Contract - Designing for Health: Designing for an International Standard of Care in Transforming Global Cultures

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Designing for Health: Designing for an International Standard of Care in Transforming Global Cultures

01 November, 2012

-By Brenda Smith, IIDA


"Designing for Health" is a monthly, web-exclusive series from the healthcare interior design leaders at Perkins+Will that focuses on the issues, trends, challenges, and research involved in crafting today's healing environments.

Surrounded by the turquoise waters of the Persian Gulf, the tiny country of Qatar recently found itself in the center of a bright spotlight.  The host of the FIFA World Cup for 2022, this nation of 1.7 million people was recently ranked the wealthiest country in the world with a GDP of $88,000 per capita; in comparison, the U.S. GDP is $48,100 per capita.  The welcome attention has brought a flood of western interest and investment capital to the country—a surge that has enabled rapid growth in infrastructure, education, and healthcare.  Like neighboring Saudi Arabia, the demand is being met largely by Western expertise, and the fast pace of expansion can be dizzying. 

In response to the challenge to create a world-class healthcare system, the Supreme Council of Health has developed an ambitious strategy for transforming the care provided to its citizens.  By 2016, the Council intends to shift healthcare from the current hospital-based model for acute care to a more community based model of preventative care.  A second tier of far-reaching goals are to be completed by 2030.  The need to change the care model is dramatically illustrated by the number of visits to the emergency department.  Hamad Medical Corporation in Doha, Qatar, is regarded as the busiest emergency department in the world, with a staggering 1,500 patient visits per day.  An emphasis on “primary care with a first point of contact,” approach to patients and “standardized care pathways,” has led to the development of a primary care clinic prototype for implementation across Qatar.  Currently, the country operates just 22 primary care centers.  Thirty additional centers are to be completed by 2013.  Staff recruitment for the facilities is ongoing, often from the local campus of Cornell University’s Weill School of Medicine.  Development of standard protocols and guidelines for disease management are part of the effort.

Dr. Miram Ali Abdul-Malik, executive director of the Primary Health Clinics, is striving to achieve international accreditation for all clinics in the system by 2013.  According to Dr. Abdul-Malik, “The Minister of Health signed an agreement with Accreditation Canada international on June 13 as the PHC (primary health clinic) is counting on the accreditation to develop a proper framework that will encourage staff and management to embrace a patient-centered approach.” 

The health council’s approach to the facilities is similar to standardized system models in the United States, think Kaiser Permanente, although the timeline demands a fast-paced race to complete the ambitious goals  by 2013. With the help of a multi-office team from Perkins + Will, the Qatari health system developed standard programs for 3 clinic types:  a small community-based clinic for primary and urgent care services; a medium-sized clinic with diagnostic services, enlarged urgent care, and community learning facilities; and a larger community center with clinic program, a fitness gym and pool, spa services, a demonstration kitchen, and classrooms. 

Standardized departmental modules with uniform destination points incorporate standard room types.  Staff may move from center to center to provide care, so the standardized rooms assure that consistent work flow occurs from room-to-room and clinic-to-clinic.  The department module allows for flexibility within the facility; a department can expand and contract based on patient census with a uniform ratio of patient spaces and support spaces per module.  The uniform approach to programming and design enabled the design team to provide healthcare planning quickly.  The approach also created efficiencies in design documentation and communication protocols with the team’s consulting partners in Lebanon and Qatar.
 
For all three prototypes, the Los Angeles office of Perkins + Will organized the building architecture around a center band of courtyards, emphasizing the protective, inner gardens prevalent in the regional architecture.  The courtyards created an opportunity for filtered daylight, and restful views.  Working with the Atlanta office, the team members responsible for planning and interiors, the public areas were carefully situated for views of the courtyards. 

The buildings were designed to the Qatar standards for sustainable design (QSAS), which closely resemble the USGBC guidelines for LEED certification.  A unique feature of QSAS is a requirement for the buildings to reflect the historical and contextual architecture of Qatar.  With an appetite for modern design, but a need to reference historical forms, the client team wanted to find the appropriate balance.  This required the design team to develop multiple design solutions in a short period of time.  To meet the request, the team turned out as a series of schematic charettes, providing sketch renderings for multiple client reviews.  This approach met the client time frame, and helped to preserve the design budget until the right balance was identified.  

Another challenge was accommodating the gender separation required by the culture.  While this separation is not obvious in the large, cosmopolitan city of Doha, it is deeply integrated into the social fiber in outlying communities.  The need for separate waiting areas and clinics, as well as gender-based check-in locations, made it difficult to maintain efficient circulation without compromising the higher design principles, especially in the smallest clinic prototype.

