Integrated Rural Health Services Generic Brief
Integrated Rural Health Services Generic Brief
Integrated Rural Health Services
Generic Brief
Acknowledgements
The development of this generic brief has been made possible by the participation of many people from the Department of Human Services and rural health services in Victoria.
Working party members included:
Sandy Bell, Aged Community and Mental Health, Department of Human Services
Jan Champlin, Rural Health Services Unit, Department of Human Services
Marie Linley, Acute Health, Hume Region, Department of Human Services
Randall Garnham, Capital Management Branch, Department of Human Services
Ralph Hampson, Aged Community and Mental Health, Department of Human Services
Michael Harbour, Baade Harbour and Associates Pty Ltd, Consultant Architect to the project.
Judy Kelso, Aged Community and Mental Health, Department of Human Services
Barbara Lund, Aged Community and Mental Health, Department of Human Services
Andrea Plantinga, Barwon South Western Region, Department of Human Services
Marion Place, Acute Health, Department of Human Services
Mike Powell, Acute Health, Department of Human Services
Annette Toohey, Loddon Mallee Region, Department of Human Services
Photographs courtesy of Wintringham, Allan Kong Architect, and Silver Thomas Hanley, Architects
Published by the Aged, Community and Mental Health Division
Victorian Government Department of Human Services
Melbourne, Victoria
June 2000
Also published on the Aged, Community and Mental Health Division Website at
http:
ISBN 0 7311 6047 9
(0061099)
© Copyright State of Victoria 2000
Contents
1 Introduction 1
1.1 Generic Brief 1
1.2 Functional Brief 1
1.3 Policy and Service Context2
1.3.1 The Framework for Service Provision 2
1.3.2 Background 2
2 Functions and Operations 5
2.1 Philosophy 5
2.2 Method of Operation 5
2.2.1 Overview 5
2.2.2 Primary Health and Community Services 6
2.2.3 Allied Health Services 6
2.2.4 Bed-Based, Medical and Emergency Services 6
2.3Integrated Service Models 8
2.3.1 Multi Purpose Services 8
2.3.2 Healthstreams 8
2.4Staffing 9
2.5Components 10
3 Design 15
3.1Implications for People within the Facility 15
3.1.1 Clients 15
3.1.2 Visitors, Volunteers, Family and Community 15
3.1.3 Staff15
3.2 General Design Criteria 15
3.3Site Selection, Planning and External Facilities 16
3.3.1 Location 16
3.3.2 Access and Topography 16
3.3.3 Size 16
3.3.4 Parking 16
3.3.5 Signage 16
3.3.6 Landscaping 16
3.3.7 Social Character 16
3.3.8 Outdoor Garden Area 17
3.4Building Form and Character 17
3.5Climatic Control 17
3.6Designing the Building 17
3.6.1 Capacity 17
3.6.2 Acoustics 18
3.6.3 Mobility 18
3.6.4 Sensory Aspects 19
3.6.5 Building Fabric and Finishes 19
3.6.6 Furniture 21
3.6.7 Signs and Graphics 21
3.6.8 Colours 21
3.7Building Services 22
3.7.1 Fire Prevention Services 22
3.7.2 Hydraulic Services 22
3.7.3 Lighting and Electrical Services 22
3.7.4 Communication Systems 23
3.7.5 Security Systems 23
3.7.6 Mechanical Services 23
3.7.7 Waste Disposal and Incineration 24
4 Functional Zones and Relationships 25
4.1 Functional Zones 25
4.2Key Functional Relationships 26
4.3Functional Zone 1: Administration and Bed-Based Services 30
4.3.1 Entry/Lobby 30
4.3.2 Waiting Areas 30
4.3.3 Reception 30
4.3.4 Staff Base 31
4.3.5 Health Records (Short Term) 32
4.3.6 Stationery/Photocopier Space 32
4.3.7 Chief Executive Officer 32
4.3.8 Director of Nursing Office 33
4.3.9 Administrative Office Spaces 33
4.3.10Multi-Use Interview Rooms 33
4.3.11 Toilets 34
4.3.12 Medications Storage 34
4.3.13 Multipurpose Meeting Spaces 34
4.3.14 Clean Utility Room 35
4.3.15 Dirty Utility Room 36
4.3.16 Assisted Bathroom 36
4.3.17 Multipurpose Day Chairs 37
4.3.18 Bedrooms 37
4.3.19 Ensuites 43
4.3.20 Lounge 44
4.3.21 Dining Areas 47
4.3.22 Kitchenette 49
4.3.23 Plating Facilities/Servery 51
