June 17, 2021 • 18 mins
Finding it both necessary and convenient, patients and clinicians across Australia embraced the change brought about by COVID-19 and took to telehealth in huge numbers – jumping from one million service events in March 2020 to six million a month later in April.
Healthcare is traditionally an area that can be slow to change, so this leap in uptake was a novel event in itself.
Under pandemic restrictions, clinicians didn’t have much of a choice. But the switch to telehealth wasn’t as simple as just turning on a computer or making a call, particularly in hospital settings where space and infrastructure are hard to come by.
We wanted to find out what the telehealth experiences of healthcare workers in Australian hospitals was like during 2020, and the implications for the spaces we design.
In collaboration with The University of Queensland’s Centre for Online Health, we discovered that hospital infrastructure in Australia is ill-equipped to accommodate the spaces needed for successful delivery of telehealth services during a pandemic. And with telehealth here to stay, that means these spaces are also left wanting in a future that is almost certain to include a greater mix of both in-person and telehealth consultations.
For episode 3 in season 2 of Hassell Talks, Senior Researcher Michaela Sheahan looks at what this means for the way new hospitals are designed or existing hospitals are reconfigured – and the almost once-in-a-lifetime opportunity to rethink the way healthcare is offered. She’s joined by Hassell Principal Leanne Guy as well as Karen Lucas, Senior Telehealth Coordinator for Metro South Hospital and Health Service and Dr Emma Thomas, Research Fellow at the Centre for Health Services Research, The University of Queensland.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:03):
- [Emma] What COVID created,
I guess it was the ultimate disruptor.
- [Karen] The general culturenow is we can't go back
to the way things were, from aservice-delivery perspective.
So telehealth and thosethings are here to stay.
- [Leanne] It's challengingus a little bit more
to think about how wedesign our facilities.
(00:23):
It's not just going to befollowing the guidelines
and rolling it out.
- [Michaela] There'ssuddenly a lot of talk
about telehealth, whichmight be a little bit galling
for all the people that have been slowly
but surely developing itquietly in the background
for decades.
Last year, in the blink of an eye,
Australia, like manyplaces around the world,
(00:44):
flicked the switch andbegan delivering telehealth
on a pretty grand scale whenthe government announced
Medicare funding fortelehealth consultations.
- [Greg] Thanks very much, Prime Minister.
What we are doing now isa radical transformation
in the way in which wedeliver our health services.
As of tomorrow, we willhave universal telehealth
(01:06):
available in Australia.
- [Michaela] I'm Michaela Sheahan.
Australian GPs, hospitals, and specialists
went from delivering 1 milliontelehealth consultations
in March to 6 million in April.
What did that mean forour healthcare services
in the heat of the moment?
And most importantly, to Hassell,
(01:27):
what does it mean for the hospitals
that we will design in the future?
There are lots of ways to describe
what we're talking about here.
There's telehealth,there's virtual health,
there's home-based care,there's digital care.
We looked at telehealth specifically
as either a telephone callor a video consultation
between a patient and a clinician,
(01:48):
or between clinicians themselves.
- [Karen] So currently,we have about 130 services
running telehealth.
- [Michaela] Karen Lucas is asenior telehealth coordinator
for the Metro SouthHospital and Health Service
in Brisbane, Queensland.
- [Karen] So groups likegeriatrics, rheumatology.
(02:08):
We also have surgical specialties,
like vascular surgery and orthopaedics.
And then we have a growingamount of allied health.
So physiotherapy doesquite a large service,
as does speech pathology,occupational therapies.
- [Michaela] In her role, shesupports six public hospitals
and other community healthproviders to establish telehealth
as one of their modes ofdelivery within their service.
(02:32):
Karen's worked in telehealthfor more than 20 years,
starting out when itwas done via ISDN lines
by doctors who wanted to findany way they could to care
for patients in the remoteparts of Outback Queensland.
She described the uptake oftelehealth as slow and steady
prior to 2020, with attitudeschanging incrementally.
And then COVID-19 hit, andhospitals needed to respond.
(02:57):
- [Karen] That experience was chaotic.
It's a really great description, I think,
because we went from thisreally nice, slow-paced,
do-it-the-right-way approachto everyone wanting it,
and everyone wanting it right now.
