The term “closed standards” refers to standards that are clearly quantifiable. In the case of hospitals, this may refer for example to minimum dimensions of patient rooms or spatial and technical requirements for operating heaters and laboratories. “Open standards” mainly consist of generally endorsed guideline criteria that are difficult to quantify. As a rule, these “open standards” refer to aspects that particularly play a role at a level of the hospital as a whole, such as the flexibility of the building structure or the quality of the built environment.
Chapter 4 goes deeper into the above-mentioned basic quality requirements. Cost norms The guidelines have been flexibly designed so that, given the basic quality requirements, various solutions are possible within specific frameworks. With respect o the building of WIZ Hospital Provision Act facilities, these frameworks are principally determined by maximum permissible investment costs. Chapter 6 describes how this investment cost framework is determined and how it is applied in practice.
Scope Appendix 1 states for which hospital functions the basic quality requirements (will) apply. The basic principle in this respect is that only the patient-related functions of a hospital will be applicable for this, such as nursing, diagnostics and treatment and medical supporting facilities (laboratories, pharmacy, central sterile supply department). With regard to the other, usually general and technical supply facilities, no basic quality requirements will be imposed with the exception of the kitchen facilities. It is this aspect that gives the standards their flexibility. . 2 Preconditions When drawing up the guidelines, account was taken of regulations relating to environment legislation and regulations applicable to building in general. Examples include the Buildings Decree (relating to storey height, delighting and ventilation regulations etc. ), the Building Access Handbook (wheelchair access), the Working Conditions Act (relating to the use of sling hoists etc. And the Tobacco Act (that states that patients and staff must be able to function without hindrance caused by the use of tobacco products). 2. Supplementary areas The above-mentioned guidelines are limited to facilities for functions that a care provider must or can provide. During realization of these facilities, it may be necessary to pay attention to other aspects that are either related to or a consequence of the building activities. Examples of this include acquisition of land, site size, parking facilities, interim facilities or technical installations. Attention is paid to these aspects in other publications of the Netherlands Board for Hospital Facilities (http://www. Boucle’s. Nil).
In instances where these publications may be of relevance, reference is made to them in this text. 3 3. BASIC PRINCIPLES IN RELATION TO CARE 3. 1 Upstaging Since the nineteen seventies, there has been a trend towards upstaging. This is due too number of causes. On the one hand, developments in the field of the medical profession as such, for example increasing specialization, quality requirements laid down by the professional associations and the introduction of expensive medical technology, lead to upstaging. On the other hand, government policy has encouraged concentration.
From the mid-seventies, policy aimed at reducing the number of beds has led to amalgamation with new buildings as a survival strategy for the smaller hospitals. From the mid-eighties, mergers took place on the basis of strategic considerations, in anticipation of the announced introduction of market efficiency in the healthcare sector. Furthermore, the hospital budget included a ‘merger premium’. This referred to the premium related to the scale based on the assumption that large hospital in principle treats more complex patients, due to avian a more extensive range of functions.
This upstaging led to a decline in the number of hospital organizations, but not to an equivalent reduction 1 in the number of hospital locations . In order to maintain access to hospital care for the general public as far as possible and also for strategic marketing reasons (retention of market share), amalgamated hospital organizations often opt to keep locations open and divide functions differently over the locations. Complex care and relatively expensive facilities such as general intensive care and cardiac care consequently tend to be concentrated. 2 Specialist medical care Developments in medical knowledge and science (applicable to healthcare) have led to extensive specialization’s and sub-specialization of physicians, as a result of which the need for intra-disciplinary cooperation has radically increased. Developments in concepts about hospital care and care organization, in which the wishes of patients are now playing an important role, have created a need for interdisciplinary cooperation to grow. Specialization, part-time work and the quality requirements of professional associations (that are often also applied by the Inspectorate) have led to larger partnerships.
The increasing Gratification of the primary process also has an impact on the development of the quality requirements of the professional associations: patients have an increasing tendency to go to court. In addition, the scarcity of medical staff can also result in concentration. Nor has medical technology stood still. This has led on the one hand to the necessary concentration of hospital care because it is only at a certain scale and production level that very expensive equipment can be efficiently used, while on the other hand deiced technology has also enabled medical specialists to function on a small-scale.
CIT has naturally made an important contribution to all of this, at both diagnostic and therapeutic levels and at a communication level. 3. 3 Organization of healthcare Until a few years ago, organization of healthcare was largely based on the perspective of the medical specializations available in a hospital and the availability of diagnostic and treatment facilities. Furthermore, due to the largely interdisciplinary approach to the patient’s care requirements, virtually every peculations had its own beds in the ward unit and diagnostic and treatment facilities in the outpatient unit.
As a result of the developments in specialist medical care described in S 3. 2 together with the fact that, due to an increasing shift from inpatient to outpatient care and day treatment, inpatient care is being Netherlands Board for Hospital Facilities: Feasibility study on desired distribution of hospitals 7 November 2000 increasingly reserved for complex and difficult medical cases, attention has been paid in recent years to a more integrated organization of healthcare, based on the tangent’s perspective.
This trend has led to a reorientation regarding the way in which the demand for hospital care is offered. This reorientation process concerns the logistic process in both the hospital organizations and the entire care chain. In broad terms the following categories may be distinguished. Although these display similarities, a different emphasis may be placed on a number of aspects with regard to the organization of the care. It is consequently also possible to combine the different planning models.