4.3.24 Quiet Sitting Room (Bed-Based Services) 51
4.3.25 Multipurpose Activities Space 51
4.3.26 Laundry (Domestic) 52
4.4Functional Zone 2: Medical Procedures 52
Introduction52
4.4.1 Levels of Medical Procedures–1, 1A, 2, 2A and 3 52
4.4.2 Sterile and Clean Stores 53
4.4.3 Medical Procedure Space 53
4.4.4 Scrub-Up Area 53
4.4.5 Patient Holding Area 54
4.4.6 Sterilising Room 54
4.4.7 Set Up Space 54
4.4.8 Recovery Area 54
4.4.9 Staff Change Room 55
4.4.10 Operating Theatre 55
4.4.11 Anaesthetics Space 55
4.4.12 Staff Base and Staff Lounge 55
4.5 Functional Zone 3: Emergency and Stabilisation /Medical Imaging 55
4.5.1 Levels of Emergency and Stabilisation—Levels 1, 2 and 3 56
4.5.2 Ambulance Entrance 56
4.5.3 Cubicles (Treatment and Change) 56
4.5.4 Resuscitation Area 56
4.5.5 Medical Imaging 57
4.5.6 Ultrasound 57
4.5.7 Pathology Space 57
4.5.8 Client/Patient Shower 58
4.5.9 Plaster Space 58
4.6 Functional Zone 4: Primary Care/Allied Health and Day Centre 58
4.6.1 Clinical Office Spaces 58
4.6.2 Multi-Use Treatment and/or Consulting Space 59
4.6.3 Library/Resource Facilities Area 60
4.6.4 Multi-Use Activities Space 60
4.6.5 Multi-Use Meeting Spaces 60
4.6.6 Fully Functional Disabled Kitchen (ADL) 60
4.6.7 Dining Rooms 61
4.7 Functional Zone 5: Service and Support Areas 61
4.7.1 Kitchen 62
4.7.2 Soiled Linen Holding Space 62
4.7.3 Clean Linen Store 62
4.7.4 Waste Disposal (Infectious and Other Waste) Store 62
4.7.5 Chemical Store 63
4.7.6 Holding or Mortuary Room 63
4.7.7 Viewing Facilities 63
4.7.8 Plant Room 63
4.7.9 Workshop 64
4.7.10 Medical Gases Area 64
4.7.11 Wheelchair Parking Space 64
4.7.12 Trolley Parking/Storage Spaces 64
4.7.13 Medical Supplies Store 64
4.7.14 Equipment Store 65
4.7.15 Cleaners’ Space 65
4.7.16 Flower Preparation Space 65
4.7.17 Circulation Space/Passageways 65
4.7.18 Staff Lounge 66
4.7.19 Staff Change/Lockers 66
4.7.20 Staff Toilets 66
4.7.21 Pharmacy 66
4.7.22 Archives 66
4.7.23 Laundry (Commercial) 67
4.8 Functional Zone 6: Other Services 67
4.8.1 Ambulance Cover/Garage 67
4.9 Functional Zone 7: External Spaces 67
4.9.1 Service Entry/Loading Bay 67
4.9.2 Service Canopy 67
4.9.3 Entry Canopy 68
4.9.4 External Recreation Areas 68
4.9.5 Children’s Play Space 68
4.9.6 Outdoor Treatment Areas 68
4.9.7 Ambulance Canopy 69
5 Other Planning Issues 71
5.1 Town Planning 71
5.2 Property Agreement 71
6 Appendices 73
Appendix 1: Facility Schedule Guidelines 75
Appendix 2: Facility Schedules 76
Appendix 3: Examples of Site Development 85
Appendix 4: Examples of Development of Existing Facilities 88
Appendix 5: Glossary of Terms 94
Appendix 6: References and Bibliography 96
List of Figures
Figure 1 Total Relationship Diagram 26
Figure 2 Primary Health/Allied Health/Day Care Relationships Diagram 27
Figure 3 Medical Procedures/ Emergency/Stabilisation Relationship Diagram 28
Figure 4 Bed-Based Relationships Diagram 29
Figure 5 Example Layout of Clean and Dirty Utility Rooms 36
Figure 6 Example Layout of a Single Bedroom with Single Ensuite (1) 40
Figure 7 Example Layout of a Single Bedroom with Single Ensuite (2) 41
Figure 8 Example Layout of a Single Bedroom with Shared Ensuite 42
Figure 9 Example Layouts of Sitting Areas 46
Figure 10 Example Layouts of Dining/Sitting Areas 48
Figure 11 Example Layouts of Kitchenette Areas 50
Figure 12 Existing Site Conditions 85
Figure 13 Proposed Development Option 1 86
Figure 14 Proposed Development Option 2 87
Figure 15 Medical Support Services (1) 88
Figure 16 Medical Support Services (2) 89
Figure 17 Main Entry/Lounge 90
Figure 18 Staff Base/Beds 91
Figure 19 Beds/Staff Base 92
Figure 20 Main Entry/Staff Base 93
List of Tables
Table 1 Components in an Integrated Rural Health Service 12
Table 2 Colour Chart 22
1Introduction
1.1Generic Brief
A generic brief provides detailed guidelines for the planning and design of health and aged care facilities.
