthcare field hospital solutions. CareBox can be observed in national healthcare systems beyond the boundaries of single particularly effective in developing countries the monolith means worldwide and calls for corresponding hospital buildings. Future healthcare or countries with limited existing healthcare changing the distribution design strategies that target the assets and infrastructure will be infrastructure. Once implemented, it of healthcare beyond mismatch between current hospital smaller, better connected and can continue to provide value to local infrastructure and the type of activities strategically dispersed in cities, with communities as an ongoing medical the boundaries of single 90 taking place in them. a stronger local presence and identity; © Arup facility or by being redeployed to hospital buildings. neighbouring locations.
38 INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
their design and execution will as care coordination, virtual health and effectively blur the boundaries between telemedicine, home and senior care as architecture and urban planning. well as behavioural change.93 In the future such private/public provision models A broader understanding of healthcare will be enhanced by centralised medical that considers the full spectrum of health – records, securely accessible to from strengthening and preserving health all practitioners, with care – particularly to acute and emergency interventions, and at its primary stages – coordinated with the treatment of illnesses and long-term local doctors to improve patient outcomes. care – will lead to the diversification and decentralisation of healthcare spaces POP-UP CARE tailored to the levels, type and location of Beyond the physical and digital provision required. Parts of the healthcare decentralisation of healthcare into non- pathway can be provided in community traditional settings and embedded across settings, for example outpatient cities and into lifestyles, the possibilities appointments, diagnostic tests or chronic of targeted data-driven interventions 92 CASE STUDY disease management. Likewise, our promise a transformation of public health Guy’s Hospital Cancer understanding of healthcare assets could delivery across cities and nations. Centre be expanded to include the likes of London, UK parks, active transport infrastructure and AI and advanced data analytics are community centres (see chapter 1). opening up new opportunities for more Guy’s Hospital Cancer Centre, London, targeted population health management applies a human scale and patient- Deinstitutionalisation, a shift in the programmes. Where providers used centred design strategy to improve spatial treatment of patients from the hospital into to target broad groups defined around utilisation and patient experience; its 14 the community, has already transformed health conditions and basic risk factors, storeys are clustered into three stacked mental health provision in some countries, advanced and intelligent analytics now ‘villages’, each related to a patient need with the aim to improve the patient allow the granular segmentation of (chemotherapy, radiotherapy, one-stop experience and recovery shown to be individual and small groups of patients clinic). Intuitive wayfinding and local impeded by the hospital environment. based on complex risk and health data. lifts and staircases within each village In the US, Ascension, a healthcare The analysis of the interaction of optimise patient movement, while design organisation focusing on community- multiple health factors combined with interventions maximise access to nature centred care provision closed the acute the wider social determinants of health and natural light. The boundaries between services of its Providence Health System such as isolation, affluence and digital care and treatment spaces are flexible, in Washington DC. Since most people fluency, allows the prioritisation of varying from blurred to clearly separated, spend only 15% of their life in acute interventions for patients at the highest in contrast to traditional hospital buildings. healthcare settings, Ascension aims to risk.94 Predictive analysis of such data This flexible spatial approach also allows shift the focus of Providence towards combined with spatial mapping can
the building to adapt to future care or Sternberg von Morley © community and population health and furthermore support strategies for treatment needs. wellbeing initiatives and services such prevention among future risk groups.
39 INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
This could include spatial interventions target areas and during lockdowns with SEE ALSO at a neighbourhood scale, such as minimised contact and travel beyond Patient Hotel Rigshospitalet access to parks, walking and cycling local areas. Accommodation for long-term infrastructure, or screening or education care patients programmes delivered in the community. Retrofitting existing transport systems can also help to alleviate local pressure.97 For example, a mobile screening unit In response to the COVID-19 pandemic, deployed into neighbourhoods identified authorities in France and India as high risk in Leeds, UK, delivers converted train carriages for medical lung cancer screenings at the doorstep use, supporting patient transport as of target groups. The initiative aims well as isolation and treatment.98,99 to detect cancer early to increase the Such hybridised systems have the chances of survival.95 potential to play a longer-term role in distributed healthcare ecosystems as part In addition, mobile and pop-up of a more resilient approach, helping healthcare services and facilities to better distribute demand as well as
can support underserved and remote providing additional capacity quickly CASE STUDY communities where health infrastructure in emergencies. ‘Healthcare on wheels’ Ghana District Hospitals is insufficiently available. This has the could be further advanced through Ghana potential to alleviate health inequalities automation, with autonomous vehicles and can provide flexible interim and and robotics facilitating provision into Part of the country’s District Health permanent solutions in service deserts high-risk areas and alleviating the Programme, the seven campus-style and areas of peaking demand, while pressure of staff shortages. district hospitals were created to respond informing longer-term development to the growing demand for healthcare strategies for health infrastructure. RISING TO THE CHALLENGE services and hospital facilities. Featuring a Designing urban healthcare facilities nimble construction model and responsive Pop-up clinics and mobile units also play that can scale, flex, morph and adapt design based on a modular system, >50% a key role in disaster and emergency in response to temporary demand the hospitals can adapt to meet local reduction of NHS beds in the last situations where they can provide a surges will be a key component of the conditions and needs as well as budgetary 30 years - from 300,000 in 1987/88 fast and targeted response. An example future urban healthcare ecosystem. constraints. Each hospital comprises to 141,000 in 2018/19 - as a result for use during a pandemic outbreak Recent experience from the COVID-19 steel-framed, single-storey buildings and is of strategies to reduce hospital is a concept for a mobile testing unit pandemic shows the need for this to be organised around a central clinical building admissions and accelerate developed by M-Rad, a Californian integrated across both healthcare and with a network of interconnected wards release times. architecture and design studio. non-healthcare facilities to ensure and covered walkways. The hospitals are The design features a repurposed overall resilience. energy efficient and their spaces can be trailer fitted with antiviral materials used as accommodation for staff and for 15% (copper) to minimise disease transmission For hospitals, this means that the education purposes for the community,
of a person’s life is spent in acute while bringing testing capacity into ability to repurpose internal spaces to © TP Bennett focusing on preventive care, child nutrition healthcare settings. communities.96 This facilitates testing in increase capacity as well as the ability and sexual health.
