Occupancy analytics - a new science for efficient hospital design

Posted: 7 January 2013 by Mathew Bacon

My key message is that health care planning and facilities design needs to move away from standard formulaic, 'best practice' approaches. Instead, it must be founded in evidence-based design that will enable the healthcare sector to deliver efficient, effective and sustainable services.  Our work provides the evidence base to this end for a new form of dialogue between clinicians and estates and facility professionals.

Why the need for this?  Because all the evidence points to hospitals that are both larger than they need to be and that are provided with engineering systems that are over-designed as well. This raises the immediate question as to the evidence for this assertion, because many would no doubt argue that this is one area in which health authorities and health planners have focused much effort.

To explore that argument more fully, many protagonists would assert that they have much experience in calculating bed capacity based on known forecast demands and there is also a wealth of guidance concerning room sizing in Health Building Notes, which are also based on decades of experience.  So how can hospitals possibly be over-sized?

Well, speak to those that operate them, and then you find some important insights. The issue of over-sizing is predicated on how the space is used not so much what space is provided. Indeed, Health Building Notes used in England make no comment about space utilisation, and yet this is a major factor in the overall sizing of space.

A WHO report last year commented to the effect that beds are used as holding spaces, while clinicians decide what to do with the patient, and many other spaces are planned with this in mind. Many of the Estates & Facilities directors to whom we have spoken concur with these observations. We have found that whilst clinical rooms maybe ‘right-sized,’ it is the number of rooms that are provided that is the issue. There are simply too many rooms for the forecast patient numbers and the available resources to service those rooms.

With the over-provision of space largely emanating from ‘best practice’ and formulaic principles used by many hospital planners, the engineers take this requirement and plan the engineering systems on these. Yet they too can, all too often, make massive assumptions concerning how the space is used, and these assumptions get fed into the basis of design for the engineering systems.

The combined effect of all of these assumptions result in a substantial over-estimation of occupancy, which is a major driver of internal heat loads on which the systems that ventilate, cool and heat the hospital are based.

Is it any wonder that a number of learned reports in recent years have commented that engineering systems can be over-designed by up to 100 per cent? Is it any wonder that forecasts of energy performance by project teams are rarely achieved in practice?  These are the arguments for a new building science developed by The Conclude Consultancy Limited.

The new science called ‘Occupancy Analytics’ addresses the ‘right-sizing’ issue, and importantly it informs hospital users how to avoid consuming more energy than they need to in the running of the hospital.  Yes, it is people that consume energy, not buildings!

Unless users understand the energy impacts of use, and are made accountable for it, then they will be unable to effectively manage consumption. ‘Right-sizing’, efficient operational practices are the keys to a sustainable future.  The recent OFGEM report is a stark reminder of the pressing needs to make change: It forecasts energy shortages by 2015.

Matthew Bacon is Chief Executive of The Conclude Consultancy Ltd