- [Michaela] Karen's team wentfrom supporting the delivery
(03:18):
of 6,000 telehealth consultations in 2019
to more than 30,000 in 2020.
- [Karen] We weren'treally set up to do that.
In public hospitals, thereisn't any free space.
Space is a challenge.
Space is often multi-purpose.
- [Emma] Clinicians quicklymade sure they had a laptop,
they had, you know, the right headphones
(03:39):
and a camera, and they setup spaces to provide care
via telehealth all over the hospital.
- [Michaela] Emma Thomasis a research fellow
at the Centre for Health Services Research
at the University of Queensland.
In her position at theCentre for Online Health,
she's involved in the implementation
and evaluation of telehealth services.
(04:00):
Given the year that we've just had,
we were really interestedto see how health workers
had experienced the lockdowns
and the extraordinarycircumstances that many hospitals
found themselves in this year.
So we approached Emmato help us speak with
and survey Australian healthcare workers
to understand thoseexperiences that they had.
- [Emma] We heard from peoplethat were trying to work
(04:21):
from cupboards and adapttheir clinical settings.
Some were working from home.
So there was a mad rushin trying to find space.
And on top of that, peoplehad these restrictions
about the number of people they could have
in a physical area.
That meant that there waseven less available space
(04:41):
for them to use.
- [Michaela] The surveygave us some real insights
into how workers in thehospital setting responded
despite this history anddespite a reluctance to change.
When push came to shove,when it came to caring
for patients safely and efficiently,
they did whatever they couldto care for those patients.
Emma Thomas, again.
(05:01):
- [Emma] It created this opportunity
to experience a new way.
And that was for bothpeople receiving care
within their own homes andalso for the clinicians
that are providing that care.
So whether that's, you know,
a GP in their officethat's able to suddenly do
a lot more phone calls and be reimbursed
(05:22):
for those phone calls forpotentially the first time ever,
or whether, you know,
that's an elderly person whofinds it quite challenging
to get to a hospital, and park,
and walk to their appointment,and wait in a clinic room.
And they may have othercaring responsibilities
and other things thatthey need to do at home
(05:42):
or require another person toto physically drive them there.
- [Michaela] Senior telehealthcoordinator, Karen Lucas.
- [Karen] The general culturenow is we can't go back
to the way things were, from aservice-delivery perspective.
So telehealth and thosethings are here to stay,
and we have to start making our space
more appropriate for that.
- [Michaela] Space, that'sthe one thing hospitals
(06:04):
don't have a lot of.
With telehealth here to stay,how are our public services
thinking about supportingtelehealth properly?
- [Karen] There has beensome talk across Queensland
around different healthdistricts starting to look
at developing telehealth orvirtual care-specific space.
(06:26):
So whether that's buildings dedicated
to offering the differentforms of telehealth.
I know there are somegroups who have bought
special telehealth podsbecause their offices
are open-planned, and sothey've bought pod spaces
for their telehealth.
So there is a lot oftalk because as we move
(06:48):
further into 2021 and, you know,
the future of our COVID world,
that's becoming a reallyinteresting question
about what are thosespaces gonna look like,
where should they be,how should they function.
I think that we are left
with some really great opportunities now,
and I think those opportunities
(07:08):
are in rethinking theway we do healthcare.
So essentially, a really nicepiece of clinical redesign.
How do we do healthcare thatis suitable for the clinicians
in terms of making sure they'recomfortable and competent
in their clinical caredelivery, that patients
(07:29):
are equally comfortable and competent
in accessing that care, beit a lot of different ways,
potentially, duringtheir healthcare journey.
And I think there's an opportunity here,
as populations get bigger and the money
to build bigger hospitals doesn't exist,
to rethink how people flowthrough that healthcare system,
(07:51):
and what other spaces andthe buildings that we need,
and where should they be,and how should both patients
and clinicians access
those spaces.
- [Leanne] Look, I thinkwe've always talked
about the design ofhospitals should be flexible
and adaptable, but you oftendon't really see it in reality.
(08:12):
Now we need to have thatingrained in everything
that we're designing and thinking about.
- [Michaela] Leanne Guy isa health sector designer
of more than 20 years experience.