A more delightful challenge for the project team was developing interior design that reflected the seemingly limitless budget available.  Knowing that many of the clinics will be constructed in remote communities, the design team first approached the interiors with an interest in uniform materials, durability and ease of maintenance.  As the project progressed, it became clear that the client team wanted the centers to reflect a higher level of design as well.  As stated by project architect for the PHC, Nikki Georgiou “The facilities should reflect a rich and luxurious interior.”  In response to this unusual request, the design team increased the use of specialty finishes and detail in public areas, enhanced the courtyards with additional amenities, and included a grand stair in the two-story prototype. 

The Perkins + Will team jumped at the opportunity to participate in developing a smart template for the delivery of healthcare in this emerging market.  The initial approach to design was to develop standards that were smartly organized and beautiful in their simplicity.   With an efficient kit of design tools, this was quickly achieved.  Urged by the client team to dream bigger, the resulting prototypes offer added elegance in an enhanced holistic environment.  Initially, the three templates are being constructed in five locations, tested operationally, and tweaked.  Adjustments will be made with the project team.  The centers will then pop up across the country, ushering in a new era in modern healthcare for the people of Qatar.


Bio
Brenda Smith, IIDA, is a Senior Associate with the Perkins + Will Atlanta office.  She leads the Atlanta healthcare interior design team and specializes in the design and project delivery for international healthcare projects in the Middle East.  Brenda can be reached at brenda.smith@perkinswill.com.

Sources
  1. Populations, Qatar Census. 2011, http://www.QSA.gov.qa
  2. Qatar National Vision 2030, Executive Summary, pg 14, 2011
  3. “Global Body to accredit all PHCs”.  Golf Times,  June 17, 2011
  4. Greenfield, Beth, “World’s Richest Countries”, Forbes Magazine,  February 22, 2012
  5. Khalid Abdulnoor Saifeldeen, M.D., “See and Treat:  A New Model of Emergency Department Care at Hamad General Hospital”, Joint Commission International, July 17, 2011.
  6. Quotes:
    a.    Miriam Ali Abdul-Malik, MD, Executive Director, Primary Health Centres, Qatar
    b.    Nikki Georgiou, Project Architect, Primary Health Centres, Public Works Authority, Qatar


Past installment of "Designing for Health" include (click on the title to access the full article):
There Is An App for That
Healing the Hospital
Exploring Collaboration in the Consolidated Interventional Platform
The Differences between U.S. and U.K. Clinical Planning Models
Widening a Circle of Natural Inclusion




Designing for Health: Designing for an International Standard of Care in Transforming Global Cultures

01 November, 2012


Brenda Smith

"Designing for Health" is a monthly, web-exclusive series from the healthcare interior design leaders at Perkins+Will that focuses on the issues, trends, challenges, and research involved in crafting today's healing environments.

Surrounded by the turquoise waters of the Persian Gulf, the tiny country of Qatar recently found itself in the center of a bright spotlight.  The host of the FIFA World Cup for 2022, this nation of 1.7 million people was recently ranked the wealthiest country in the world with a GDP of $88,000 per capita; in comparison, the U.S. GDP is $48,100 per capita.  The welcome attention has brought a flood of western interest and investment capital to the country—a surge that has enabled rapid growth in infrastructure, education, and healthcare.  Like neighboring Saudi Arabia, the demand is being met largely by Western expertise, and the fast pace of expansion can be dizzying. 

In response to the challenge to create a world-class healthcare system, the Supreme Council of Health has developed an ambitious strategy for transforming the care provided to its citizens.  By 2016, the Council intends to shift healthcare from the current hospital-based model for acute care to a more community based model of preventative care.  A second tier of far-reaching goals are to be completed by 2030.  The need to change the care model is dramatically illustrated by the number of visits to the emergency department.  Hamad Medical Corporation in Doha, Qatar, is regarded as the busiest emergency department in the world, with a staggering 1,500 patient visits per day.  An emphasis on “primary care with a first point of contact,” approach to patients and “standardized care pathways,” has led to the development of a primary care clinic prototype for implementation across Qatar.  Currently, the country operates just 22 primary care centers.  Thirty additional centers are to be completed by 2013.  Staff recruitment for the facilities is ongoing, often from the local campus of Cornell University’s Weill School of Medicine.  Development of standard protocols and guidelines for disease management are part of the effort.

Dr. Miram Ali Abdul-Malik, executive director of the Primary Health Clinics, is striving to achieve international accreditation for all clinics in the system by 2013.  According to Dr. Abdul-Malik, “The Minister of Health signed an agreement with Accreditation Canada international on June 13 as the PHC (primary health clinic) is counting on the accreditation to develop a proper framework that will encourage staff and management to embrace a patient-centered approach.” 