40 INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
to plug additional infrastructure into demand surges and to prevent other SEE ALSO existing buildings will be necessary patients from contracting infectious Paris ‘15 minute City’ requirements for future design. diseases. In Seattle, University of Urban planning initiative for Washington (UW) Medicine turned neighbourhood reorganisation Depending on the intended use, one floor of a multi-level car park in converting existing facilities (such as one of its medical centres into a drive- Mobile dental surgery operating theatres, wards and support through COVID-19 testing clinic Refurbished trailer providing areas) into temporary pandemic wards for employees.103 The clinic used dental care includes a series of considerations medical tents to benefit from the airflow related to construction disruption and of the non-enclosed car park and basic safety during modifications, patient signage to help drivers navigate the traffic flows and circulation, as well as facility. Similarly, a floor of a military logistics flows and waste management, hospital car park in Bahrain was CASE STUDY with recent examples of hospitals converted into a makeshift Intensive Airbnb ‘Open Homes’ repurposing their spaces to respond to Care Unit (ICU) with 130 beds for San Francisco, USA COVID-19 highlighting the importance COVID-19 patients, part of a wider of designing hospital facilities with scheme to increase overall hospital Airbnb’s Open Homes initiative provides extreme events in mind.100 capacity through similar field units short-term free or subsidised housing across the country.104 for those in need, including medical The hospital tower of the Rush stays, disaster relief, and refugees and University Medical Center, Chicago, It is important to note that the success asylum seekers. Hosts can either open was specifically designed to provide of conversion and expansion examples their homes for free or have their charges treatment in the case of infectious such as these lie in the ability of the subsidised by Airbnb and participating Deinstitutionalisation, a disease outbreaks. Following the hospital system to accommodate ‘plug- organisations. Airbnb waives its fees for 9/11 terrorist attacks, the need for a in’ solutions, either within or adjacent Open Homes participants. The initiative shift in the treatment of specialised area that could expand to existing building infrastructure. includes a partnership with Cancer Support patients from the hospital to handle large-scale, natural or Community, a global professionally-led into the community, has man-made emergencies was key. However, finding space within the charitable network of cancer support, to The building includes 40 negative building footprint of a hospital is not facilitate free accommodation for low- already transformed pressure rooms and three 20-bed units always possible. In this case, modular, income patients and carers travelling over mental health provision which can be isolated from the rest of flexible and mobile solutions have the 50 miles to receive treatment. Although in some countries, with the building with separate air handling. potential to increase hospital capacity. organised and validated through the Airbnb Any wing of the hospital can also be Self-contained, mobile operating platform, Open Homes effectively works the aim to improve the converted into a negative pressure theatre and ward units can be as a decentralised, local solution to short patient experience and ward within two hours.101,102 repurposed to isolate virus-infected term accommodation needs. For hospitals recovery shown to be patients, decant existing internal space, where capacity is available nearby it Beyond internal spaces, hospitals are maintain critical day surgery operations effectively acts as an extension of a facility’s impeded by the hospital 105 also repurposing areas such as car away from pandemic treatment zones Halfpoint/Shutterstock © physical space to support improved access environment. parks to increase their capacity during or to function as ICUs. to treatment.
41 INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
In Italy, CURA, an open-source design Significantly, any rapid transformation solution, converts shipping containers of space for medical use requires an into plug-in ICUs with biocontainment equally rapid expansion of supply chains abilities; the plug-in units can easily and labour supply. Even temporary be transported and quickly installed adaptations to the built environment must near to existing medical facilities or consider these fundamental systems – field hospitals.106,107 whether pharmaceutical production, PPE, or staff – in tandem to avoid creating new Non-medical spaces also have capacity that is unusable. the potential to be repurposed to increase healthcare capacity during Future planning for healthcare crises emergencies. The first quarter of 2020 like COVID-19 which cause temporary saw many countries and national demand surge and are likely to be healthcare systems adapting stadia, periodical should involve both medical sports facilities, dormitories and other and non-medical facilities and spaces. community facilities, conference In every case, the right infrastructure centres, hotels and even airports into for the right space, at the right time will efficient-to-operate healthcare sites. determine the efficiency, effectiveness Examples include the conversion of and overall success of such projects. Glasgow Airport’s 17-acre car park into a drive through testing facility;108 and the use of the runway at Istanbul’s Atatürk Airport as a COVID-19 field hospital.
EIR MEDMODULAR Mobile and pop-up New York, USA healthcare services and These competitively priced modular facilities can support hospital rooms can be used upon arrival underserved and remote and focus on workflow optimisation, communities where the use of new medical technologies, and customised design to improve health infrastructure is © EIR Healthcare EIR © patient experience. Click to read more insufficiently available. on Arup Inspire
42 INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
Future healthcare systems will be experience and optimise operational A vision for characterised by a distribution of efficiency. Hospitals will be agile, services, both within healthcare flexible, interconnected units that can a permeable facilities and across the communities scale up and contract to respond to and cities these facilities serve. demand surges. healthcare This transformation will be driven by preventive healthcare modes, Healthcare delivery will permeate ecosystem lifestyle and behavioural changes, the urban fabric and care access technological advances and points will be embedded into urbanisation, as well as temporary communities and non-traditional high-rise GP and periodic climate and global settings and spaces. Retail health health crises. clinics will keep strengthening the capacity of national systems and test kit delivery In this new landscape of healthcare pop-up, mobile healthcare touchpoints, delivery, hospitals will adapt their underpinned by AI and advanced recovery centre spaces and infrastructure to align data analytics technology will reach with patients’ needs, match care and patients and vulnerable populations in treatment functions, elevate the user their communities.
open-air waiting acupuncture practice room
repurposed carpark
Pop-up, floating testing area healthcare facility
pharmacy
consultation area
43 INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
Key recommendations
HEALTHCARE PROVIDERS AND OPERATORS Diversify built asset portfolios with buildings, infrastructure and spaces that are modular, flexible and able to scale through plug-in solutions to enable lower- cost adaptability and resilience.
DEVELOPERS, ARCHITECTS AND ENGINEERS Make healthcare professionals, local communities and patients integral to the design and decision-making process to strengthen the human-centric approach of healthcare facility design.
POLICYMAKERS Establish a flexible policy framework to enable local and central governments to facilitate mobilisation and coordination between public and private sector stakeholders for mutually beneficial use of space and functions across an expanded ‘site’.
44 INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
Behind the scenes
The operation of future healthcare systems will inevitably become more complex, driven by the demands of personalised medicine, greater numbers of touchpoints – both on- and off-line – climate change-driven environmental extremes, and global health crises that will make safe, accessible and consistent services more challenging. The human and digital systems that underpin healthcare systems’ performance will evolve to deliver improved access and outcomes while the capacity to respond to sudden demand will surge, enabled by advances in logistics, resilient infrastructure, automation and communication technologies.
