CONTAINING HEALTHCARE COST THROUGH HOSPITAL DESIGN WORKSHOP Florence , 3rd to 5th June 2014

1. CONTAINING HEALTHCARE COST THROUGH HOSPITAL DESIGN WORKSHOP Florence, 3rd to 5th June 2014

2. The “design development process” can generate direct and induced effects on a variety of “cost” categories. Investment cost and operational costs, namely on the: • technical cost/fees • value of works (construction cost) • in use cost • management cost • maintenance cost • refurbishment cost • demolition cost • infrastructure and mobility cost • sustainability cost CONTAINING HEALTHCARE COST THROUGH HOSPITAL DESIGN

3. The costs of the first two items(technical cost/fees - value of works) are influenced by the embedded procedures and by the actual costs of the physical quantities deployed: • professional fees plus time / type of contract • cost of materials and procurement procedures The question to be asked is: • How can we reduce the technical cost of design? How can we reduce the cost of construction? • BIM (Building Information Modeling) can help to reduce costs? And times? CONTAINING HEALTHCARE COST THROUGH HOSPITAL DESIGN

4. In use service costs are the highest percentage of the global cost of a hospital. They include: • cost of staff responsible for the delivery of care (doctors, physicians, caregivers ...) patients’ mobility; • energy cost (heating / cooling, lighting, water ...); • safety and security cost (direct and indirect) both related to clinical risk and prevention cost, costs of infections/falls; • cost of goods ( drugs, general materials ...) Such in use costs-generated by the ‘fixed costs’ category- have the highest impact on hospital’s global cost and are “strongly” dependent on design related decisions. On these type of costs we must pay our utmost attention. * Policy based on “standardized costs” tend to define the maximum cost compatible with each service, in order to keep expenditures within the fixed budget. The question to be asked is: • What kind of planning decisions affect in use costs? Which issues should we focus our attention on,which suggestions (rules of thumb) arise from the most advanced management experiences? CONTAINING HEALTHCARE COST THROUGH HOSPITAL DESIGN

5. Management costs relate to the costs generated by general services: food - laundry – information technology - drug distribution – warehouse management - sterilization - cleaning - waste disposal. These activities do not fall into the “core” functions of the hospital but are essential for its efficiency. The containment of such costs is determined both by the design solutions and by the management policy. The question to be asked is: • Which design decisions affect management cost?How does management policy interact with design solutions? Which guidelines/lessons from advances experiences can be taken into consideration? CONTAINING HEALTHCARE COST THROUGH HOSPITAL DESIGN

6. The maintenance project has became an integral part of the design process, the correct estimate of costs and times in connection with the strict implementation of operations play a key role in the cost containment. The question to be asked is: • How to prevent increasing costs for to guaranteeing the right performance level during the life cycle of the building? CONTAINING HEALTHCARE COST THROUGH HOSPITAL DESIGN

7. Adaptive reuse cost is strongly related to the degree of resilience and flexibility of the hospital as conceived by the original project. The question to be asked is: • What level of resilience and flexibility must be guarantee and which are the best solutions to be implemented? CONTAINING HEALTHCARE COST THROUGH HOSPITAL DESIGN

8. Demolition costs are strongly influenced by construction techniques and therefore by the design solutions taken during the life cycle assessment cost. The question to be asked is: • What technical design devices (for example, simulation models) and which technical solutions to implement towards cost containment? CONTAINING HEALTHCARE COST THROUGH HOSPITAL DESIGN

9. Infrastructure costs for mobility regard both the investment for the construction of roads, tram and rail lines, car parkings, etc … , and the cost of transport charges for users. Such costs are usually associated with planning–stage decisions related to the choice of the site and the level of existing infrastructure. The question to be asked is: • Which policies and assessments maximize and improve the decision-making process in terms of economic implications? • How to evaluate the relationship cost/benefit for investors and for end users? CONTAINING HEALTHCARE COST THROUGH HOSPITAL DESIGN

10. Sustainability costs are playing an ever increasing and relevant role in the realization of social interventions. The costs of environmentaland social sustainability are difficult to define as “targets” but must certainly be addressed to be able to reduce their impact. To this end, design decisions play a major role. CONTAINING HEALTHCARE COST THROUGH HOSPITAL DESIGN