The Great Debate: Who is the Client of the Hospital? The Patient, or the Clinician?

By: Australian Healthcare Week HQ

Over the past decade, the way hospitals are designed, built and operated has evolved with many projects exploring new ways to deliver innovative and cost effective models of care.

But despite such progress, one question has remained constant: whose voice should be prioritised when funding and designing hospitals and health services? The Patient, or the Clinician?

This question is undoubtedly a stumbling block for many. While patient centricity, comfort and convenience is key to optimal care, if clinicians aren’t kept in mind through the design and development phase of any project, whether structural or technological, how are they expected to effectively navigate the infrastructure and deliver care?

Ahead of the Australian Healthcare Week Expo 2019 two of our resident speakers debate both sides of the coin:

For the Clinican: Gordon Bingham Chief Nursing Information Officer, Alfred Health

For the Patient: Dr Ian Town, Chairman, Health Precinct Advisory Council (NZ)

For the Clinican: Gordon Bingham Chief Nursing Information Officer, Alfred Health

Fundamentally the patient cannot be the ultimate voice of healthcare infrastructure design because they’re not using the system day in and day out. They are recipients of care; and that care is facilitated by a space or system which clinicians occupy daily. This simple fact nullifies the patient-centric argument.

As Chief Nursing Information Officer and Chief Nursing and Allied Health Information Officer for Alfred Health I essentially act as the jam between the Clinician/IT sandwich and work to ensure that we develop clinically useable IT infrastructure that simultaneously captures the right data. 

Coming from a Chief Nursing Officer background it easy to understand why I firmly believe that clinicians are the voice of the hospital and why they should be the ones we design infrastructure for. 
While I haven’t really been involved with the physical-space perspective of hospital design the same would still apply regardless whether we’re looking at space or technology, but drawing on my background, from a technology perspective what it comes down to is that the patient is not an end user of the system, they’re an end recipient. 

In that respect the system needs to be optimised to allow clinicians to deliver them the best outcome that they could possibly have, which can only come with engaging and prioritising the clinicians’ usability of any system, to ensure they do the right thing to the right patient at the right time.

To support this statement lets take the example of medication administration. If you design a system that doesn’t work, that has no alerts, that has no hard or soft stops to either prescription or administration of medicine you make it much easier for clinicians to do the wrong thing to the wrong patient at the wrong time.

Whereas, if a physical space or a system has been designed with clinicians primarily in mind - and ideally with their input and consultation - it firstly presents the opportunity to influence their practice and streamlines change management. 

By designing for the clinician we’re also able to leverage technology and create medication order sentences that make administering the right medication to the right patient. So ultimately the downstream effects of a well-designed system with the clinician in mind or involving the clinician, is integral to ensuring an outcome.

Fundamentally the patient cannot be the ultimate voice of healthcare infrastructure design because they’re not using the system and space day in and day out. They’re a visitor, only there for a short time. They are recipients of care, the care is facilitated by clinicians and nurses, and by technology and space. A patient doesn’t engage with the system, their care is merely facilitated by it. 

For the Patient: Dr Ian Town, Chairman, Health Precinct Advisory Council (NZ)

In February 2011 Christchurch was struck by a 6.3 magnitude earthquake that not only caused severe structural damage, but also killed 185 people and injured thousands more. With so much destruction and disruption we had to work together with patients really quickly to discuss how we would deliver services, mainly because a number of health centres were closed and travel was difficult. 

The conditions imposed as a result of the earthquake forced us to become much more mindful of delivering services in the community. When we commenced development of the new Christchurch Health Precinct we took this community centric philosophy and extended it to the design of our new facilities as we realised it presented a number of positives for our patients.

As Chairman of the Christchurch Health Precinct Advisory Council and following the lessons learned during the Christchurch earthquake my opening position on the question of who is the client of the hospital, the patient, or the clinician? It very much is with the patient. 

There are a number of reasons I’ve taken this stance, with the primary one being that patients and their families and friends often become anxious and confused in a large place like a hospital and this is only heightened when a loved one is unwell.  By designing facilities tailored to patient needs – ie with clear way finding, therapeutic spaces, green areas, quiet and privacy – we can increase comfort, encourage relaxation and aid wellbeing and recovery. 

Additionally, it is common knowledge that if a patient is stressed, whether that be about where their family is, or the parking meter, or about how they’ll find a certain building or ward, they’re less likely to take in vital information in when a doctor or nurse is speaking to them. This is detrimental not just to their wellbeing, but also to their engagement with their management.

Doctors and nurses however, they’re in these spaces every day. They’re trained to understand systems, they know their way around the physical space, they’re usually fit and mobile, so moving from space to space isn’t an issue, and while at work their emotions, judgement and mental capacity are not being clouded by worry about the health of a friend or family member. 

Clinicians and hospitals exist to deliver healthcare services for the patient. To effectively enable this, patients, not clinicians, must be seen as the primary client of a hospital. 

Join the debate at the 2019 Australian Healthcare Week Expo running on the 27-28 March at the International Convention Centre, Sydney.