45 INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
MEDICAL DATA The digitisation of healthcare will treatment guides informed by support improved health outcomes machine learning and collective through personalised treatments, medical experience. These systems the automation of services, and the work by encoding thought processes application of AI to achieve medical and decisions as clinical data. breakthroughs from dementia to cancer International schemes such as the (see chapter 3), and schemes such as the Human Diagnosis Project or ‘Human UK’s £250 million National Artificial Dx’ show the potential for a common Intelligence lab will have as much frame of reference and step-by-step impact on the efficient operation of treatment maps to treat any patient.111 hospitals and healthcare infrastructure Such tools could radically democratise as on the health of patients.109 specialist knowledge, with implications for medical centres in remote or rural Behind every anticipated medical locations, under-resourced healthcare CASE STUDY breakthrough will also lie the aggregation systems, and in the diagnosis of Digital Twins for Hospitals and analysis of medical data, a process rare illnesses. Boston, USA that is being accelerated massively by AI CURING INEFFICIENCY with Machine Learning, seen recently A hospital Digital Twin combines live in the hunt for a COVID-19 vaccine.110 Individual hospital funding mechanisms data on performance and patients, ward New York-based digital platform Owkin clearly vary, with capital budgets and configuration, equipment and resource is applying Machine Learning to patient operational budgets managed separately use into a digital model in order to test data at multiple medical institutions. in many cases. A more holistic scenarios, inform decisions and This ‘federated’ approach means that data approach is needed to realise future improve efficiency. Various companies, remains secure within each institution operational improvements, whereby including Siemens and GE Healthcare, while allowing Machine Learning models design and capital spend allow for are now providing these systems, to work at scale, identifying target patient reduced operational expenditure over combining the spatial configuration of a groups and predicting their response the long term, for example through hospital and its wards with real time data to treatment. Such national and layout flexibility and low or zero- from its associated systems, including international networks of medical data energy buildings. ambulances, energy use and medical 400,000 and intelligent processing promise to supply levels. Hospital managers are able sign-ups to the GoodSAM pandemic reduce the human resource burden of Much has been made of the potential to understand present and future capacity, volunteer support scheme within 24 medical research, increasing capacity for Digital Twins – virtual models staff flows, optimal floorplan arrangements hours of launch. and speed of discovery, while also of physical enitities – to improve the and care approaches. The use of Machine lowering the costs of drug development. efficiency and smooth operation of Learning and AI also supports scenario physical assets from power stations to development, modelling the real impacts 30% On the ground diagnosis and treatment transport infrastructure by integrating of potential changes or shocks to inform
of a nurse’s time in the US is currently will also see the benefits of a networked data from multiple sources including Coffeemill/Shutterstock © the redesign and reconfiguration of existing spent on non-value-added tasks. approach through the use of online BIM and real-time sensor networks.112 hospitals and the design of new ones.
46 INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
SEE ALSO Chowbotics’ Sally Robotic salad bar
CASE STUDY Matternet Station San Francisco, USA
Autonomous drone logistics developer Matternet has designed a new delivery port for use by medical facilities that promises faster turnaround times for blood samples, pathology specimens and medical supplies. The 3m-tall Matternet Station includes a hatch for loading and unloading of consignments, a raised landing platform, and a segmented canopy that opens and closes for take-off and landing. Once a drone has landed, the station automatically replaces its payload and battery, while remote operators use a dashboard to schedule collection and delivery. As well as reducing the cost and time associated with medical logistics, the system also allows the greater centralisation of laboratories, reducing the
space and cost requirements of smaller Matternet © medical facilities.
47 INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
Digital Twins are particularly suited to retrieving supplies. This could increase the complexity of hospitals, combining nursing capacity, with estimates multiple systems and spaces in order to suggesting that nurses currently spend inform decision-making and strategy up to 30% of their time on non-value- without risking ongoing hospital added tasks.114 Deployed at scale operation or patient wellbeing. throughout a hospital, or even individual units in smaller medical centres, robotic Managers of hospitals and healthcare assistants could improve the utilisation facilities will be able to use a Digital rates of valuable human medical Twin of their facility to understand professionals. Their increased use may capacity, resource flows and optimal however be contingent on, or even ward arrangements and how they drive, robotically-accessible hospital interrelate in real time. Further, design, for example laboratory or
integrated AI will allow operators storage facilities. CASE STUDY to test alternative scenarios – from LifeBank floorplan reconfiguration to supply For healthcare professionals, a Lagos, Nigeria shortages – with integrated outcome new wave of smartphone apps and predictions. Analysis suggests that the digital platforms is already LifeBank is designed to tackle the use of hospital Digital Twins could disrupting established staffing models. shortage of essential medical supplies in result in 900% of cost savings, and an Their greater proliferation and hospitals across Africa, including blood, almost two-thirds reduction in medical development could support a more oxygen and vaccines. Created in Lagos, emergencies,113 the result of faster agile and resilient hospital workforce. Nigeria, the digital platform encourages patient turnaround, capacity increases One example in use across England individuals to register to donate blood, and reduced costs. Spatially, scenario and Wales, Patchwork, matches and subsequently connects them to modelling within a Digital Twin will healthcare organisations with workers their local blood bank. Supplies are then support decision making around new to fill temporary staffing vacancies, couriered by motorbike in response to To realise future configurations, furthering the argument from admin roles to qualified doctors real-time hospital demand. The system is operational improvements, for flexible layouts and support systems. and nurses. The tool integrates pre- effective as it can respond rapidly, with a employment checks, compliance and decentralised network of donors, blood a holistic approach is ADAPTIVE STAFFING payroll, acting as a digital ‘staff bank’, banks, medical suppliers and hospitals. needed whereby design While we have seen the potential role challenging the conventional agency Central to the organisation’s mission is and capital spend allows that robotics can play in patient care model and reducing associated costs.115 its belief that poverty should not be a (see chapter 2), their presence will also barrier to healthcare access. As such, it for reduced operational affect hospital workflow and staffing Greater integration and normalisation provides free blood and oxygen to those expenditure over the long requirements. Automated logistics of digital marketplaces for staff that cannot afford to pay hospital bills, term, for example through systems and medical assistance robots, and volunteers will support flexible funded by private sector funding partners. such as US-based ‘Moxi’, are designed healthcare systems, better able to LifeBank has already moved over 21,000 layout flexibility and low or to only execute non-patient facing reach surge capacity both locally in © Lifebank products across 1,000 hospitals, saving zero-energy buildings. tasks, including delivering samples or the event of emergencies, or across a more than 7,100 lives.
48 INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
whole network for prolonged periods.116 Incorporating drone delivery into the Their greater use could also support building’s fabric, for example with a better life-work balance by giving drone ports built into the windows of individuals greater control over shift wards or patient rooms, could reduce times and encourage greater utilisation the need for road traffic as well of older workers through shorter and as limiting on-site storage and less frequent shifts. However, issues distribution needs.119 Further, it around precarity and skills will need to would ensure ongoing delivery of be addressed to avoid exploitation and vital food and medicines in the event CASE STUDY maintain safety. of road closures, power outages or GoodSAM non-availability of logistics workers – London, UK HEALTHY ASSETS requirements that are crucial to Pharmacies and medicine sellers medical centres in rural sites or areas The UK’s ‘GoodSAM’ digital platform more broadly are an integral part prone to natural disasters. Indeed, while coordinates the sign-up and deployment of healthcare networks that should the global COVID-19 pandemic is front of NHS volunteer responders. The public complement rather than compete of mind, the prolonged instability and volunteer scheme was established to with formal providers.117 Indeed the likely disruption caused by climate support the health service and care greater willingness of consumers to change must not be forgotten. sector during the early stages of the buy medicines online and the increase COVID-19 pandemic and received in diversity of distribution points, The use of rainwater harvesting for use 400,000 sign-ups within 24 hours such as retail clinics, will support in greywater systems, as well as on-site of launch. Healthcare professionals greater decentralisation and thus power generation, for example through can directly refer individuals needing system resilience. solar PV, will increase site resilience as assistance, while volunteers must well as reducing carbon emissions. complete a series of checks, including For the operation of hospitals Yet on-site renewables must come identity and health status, before being themselves, diversifying supply-chains, hand-in-hand with reliable and efficient offered local tasks via the app. These increasing self-sufficiency and reducing battery storage to ensure the system as include driving patients to and from resource-use where possible will leave a whole is resilient, particularly given appointments, delivering medicine from them better able to cope with extreme the risks inherent in spaces and systems pharmacies, and making regular phone weather events and disruption as well across hospitals, such as operating calls to check in on people self-isolating as reducing their environmental impact. theatres and ventilators. or shielding. These tasks support Schemes in developing economies have vulnerable or isolated people potentially demonstrated how to remain agile with More broadly, the health sector must cut off from friends and family, and those fewer resources, including ‘LifeBank’, recognise and take responsibility most at risk from contracting COVID-19. a blood and medical products collection for its climate footprint. Health The platform has been shown to enable and delivery scheme that responds in Care without Harm’s report, Health the rapid, crowd-sourced expansion real-time to hospital demand through Care’s Climate Footprint, delivered
of support networks, and support Sallie CC0 © a decentralised network of suppliers, in collaboration with Arup, estimates healthcare system resilience. donors and delivery vehicles.118 a climate footprint of 4.4% of global
49 INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
net carbon emissions due to the healthcare sector – equivalent to 514 coal-fired power plants.120 Seventy-one per cent of emissions are attributable to its carbon-intensive supply chain, including the production transport and disposal of goods and services. As well as reducing emissions from healthcare facilities themselves, the sector must invest and support the decarbonisation of local and national energy systems and zero-emissions procurement. Given their additional impact on air quality and associated health impacts, the use of electrified transport and renewable energy sources over diesel and petrol fuels must be an immediate goal.
