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NHI’s success hinges on improving infrastructure at all hospitals

Many public hospitals and clinics would have to close if minimum operational requirements were enforced, while private facilities will also need to adapt their systems

15 OCTOBER 2019 – 14:34 NAEEM CASSIM

The aim of the NHI Bill is to bring better health care to more South Africans. Picture:Gallo Images

The objectives of the National Health Insurance (NHI) legislation have considerable merit, but if the NHI is to deliver on its mandate of providing essential health care to all South Africans, infrastructure at private and public hospitals must be improved and developed.

Though the NHI will not manage hospitals, clinics or the practices of other health-care professionals — instead contracting with practitioners to provide these services to South Africans — the public health system is already constrained and cannot continue with business as usual. Many public hospitals and clinics would be forced to close due to practical infrastructure breakdown if the minimum operational requirements of the infrastructure unit support systems were enforced.

Private health-care facilities will also need to adapt their systems and structures to address the expected intake of NHI patients, as they will be expected to deliver primary health care to more people than they’re accustomed to. This represents a significant shift in their target market.

Hospitals designed for old systems and technology must be improved and upgraded if NHI is to be successful. New health-care facilities should be properly planned for maximum efficiency at minimum cost to cater for future demands, including increased patient numbers, new technology, more effective ways of managing patients, and making the most efficient use of facilities and medical staff’s time.

Proper assessment

With budget constraints across the government and the Treasury seeking budget cuts to contain debt in a weak economy, any money spent on developing health-care infrastructure must be carefully planned and 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 a priority. Hospitals internationally are increasingly becoming like standard businesses, with all the related operating risks. Care providers must balance costs and health yields, and the price-performance ratio of health-care properties is an important strategic measurement.

Questions to be considered include whether the proposed changes lead to better care, whether 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 implement these well, which calls for in-depth knowledge and experience of property and technology at all levels.

Virtual design

This can be done in the following ways:

  • A virtual design and construction approach to repurposing existing health-care 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 very quickly.
  • The Schillenmethode used in the Netherlands is a functional zoning model that revolutionises how hospitals are planned, built and run, and how patients are treated. It allows for integrated, modular and flexible planning that makes smart patient-centric care and staff-orientated 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 zones, linked digitally to medical services. The “office” houses administration, management and day clinics, while the “factory” includes support functions such as laundries and kitchens.
  • Public-private partnerships are vital to create meaningful solutions for a more sustainable society. While the department of health has a wealth of health-care expertise within its ranks, with its political head a qualified doctor, achieving health-care infrastructure that meets the needs and requirements of the NHI is likely to be more efficient if professionals experienced in health-care development are afforded the opportunity to contribute.
  • Once public hospitals have been upgraded or built to infrastructure unit support systems standards that will allow the NHI to succeed, proactive management is essential to maintain high levels of service delivery. Effective asset management helps optimise efficiency and impact 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 3D model of the building — or digital twin — to help identify and prevent structural and process defects. This approach results in a proven 25%-50% reduction of the contingency.

Health care is a right that is entrenched in the constitution, but it can only be delivered effectively through the goals of the NHI if health-care environments are designed and adapted or built for the needs of the communities they serve.

• Cassim is senior health-care architect at Royal HaskoningDHV.