Doors open at world-class Royal Children’s Hospital

By John Connole
Tuesday, 16 October, 2012

The Australian Hospital and Healthcare Bulletin speaks exclusively with Tony Lubofsky, Project Director of the new Royal Children’s Hospital Project, from the Department of Health, Victoria.

What were the chief motivations behind the decision to build the new Royal Children’s Hospital (RCH)?

Whilst there were a multitude of good reasons behind the decision to build a new hospital, the main issue was that the old hospital was fast approaching its use by date. The existing hospital, which was opened by the Queen 48 years ago, was designed and built at a time when there were very different equipment and technologies compared to the present day, and very different models of care. Aside from its ageing infrastructure, the old facility was not well suited to current technologies, and current models of patient and family-centred care. When the old hospital was opened, visiting hours were limited to perhaps a couple of hours a day. Now, parents stay overnight with the children, so we wanted to build a facility that is much more family friendly, and one that was more adaptable to today’s care and technologies. And of course, we wanted one that was bigger.

What design concepts were considered in terms of striking the balance between form and function?

It really is a balancing act, since you can maximise functional and operational efficiencies by designing a box; although in doing so, you achieve a poor outcome in terms of architectural aesthetics, integration with the surrounding parkland, access to views and natural light and so on. On this project, we had a strong view that we wanted something that was going to make a substantial architectural statement – because of the nature of the hospital, the amount of money government was investing, and the prominence of the Royal Park location. We therefore placed as much emphasis on the importance of the architecture and the urban planning as we did on the health planning and the design of the clinical areas. We also wanted to create a hospital that was very environmentally friendly and sustainable. We now have the greenest hospital in the country, which incorporates a 2.4 megawatt trigeneration plant to blackwater treatment. It has a five star green star rating based on the pilot rating tool that was in place at the time when we were putting the brief together.

Were there any especially challenging aspects regarding construction?

There were many challenges, not least being the sheer scale of the project and the technical complexities of designing and building a state of the art tertiary hospital. The hospital has around 90 different departments, and some 4,500 rooms. This presents enormous challenges compared to say an office building simply because with a hospital each area will have its own unique design requirements, as well as special requirements in terms of engineering services, equipment, ICT, redundancies etc. For example, the design of the operating theatres is fundamentally different to, say, the design of the in-patient unit, which in turn is completely different from imaging, ED, CSSD or the research labs etc. You've really got to come up with 90 different briefs, each of which is highly specialised and complex. Other challenges relate to things such as procurement of equipment, again as a result of the volume and complexity of the equipment and the desire to delay purchasing until the last minute, whilst of course having to finalise design and services elements much earlier in the program. IT and communications systems also pose many challenges, given the rate at which technology is changing, and the interplay between systems such as telephone, nurse call, paging, computers, PABX (private automatic branch exchange), security systems and so on.

Can you talk about the collaboration regarding the Public Private Partnership (PPP)?

We got tremendous value from the PPP process. Much of the design innovation must be credited to our private-sector partners – Babcock and Brown, Lend Lease and architects Bates Smart, Billard Leece and HKS (who are based in Texas). It was them that came up with the wonderful design, admittedly in response to a brief that we put together that I think was quite visionary. A lot of the design innovation, interior design solution and the many unique elements that have already attracted significant media attention such as the two-story coral reef aquarium, the meerkat enclosure, outstanding feature artworks, a Hoyts beanbag cinema, we never would have had if the project was not procured as a PPP. We've enjoyed an excellent relationship with our private-sector partners, and it’s been one where despite our sometimes competing priorities, there has been a consistent common denominator being a desire by all parties to build a truly world class hospital.

What will the facility offer in terms of additional patient and research outcomes?

One of the key principles was that we wanted the new hospital to incorporate evidence-based design principles. In other words, as far as possible, we wanted the design of the facility to lend itself to achieving improvements in patient outcomes, reduced length of stay, a better environment for staff, etc. There is a growing body of evidence as to the design factors that can contribute towards the achievement of these outcomes. As a result, the new hospital has the highest percentage of single rooms of any hospital in the country, which provides better management of noise, improved infection control and increased privacy. Eighty-five per cent of the inpatient rooms are single rooms, and all have external views overlooking the surrounding parkland. Patient rooms are divided into clinical, patient and parent zones, which we hope will also assist in achieving better patient outcomes due to the standardisation of these rooms across the facility. And we have outstanding facilities for staff, which will help the hospital to attract and retain the best staff.

In terms of research, we have built state-of-the art laboratories and related facilities which will be operated by the Murdoch Children’s Research Institute. The new hospital has twice as much research space than the current hospital – some 20,000 square metres in total which will make it one of the largest research facilities in the country. We think we've also achieved a fantastic integration of research and education spaces, given the magnificent new collaborative teaching facilities that will be used by the University of Melbourne’s Department of Paediatrics. I think it is reasonable to expect that this integration of clinical, research and education facilities will produce benefits in terms of patient and research outcomes.

Have aspects of the new hospital design accommodated for future developments in e-health, and if so what challenges did this present?

The major thing was for us to ensure the hospital was fully wireless, with an IT solution that involved a mix of fixed PCs and mobile devices, as well as access to patient information through a single sign-on from any computer in the hospital. There are interstitial workstations between every two inpatient rooms which include computers with double monitors, can be easily accessed by doctors and nurses. We also have advanced audio visual facilities across the new hospital, especially in operating theatres, teaching spaces and meeting rooms. The major challenges associated with e-health, as with any new IT project, is that the software solutions are continuing to evolve, and they also have implications in terms of work practices and change management. This is a project that is ongoing and will continue to be implemented over the next couple of years in terms of the hospital moving towards full electronic medical records.

At this early stage, can you talk about the feedback from staff and patients?

The feedback to date has been overwhelmingly positive. I don’t think there is anything quite like the new RCH anywhere in the world. Nevertheless, it is early days and ultimately, this is the sort of thing you’re only going to be able to properly judge in about 12 months’ time when the dust has settled. One thing we are certain of is that patients and their families will absolutely love it – the kids we've shown through the hospital don’t want to leave.

Tony Lubofsky

Tony Lubofsky is the Project Director responsible for the recently completed $1 billion new Royal Children’s Hospital project in Melbourne. Tony was previously the Project Director for the $300m Royal Women’s Hospital redevelopment, the $100m Casey Hospital Project and the $250m Partnerships Victoria in Schools project. Prior to taking on these roles, Tony spent eight years as a Director with KPMG Corporate Finance in Melbourne, which was preceded by a number of years practising commercial law.

Tony is one the foremost exponents of PPP procurement in Australia. He has played a leading role in the development of the PPP procurement model, and continues to be at the forefront in the evolution of that model particularly for social infrastructure projects. Whilst Tony has a strong commercial background, he is equally passionate about using PPPs to achieve outstanding outcomes in architecture, health planning and sustainability.

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