Lastly, healthcare facilities also have a responsibility towards low or net-zero construction and to acknowledge the environmental impact of the materials they build with. Materials such as blended cement, concrete that stores
CO2, and timber can reduce the carbon impact of new hospital buildings, the 4.4% latter seen in the UK at the Dyson of global net emissions are due to the Centre for Neonatal Care at the Royal healthcare sector – equivalent to 514 United Hospital in Bath.121 Here, large coal-fired power plants. cross-laminated timber (CLT) panels ZIPLINE comprise the main structure, providing San Francisco, USA an efficient and clean construction 71% process, as well as substantially A drone delivery system dispatches critical of healthcare emissions are reduced embodied carbon compared to medical products in underserved areas, attributable to its carbon-intensive steel and concrete. complementing or replacing existing supply chain, including the production delivery methods, speeding up deliveries
transport and disposal of goods Roksenhorn CC0 © and increasing supply-chain resilience. and services. Click to read more on Arup Inspire.
50 INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
Future healthcare ecosystems will have Larger healthcare assets, like A vision for to operate in an unstable environment hospitals, will see the biggest shift an efficient – both physically, in terms of extreme with automation and flexible layouts weather events and natural disasters increasing operational capacity and on-site renewables associated with climate change, and improving outcomes. However, the healthcare man-made critical events including contribution of healthcare systems ecosystem terrorism and infrastructure failure – to climate change must not be lights-out as well as socio-economically, due to overlooked, with the potential to operation changing demographics and the varied become a beneficial actor with cost and fallout from the COVID-19 pandemic. self-sufficiency benefits as well as for Yet the application of technology, human health. whether to design new therapeutics or improve hospital efficiency, alongside supply-chain and resource strategies that encourage a networked approach, low carbon will support system resilience. supply chain
FM room Digital Twin control panels dashboard medical drone automated logistics delivery
cleaning bots
delivery bot
51 INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
Key recommendations
HEALTHCARE PROVIDERS AND OPERATORS Invest in national, cross-organisational digital systems enhanced by AI to help monitor, predict and plan everything from supply levels and floorplan layouts to clinical trials.
Larger healthcare asset operators should reduce building resource needs to increase resilience and self-sufficiency and cut carbon emissions.
DEVELOPERS, ARCHITECTS AND ENGINEERS Work to accommodate automation alongside human healthcare professionals, providing flexible and digitally-enabled spaces and networks to increase capacity.
POLICYMAKERS Incentivise and legislate for more integrated and adaptable supply chains to better cope with uneven and unstable demand and improved system resilience.
52 INTRODUCTION PREVENTIVE ANYTIME, HIGH TECH, BESPOKE CATALYST FOR URBAN DIFFUSING THE BEHIND THE CONCLUSION ANYWHERE HIGH TOUCH FOR ALL REGENERATION MONOLITH SCENES
The future of healthcare will be a At the same time, cities will play a operational capacity and efficiency prosperity will pave the way to a An integrated, ecosystem-based Conclusion story written and told outside the major role in keeping people healthy. in healthcare delivery. Researchers, healthy future from the microbe, to approach to healthcare will therefore be hospital. As this report demonstrates, Spaces such as public parks and healthcare professionals, patients, the human, to the planetary level. key in ensuring that trust, equity and change is already visible in the shift community centres as well as technologists, hospital operators, ownership is nurtured, whether during towards preventive care models and the infrastructure systems such as designers, architects, engineers, A human-centred approach to a teleconsultation session, during an disruptive advances in digital and active transport networks will function planners, real estate developers and healthcare means that providers open, honest discussion with a doctor mobile technology that are leading to as local or regional health assets policymakers will need to form a should address the core of patient in a safe, familiar and comfortable new ways of accessing and delivering promoting an active, healthy lifestyle for common front where healthcare needs. In a future where healthcare is environment, or in a variety of healthcare services. all and enabling preventive approaches delivery and access is founded embedded into all aspects of everyday settings that span buildings (homes, to healthcare. Asset-based strategies on education, inclusivity, equity life, it will be crucial to understand offices, hospitals), places (community It is clear that innovation in healthcare that prioritise healthcare will catalyse and resilience. human emotions and behaviour. centre, mixed-use developments) and isn’t determined by technology alone, the revitalisation of neighbourhoods and As care moves away from the infrastructure networks. Only then will nor is it restricted to direct improvements districts by connecting strong, but A common understanding of how hospital, so does the emotional journey healthcare be able to act as a catalyst in human health and wellbeing. mostly disconnected, sectors delivering the ecosystems outside healthcare – of patients. Healthcare systems that not only for total health but also wider Advances in biological science, for economic and social value and natural, socio-economic, technological, cater only for operational efficiency socioeconomic, environmental and example, will improve human health strengthening community cohesion R&D, jurisdictional – function and and capacity, but which fail to cultural resilience. through new cell, gene and RNA and resilience. co-exist will be a key factor of long- recognise that the human experience therapies; but in the coming decades term success. Understanding of the of healthcare extends beyond the hard a larger impact is expected in other The trends which are analysed in this connections like those found between boundaries of conventional medical sectors, including agriculture, report and which will likely shape the biodiversity preservation and human typologies, will eventually lack the consumer products and energy future of healthcare indicate that it health as well as the wider impact the necessary influence to establish or production. This in turn could support will take a convergence of innovations protection of a natural ecosystem has restore trust with their patients and improved nutrition, personalised care and interventions from various sectors on nutrition and food security, disease empower them to take control of their and a healthier environment.122 and industries to achieve improved prevention, business and community own health.