She's worked in theplanning and coordination
of major healthcare projectsin Australia and London,
and at Hassell, she leadsthe Health Sector team.
She also happens to be a registered nurse.
(08:32):
- [Leanne] Nothing simplein reconfiguring spaces.
I guess we should probably clarify that.
But certainly, when we'redesigning hospitals,
we think about adaptabilityand flexibility
because healthcare is always evolving.
The models of care are always changing.
So we're always designingwith that in mind anyway.
To do telehealth properly,
you have to really havethe right technology
(08:54):
and the right acoustics andthe right space to do it.
You know, the last thing clinicians want
is to miss something through telehealth
'cause then we'll just go back to,
you know, the start.
- [Michaela] We know thatAustralia is not alone
in this transformative moment.
Many countries have experiencedshifts to telehealth
but in a bigger way thanwe've seen in Australia
because they've been affected by COVID
a lot more than we have.
(09:16):
Most countries wherethey've had the connectivity
and the infrastructure have given it a go,
but it's the United Stateswho are leaders in this field.
- [Leanne] The MercyVirtual Centre in the US
is a dedicated facility for virtual care.
It was responding directlyto a need for access
in rural and regional areasin a shortage of physicians.
It's four stories.
(09:37):
It has staff of over600 clinicians, doctors.
It has full telehealth medical records,
electronic medicalrecords, and data analytics
to diagnose patients and deliver care
without any patientsattending the facility.
So it's basically a hospital without beds.
Most spaces are not adequatelyset up for telehealth
(09:59):
in the hospitals at this point.
They're looking for refurbishment,
they're looking for betterconnectivity to Wi-Fi,
and better technology,lighting, acoustics.
We have to be able to mobilise quickly,
whether it's a pandemic ora different way of working.
But we still want to have activated,
lively healthcare spaces,and that means people.
(10:19):
So how do we do that safely?
- [Michaela] The surveyrevealed a number of hurdles
that clinicians need to jump
to provide a successfultelehealth experience
for patients and themselves.
And at the top of the list, privacy.
- [Emma] From the patient point of view,
they wanna make surethat they're somewhere
where there's not, Iguess, background noise.
(10:40):
There's not someone walking past them.
- [Michaela] Researcher, Emma Thomas.
- [Emma] These are often very sensitive
and private conversation, andthat's not always available
in busy hospital settings.
- [Leanne] When youthink about it, you know,
sitting in the emergencydepartment with your child,
and you know exactly what's going on
with the child next door.
- [Michaela] Designer, Leanne Guy.
- [Leanne] It's often thisrequest when we're designing
(11:01):
and briefing hospitals that, you know,
patient privacy is the utmost importance,
and we need confidentiality.
But in reality, you know,
you rarely get that inthe clinical situation.
So this is a positive for patients
to be able to have that conversation,
as they would say, in a GPs office
or a consult room where thereis a closed door scenario.
(11:26):
- [Michaela] After weanalysed the research data,
we realised that perhapsthe most useful thing
we could contribute to the conversation
is to look at the differentways that telehealth
might be implemented inthe hospital setting.
We looked at an outpatients department.
As it is now, as business as usual,
with about 10% telehealth services.
(11:47):
Then we looked at a mixed mode,
where an outpatient'sdepartment might be delivering
half its services by telehealth.
And then we looked atcomplete transformation,
a building or a facility thatdelivers all of its services
by telehealth, essentiallya hospital without patients.
- [Emma] Most cliniciansthat you would talk to,
even if they've had areally great experience
(12:09):
with telehealth during COVID, will say
that there's certain aspectsof care that they have to do
or they prefer to doface-to-face or in-person.
And they want to be able to move flexibly
between hybrid models of carewhere they can see one person
in person and then use that same setting
(12:30):
to then be able to jumponline and see another person
that might be based at home.
And it may be depending
on whether it's the clinicalcondition that they've got,
or whether it's an initialappointment versus a review,
or what they need to do withinthat clinical appointment.
Or the preference of the person,which is really important,
(12:50):
will depend on whattype of modality of care
they wanna provide.
And clinicians wanna beable to seamlessly move
between these differentmodalities of care.