This generic brief has been developed for an Integrated Rural Health Service (IRHS) facility. The aim of this generic brief is to:
•Outline the guidelines for the development of project specific briefs for individual IRHS facilities including Multi Purpose Services and Healthstreams agencies in less populated and remote rural communities in Victoria (generally group D and E hospitals).
•Provide a consistent and clear framework within which regions develop and negotiate health service delivery strategies with potential service providers.
•Provide general principles for quality design outcomes for IRHS facilities in Victoria.
•Provide an overview of the services and activities that an IRHS facility will commonly provide.
•Describe, in generic terms, the spaces required to conduct those services and activities.
Each design should be refined to suit the service needs and community circumstances as identified in an agency’s service plan, which must be approved by the Department of Human Services (Department). Prior to considering the facility requirements for service delivery it is important that each health service provider develops a comprehensive knowledge and understanding of local community health and aged care needs.
The Department is committed to a philosophy providing the highest quality, most effective and cost efficient health and aged care services. These guidelines have been structured around this principle with the main objectives being:
•Respect for a person’s rights and dignity and continuous improvement in their quality of life.
•An environment for aged care client which promotes:
•A domestic lifestyle.
•Self-respect.
•Independence.
•Social opportunities.
•An environment which meets the objectives of ‘Ageing in Place’.
•Flexibility to cater for patients/residents with a range of frailties, disabilities, support needs and confusional states which may vary over time.
The selected design influences many elements of the economic viability of the facility. These include:
•Work practices
•Management
•Flexibility
•Maintenance
•Energy efficiency
•Operating costs.
This generic brief has been developed through literature review and an extensive consultation process.
The processes used to develop the generic brief entailed:
•The establishment of a steering committee.
•A guidelines workshop with an expert group comprising key service providers and policy advisers.
•Site visits to existing facilities.
•A survey of agencies which have already undertaken major redevelopment projects and those who are still functioning from older facilities.
Variations in developing each facility may be necessary in order to adjust the design to proposed sites including consideration of refurbishment. Some sections of this document relate to specific legislative requirements such as building codes and safety specifications, however many aspects are indicative or conceptual in nature providing a framework which can be adapted to meet local needs.
The development of IRHS in Victoria will be guided by this generic brief.
1.2Functional Brief
The information in this generic brief can be taken and adapted by an agency in conjunction with an architect to develop a project specific functional brief from which a building can be constructed or redeveloped. Development of a project specific functional brief that will deliver well-planned IRHS facilities involves extensive consultation, investigation and coordination. In the planning stage consultation for individual facilities will involve the Department, service providers, consumers and carers in the community. Information on the development of a functional brief should be obtained from the Department of Human Services Capital Development Guidelines.
Particular note should be taken of the guidelines for:
•Policies and procedures for undertaking capital developments.
•The planning and evaluation phase.
•Fire risk management.
Proposed capital redevelopment projects should be supported by a current needs analysis and service plan which has been endorsed by the Department.
A project control group (PCG) is formed to manage and ensure a capital project is delivered in a manner that complies with functional requirements, approved scope of works and is delivered within the scope, budgets and time constraints of an individual project. The project control group gives final endorsement for the project. Final written approval for each phase of a project must be obtained from the Department. Representatives from the Department at a regional, branch and program level, together with representatives of the agency will participate in individual project control groups to contribute constructively to the planning, design, development and implementation of the service and to facilitate the approval processes.
1.3Policy and Service Context
1.3.1The Framework for Service Provision
Health care in Australia has changed significantly over the last few decades and the traditional focus of rural hospitals on acute and hospital-based services is no longer appropriate in responding to community needs. In rural communities there is a trend towards decreasing population especially in the younger age groups. In parallel the proportion of older people in these communities has and will continue to increase.
As the population has declined communities in remote areas have faced increasing difficulty in maintaining viable health service infrastructures. This has been especially true for isolated rural communities. Change has brought about a need for flexibility in how rural health services deliver services. Different approaches to funding and reporting arrangements are being adopted. New funding approaches which allow pooling of funds across service areas without some of the constraints previously imposed by program areas, will enhance and promote flexibility in service configuration.