53 1 Prasad, S. (2020). Typology: Hospitals. 14 ‘NHS Skype doctors and nurses’ prevent 24 Dean, J. (2019). The Future of Wearable Tech Is features/2019-04-18/the-future-of-wearable-tech-is- 43 Written by Xiao Liu, F.at the C.for the F.I.R. (2020). References Architectural Review. Available from https://www. thousands of avoidable hospital trips (no date). NHS Called a Hearing Aid. Bloomberg.com. Bloomberg. called-a-hearing-aid The Internet of Bodies is here. This is how it will architectural-review.com/essays/typology/typology- Choices. NHS. Available from https://www.england. Available from https://www.bloomberg.com/news/ change our lives. World Economic Forum. Available hospitals/8629443.article nhs.uk/2019/05/nhs-skype-doctors-and-nurses- features/2019-04-18/the-future-of-wearable-tech-is- 34 Etherington, D. (2019). Amazon might reveal from https://www.weforum.org/agenda/2020/06/ prevent-thousands-of-avoidable-hospital-trips/ called-a-hearing-aid fitness-tracking Alexa wireless earbuds, Echo with internet-of-bodies-covid19-recovery-governance- 2 Vlaev, I. et al. (2019). Changing health behaviors better sound this week. TechCrunch. TechCrunch. health-data/ using financial incentives: a review from behavioral 15 ‘NHS Skype doctors and nurses’ prevent 25 Jones, S. (2020). Liechtenstein rolls out radical Available from https://techcrunch.com/2019/09/23/ economics. BMC Public Health 19, 1059. https://doi. thousands of avoidable hospital trips (no date). NHS Covid-19 bracelet programme. Subscribe to read amazon-might-reveal-fitness-tracking-alexa- 44 Karamians, R. et al. (2019). Effectiveness of org/10.1186/s12889-019-7407-8 Choices. NHS. Available from https://www.england. | Financial Times. Financial Times. Available from wireless-earbuds-echo-with-better-sound-this- Virtual Reality- and Gaming-Based Interventions nhs.uk/2019/05/nhs-skype-doctors-and-nurses- https://www.ft.com/content/06b7e6f3-a725-4eda- week/ for Upper Extremity Rehabilitation Poststroke: A 3 Health at a Glance 2019: OECD Indicators (2019). prevent-thousands-of-avoidable-hospital-trips/ 9153-e0af48040e30?desktop=true Meta-analysis. Archives of Physical Medicine and OECD. Available from http://www.oecd.org/health/ 35 Murgia, M. (2020). AI-designed drug to enter Rehabilitation. W.B. Saunders. Available from https:// health-systems/health-at-a-glance-19991312.htm 16 Siddique, H. (2019). NHS teams up with Amazon 26 Kelion, L. (2020). Coronavirus: UK confirms human clinical trial for first time. Financial Times. www.sciencedirect.com/science/article/abs/pii/ to bring Alexa to patients. The Guardian. Guardian plan for its own contact tracing app. BBC News. Financial Times. Available from https://www.ft.com/ S0003999319314388 4 The Wellbeing Budget 2019 (2019). The Treasury News and Media. Available from BBC. Available from https://www.bbc.co.uk/news/ content/fe55190e-42bf-11ea-a43a-c4b328d9061c New Zealand. Available from https://treasury. https://www.theguardian.com/society/2019/jul/10/ technology-52263244 45 Zanier, E.R. et al. (2018). Virtual Reality for govt.nz/publications/wellbeing-budget/wellbeing- nhs-teams-up-with-amazon-to-bring-alexa-to- 36 IoT Medical Devices Market worth $63.43 Billion Traumatic Brain Injury. Frontiers in neurology. budget-2019 patients 27 Newton, C. (2020). Apple and Google have by 2023 (2019). Markets and Markets. Available Frontiers Media S.A. Available from https://www. a clever way of encouraging people to install from https://www.marketsandmarkets.com/ ncbi.nlm.nih.gov/pmc/articles/PMC5964310/ 5 Mental health (2012). The King’s Fund. Available 17 Moro-Velazquez, L., Cho, J., Watanabe, S., contact-tracing apps for COVID-19. The Verge. PressReleases/iot-medical-device.asp. from https://www.kingsfund.org.uk/projects/ Hasegawa-Johnson, M.A., Scharenborg, O., Kim, The Verge. Available from https://www.theverge. 46 Schneider, Susan & Workman, M. (2000). Virtual time-think-differently/trends-disease-and-disability- H., Dehak, N. (2019) Study of the Performance of com/interface/2020/4/14/21219289/apple-google- 37 IoT Medical Devices Market worth $63.43 Billion reality as a distraction intervention for older children mental-physical-health Automatic Speech Recognition Systems in Speakers contact-tracing-app-android-ios-pros-cons- by 2023 (2019). Markets and Markets. Available receiving chemotherapy. Pediatric nursing. 26. 593- with Parkinson’s Disease. Proc. Interspeech 2019, quarantine-testing from https://www.marketsandmarkets.com/ 7. 6 GoForward Inc. Available from https://goforward. 3875-3879, DOI: 10.21437/Interspeech.2019-2993. PressReleases/iot-medical-device.asp. com/how-it-works 28 Dennis Normile Mar. 6, 2020 et al. (2020). 47 FUTURE HOSPITAL (2020). CW . Available from 18 Etherington, D. (2019). Amazon launches Amazon Why airport screening won’t stop the spread of 38 Raghupathi, W. and Raghupathi, V. (2018). An https://www.cwplus.org.uk/our-work/art-and- 7 Marmalade Lane - Cambridge’s first cohousing Care, a virtual and in-person healthcare offering for coronavirus. Science. Available from https://www. Empirical Study of Chronic Diseases in the United design/future-hospital/ community. Available from https://marmaladelane. employees. TechCrunch. TechCrunch. Available from sciencemag.org/news/2020/03/why-airport- States: A Visual Analytics Approach. International co.uk/ https://techcrunch.com/2019/09/24/amazon-care- screening-wont-stop-spread-coronavirus journal of environmental research and public health. 48 Allen, D.S. (2019). 2020 Global Health Care healthcare-service/ MDPI. Available from https://www.ncbi.nlm.nih.gov/ Outlook, Laying a foundation for the future. Deloitte. 8 Xian, Y. et al. (2017). An Initial Evaluation of the 29 Reinsfield, J. (2019). Digital Nation: How Australia pmc/articles/PMC5876976/ Insights. Available from https://www2.deloitte.com/ Impact of Pokémon GO on Physical Activity. Journal 19 Wearables - United Kingdom: Statista Market became a digital health pioneer []. Available from global/en/pages/life-sciences-and-healthcare/ of the American Heart Association, 6 (5). https://doi. Forecast (2020). Statista. Available from https:// https://www.bluelatitude.com/site/assets/files/5364/ 39 Malkary, G. (2019). Trends in Remote Patient articles/global-health-care-sector-outlook.html org/10.1161/JAHA.116.005341 www.statista.com/outlook/319/156/wearables/ how_australia_became_a_digital_health_pioneer. Monitoring 2019. Market Intelligence for Competitive united-kingdom pdf?utm_campaign=How%20Australia%20 Advantage. Available from http://www.spyglass- 49 Ahuja A. S. (2019). The impact of artificial 9 Indoor Air Quality (2018). EPA. Environmental is%20becoming%20a%20digital%20health%20 consulting.com/wp_RPM_2019.html intelligence in medicine on the future role of the Protection Agency. Available from https://www.epa. 20 Tankovska, P.by H. (2020). Global connected pioneer&utm_medium=email&utm_ physician. PeerJ, 7, e7702. https://doi.org/10.7717/ gov/report-environment/indoor-air-quality wearable devices 2016-2022. Statista. Available from source=Eloqua. 