- [Michaela] As cliniciansand administrators
look at the successes oftelehealth during 2020,
it's likely that many will look to deliver
mixed mode healthcare on an ongoing basis.
(13:11):
Introducing this into existingspaces will be challenging
in some facilities, butthere are small changes
that can be made straight away.
- [Leanne] And one of thethings that we've been trying
to work through over the yearsis not to have duplication
of spaces for clinicians sothey don't have an office
in every department thatthey work in, but it might be
that it is an activity-basedhot desk scenario
(13:33):
where it can be utilised by anumber of different clinicians
in a shared resource scenario.
That mixed mode is probablywhere we'll see that first step.
And I think just that resistance to change
to a hundred percent will also, you know,
we're going to see that.
So I think this mixed mode approach
(13:54):
is probably the most realisticoption that we'll see.
And in some of our briefingthat we're currently doing,
certainly the cliniciansand the health services
are acknowledging that, you know,
yes, we've proven that it worked.
Yes, we are changing, but we're not ready
for a hundred percent, or we're not ready
(14:15):
for that huge step change,and they just can't see that
happening in the short term.
So I think that mixedmode is really important,
that we have that integratedinto how we're thinking
about the design of our health facilities.
(gentle music)
- [Michaela] It can't be a podcast
without some predictions for the future.
(14:36):
What does the future look like
for the designs of our hospitals?
- [Emma] What we expect
is that there will be a greater shift
towards community-based care
and servicing people within their homes
rather than having everyonecoming into hospital.
So that's sort of one area
(14:57):
that we're definitely moving towards,
I think, in the future.
- [Leanne] I think that thispandemic has really proven
that there's value in thishospital-in-the-home model
and this virtual care model.
And hopefully, out ofthat, we'll see funding
being allocated specificallyto address spaces
(15:17):
that aren't adequately fit about
or don't have the righttechnology to be able to support,
you know, really efficient
and safe care in this mode.
You know, the HealthMinister in West Australia
acknowledged that thereis no turning back.
You know, we have proven that this works,
and this works well.
(15:38):
So this is how we will be continuing.
And I think that that's reallyimportant to acknowledge
that, you know, of our existing facilities
and new facilities, thishas to be integrated
into how we're approachingthe design of our hospitals.
So I think we're going tosee this greater efficiency.
We're gonna see less peoplepresent in hospitals,
which can only be a benefit for everyone.
(16:01):
- [Michaela] What we know fromAustralia's unique experience
of the pandemic, where welargely suppress the virus,
is that as lockdownseased and life returned
to something approaching normal,people wanted to get back
to in-person visits to hospitals and GPs.
The rates of telehealth droppedfrom their dizzying heights
early in 2020, but theyhave not yet returned
to previous levels.
(16:21):
And our research revealedthat very few clinicians
believe they ever will again.
The pandemic has givenus a kick up the pants
to get on with something weshould have been more willing
to adopt, particularly forremote and regional patients
but also for equitableaccess to healthcare
for vulnerable populations in cities, too.
Patients will stillneed to go to hospital,
(16:44):
but if they don't need or want to,
it makes perfect senseto take care of them
in the most appropriate,efficient, and effective mode.
That might be a nurse coming to your home
to take your stitches out,
or a psychology consultation online,
or monitoring of your heartrate on a mobile device.
Leanne Guy.
- [Leanne] Yeah, we've just come so far,
(17:05):
and this has really allowedeveryone to just embrace what,
you know, healthcaresystems and what technology
is capable of doing.
You know, hospitals arehard things to design.
You know, they're hard to get right.
It's challenging us alittle bit more to think
about how we design our facilities.
It's not just going to befollowing the guidelines
(17:26):
and rolling it out.
And this is where thisreally deep understanding
in this specialist knowledge of designing
healthcare facilities is important.
It's not just simply having a soft space
that can be converted intosomething else easily.
It's really thinking about the nuances
about how we can designour facilities to allow
this flexibility that weneed to respond to quickly.
(17:47):
- [Michaela] Karen Lucas.
- [Karen] Prior to 2020,if you'd asked most people
at your local shoppingcentre what telehealth was,
they probably wouldn't havenever heard the word before.
People know what telehealth is now.
People ask for telehealth.
