THE bulldozing is over. Visitors and patients are moving through the new Auburn Hospital with seeming ease and the newest batch of babies is being delivered.Touring the hospital, which opened in May, the size of the eight delivery rooms makes the greatest impression – each about 30 square metres.This is no accident. Size matters in an area of such cultural diversity.Faleata Tuifua, a new mother from Granville, says her Tongan heritage made childbirth a family affair. She was assisted during labour by an auntie, a cousin, her husband and medical staff.Having delivered four children at the old Auburn hospital, she appreciated that the new quarters were not as cramped. ”I think it’s excellent. More clean, more light, and the staff are still the same, only the hospital has changed,” she said.The ritual of bathing a newborn has been simplified through the installation of baby baths in the post natal rooms, to specifications set by the hospital’s midwives.The maternity unit is decorated with art, including words from lullabies in Burmese, Tamil, Finnish, Gujarati and Telugu.Art was viewed as a way to engage the community, and $300,000 was spent on a program to procure and commission art locally.About 70 per cent of the rooms in the hospital, built by Brookfield Multiplex, are single or twin. The architects, Joe Mihaljevic of Silver Thomas Hanley and Brian Cunningham of Hassell, said there was a trend to single rooms as the dominant mode of accommodation in hospitals.”We are tending to see more acute patients, and the issue of hospital-acquired infection is a worldwide one,” Mr Cunningham said.Single and twin rooms also circumvented the need with four-bed rooms to move patients as the ratio of male to female shifted.The co-ordinator of the project, David Caines, said the new facilities had been well received by the public and the 500-plus workforce.Mr Caines, who has a background in nursing, is a fan of simple initiatives that he says greatly improve a patient’s experience, such as the fact that the new hospital has five lifts over five storeys: two for the public, three reserved for staff and patients and goods.In the old hospital, there were three lifts over eight storeys, and surgical patients had to jostle for space with the general public.2009 Auburn hospitalSingle rooms – 35%Two-bed rooms – 36%Four-bed rooms- 29%1964 Auburn hospitalSingle rooms – 6%Two-bed rooms – 14%Four-bed rooms – 80%
Hands up all who have ventured into hospitals and have ever: 1) been lost trying to navigate their way around; 2) had their dignity and privacy shredded by curtains masquerading as sound barriers; 3) left sleep deprived after all the racket; and 4) picked up a hospital-acquired infection.Keep your hand up if you feel you’ve ever won the public hospital lottery – a private room. Not so many hands waving. This is about to change with a revolution coming to hospital design.The new generation of hospitals being built – including multibillion-dollar public hospital projects such as the Fiona Stanley Hospital in Perth, the Gold Coast University Hospital and the new Royal Adelaide Hospital – are signalling the demise of multi-bed wards. Single-bed rooms will account for 60 to 75 per cent of accommodation in these new hospitals.The new public/private Mater Mothers’ Hospital in Brisbane, which delivers 10,000 babies a year, is already basking on the public relations map as ”the premier maternity facility in the southern hemisphere”. All 90 beds in the private section are single. In the public part, 39 per cent are singles – 61 per cent are two-bed rooms.Australian health facility guidelines call for 30 per cent of beds to be single roomed – and the guidelines aren’t mandatory. What has tipped the balance to accepting the single room movement, despite higher construction costs, is the work of an American architecture professor, Roger Ulrich, the guru of evidence-based design.Just as evidence-based medicine sought to analyse studies and make findings about what treatments, procedures and drugs were most effective for patients, Ulrich asked how hospital design affected medical errors, infection rates, falls, pain, stress, sleep, privacy and patient satisfaction.His work has influenced the design of Sydney’s newest public hospital – the $145 million Auburn Hospital – and its collaborating architects, Silver Thomas Hanley and Hassell, have engaged Ulrich as a consultant on two of their projects, the $1.76 billion Fiona Stanley and the $1.5 billion Gold Coast University hospitals.NSW could do with some good news about its hospitals. The Garling inquiry’s endorsement of our public hospitals as one of the better public health care systems in the developed world was overwhelmed by the evidence of a system in crisis.It told of elderly women, and men, stuck in mixed-gender wards in our premier teaching hospitals. And doctors whose hand hygiene was so poor Garling wrote: ”A sizeable proportion of them trail infection around like sparks in a dry wheat field on the black soil plains at Mullaley, bringing great risk to the patients.”Ailing infrastructure was highlighted again by the publication last month of a damning photo of a possum, and its offending poo, inside a unit at Hornsby Hospital. And even when NSW did embark on new hospitals, there were spectacular bungles. Failing to listen to clinical staff, the new $100 million Bathurst Base Hospital was riddled with construction and design failures, from operating theatres that were too small to inadequate