The choice and detailing of the organization of the care is dependent on the situation and is argyle determined by weighing up the interests of the patient and the care provider in relation to management (scale size). Planning on the basis of target-groups/clinical entities The basis of this model is clustering activities as far as possible around the treatment of the patient, whereby a distinction is generally made according to care units and supporting units. The care units concern the primary process, patient care.
This is based on grouping the different specializations present in the hospital, aimed at achieving a more or less comprehensive range of care for patients with similar alnico entities. Classification into care units/themes depends on the care profile of a hospital, whether or not certain specializations are present, the scope of the existing specializations and the hospital’s policy and profiling. Examples of care units/themes include ‘mother & child’, ‘oncology, ‘brain & sense organs’ and ‘heart & vascular’. The supporting units are focused on medical and general & technical support for the primary process.
Medical support includes imaging diagnostics, general organ function investigation, the pharmacy and the laboratories. General & technical purport mainly comprises facilities for management, such as administration and provision of information, central kitchen, technical service and personnel facilities. In practice, it is shown that the functional and spatial planning of the above-mentioned units can be tackled in different ways. Some projects have opted to combine inpatient and outpatient activities within one care unit, with the incorporation of medical supporting functions.
Other projects on the other hand have chosen a more traditional form of planning in which a greater distinction is advocated between inpatient and outpatient care and diagnostics. In his situation, the care process around the patient is generally based on the principle of virtual multidisciplinary cooperation. These are forms of cooperation that are not recognizable in a physical sense. The medical specialists work together around one patient group but do not have office visits at the same time at one location.
It is determined by means of protocols in what manner the different specializations and medical supporting facilities are used in the treatment of the patient group. Theme 1: Brain & sensory organs Theme 2: Oncology Theme 3: Immune system, metabolism & aging Theme 4: Acute care & musculoskeletal system Theme 5: Heart & vascular Theme 6: Growth, development and reproduction 5 Source: Erasmus MAC Rotterdam Planning on the basis of patient flows In this model a distinction is made between four patient flows: acute care, urgent care, elective care and chronic care.
The underlying principle of this subdivision is the assumption that each patient flow basically differs from the other in terms of atmosphere, organization, playability, position of professionals, relationship with referrers and follow-up care and the building aspect. The acute care unit only deals with patients who are in a truly life-threatening situation. This is in fact a well- quipped emergency department where mainly patients with severe trauma and injury are treated. The urgent care unit deals with patients in cases where a few hours between registration at reception and treatment will not lead to problems.
With urgent care there is time between registration and carrying out diagnostic procedures and treatment. This time is used to gather information about the patient, to prepare the treatment plan within the hospital or arrange any follow-up care. A large proportion of the patients who are currently (wrongly) admitted to the emergency care unit will be treated in the urgent care unit. An observation unit forms part of the urgent care unit. The purpose of the urgent care unit is to relieve pressure on the adjacent acute care unit (emergency department) as far as possible.
Elective care concerns care when there is a period of time (days, weeks) between registration and an appointment. Elective care can usually be well planned. In order to safeguard this playability, it is necessary to determine what has to be achieved with each patient target-group (the objectives). Agreements are made between general practitioners, medical specialists, patient associations and other parties involved about admission waiting-time, total treatment time, allocation of tasks and responsibility.
Chronic care concerns care where a long-term relationship with the patient is required. This type of care demands a strong personal contact in a relaxed, non-hospital-like atmosphere. A great deal of attention is paid to providing information and counseling to the patient, relatives, other parties concerned and the referrer. Examples of chronic care are patients with heart failure, back problems, lung/asthmatic conditions and diabetics. 6 Source: Adventure Hospitals Planning on the basis of the care process
This model is largely based on the stages through which a patient passes from the moment the patient arrives in the hospital until the moment he/she leaves it. Six main processes may be distinguished here, as follows: ; treatment from the general practitioner, resulting in referral; ; screening and diagnostic procedures; ; appointment with the specialist(s) to discuss the diagnostic results, advice, treatment possibilities and treatment planning; ; treatment in different forms; ; care in different forms; ; aftercare in different forms.
Grouped around these main processes are ‘CT, the organization and the facilities, exulting in six different centers: 1 . The centre for screening and diagnostics where investigations can be carried out; 2. Appointment centre where consultations take place; 3. The treatment centre where treatment is carried out; 4. The nursing centre where nursing takes place; 5. The logistics centre from which support is given to the above-mentioned centers; 6. He knowledge/expertise centre where the professionals (in the broadest sense of the word) have a place to work and meet each other. This model is based on the assumption that modern CIT techniques are applied, mimed at integrated planning of the care process – not only in the hospital but also outside. The basic principle is that professionals in the care chain must be able to consult all information independent of time and place. This means that all information must be digitally available. 7 Source: Orbits Sitar 3. Differentiated care The developments described above have led to a wide variety of forms of hospital care , such as: ; general practitioner centers in hospitals; ; the external outpatient unit that provides outpatient care during office hours (an independent treatment centre can fulfill this description); the day hospital that provides general, specialist medical care that is not too complex, but where no 24-hour care is provided (an independent treatment centre can fulfill this description); ; the specialized hospital that concentrates on certain sections of hospital care or certain outrageous and where 24-hour care and/or day nursing is provided; ; the general hospital where a distinction can be made between a basic hospital and a top clinical hospital/intervention centre; ; the university teaching hospital.