40 Malkary, G. (2019). Trends in Remote Patient peerj.7702 https://www.statista.com/statistics/487291/global- Monitoring 2019. Market Intelligence for Competitive 10 Sallis, J.F. and Glanz, K. (2009). Physical Activity connected-wearable-devices/ 30 TraceTogether. Available from https://www. Advantage. Available from http://www.spyglass- 50 Allen, D.S. (2019). 2020 Global Health Care and Food Environments: Solutions to the Obesity tracetogether.gov.sg/ consulting.com/wp_RPM_2019.html Outlook, Laying a foundation for the future. Deloitte. Epidemic. Milbank Quarterly, 87 (1), 123–154. 21 Arup and Ricoh Europe (2019). . Available from Insights. Available from https://www2.deloitte.com/ 10.1111/j.1468-0009.2009.00550.x https://www.ricoh-europe.com/insights/future-of- 31 Farr, M. and Hurst, D. (2020). Australian 41 Zullig, L.L. et al. (2018). The new landscape global/en/pages/life-sciences-and-healthcare/ work/index.html government plans to bring in mobile phone app of medication adherence improvement: where articles/global-health-care-sector-outlook.html 11 Townshend, T. and Lake, A. (2017). Obesogenic to track people with coronavirus. The Guardian. population health science meets precision medicine. environments: current evidence of the built and food 22 郭凯 (2019). China performs first 5G-based Guardian News and Media. Available from https:// Patient preference and adherence. Dove Medical 51 Patel, V. et al. (2018). The Lancet Commission on environments. Perspectives in Public Health, 137 (1), remote surgery on human brain. Chinadaily.com. www.theguardian.com/australia-news/2020/apr/14/ Press. Available from https://www.ncbi.nlm.nih.gov/ global mental health and sustainable development. 38–44. https://doi.org/10.1177/1757913916679860 cn. Available from http://www.chinadaily.com. australian-government-plans-to-bring-in-mobile- pmc/articles/PMC6049050/ The Lancet, 392 (10157), 1553–1598. cn/a/201903/18/WS5c8f0528a3106c65c34ef2b6. phone-app-to-track-people-with-coronavirus 12 Xiamen Bicycle Skyway (2017). Dissing+Weitling. html 42 Au-Yeung, A. (2019). Take Your Medicine: This 52 Translation Service (2020). WSLHD. Available Available from https://dissingweitling.com/en/ 32 Singapore, G.D.S. (2020). Government Digital $1.5 Billion Health Startup’s Smart Pills Keep from https://www.wslhd.health.nsw.gov.au/ project/xiamen-bicycle-skyway 23 Dean, J. (2019). The Future of Wearable Tech Is Services. Available from https://www.hive.gov.sg/ Patients From Forgetting. Forbes. Forbes Magazine. Translation-Service Called a Hearing Aid. Bloomberg.com. Bloomberg. Available from https://www.forbes.com/sites/ 13 Space to Thrive. (2020). The National Lottery Available from https://www.bloomberg.com/news/ 33 Dean, J. (2019). The Future of Wearable Tech Is angelauyeung/2019/04/01/take-your-medicine-this- 53 Huisman, E. et al. (2012). Healing environment: A Heritage Fund. Available from https://www. features/2019-04-18/the-future-of-wearable-tech-is- Called a Hearing Aid. Bloomberg.com. Bloomberg. 15-billion-health-startups-smart-pills-keep-patients- review of the impact of physical environmental factors heritagefund.org.uk/publications/space-thrive called-a-hearing-aid Available from https://www.bloomberg.com/news/ from-forgetting/ on users. Building and Environment, 58 70–80.
54 54 Huisman, E. et al. (2012). Healing environment: 67 Varsity (2020). Traditional but unconventional: 77 Jain, N. and Murphy, K. (2020). What’s Behind 86 Student and Elderly Intergenerational Care Home 95 Yorkshire Lung Screening Trial funded by References A review of the impact of physical environmental Hong Kong’s first Chinese medicine hospital the Surge in Retail Healthcare Deals? Bain. Available Scheme (2016). Arup Inspire. Available from https:// Yorkshire Cancer Research (2019). Leeds Academic factors on users. Building and Environment, 58 signals a change in gov’t attitude. Hong Kong Free from https://www.bain.com/insights/whats-behind- inspire.driversofchange.com/insights/student-and- Health Partnership. Available from https://www. 70–80. Press HKFP. Available from https://hongkongfp. the-surge-in-retail-healthcare-deals/ elderly-intergenerational-care-home-scheme/. leedsacademichealthpartnership.org/projects/ com/2019/04/20/traditional-unconventional-hong- yorkshire-lung-screening-trial-funded-by-yorkshire- 55 Ulrich, R. (1984). View through a window may kongs-first-chinese-medicine-hospital-signals- 78 Mayora, C. et al. (2018). Private retail drug shops: 87 Balcer, B. (2020). First Senior Co-Housing For cancer-research/ influence recovery from surgery. Science, 224 (4647), change-govt-attitude/ what they are, how they operate, and implications Women Only Is the Future of Independent Ageing. 420–421. for health care delivery in rural Uganda. BMC Pop Up City. Available from https://popupcity.net/ 96 Hitti, N. (2020). M-Rad designs mobile Covid-19 68 Ritchie, H. and Roser, M. (2018). Urbanization. health services research. BioMed Central. Available observations/first-senior-co-housing-for-women-only- testing unit concept from “virus-destroying” copper. 56 Fell, D. R. (2010) Wood in the Human Oxford Martin School, University of Oxford. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/ is-the-future-of-independent-ageing/ Dezeen. Available from https://www.dezeen.com/2020 Environment: Restorative Properties of Wood in the from https://ourworldindata.org/urbanization PMC6038354/ /05/07/m-rad-covid-19-testing-unit-copper-design/ Built Indoor Environment. PhD Thesis, University 88 Katz, B. and McKinney, S. (2019). The Illinois of British Columbia. Available from https://open. 69 Hagberg Fisher, E. Healthcare and Its 79 Embrey, M. et al. (2016). Understanding the Role Medical District: Where Innovation Districts and 97 Alternative Function Autonomous Vehicles library.ubc.ca/cIRcle/collections/ubctheses/24/ Communities. Gensler. Available from https:// of Accredited Drug Dispensing Outlets in Tanzania’s Opportunity Zones Meet. The New Localism. Available (2018). Arup Inspire. Available from https://inspire. items/1.0071305 www.gensler.com/research-insight/publications/ Health System. PLOS ONE. Public Library of from https://www.thenewlocalism.com/newsletter/the- driversofchange.com/insights/alternative-function- dialogue/30/healthcare-and-its-communities Science. Available from https://journals.plos.org/ illinois-medical-district-where-innovation-districts-and- autonomous-vehicles/. 