communications and alarm systems.Professor Guy Maddern, from the Royal Australasian College of Surgeons, says clinicians had to be involved with the planning of facilities. ”Most of us get quite frustrated because they [architects] don’t fully understand what might be coming with respect to new treatments or interventions. For example, no one built for the explosion in minimal access surgery.”What has already arrived is the era of bringing technology to the room, rather than trolleying the patient to the technology. Studies show this reduces medical errors. Operating theatres are also changing. They need to be bigger to cater for more technology and staff, Maddern says.”I suspect with the ageing population it is going to require more reliance on hospital-based care than we have had for the last 20 years. Although the procedures are less invasive, the patients are not as fit medically. The architects say most patients should be managed by single rooms. That greatly enhances the potential for infection control, but if people don’t wash their hands â?¦”In his home town, the new Royal Adelaide Hospital will be staggeringly different. ”Currently there would be 5 per cent single rooms. They are talking 60-70 per cent single.” And the redevelopment of The Queen Elizabeth Hospital in Adelaide has 40 per cent single occupancy, 40 per cent two-person, with 20 per cent given to traditional room numbers.Associate Professor Jane Carthey, director of the Centre for Health Assets Australasia at UNSW, says Australia has some of the best and most creative health architects in the world. But she queries the wholesale adoption of Ulrich’s recommendations, as they rely substantially on overseas research. She also believes he doesn’t sufficiently emphasise other important factors such as environmental sustainability and working conditions.In Australia, the nature of our public system means funds are limited. ”The amount we spend on health care is approximately 9.3 per cent of GDP compared with the US, which spends well over 15 per cent,” Carthey says.When it came to single rooms, the evidence was that most patients preferred them, they were less noisy, less stressful and there was less exposure to infections. But much of the research comes from countries with higher rates of hospital-acquired infection than experienced in Australia.”Western Australia and South Australia are both building major hospital projects and have relied on overseas evidence. In reality they have had to make judgments based on information provided by overseas experts regarding what would work for our system, which is quite different to the US system in particular,” Carthey says.”I think we need more single rooms, but whether it’s 100 per cent or 75 per cent, or fewer, I don’t know. I don’t believe anybody knows this, as so little Australian-focused research on this issue has been done; also the issue must be considered in terms of what we can actually afford to build.”While some architects champion technology as a way to help nurses overcome all the walking that results from single-patient rooms – by using monitors feeding information to the nurses in satellite locations – it was not a model that all nurses preferred.Nurses, especially student nurses, often prefer to work together in a central spot where they can support each other and share expertise, Carthey says. As for remote monitoring: ”Nurses have to be visible to patients, so that the patients feel cared for. Some patients, especially older ones, feel neglected if they see nurses and other staff less often, and this seems to be the case where there are many single rooms on a ward.”Sarita Chand, a principal of BVN Architecture and one of the country’s foremost health centre designers, says Ulrich’s research validated what many architects had been intuitively designing. But she agreed with Carthey that the Ulrich patient-focused model did not adequately address staff working conditions.The Australian Building Code has always required natural light in overnight patients’ rooms but there’s no such code for staff, she says. ”We have staff sitting for 20 years of their life in offices without windows. Staff work areas and offices are required to have access to natural light in Europe.”That meant hospitals needed to be designed with a thin architectural footprint, with courtyards funnelling natural light into offices and treatment and diagnostic areas – not the fat footprints seen in 1970s-era hospitals such as the old Prince of Wales at Randwick and Royal North Shore. This type of building would also address sustainable design issues for hospitals, which are huge consumers of energy.”Hospital buildings are the most expensive buildings, the most complex buildings â?¦ they are buildings where humans are at their most vulnerable and technology is at its highest,” Chand says. She knows the pros and cons of the two camps – those comforted by visible technology; those wanting resort style ”hospitals in disguise” – but she is in no doubt that technology is crucial in managing a health system dealing with chronic staff shortages.”Clever use of technology can improve clinical processes, it can organise better and safe patient flow, and avoid duplication,” she says.To her mind, hospitals have lost their status as valuable landmarks; the importance that comes with places of birth and death. ”My crusade is to get better design into hospitals, and for them to regain their status as being valued elements in the community.”