The evolution and development in recent years of an IRHS is bringing together acute, sub-acute, aged and community-based services. The focus of healthcare is shifting to more integrated services with an emphasis on primary care providing an opportunity for the reconfiguration of rural health services in Victoria.
1.3.2Background
A ‘Commonwealth and State Governments’ Task Force’ was established in 1991 to recommend new service structures which could meet the very special requirements of small rural communities needing to sustain hospital, medical, aged and community services. This resulted in a joint State/Commonwealth MPS (MPS) program targeted to isolated rural communities in which funding is pooled and cashed out allowing flexibility for a range of health, aged and community care services.
In July 1993, the Victorian Government released Everyone’s Future: Directions for Aged Care Services in the 1990s. The publication outlined twelve key objectives for the delivery of Aged Care Division’s services now and in the future. Objective 6—Creating Flexible Services in Rural Victoria acknowledged the task was to develop more flexible health and aged care services in rural and remote areas, building on the concept of the MPS model.
The ‘Small Rural Hospitals Taskforce’ (SRHTF) in 1993–4 also recognised the need for change and the need for more flexible funding arrangements for health services in rural areas in order to better meet the needs of local communities. Small rural hospitals have since had opportunities to broaden their role to meet community health needs through provision of an expanded range of community-based services which enable more people to be cared for in the community rather than in bed-based services.
The SRHTF redevelopments and MPS have provided models for service delivery which are more responsive to community needs and have and will play a key role in improving health care service delivery in more remote parts of the state.
Casemix funding which provided a formula for reimbursing acute health services was implemented in 1993–94. Casemix has provided improved efficiency and accountability across the public acute health sector, delivered through a mixture of activity-based and incentives-based funding.
‘Healthstreams’ was established in 1996–97 to provide an integrated health service model for smaller health services in rural Victoria. Using more flexible funding for health services, Healthstreams enables rural agencies to deliver a broader range of services. It involves the pooling of various sources of funding under appropriate service agreement guidelines, to deliver a mix of bed-based and community-based services.
Towards a Stronger Primary Health and Community Support: Discussion Paper was circulated in June 1998 and was part of the ongoing process aimed at better meeting future health care needs in Victoria. Specific issues for rural communities were outlined and related to flexibility in service arrangements, accessibility of rural services and the need to take rural characteristics into account in designing implementation processes.
2Functions and Operations
2.1Philosophy
Although approximately only fifteen per cent of the Australian population live in rural areas, health services that are economically viable and ensure access to a broad range of health and community programs need to be provided to all Australians who live in these areas.
Rural hospitals in less populated and remote areas are recognising the need to broaden their roles and be more flexible and innovative in the delivery of health services to better meet the health needs of local communities. Cooperative health planning that encompasses a community driven approach to all rural health services planning will play a key role in improving health outcomes for all people who live in rural Victoria.
An IRHS with funding and program flexibility is an opportunity to bring together a mix and range of health, aged and primary care services appropriate to the local community. An important goal of an IRHS is the belief that health services should be provided in the home where possible and appropriate.
Other goals for an IRHS include:
•Appropriate access to a comprehensive range of health care services within an identified area.
•Improved targeting of health and aged care services to meet the needs of the local community.
•Better coordination of health and aged care services, both locally and regionally.
•Alternative funding mechanisms for rural agencies and a range of service options to encourage greater responsiveness to local community needs.
•Inducements for rural communities to invest more heavily in primary health prevention and treatment, including home-based services and community support services.
•An appropriate level and mix of health and aged care services delivered in a cost effective, flexible and coordinated manner to meet individual needs and assessed community needs.
•Ensuring that the health care services for clients in rural Victoria are of a consistently high quality.
•Continuity of care by utilising concepts of managed care (that is, critical pathways, discharge planning, risk assessment and case management).
IRHS planning and development should encompass the following principles and structures:
•Service provision in a way that recognises the rights, dignity and independence of the people.
•Information for clients on the operations of the service and assistance available from the service.
•Consultation with local communities on an ongoing basis.
•Service management in a way which enhances flexibility and responsiveness to service users.
•Equitable access to all users or potential users of the service.
•Linkages should be developed with related services.
Literature reviewed on health perceptions in rural Australia indicates that attitudes to health, disability and illness may differ between rural and urban people. Health care providers must have understanding of and sensitivity to local cultural and community differences and expectations when planning rural health services.
2.2Method of Operation
2.2.1Overview
Service components in an IRHS can include primary health care and community support as well as acute health and aged residential care. Some services such as allied health, medicine and nursing may span more than one of these areas of care.
It should be noted that the range of services in an IRHS will depend on the local community needs. Some components will be considered essential to the particular community in which the IRHS is to be situated.