People don't wanna go back to in-person
because they suddenly realisethat this is an option
to keep going in 2021.
(18:11):
- [Michaela] Thank youto our guests, Emma,
Karen, and Leanne fortheir time and insights.
This episode was recorded, edited,
and produced in-house bysome of our creative makers,
Eleanor Thomas and Prue Vincent.
Thanks for listening to this podcast
and please subscribe, rate, and review.
It helps us get intothe ears of more people
(18:32):
and share the fantasticresearch and insights
from across our network ofdesigners and strategists.
- [Emma] What COVID created,
I guess it was the ultimate disruptor.
- [Karen] The general culturenow is we can't go back
to the way things were, from aservice-delivery perspective.
So telehealth and thosethings are here to stay.
- [Leanne] It's challengingus a little bit more
to think about how wedesign our facilities.
(00:23):
It's not just going to befollowing the guidelines
and rolling it out.
- [Michaela] There'ssuddenly a lot of talk
about telehealth, whichmight be a little bit galling
for all the people that have been slowly
but surely developing itquietly in the background
for decades.
Last year, in the blink of an eye,
Australia, like manyplaces around the world,
(00:44):
flicked the switch andbegan delivering telehealth
on a pretty grand scale whenthe government announced
Medicare funding fortelehealth consultations.
- [Greg] Thanks very much, Prime Minister.
What we are doing now isa radical transformation
in the way in which wedeliver our health services.
As of tomorrow, we willhave universal telehealth
(01:06):
available in Australia.
- [Michaela] I'm Michaela Sheahan.
Australian GPs, hospitals, and specialists
went from delivering 1 milliontelehealth consultations
in March to 6 million in April.
What did that mean forour healthcare services
in the heat of the moment?
And most importantly, to Hassell,
(01:27):
what does it mean for the hospitals
that we will design in the future?
There are lots of ways to describe
what we're talking about here.
There's telehealth,there's virtual health,
there's home-based care,there's digital care.
We looked at telehealth specifically
as either a telephone callor a video consultation
between a patient and a clinician,
(01:48):
or between clinicians themselves.
- [Karen] So currently,we have about 130 services
running telehealth.
- [Michaela] Karen Lucas is asenior telehealth coordinator
for the Metro SouthHospital and Health Service
in Brisbane, Queensland.
- [Karen] So groups likegeriatrics, rheumatology.
(02:08):
We also have surgical specialties,
like vascular surgery and orthopaedics.
And then we have a growingamount of allied health.
So physiotherapy doesquite a large service,
as does speech pathology,occupational therapies.
- [Michaela] In her role, shesupports six public hospitals
and other community healthproviders to establish telehealth
as one of their modes ofdelivery within their service.
(02:32):
Karen's worked in telehealthfor more than 20 years,
starting out when itwas done via ISDN lines
by doctors who wanted to findany way they could to care
for patients in the remoteparts of Outback Queensland.
She described the uptake oftelehealth as slow and steady
prior to 2020, with attitudeschanging incrementally.
And then COVID-19 hit, andhospitals needed to respond.
(02:57):
- [Karen] That experience was chaotic.
It's a really great description, I think,
because we went from thisreally nice, slow-paced,
do-it-the-right-way approachto everyone wanting it,
and everyone wanting it right now.
- [Michaela] Karen's team wentfrom supporting the delivery
(03:18):
of 6,000 telehealth consultations in 2019
to more than 30,000 in 2020.
- [Karen] We weren'treally set up to do that.
In public hospitals, thereisn't any free space.
Space is a challenge.
Space is often multi-purpose.
- [Emma] Clinicians quicklymade sure they had a laptop,
they had, you know, the right headphones
(03:39):
and a camera, and they setup spaces to provide care
via telehealth all over the hospital.
- [Michaela] Emma Thomasis a research fellow
at the Centre for Health Services Research
at the University of Queensland.
In her position at theCentre for Online Health,
she's involved in the implementation
and evaluation of telehealth services.
(04:00):
Given the year that we've just had,
we were really interestedto see how health workers
had experienced the lockdowns
and the extraordinarycircumstances that many hospitals
found themselves in this year.
So we approached Emmato help us speak with
and survey Australian healthcare workers
to understand thoseexperiences that they had.
