Author: Holly McMillan, Senior Project Manager—Clinical Planning and Service Readiness, Metro North Hospital and Health Service

It’s a sadly familiar story. After several months—and several $100,000s—of planning and design work, a major health infrastructure project is in crisis. Health service managers reject the new facility design: “This isn’t what we need!”. Design consultants lament, “But this meets the investment announcement brief and budget!” How can they both be right, but it’s all gone so wrong? In so many cases, it’s because we jumped to the solution, before really understanding the problem. In the health infrastructure project context, “understanding the problem” means understanding the health service need, and planning the best service strategy to meet it. Only then, should we start thinking about what infrastructure investment is needed. To put it simply: Form must follow function. 

Health Service Planning

So how do we determine the health services functions that health infrastructure needs to enable? By developing a health service plan (HSP). An HSP has similar elements to any good organisational plan. It identifies opportunities and challenges through demographic, epidemiological, and service delivery assessment. It identifies a desired end-state or vision. And finally, it bridges the gap, through identification of key strategies. As such, we can identify two key parts to an HSP: the Health Service Needs Assessment (HSNA) and the Health Service Strategy (HSS).

Part A: Health Service Needs Assessment

It is a process known by many names, but importantly, this is the starting point for a health services plan. To maintain a person-centred approach to health planning, a good Health Service Needs Assessment (HSNA) should begin with the population. As health service organisations (HSOs), we need to first understand the people we serve and their key health concerns, through data analysis of key demographics, health status and health service demand, as well as through consumer insights for their experiences of health and care.

The HSNA should then seek to understand how and where those health needs are being addressed. This is often done through a service mapping process across the health care continuum. Whole of continuum service demand and supply mapping is important, even if an HSO only operates in one part, understanding of service need across the continuum assists in identifying drivers of demand and can result in service partnership strategies for mutual benefit.

The HSNA is also an important opportunity to understand the opportunities to do healthcare differently. Emerging treatments and therapies, new models of care, different workforce roles, next generation medical equipment, and rapidly evolving digital technologies, all provide the chance to re-think how we address health service needs.

At the end of the HSNA process, we will understand the health service needs/gaps, and the HSO’s opportunity to address them. Most HSOs will develop base-case demand analyses for the impact of service needs on key enablers such as workforce (i.e. FTEs) and infrastructure (i.e. beds and treatment spaces/points of care).

Part B: Health Service Strategy

Health service strategy has two components: Vision and Actions.

The Vision component is important for the HSO to outline its high-level intentions as to the key features of its service organisation and delivery, after considering the challenges and opportunities from the HSNA. Simply, what is the end-state for the HSO following the implementation of the HSP? For example, what services will we provide? How will our services be organised? What high-level models of care will we use?

Service visioning likely involves the development and testing of service options. For example, if we increased our use of Hospital in The Home (HiTH) models in meeting service need, what would be the impact on hospital bed and/or outpatient clinic demand? If we increased service capability for paediatric surgery at a particular hospital, what would be the impact on patient flows across our service network, and the impact on bed demand at various facilities? As such, it is important to recognise that health service planning is an iterative, not a linear, process. Scenario demand modelling is commonly undertaken to model the impact of proposed changes in service strategy on key enablers such as infrastructure and workforce.

The Actions component details the key service actions to be undertaken by the HSO to bridge the gap between the service needs and the service vision. Example actions may include expanding Hospital in The Home services to new patient cohorts or expanding paediatric surgical services at X Hospital.

Translating Service Plans to Infrastructure Planning

“Are we there yet?”, I hear you ask.

Yes. Following the development of a robust HSP, HSOs should have a clear view of future health service strategy and its impact on infrastructure demand. You are now ready to put pen to paper on your Gate 0 Investment Concept Brief, or similar. And, thanks to your HSP, you have all the evidence you require to demonstrate that the proposed significant infrastructure investment is based on current and future health service need. You’re welcome.

In the words of your favourite informercial, “But wait! There’s more!” Don’t cut your health planning experts loose just yet. Health planning expertise is an absolutely essential part of any health infrastructure project team. In the early stages of an infrastructure project, health planners develop the strategic/high level models of care (MoCs) and functional design briefs (FDBs) that inform facility design. They provide the essential link from architects, engineers and other technical consultants

to frontline clinical stakeholders during detailed design and service readiness phases, to ensure that the built facility meets clinical operational requirements.

As the project progresses, health planners develop detailed MoCs to identify how health services will operate in the new building context. Importantly, detailed MoCs identify change impacts for service delivery processes, workforce, equipment and technology; thus, providing the essential blueprint for service and operational readiness and change management activities throughout operational commissioning.

Form Follows Function

Across Australia and New Zealand, there is $42 billion worth of health infrastructure projects in the capital pipeline.¹ The vast majority is government-funded. The health infrastructure sector has a collective responsibility to ensure that these significant investments achieve best value for the taxpayer, in terms of meeting the health service needs and health outcomes for all in our communities. Robust, evidence-based and future-focussed health service planning must provide the basis for health infrastructure investment. Health service planning must come first, and it must continue to inform facility development across the length of the infrastructure project. Health infrastructure projects provide the opportunity to RETHINK care, not just REBUILD it.