The $1.76 billion, 750-bed tertiary Gold Coast University Hospital (GCUH) is part of a major expansion of health services for the Gold Coast community. The site covers an area of almost 20 hectares and replaces the existing Gold Coast Hospital, which was built in the 1970s. The hospital is co-located with Griffith University, forming a valuable health and knowledge precinct for the Gold Coast and attracting students to build a lasting workforce.

Opened in September 2013, GCUH aims to provide the South Eastern Queensland and Northern New South Wales region with a facility that espouses wellness - not just treatment – and has been doing just that for almost six years.

Like with any facility though there was, and there continue to be, post-transition challenges and opportunities that no amount of strategic planning and forward thinking could account for.

Ahead of Australian Healthcare Week 2020, we caught up with Toni Peggrem, Executive Director of Strategy and Planning at Gold Coast Health, who discusses post-implementation design challenges at GCUH and shares top tips and lessons learned from the $1.7 billion project.

Meeting Need with Updated Designs

The notion of making a hospital adaptable for new technology and space requirements has been a focus area for any new hospital design and development project, with project teams no longer simply constructing a shell for a building, but rather a system that could be flexible and accommodate multiple types of equipment needs.

AT GCUH the space design delivers effective solutions that provide long term flexibility and future-proofing. The solutions complement patient models of care and capture innovations in technology and building sustainability. While GCUH overall is a success, with the facility delivering higher quality health care services, as well as a wider range of services, as Toni explains, as with any project, there are challenges and changes required to any space once the transition from the planning to the operational actually occurs.

“We’ve had a number of challenges emerge since transitioning into the new GCUH. While these challenges aren’t insurmountable, they remain things that we hadn’t envisaged at the planning stage, and things that we now need to invest in to update,” says Toni.

Like most hospitals GCUH is similarly on an EMR journey. With a facility less than six years old the project teams behind the construction and the EMR roll-out assumed the new building wouldn’t require any retrofit to accommodate the medical records. As Toni explains however; “what we found is we had to do a significant power and data uplift, as well as an uplift of the background infrastructure associated with that.  So we thought we had plenty of power points, and we thought we had plenty of data points, and we thought we had sufficient background infrastructure including training rooms – we didn’t.   Then of course there is all the background infrastructure that goes with that additional capacity.  Air conditioning and data racks and the background cabling. We’ve had to work across all of the Gold Coast Health Service facilities over the last year, to have our old and new facilities up to the level where it could support EMR rollout. We thought we’d future-proofed, but we hadn’t future-proofed sufficiently.”

Along with technological capabilities GCUH is also experiencing challenges from a spatial and design perspective too. As Toni explains the location of the intraoperative MRI in the depths of the theatre complex doesn’t allow for flow inside theatre and for multiple uses of the equipment.  The operational work around now required could have been managed to allow the flow through theatre and maximise the MRI use.  

Additionally, the team are now going back and adding elements that were initially value managed out. One of these elements is a $6 million hybrid theatre which requires additional equipment as well as updates to engineering solutions to support the added load, altered airflow and accommodate control rooms etc.  inside an existing theatre complex.

“It’s not to say the facility isn’t working. We’re still delivering great care and supporting the communities we serve, it’s just that it’s not working as well as we’d like it to,” adds Toni.

Top Tips and Lessons Learned  

Project delays, cost blowouts, poor stakeholder engagement and communication breakdowns are but a few of the problems faced in delivering any large-scale infrastructure project. Due to meticulous planning and strategic stakeholder engagement initiatives however the GCUH project team avoided most of these.

While there may have been initial cost increases (initial project figures came in at about $1.23 billion), when move in day came, Australia’s largest off-site hospital relocation, which required a seamless transfer of 250 patients, staff and equipment from the existing Gold Coast Hospital into a new facility 5km away, went without major incident.

As with any project of this size and scale however there will always be lessons learned and some best practice tips to take away. 

“There were definitely some things we did really well at GCUH. Our stakeholder engagement was great and we’ve got a lot of clinical goodwill within this facility as staff prepared to move from the old Gold Coast Hospital. This is a testament to the fact we engaged our clinicians throughout the process which means they feel they own the facility and are prepared to work through solutions. That's probably the first lesson learned; that underlying way of approaching clinician engagement is really critical to get long term ownership of the facility,” says Toni.

This stakeholder engagement has not only meant that clinicians are more engaged, but also that the core project team, with their expertise and insight into the specifics of the GCUH project have stayed on and this has proven invaluable. There’s an immediacy in understanding the building, and knowing nuances that are specific to the facility.

From a facility design and development perspective there have also been a number of lessons learned. As Toni explains; “we’ve had a lot of feedback around how we use the facility, and some of the design decisions we’ve made.  They’ve been around the use of single rooms, and the number of single rooms that we put in, and whether or not we’ve gained the benefits from infection control that we thought we would get, but also in terms of patients comfort. In hindsight I think we would make some different decisions, particularly around the single room space.”

Toni adds; “we’re also finding that our emergency department functionality isn’t quite right, and so we are doing lots of work to continually try and modify how we use that emergency department, and there are significant learnings in that space around how we’re managing such a big ED moving forward.”

Toni’s Top Tips

“People often see green space as an expansion zone.  The value of gardens and green spaces as therapeutic zones for patients and staff shouldn’t be underestimated.”

“Back of house functionality shouldn’t be overlooked. The facility should be just as easy to use and navigate for the people that are in there every single day as it is for patients and visitors.”

“Understanding your environment and the area that you’re building in is important. Because we’re on the Gold Coast, GCUH was designed to be lighter and more colourful. Because of this the hospital doesn’t feel ‘public sector’ which has changed how people perceive it coming into it.”

Interested In Learning More?

Join us at the Australian Healthcare Week 2020 where you'll explore:

• Ensure design relevance and feasibility with a fit-for purpose budget and master plan
• Build and commission a patient-centric facility through effective stakeholder engagement
• Develop operational readiness to overcome clinical challenges post-opening