- [Emma] We heard from peoplethat were trying to work
(04:21):
from cupboards and adapttheir clinical settings.
Some were working from home.
So there was a mad rushin trying to find space.
And on top of that, peoplehad these restrictions
about the number of people they could have
in a physical area.
That meant that there waseven less available space
(04:41):
for them to use.
- [Michaela] The surveygave us some real insights
into how workers in thehospital setting responded
despite this history anddespite a reluctance to change.
When push came to shove,when it came to caring
for patients safely and efficiently,
they did whatever they couldto care for those patients.
Emma Thomas, again.
(05:01):
- [Emma] It created this opportunity
to experience a new way.
And that was for bothpeople receiving care
within their own homes andalso for the clinicians
that are providing that care.
So whether that's, you know,
a GP in their officethat's able to suddenly do
a lot more phone calls and be reimbursed
(05:22):
for those phone calls forpotentially the first time ever,
or whether, you know,
that's an elderly person whofinds it quite challenging
to get to a hospital, and park,
and walk to their appointment,and wait in a clinic room.
And they may have othercaring responsibilities
and other things thatthey need to do at home
(05:42):
or require another person toto physically drive them there.
- [Michaela] Senior telehealthcoordinator, Karen Lucas.
- [Karen] The general culturenow is we can't go back
to the way things were, from aservice-delivery perspective.
So telehealth and thosethings are here to stay,
and we have to start making our space
more appropriate for that.
- [Michaela] Space, that'sthe one thing hospitals
(06:04):
don't have a lot of.
With telehealth here to stay,how are our public services
thinking about supportingtelehealth properly?
- [Karen] There has beensome talk across Queensland
around different healthdistricts starting to look
at developing telehealth orvirtual care-specific space.
(06:26):
So whether that's buildings dedicated
to offering the differentforms of telehealth.
I know there are somegroups who have bought
special telehealth podsbecause their offices
are open-planned, and sothey've bought pod spaces
for their telehealth.
So there is a lot oftalk because as we move
(06:48):
further into 2021 and, you know,
the future of our COVID world,
that's becoming a reallyinteresting question
about what are thosespaces gonna look like,
where should they be,how should they function.
I think that we are left
with some really great opportunities now,
and I think those opportunities
(07:08):
are in rethinking theway we do healthcare.
So essentially, a really nicepiece of clinical redesign.
How do we do healthcare thatis suitable for the clinicians
in terms of making sure they'recomfortable and competent
in their clinical caredelivery, that patients
(07:29):
are equally comfortable and competent
in accessing that care, beit a lot of different ways,
potentially, duringtheir healthcare journey.
And I think there's an opportunity here,
as populations get bigger and the money
to build bigger hospitals doesn't exist,
to rethink how people flowthrough that healthcare system,
(07:51):
and what other spaces andthe buildings that we need,
and where should they be,and how should both patients
and clinicians access
those spaces.
- [Leanne] Look, I thinkwe've always talked
about the design ofhospitals should be flexible
and adaptable, but you oftendon't really see it in reality.
(08:12):
Now we need to have thatingrained in everything
that we're designing and thinking about.
- [Michaela] Leanne Guy isa health sector designer
of more than 20 years experience.
She's worked in theplanning and coordination
of major healthcare projectsin Australia and London,
and at Hassell, she leadsthe Health Sector team.
She also happens to be a registered nurse.
(08:32):
- [Leanne] Nothing simplein reconfiguring spaces.
I guess we should probably clarify that.
But certainly, when we'redesigning hospitals,
we think about adaptabilityand flexibility
because healthcare is always evolving.
The models of care are always changing.
So we're always designingwith that in mind anyway.
To do telehealth properly,
you have to really havethe right technology
(08:54):
and the right acoustics andthe right space to do it.
You know, the last thing clinicians want
is to miss something through telehealth
'cause then we'll just go back to,
you know, the start.
- [Michaela] We know thatAustralia is not alone
in this transformative moment.
Many countries have experiencedshifts to telehealth
but in a bigger way thanwe've seen in Australia
because they've been affected by COVID
a lot more than we have.
(09:16):
Most countries wherethey've had the connectivity
and the infrastructure have given it a go,
but it's the United Stateswho are leaders in this field.
