n A comprehensive approach to designing for recruitment and retention of staff in hospitals has lessons for the commercial construction industry. Jim Miara reports.
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If all goes to plan, when the Royal Children's Hospital opens in Me lbourne In 2011 the facility's multiple stakeholders will be as pleased as punch. Patients and their families will note the easy flow through admission and
discharge and the sensitivity to environmental factors such as privacy, light and views that aid the healing pmcess. The community w;a ooas-t of a S 1 bmiOn hOSPital consvuction
P<O)ect. 011e of the largest in Avstralian history. that blends seamleSSiy into its parkland setting and l)<oduces a cartlon footpnnt lhat is 40 percent smane< than a typiCal hOspital ol the past. Victorians wit take pride in knowing lhey have a state·Of· lhe-M hOspital prollicing U1e children of U1e state with the best care the W()f1d haS to offer. But the design is aJso extraordinarily sensitive to the needs of another constituency- the medical staff -whose satisfaction with and commitment to 111e hOspiital are essootial to U1e delive<y ol high·QUality care. And among the madieal per'S0f111el, particulat attention was given to the needs.l:x>th professional and personal, of U1e nursing staff whOsa ranks have been shnnking in Avstralia and arovnd lhe wo~d .
·Nurse retention was of central importance.~ said KriSten 'M1ittle, desigl director at the Melboorne offioe of Bates SmM. an af'Cflitecture firm that Is a member of the public private pMnership coosortium develOping the RCH. "We su.veyed the ~Using staff and asked wllat would help imP<OII<! lheir conditions. Their intetests were embedded i'l the brief.•
Stress caused by too mUCh responsibility and not enough power, erratic work schedUles that strail home lite and outdated equipment and facilities are the causes of nurse dissatisfaction most often cited. ~Interest in retention strategies has increased, but it requires a detailed unde<standing of what motivates IUsas,• said CIYist()f)her Raley, communications director for Harvard tvtedicallnternational (HMQ. a hOspital planning and management firm lhat is wOO<ing closely with the SP<ingfleld l.and Cot-POtatiOn 011 the development of Springfield Heall/1 City in Queensland. "Several trends have made retention more impooant. While demand for nurses is growing. more nurses are retiring or leaving the professi011 than are entering tt. At the same time. U1e pop<AatiOn is ageing. wf1ich means more patients with more severe problems.· Roya l Children's Hospital
What do nurses want?
Nursas assodations have consistently appealed lor higher wages, but at the same time U1ey acklloYAedge mat remuneration is orty a pM, end perhaPs not even U1e largest part, of the P<oblom.
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www.ptOp«tffl.com.au 11101
"We have a hOlistic view of design. It's all aboot saying lhe envirooment affects our wellbeing." says Kristen Whittle of Sates Smart. "Mind and body are connected and 011 goal is to use the environtnent to affect heall/1."
Whh a holistic 8PI)IOOCh, says v.wttie,
design is used to promote positive feelings and to oxtond a dogroe of control over OllWonmentei conditions. "When it came to doslgning RCH, there was a 101 of research about health and ns ralat~ to design." Whinle oxplained. "Staff 111tentlon was central because k is absolutely good lor ~ lor ruses to remaon in p~ace: The RCH deSign IS "t'ddence-basecr. ,_,.-,g tho doo9l IS I obmed by aCiual e.pellonoe. boll> poooiMI and negal!\'9. h ~- Slrategoos. begirri1g 1Mlh tho facoldy's tocel!()(l end onental!()(l, ~ ....... ol pari< flora and
maxomosong netlnll9\1, Acoording to
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Whittle, the CtKrent fllCiity. wi"Oeh is located in Royal Park, Melbourne's largest, "turns Its back on !he par1<." while tho nfNI RCH melds wilh !he landscape. Tho can-c>us·slylo complex iS situated in a way that is open to natural ~ton an sides. Most inpatient rooms have part< views, wtli!e the remainder overlook courtyards. Reflective surfaces make It possible k>r even bedridden patients IO S88 outdoors. 'In the Quielosl pan of !he silo, facing
north tor maximum su~t. the inpatient unit reaches into the patk in long, light· filled b<Adings, • aoco<ding to Bates Smart. ~lntemctlon with the surrounding park is maximised and a range of famlly-focosed
indoor and outdOOr scaces create an imaginative. child·oentred ei'I'W()I"r'T)ent on a manageable scale fO< every age group.· The holistic desigl assumes that fl'O<noling a feeling of wellbeing 111toughoul the faCiity POSilively affocls !he heaang fl'OC8SS an<1 serves as the foundalion fO< other n!Xse-directed amenities. Most rurveys of OO'SOS' attitudes have fotsld that control - or lack thereof - is a n$ issue. Nti'SeS want to have a voice In the adrriniSlrativ& f)(OCOSS, but they also wan! groaler con1ro1 of !heir phySiCal space. The RCH desOgn prollides unobstrucled sighllines 10 a1 P<V~s of tl1e stalions and Sihoner distances from central desk to patient rooms, lhus reducing the amoun1 of walking per shift. Tho deSign also includes rooms fO< pareo1s as wet as Chldren'S spaces outSide !heir rooms. Those elemon!S aooorrvncxlale palienls and !heir fanWies, bul researCh shows they also mduce stress on the nursing staff. Tho RCH buildings are low and. 1ogo1her with !he na•ure-greon COO< sCheme. virtually
e6"nif'late the unpleasant aura ot institutional cklsters. The QO<OPiex is set along the slOped contours of the site. which a1ows one section to be in direct contact with the landscape on lhree levels. Tho facili!y's unif)ing alomontls a nOrth·south flowing "main street·. whiCh serves as bOth a town centre around vmieh amenities are situated and a "wayfinding" device that 'llisitors use as a reference point. "The street connects departments. but it also has useful retail outle!S - coffee shops, restoorants, a fOod court. a bank, even a mid-size superrnatket - that the hoopitat staff can use, .. Whittle explains. •A nurse on the way home catl pick up things for dinner or stay for cinnE!( at a restaurant." Othet amonilies include a gym. ample parking s~. bicycle lanes and a vam stOP. The RCH in not only in the park, btrt as Whittle insists. it is part of the park. Design as a recruiting tool Nursing shortages are ubiQuitous so it is~ surprising that other Australian hOSPitalS ate adding deSign to their recruiting tool box. Or Maha Sinnathamby. chairman o1 Springfield Land Corporation. which is overseeing the construction of Sp<ingfleld Health City, notes that health seMces ate sttessed and
·no Change is not an aptian.· In additiOn to Signing agreements with Mate< Heallh Services and the ~iverSity of Oveensland, he is implementing HMI's reooovnendations regardilg nurse-retention strategies. Springfield Health City Is expected to expand its seMce POPUlation from approximately t32.000 tOday to 236.000 by 2021. In May this year Bevis Lend Lease began renovations to Uverpoot Hospital, a tertiary referral hospital in south west Sydney. Construction includes a new, seven-stO<ey Cinical faciity, wilh a basement level and a helport. Tho buii<Jing, whiCh will be completed in 2010. is shaped by oviclenco-based deSign thet accommodates the ()(Ofossional and personal needs of the medical slaff. In fact. says Whittle. the evidence-based design approach being used fO< hOSpital construction applies equally to oommorcial buildings. Businesses operating from those buildings ate in stiff competition to meruit the best and briglltest wor1<ers. Design amon~ieS cen make the difference. "The environment we are i'l affects Ot.K well:>eing," VhlittJe says.. "The ob;ectlve is to create an environment vmere people feel good about themselves and their wor1<."
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