The success of NHI depends on planning

Despite rumblings that Cabinet has rejected the NHI Bill, the health department is adamant that "all is well". Picture: iStock
Despite rumblings that Cabinet has rejected the NHI Bill, the health department is adamant that "all is well". Picture: iStock

The objectives of the National Health Insurance (NHI) Bill have considerable merit.

But if the NHI is to deliver on its mandate, infrastructure at private and public hospitals must be improved and developed.

Although the NHI will not manage hospitals, clinics or the practices of other healthcare professionals, but contract practitioners to provide these services, it cannot continue to be business as usual for the already constrained public health system.

Indeed, many public health facilities would be forced to close due to infrastructure breakdown if the minimum operational requirements of the Infrastructure Unit Support Systems were enforced.

Private healthcare facilities would also need to adapt their systems and structures to address the intake of NHI patients, as they will be expected to deliver primary healthcare to more people than they’re accustomed to.

This is also a shift from their target market.

Existing facilities designed for old systems and technology must be improved and upgraded if the NHI is to be successful.

New facilities should be properly planned for maximum efficiency at minimum cost, to cater for future demands, including increased patient numbers, new technology and more effective ways of managing patients.

With budget constraints across government, and Treasury seeking spending cuts to contain debt in a weak economy, any money spent on developing healthcare infrastructure must be used to its maximum effect, with no wastage in the funds allocated for capital or maintenance projects.

With all its complex functions, a hospital is a very specific type of property. Modernised and efficient hospitals contain advanced technologies that require a multidisciplinary approach.

Every proposed innovation or modification calls for a proper assessment of the yields, profitability and risks.

Globally, the hospital landscape is transforming, as the provision of affordable, accessible, long-term high quality care is increasingly becoming a priority.

Read: The business of health: How the challenges could scupper the NHI

Hospitals internationally are progressively becoming “normal” businesses, with all the related operating risks.

Care providers must balance costs and health yields, and the price-performance ratio of healthcare properties is an important strategic measurement.

Questions to be considered include whether proposed changes lead to better care; if the investments are viable; and whether the changes can be performed in a way that does not compromise continuity and patient safety.

The trick is to make the right changes and to implement these well, which calls for in-depth knowledge and experience of property and technology at all levels.

There are several ways this can be done:

. A Virtual Design and Construction approach to repurposing existing healthcare facilities or building new ones allows everyone involved in a project to “see” the final product before ground is broken. By virtually building the project, all stakeholders achieve a better understanding of the design and any bottlenecks become clear quickly.

. The Schillenmethode used in the Netherlands is a functional zoning model that revolutionises how hospitals are planned, built and run, and patients are treated. It allows for integrated, modular and flexible planning that makes smart patient-centric care and staff-oriented facilities possible through quick modular construction.

It includes a “hot floor”, which provides advanced monitoring technologies for the sickest patients, including imaging facilities and operating theatres. The “hotel” is the hospital’s accommodation zone, linked digitally to medical services. The “office” houses administration, management and day clinics, while the “factory” includes support functions such as laundries and kitchens.

. Private-public partnerships are vital to create meaningful solutions. While the department of health has a wealth of expertise, with its political head a qualified doctor, achieving healthcare infrastructure that meets the needs and requirements of the NHI is likely to be more efficient if professionals experienced in healthcare development are afforded the opportunity to contribute.

. Once public hospitals have been upgraded or built to Infrastructure Unit Support Systems standards that will ensure the success of the NHI, proactive management is essential to maintain high levels of service delivery.

Effective asset management helps optimise efficiency by offering insight into costs, yields, care performance and the feasibility of any further strategies or interventions.

This can be achieved with building information modelling that creates a dynamic and digital 3-D model of the building – or digital twin – which helps to identify and prevent structural and process defects.

This approach results in a proven reduction of the contingency by 25% to 50%.

Healthcare is a right entrenched in the Constitution.

But this right can only be delivered effectively through the goals of the NHI if healthcare environments are designed and adapted or built for the needs of the communities they serve.

Cassim is a senior healthcare architect at Royal HaskoningDHV

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