- [Leanne] The MercyVirtual Centre in the US
is a dedicated facility for virtual care.
It was responding directlyto a need for access
in rural and regional areasin a shortage of physicians.
It's four stories.
(09:37):
It has staff of over600 clinicians, doctors.
It has full telehealth medical records,
electronic medicalrecords, and data analytics
to diagnose patients and deliver care
without any patientsattending the facility.
So it's basically a hospital without beds.
Most spaces are not adequatelyset up for telehealth
(09:59):
in the hospitals at this point.
They're looking for refurbishment,
they're looking for betterconnectivity to Wi-Fi,
and better technology,lighting, acoustics.
We have to be able to mobilise quickly,
whether it's a pandemic ora different way of working.
But we still want to have activated,
lively healthcare spaces,and that means people.
(10:19):
So how do we do that safely?
- [Michaela] The surveyrevealed a number of hurdles
that clinicians need to jump
to provide a successfultelehealth experience
for patients and themselves.
And at the top of the list, privacy.
- [Emma] From the patient point of view,
they wanna make surethat they're somewhere
where there's not, Iguess, background noise.
(10:40):
There's not someone walking past them.
- [Michaela] Researcher, Emma Thomas.
- [Emma] These are often very sensitive
and private conversation, andthat's not always available
in busy hospital settings.
- [Leanne] When youthink about it, you know,
sitting in the emergencydepartment with your child,
and you know exactly what's going on
with the child next door.
- [Michaela] Designer, Leanne Guy.
- [Leanne] It's often thisrequest when we're designing
(11:01):
and briefing hospitals that, you know,
patient privacy is the utmost importance,
and we need confidentiality.
But in reality, you know,
you rarely get that inthe clinical situation.
So this is a positive for patients
to be able to have that conversation,
as they would say, in a GPs office
or a consult room where thereis a closed door scenario.
(11:26):
- [Michaela] After weanalysed the research data,
we realised that perhapsthe most useful thing
we could contribute to the conversation
is to look at the differentways that telehealth
might be implemented inthe hospital setting.
We looked at an outpatients department.
As it is now, as business as usual,
with about 10% telehealth services.
(11:47):
Then we looked at a mixed mode,
where an outpatient'sdepartment might be delivering
half its services by telehealth.
And then we looked atcomplete transformation,
a building or a facility thatdelivers all of its services
by telehealth, essentiallya hospital without patients.
- [Emma] Most cliniciansthat you would talk to,
even if they've had areally great experience
(12:09):
with telehealth during COVID, will say
that there's certain aspectsof care that they have to do
or they prefer to doface-to-face or in-person.
And they want to be able to move flexibly
between hybrid models of carewhere they can see one person
in person and then use that same setting
(12:30):
to then be able to jumponline and see another person
that might be based at home.
And it may be depending
on whether it's the clinicalcondition that they've got,
or whether it's an initialappointment versus a review,
or what they need to do withinthat clinical appointment.
Or the preference of the person,which is really important,
(12:50):
will depend on whattype of modality of care
they wanna provide.
And clinicians wanna beable to seamlessly move
between these differentmodalities of care.
- [Michaela] As cliniciansand administrators
look at the successes oftelehealth during 2020,
it's likely that many will look to deliver
mixed mode healthcare on an ongoing basis.
(13:11):
Introducing this into existingspaces will be challenging
in some facilities, butthere are small changes
that can be made straight away.
- [Leanne] And one of thethings that we've been trying
to work through over the yearsis not to have duplication
of spaces for clinicians sothey don't have an office
in every department thatthey work in, but it might be
that it is an activity-basedhot desk scenario
(13:33):
where it can be utilised by anumber of different clinicians
in a shared resource scenario.
That mixed mode is probablywhere we'll see that first step.
And I think just that resistance to change
to a hundred percent will also, you know,
we're going to see that.
So I think this mixed mode approach
(13:54):
is probably the most realisticoption that we'll see.
And in some of our briefingthat we're currently doing,
certainly the cliniciansand the health services
are acknowledging that, you know,
yes, we've proven that it worked.
Yes, we are changing, but we're not ready
for a hundred percent, or we're not ready
(14:15):
for that huge step change,and they just can't see that
happening in the short term.