57 New Royal Adelaide Hospital (2017). DesignInc. plosone/article?id=10.1371%2Fjournal.pone.0164332 opportunity-zones-meet/ Available from https://designinc.com.au/projects/sa/ 70 Sonoran Crossing Medical Center Groundbreaking 98 Coffey, H. (2020). India converts trains into new-royal-adelaide-hospital Announcement (2018). HonorHealth. HonorHealth. 80 Miller, R. and Goodman, C. (2016). Performance 89 Ewbank, L. et al. (2020). NHS hospital bed hospitals in response to coronavirus pandemic. The Available from https://www.honorhealth.com/ of retail pharmacies in low- and middle-income numbers. The King’s Fund. Available from https:// Independent. Independent Digital News and Media. 58 Arndt, R.Z. (2017). Redesigning hospitals with honorhealth-breaks-ground-sonoran-medical-center Asian settings: a systematic review. OUP Academic. www.kingsfund.org.uk/publications/nhs-hospital-bed- Available from https://www.independent.co.uk/travel/ patient experience in mind. Modern Healthcare. Oxford University Press. Available from https:// numbers news-and-advice/coronavirus-india-trains-hospitals- Available from https://www.modernhealthcare.com/ 71 Colorado Real Estate Journal (2019). Synergy academic.oup.com/heapol/article/31/7/940/1750323 isolation-wards-pandemic-a9449361.html ar ticle/20171111/NE WS/171109884/redesigning- Medical to deliver mixed-use development to Swedish 90 Lambert, V. (2016). Take look inside the hospital of hospitals-with-patient-experience-in-mind Medical Center campus. Available from https://crej. 81 Ballmer, J. (2019). How Health Care and Wellness the future. The Telegraph. Available from https://www. 99 O’Sullivan, F. (2020). How to Fight Coronavirus com/news/synergy-medical-to-deliver-mixed-use- Properties Can Anchor Mixed-Use Developments. telegraph.co.uk/wellbeing/future-health/hospitals-of- With High-Speed Rail. Bloomberg.com. Bloomberg. 59 Berg, J.S. et al. (2017). Newborn Sequencing in development-to-swedish-medical-center-campus/ NAIOP Commercial Real Estate Development the-future/ Available from https://www.bloomberg.com/news/ Genomic Medicine and Public Health. Pediatrics, Association. Available from https://www.naiop. articles/2020-03-26/how-to-fight-coronavirus-with- 139 (2) 72 Retail Health, Retail Medicine and the New org/Research-and-Publications/Magazine/2019/ 91 Woman Mother Child Center (2020). Available from high-speed-rail Healthcare Experience: Research & Insight (2015). Spring-2019/Business-Trends/How-Health-Care- https://www.mmc.nl/english/woman-mother-child-center 60 Hammond, R. (2019). Future Health, Care and Gensler. Available from https://www.gensler.com/ and-Wellness-Properties-Can-Anchor--MixedUse- 100 How flexible healthcare infrastructure can be Wellbeing Allianz Partners. research-insight/blog/retail-health-retail-medicine- Developments 92 Harvey, S. and McMahon, L. (2008) Shifting the crucial to fighting Covid-19. (2020) Hospital Times. the-new-healthcare-experience Balance of Health Care to Local Settings: the SeeSaw Available from https://www.hospitaltimes.co.uk/how- 61 OECD (2017), Tackling Wasteful Spending on 82 Wathen, P. (2017) Health Care Continues report. The King’s Fund. Available from: flexible-healthcare-infrastructure-can-be-crucial-to- Health, OECD Publishing, Paris. Available from 73 Sozdatelev, A. and Singhal, S. (2020). Trends Expansion Into Retail. Industry Insights. ICSC. https://www.kingsfund.org.uk/sites/default/files/ fighting-covid-19/ https://doi.org/10.1787/9789264266414-en. disrupting pharmacy value pools and potential Available from: https://www.icsc.com/uploads/t07- Shifting-the-Balance-of-Care-to-Local-Settings-The- implications for the value chain. McKinsey & subpage/Health-Care-Continues-Expansion-Into- SeeSaw-report-Sarah-Harvey-Laurie-McMahon- 101 ‘This Is What Rush Was Built For’ (2020). News 62 KINDBODY. Islyn. Available from https://www. Company. Available from https://www.mckinsey. Retail.pdf Kings-Fund-June-2008_0.pdf | Rush University. Available from https://www.rushu. islynstudio.com/projects/kindbody/ com/industries/healthcare-systems-and-services/ rush.edu/news/%E2%80%98-what-rush-was-built- our-insights/trends-disrupting-pharmacy-value-pools- 83 Glades, C. (2019). The Changing Geography of 93 Gooch, K. Ascension-owned hospital will %E2%80%99 63 Informal Local Clinic Design (2017). Arup Inspire. and-potential-implications-for-the-value-chain Health Care Real Estate. NAIOP Commercial Real shift to ‘community-focused’ healthcare in D.C.: Available from https://inspire.driversofchange.com/ Estate Development Association. Available from Providence Health System in Washington, D. C. , 102 New Hospital Tower Rush University Medical insights/informal-local-clinic-design/ 74 Klingan, F.-R., Precht, C. and Miani, G.B. (2020). https://www.naiop.org/Research-and-Publications/ owned by St. Louis-based Ascension, will close Center / Perkins Will (2013). ArchDaily. Available from Retail Healthcare Continues to Consolidate in Europe. Magazine/2019/Spring-2019/Development- acute care services and focus on services to support https://www.archdaily.com/443648/new-hospital- 64 Friluftssykehuset – the Outdoor Care Retreat Bain. Available from https://www.bain.com/insights/ Ownership/The-Changing-Geography-of-Health- community needs and population health initiatives. tower-rush-university-medical-center-perkins-will (2019). Snøhetta. Available from https://snohetta.com/ retail-healthcare-continues-to-consolidate-in-europe/ Care-Real-Estate Becker’s Hospital Review. Available from https:// projects/419-friluftssykehuset-the-outdoor-care-retreat www.beckershospitalreview.com/care-coordination/ 103 Hamilton, J. (2020). Seattle Health Care System 75 Stanek, D. (2018). The Future of Healthcare 84 The Hospital Left Behind (2016). Gensler. ascension-owned-system-will-shift-to-community- Offers Drive-Through Coronavirus Testing For 65 WHO global report on traditional and Looks a Lot Like Retail. Modern Healthcare. Available from https://www.gensler.com/research- focused-healthcare-in-d-c.html Workers. NPR. NPR. Available from https://www.npr. complementary medicine, 2019 (2019). Geneva, Available from https://www.modernhealthcare.com/ insight/gensler-research-institute/new-life-for- org/sections/health-shots/2020/03/08/813501632/ Switzerland: World Health Organization. article/20181026/SPONSORED/181029924/the- hospital-buildings 94 Advanced clinical AI and social determinants seattle-health-care-system-offers-drive-through- future-of-healthcare-looks-a-lot-like-retail of health: Influence community interventions and coronavirus-testing-for-workers?t=1599148718140 66 Global Complementary & Alternative 85 Yoders, J. (2019). Cook County General programs by understanding individual barriers first. Medicines Market - Analysis & Forecast to 2024 - 76 Retail Health, Retail Medicine and the New Hospital’s $90-Million Redevelopment Saves a (2020). Becker’s Hospital Review. Available from 104 Menon, B. (2020). Bahrain converts car park ResearchAndMarkets.com (2020). Business Wire. Healthcare Experience: Research & Insight (2015). Chicago Icon. Engineering News Record Midwest. https://www.beckershospitalreview.com/advanced- into COVID-19 hospital. Gulf News. Available Available from https://www.businesswire.com/news/ Gensler. Available from https://www.gensler.com/ Available from https://www.enr.com/articles/46518- clinical-ai-and-social-determinants-of-health- from https://gulfnews.com/photos/news/photos- home/20200204005716/en/Global-Complementary- research-insight/blog/retail-health-retail-medicine- cook-county-general-hospitals-90-million- influence-community-interventions-and-programs-by- bahrain-converts-car-park-into-covid-19-hospital- Alternative-Medicines-Market---Analysis the-new-healthcare-experience redevelopment-saves-a-chicago-icon understanding-individual-barriers-first.html 1.1586946481063?slide=1