THE State Government has moved to strengthen legislation so that force can be used to obtain the DNA of those listed on the child protection register who refuse to provide it voluntarily.It follows pressure from the police, who said some offenders on the register have refused to co-operate since the Government’s move last year requiring them to provide their DNA.”Offenders who come into regular contact with police are adept at skirting around the law as a way of frustrating authorities and avoiding detection,” the Attorney-General, John Hatzistergos, said. “These new laws will strengthen the process for taking DNA from offenders who have a history of harming children and continue to pose a risk to the community.”Lawyers cautioned that the courts already hold these powers, and that the police could make their case to the courts and let a judge decide.”It is unreasonable to give police that sort of power,” said Stephen Blanks of the NSW Council for Civil Liberties. ”The power to compel DNA samples should be up to the courts.”Under the proposed legislation, police will be able to detain people on the register who fail to co-operate and, if necessary, take a DNA sample by force. Additionally, if people on the register refuse to present themselves at a police station to provide a DNA sample, then police will be able to obtain a warrant for their arrest.”It is important that we take a DNA sample from everyone who has ever committed a serious crime against a child,” Mr Hatzistergos said.Offenders who go to prison for indictable offences automatically have their DNA taken under laws introduced in 2000. But those who committed offences earlier, or interstate offenders now living in NSW, do not have their DNA on file.People on the register must let police know where they live and work, and also what car they drive. This information allows police to keep tabs on them and gives police an important way of targeting repeat offenders.
TALKS between the State Government and newsagents over the sale of NSW Lotteries have broken down and relations have become acrimonious following a decision by the agents to bid for the asset.The Newsagents Association of NSW and the ACT had been pressuring the Government to introduce onerous conditions on the sale that would protect newsagents for up to six years.But this week the association told the Government it was planning to enter a consortium to bid for the lotteries, leaving it open to the claim that by pushing for conditions on the purchaser, it could have been driving down the sale price for its own benefit.The sale is expected to fetch more than $500 million.”The NSW Government will no longer discuss with [the association] potential legislative amendments or licence conditions given probity requirements and the need to ensure a fair process for all bidders,” the Treasurer, Eric Roozendaal, informed the association yesterday in a letter obtained by the Herald.In a surprise move this week, the association told the Government it was launching a consortium of all newsagents to bid for NSW Lotteries, arguing that maintaining present resale arrangements for lottery products ”is in the best interests of the people of NSW”.In meetings with some MPs this week, the association said the sale proposal and the associated regulations would not provide sufficient protection for the viability of many newsagents.”Our consortium represents all NSW Lotteries agents and enshrines the role of small businesses being the provider of lotteries products and services in NSW,” it said in a briefing note given to the MPs.The Government receives about $350 million a year in royalties and taxes from NSW Lotteries. This is forecast to fall by about $50 million a year following the sale.The State Opposition put its weight behind the lotteries sale last year, but it is now opposing the privatisation and claiming that newsagents need greater protection.
THE Treasurer, Wayne Swan, said yesterday the eyes of the Government were firmly fixed on a dispute at the Newcastle coal terminal that threatens to jeopardise future port expansion plans and cost the country millions in lost export earnings.The Australian Competition and Consumer Commission this week lost patience with the BHP-led consortium at Newcastle over its refusal to sign up to a new agreement on sharing port facilities.The dispute is typical of arguments over who gets to use port and rail facilities. Because this infrastructure is often owned by a monopoly, regulators need to ensure that other parties have access.At Newcastle, the ACCC has had a temporary approval in place for years, allowing development of the port facilities. But it has revoked the approval because, it is understood, of differences with BHP over who should control use of the crowded facilities.Mr Swan said he was ”extremely concerned” at reports that the expansion plans could be jeopardised, and would contact the Infrastructure Minister, Anthony Albanese, about the issue.”It goes to the core of our productive capacity, and our capacity to export,” the Treasurer said.Later, Mr Albanese said the Commonwealth had had discussions with the NSW Ports Minister and urged a timely resolution of any outstanding issues. The chairman of the ACCC, Graeme Samuel, told ABC Radio the parties had plenty of time to meet a deadline about a new agreement to share the facilities.”We’ve come to the conclusion that it is no longer in the public interest, there’s no longer an overwhelming public benefit in having this so called transition arrangement in place,” Mr Samuel said.The NSW Ports Minister, Joe Tripodi, said the Newcastle Coal Infrastructure Group – led by BHP – had helped out on signing a new agreement with the State Government because the state insisted it build a new coal loader to its full capacity.”That’s the sticking point, the Government will not change its position on this, that we are not allowing a coal-loading business to sit on capacity while there’s so much demand from coal producers to have export capacity through the port,” Mr Tripodi said.