So I think that mixedmode is really important,
that we have that integratedinto how we're thinking
about the design of our health facilities.
(gentle music)
- [Michaela] It can't be a podcast
without some predictions for the future.
(14:36):
What does the future look like
for the designs of our hospitals?
- [Emma] What we expect
is that there will be a greater shift
towards community-based care
and servicing people within their homes
rather than having everyonecoming into hospital.
So that's sort of one area
(14:57):
that we're definitely moving towards,
I think, in the future.
- [Leanne] I think that thispandemic has really proven
that there's value in thishospital-in-the-home model
and this virtual care model.
And hopefully, out ofthat, we'll see funding
being allocated specificallyto address spaces
(15:17):
that aren't adequately fit about
or don't have the righttechnology to be able to support,
you know, really efficient
and safe care in this mode.
You know, the HealthMinister in West Australia
acknowledged that thereis no turning back.
You know, we have proven that this works,
and this works well.
(15:38):
So this is how we will be continuing.
And I think that that's reallyimportant to acknowledge
that, you know, of our existing facilities
and new facilities, thishas to be integrated
into how we're approachingthe design of our hospitals.
So I think we're going tosee this greater efficiency.
We're gonna see less peoplepresent in hospitals,
which can only be a benefit for everyone.
(16:01):
- [Michaela] What we know fromAustralia's unique experience
of the pandemic, where welargely suppress the virus,
is that as lockdownseased and life returned
to something approaching normal,people wanted to get back
to in-person visits to hospitals and GPs.
The rates of telehealth droppedfrom their dizzying heights
early in 2020, but theyhave not yet returned
to previous levels.
(16:21):
And our research revealedthat very few clinicians
believe they ever will again.
The pandemic has givenus a kick up the pants
to get on with something weshould have been more willing
to adopt, particularly forremote and regional patients
but also for equitableaccess to healthcare
for vulnerable populations in cities, too.
Patients will stillneed to go to hospital,
(16:44):
but if they don't need or want to,
it makes perfect senseto take care of them
in the most appropriate,efficient, and effective mode.
That might be a nurse coming to your home
to take your stitches out,
or a psychology consultation online,
or monitoring of your heartrate on a mobile device.
Leanne Guy.
- [Leanne] Yeah, we've just come so far,
(17:05):
and this has really allowedeveryone to just embrace what,
you know, healthcaresystems and what technology
is capable of doing.
You know, hospitals arehard things to design.
You know, they're hard to get right.
It's challenging us alittle bit more to think
about how we design our facilities.
It's not just going to befollowing the guidelines
(17:26):
and rolling it out.
And this is where thisreally deep understanding
in this specialist knowledge of designing
healthcare facilities is important.
It's not just simply having a soft space
that can be converted intosomething else easily.
It's really thinking about the nuances
about how we can designour facilities to allow
this flexibility that weneed to respond to quickly.
(17:47):
- [Michaela] Karen Lucas.
- [Karen] Prior to 2020,if you'd asked most people
at your local shoppingcentre what telehealth was,
they probably wouldn't havenever heard the word before.
People know what telehealth is now.
People ask for telehealth.
People don't wanna go back to in-person
because they suddenly realisethat this is an option
to keep going in 2021.
(18:11):
- [Michaela] Thank youto our guests, Emma,
Karen, and Leanne fortheir time and insights.
This episode was recorded, edited,
and produced in-house bysome of our creative makers,
Eleanor Thomas and Prue Vincent.
Thanks for listening to this podcast
and please subscribe, rate, and review.
It helps us get intothe ears of more people
(18:32):
and share the fantasticresearch and insights
from across our network ofdesigners and strategists.
Popular Podcasts
24/7 News: The Latest
The latest news in 4 minutes updated every hour, every day.
Therapy Gecko
An unlicensed lizard psychologist travels the universe talking to strangers about absolutely nothing. TO CALL THE GECKO: follow me on https://www.twitch.tv/lyleforever to get a notification for when I am taking calls. I am usually live Mondays, Wednesdays, and Fridays but lately a lot of other times too. I am a gecko.
The Joe Rogan Experience
The official podcast of comedian Joe Rogan.