55 105 Modular solutions provide additional COVID-19 114 Moxi (2020). Diligent Robotics. Available References capacity (2020). Vanguard Healthcare Solutions. from https://diligentrobots.com/moxi Available from https://www.vanguardhealthcare. co.uk/news-and-events/modular-solutions-provide- 115 Increasing Bank Fill Rates and Reducing additional-covid-19-capacity/ Agency Spend at Chelsea and Westminster NHS Foundation Trust (2020) Patchwork Health. 106 Ravenscroft, T. (2020). Shipping-container Available from www.patchwork.health/case- intensive care unit installed at Turin hospital. Dezeen. studies/chelsea-and-westminster-hospital. Available from https://www.dezeen.com/2020/04/21/ shipping-container-intensive-care-unit-installed-at- 116 Over 400,000 people join NHS army of turin-hospital/ volunteers in one day (2020). NHS. Available from https://www.england.nhs.uk/2020/03/over- 107 Beech, P. (2020). Inside the COVID-19 hospital 400000-people-join-nhs-army-of-volunteers-in- built from a shipping container. World Economic one-day/ Forum. Available from https://www.weforum.org/ agenda/2020/04/inside-the-covid-19-hospital-made- 117 Hughes, R. et al. (2012). Medicine sellers’ from-shipping-containers/ perspectives on their role in providing health care in North-West Cameroon: a qualitative 108 Glasgow Airport to support country’s Coronavirus study. OUP Academic. Oxford University Press. response by hosting testing facility (2020). Glasgow Available from https://academic.oup.com/ Airport. Available from https://www.glasgowairport. heapol/article/28/6/636/690108 com/media-centre/glasgow-airport-to-support- country-s-coronavirus-response-by-hosting-testing- 118 LifeBank Nigeria (2020). Available from facility/?adnetwork=af https://lifebank.ng/
109 Neville, S. (2019). NHS looks to artificial intelligence 119 The drone-powered hospital (2019). Leo to improve healthcare. Financial Times. Available from A Daly. Available from https://leoadaly.com/ https://www.ft.com/content/c0b3be56-b922-11e9- perspectives/the-drone-powered-hospital/ 96bd-8e884d3ea203?emailId=5d4c15b6fdabc10004 7125a8 120 Healthcare’s climate footprint (2019). Arup. Available from https://www.arup.com/ 110 Simonite, T. (2020). AI Uncovers a Potential perspectives/publications/research/section/ Treatment for Covid-19 Patients. Wired. Conde Nast. healthcares-climate-footprint Available from https://www.wired.com/story/ai- uncovers-potential-treatment-covid-19-patients/ 121 Using timber to build healthier hospitals (2017). TRADA. Available from https://www. 111 The Human Diagnosis Project (2020). Available trada.co.uk/news/using-timber-to-build- from https://www.humandx.org/context/background healthier-hospitals/
112 Digital twin: towards a meaningful framework 122 Chui, M. et al. (2020). The Bio Revolution: (2019). Arup. Available from https://www.arup.com/ Innovations transforming economies, societies, perspectives/publications/research/section/digital-twin- and our lives. McKinsey & Company. towards-a-meaningful-framework Available from https://www.mckinsey.com/ industries/pharmaceuticals-and-medical- 113 Transforming Healthcare with Digital Twins (2018). products/our-insights/the-bio-revolution- Challenge. Challenge Advisory. Available from https:// innovations-transforming-economies-societies- www.challenge.org/wp-content/uploads/2019/03/ and-our-lives Digital_Era_02.pdf.
56 PROJECT TEAM CONTRIBUTORS Acknowledgements Authors Edith Blennerhassett Alexander Alexiou Elise Chan Tom Butler Aimee Clarke Iris Gramegna David Harding Felicitas zu Dohna Josef Hargrave Liam Luddy Research Eimear Lynch Alexander Alexiou Dan Moran Tom Butler Dave Pitman Iris Gramegna Sarah-Jane Prew Susan Moore Andrew Rolf Eleanor Tomlinson Bill Scrantom Felicitas zu Dohna Richard Sharp Rhiannon Williams Malcolm Smith Julian Soper Design Georgia Vitale Iris Gramegna Katie Wood Emily Clements Patrick Yung Bill Searle Eleanor Tomlinson
Copy Editing Tom Butler Amanda McFerren
Marketing and Communications Annabel Rabbets
Project Management Alexander Alexiou
57 The COVID-19 pandemic has caused immense suffering, CONTACT About disrupted economies and communities and pushed national To find out more about healthcare at Arup, email To find out more about Arup Foresight, email healthcare systems to their limits. Yet even before its [email protected] or search ‘Healthcare’ on arup.com. [email protected] or visit foresight.arup.com. emergence, healthcare systems globally were facing mounting pressure to change and innovate. Affordability, ageing Dave Pitman Josef Hargrave populations and a rise in lifestyle-related and chronic diseases UKIMEA Healthcare Business Leader Project Director and Global Foresight Leader are forcing us to rethink how and where future healthcare [email protected] [email protected] services are delivered. Julian Soper Alexander Alexiou Future of Healthcare Ecosystems explores the trends, Australasia Healthcare Business Leader Project Manager and Senior Foresight Strategist drivers and contexts shaping the future of healthcare and the [email protected] [email protected] innovations affecting change. It covers a variety of scales from individual to urban, microbial to planetary, supported by Bill Scrantom Iris Gramegna global exemplars and emerging best practice. It also considers Americas Healthcare Business Leader Lead Designer and Foresight Consultant the long-term future of healthcare as a collaborative and [email protected] [email protected] multi-disciplinary endeavour, one that extends beyond built healthcare assets towards ecosystems that include transport Patrick Yung networks, public spaces, residential and commercial design, East Asia Healthcare Business Leader urban planning and more. [email protected]
ARUP INSPIRE Dan Moran Explore our curated collection of emerging ideas and case Europe Healthcare Business Leader studies from around the world at: inspire.driversofchange.com. [email protected]
We shape a better world