The health council’s approach to the facilities is similar to standardized system models in the United States, think Kaiser Permanente, although the timeline demands a fast-paced race to complete the ambitious goals  by 2013. With the help of a multi-office team from Perkins + Will, the Qatari health system developed standard programs for 3 clinic types:  a small community-based clinic for primary and urgent care services; a medium-sized clinic with diagnostic services, enlarged urgent care, and community learning facilities; and a larger community center with clinic program, a fitness gym and pool, spa services, a demonstration kitchen, and classrooms. 

Standardized departmental modules with uniform destination points incorporate standard room types.  Staff may move from center to center to provide care, so the standardized rooms assure that consistent work flow occurs from room-to-room and clinic-to-clinic.  The department module allows for flexibility within the facility; a department can expand and contract based on patient census with a uniform ratio of patient spaces and support spaces per module.  The uniform approach to programming and design enabled the design team to provide healthcare planning quickly.  The approach also created efficiencies in design documentation and communication protocols with the team’s consulting partners in Lebanon and Qatar.
 
For all three prototypes, the Los Angeles office of Perkins + Will organized the building architecture around a center band of courtyards, emphasizing the protective, inner gardens prevalent in the regional architecture.  The courtyards created an opportunity for filtered daylight, and restful views.  Working with the Atlanta office, the team members responsible for planning and interiors, the public areas were carefully situated for views of the courtyards. 

The buildings were designed to the Qatar standards for sustainable design (QSAS), which closely resemble the USGBC guidelines for LEED certification.  A unique feature of QSAS is a requirement for the buildings to reflect the historical and contextual architecture of Qatar.  With an appetite for modern design, but a need to reference historical forms, the client team wanted to find the appropriate balance.  This required the design team to develop multiple design solutions in a short period of time.  To meet the request, the team turned out as a series of schematic charettes, providing sketch renderings for multiple client reviews.  This approach met the client time frame, and helped to preserve the design budget until the right balance was identified.  

Another challenge was accommodating the gender separation required by the culture.  While this separation is not obvious in the large, cosmopolitan city of Doha, it is deeply integrated into the social fiber in outlying communities.  The need for separate waiting areas and clinics, as well as gender-based check-in locations, made it difficult to maintain efficient circulation without compromising the higher design principles, especially in the smallest clinic prototype.

A more delightful challenge for the project team was developing interior design that reflected the seemingly limitless budget available.  Knowing that many of the clinics will be constructed in remote communities, the design team first approached the interiors with an interest in uniform materials, durability and ease of maintenance.  As the project progressed, it became clear that the client team wanted the centers to reflect a higher level of design as well.  As stated by project architect for the PHC, Nikki Georgiou “The facilities should reflect a rich and luxurious interior.”  In response to this unusual request, the design team increased the use of specialty finishes and detail in public areas, enhanced the courtyards with additional amenities, and included a grand stair in the two-story prototype. 

The Perkins + Will team jumped at the opportunity to participate in developing a smart template for the delivery of healthcare in this emerging market.  The initial approach to design was to develop standards that were smartly organized and beautiful in their simplicity.   With an efficient kit of design tools, this was quickly achieved.  Urged by the client team to dream bigger, the resulting prototypes offer added elegance in an enhanced holistic environment.  Initially, the three templates are being constructed in five locations, tested operationally, and tweaked.  Adjustments will be made with the project team.  The centers will then pop up across the country, ushering in a new era in modern healthcare for the people of Qatar.


Bio
Brenda Smith, IIDA, is a Senior Associate with the Perkins + Will Atlanta office.  She leads the Atlanta healthcare interior design team and specializes in the design and project delivery for international healthcare projects in the Middle East.  Brenda can be reached at brenda.smith@perkinswill.com.

Sources
  1. Populations, Qatar Census. 2011, http://www.QSA.gov.qa
  2. Qatar National Vision 2030, Executive Summary, pg 14, 2011
  3. “Global Body to accredit all PHCs”.  Golf Times,  June 17, 2011
  4. Greenfield, Beth, “World’s Richest Countries”, Forbes Magazine,  February 22, 2012
  5. Khalid Abdulnoor Saifeldeen, M.D., “See and Treat:  A New Model of Emergency Department Care at Hamad General Hospital”, Joint Commission International, July 17, 2011.
  6. Quotes:
    a.    Miriam Ali Abdul-Malik, MD, Executive Director, Primary Health Centres, Qatar
    b.    Nikki Georgiou, Project Architect, Primary Health Centres, Public Works Authority, Qatar


Past installment of "Designing for Health" include (click on the title to access the full article):
There Is An App for That
Healing the Hospital
Exploring Collaboration in the Consolidated Interventional Platform
The Differences between U.S. and U.K. Clinical Planning Models
Widening a Circle of Natural Inclusion

 


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