Picture a hospital and images of bustling corridors spring to mind, full of patients being wheeled on beds or wheelchairs from A to B, visitors bearing fruit and flowers, nurses wheeling trolleys of medication with FM staff banging trolleys of food and drink, rubbish and dirty linen from end to end. Noise levels are high as people shout to be heard over the din of trolleys trundling up and down and banging into walls.
Which is why, when FM World visited the new Forth Valley Royal Hospital in Larbert, Scotland, we could have been forgiven for thinking we were in a corporate HQ or retail environment.
Walk through the doors of the £300m PPP hospital, which opened last August and whose final phase will open this July, and the first thing the visitor sees is a Starbucks, swiftly followed by a WH Smith and an M&S Simply Food.
And while there are a few people milling about and sitting around on the comfy (and stylish) reception sofas, the main entrance doesn’t have that usual hurried feeling of a hospital where people dash around looking confused about where they are. Partly that’s because of good signage (each floor has a different colour scheme reflecting the changing seasons) but also because there are several entrances to the facility — the main entrance, an A&E entrance, a separate access to the mother and baby department, the renal department and mental healthdepartment. There is also a discrete blue-light road straight to the A&E department. “The different entrances take the flow of traffic to different parts of the building, which allows the main entrance to retain a sense of calm,” says Mike Mackay, Serco’s contract director who oversees the 32-year PPP contract for soft and hard FM services.
Going with the flow
Delve further into the building and that sense of peace pervades. Not just in the circular multi-faith facility on the ground floor, but throughout the wards and common areas. There is little bustling to be done at Forth Valley, partly because the hospital is not yet fully operational — services and patients from Stirling Royal Infirmary will transfer in July — but mainly because of the decision, by NHS Forth Valley at tender stage to request the segregation of flows.
DESIGN AND CONSTRUCT: Laing O’Rourke
HARD AND SOFT FM SERVICES: Serco
FINANCE: Bank of Scotland and European Investment Bank
CIVIL AND STRUCTURAL ENGINEERING: WSP
BUILDING SERVICES: DSSR
IN-PATIENT AND DAY CARE SPACES: 860
COST OF THE HOSPITAL: £300m
LENGTH OF THE PFI CONTRACT: 32 years
ROBOTS ON SITE: 12
Mackay explains: “They didn’t want the public wandering around areas where patients were going for operations.
“They wanted to avoid lift lobbies where patients, visitors and FM staff with clinical waste or patient food competed for the lifts, for reasons of privacy, dignity, security and infection control.” Mackay has been with Serco for more than 20 years, working at hospitals in Scotland, Leicester and Surrey.
That segregation also creates a calmer environment for patients as you don’t have linen, food and waste trolleys rattling up and down corridors mingling with patients and their visitors, he explains.
Visitors can only access patient areas at set times, although they are free to use the hospital’s other facilities throughout the day.
And the facilities management traffic is kept completely separate from patients and clinical staff so you will never see trolleys of dirty laundry, clinical waste or food and drink being wheeled around.
A segregated lift strategy helps: there are 11 service lifts; six visitor lifts and four beds lifts — two of which go down to the basement to access the mortuary. This is all supported by half a kilometre of subterranean service tunnels allowing FM staff and goods to move unseen, underneath the building, popping up in the lift to certain areas.
While the ‘segregated flows’ strategy is the key success of the hospital, it has been the introduction of automatic guided vehicles which have caught the headlines — and patients’ imagination. Serco purchased 12 robots, looking a little like small white forklift trucks, which act as unseen porters around the hospital. They take food trolleys from the kitchen in the basement in the FM lifts to one of 30-40 hub areas where it is then collected by housekeeping staff and served to patients. Food is cooked fresh on site, delivered to the wards in bulk and plated in front of the patients. The robot pages the ward housekeeping staff on their PDA to let them know the food arrived. When the ward housekeeper places the used food trolley in the robot bay, the system automatically dispatches a robot to collect it; when the robot arrives an electronic card using RFID technology is read by the vehicle which instructs the delivery location.
Other ‘dirty’ hubs contain waste chutes which carry general waste and soiled linen to waiting wheelie bins in the basement. Sensors tell the robots when the bins are full and they carry them along the concrete service tunnels to the waste compound. All cardboard is separated at source but all other waste taken away by a third party and sorted — around 85 per cent is then recycled. Clinical waste containers are collected from the ‘dirty’ rooms via the lifts by a robot. The robots also deliver sterile clinical supplies to theatres and a robotic pharmacist dispenses drugs.
“The idea is that a robot moves along the tunnel and can go up to any floor without meeting the public or going into any clinical space. This improves privacy and dignity for the patient; reduces the risk of healthcare-acquired infections; improves FM efficiency as we’re not waiting for lifts and trying to squeeze in among general and clinical traffic; and the patient and visitor experience is calmer,” says MacKay. Importantly, it also frees up support staff time to focus on patients.
The robots follow pre-programmed routes and have sensors on their front and sides, but Mackay points out this is more to protect the robot than people — although he demonstrates that if you stand in front of the robot it will stop immediately. On the top of the robot sits a revolving laser which triangulates the robot’s position with reflective strips on the walls. The robots are self-charging — when they reach 60 per cent of power they take themselves to the charging area.
The robots are part of the hospital’s FM helpdesk system, supplied by SoftSols. It monitors the robots, generating performance management statistics as part of an automated system which flags an alert if the robots fail to deliver on time, automatically allocates and dispatches porters based on their location in the hospital, takes food orders, and manages reception, estates maintenance, security and cleaning.
Although Forth Valley Royal Hospital is the first in the UK to install robots, they are a tried-and-tested technology elsewhere. Before the Forth Valley installation, Mackay visited Ohio State hospital to look at the robots which also move food and waste. The same technology is in use across Europe and Serco is a preferred bidder for the Fiona Stanley hospital in Western Australia which will have robots.
Although the health board had asked for segregation of flows, apparently they were surprised when the consortium of which Serco is part, presented the robot solution. “We are not contracted to provide the robots, we are contracted to provide portering, catering and waste management services. How we do it is our call.” MacKay emphasises that robots are a new build not a retrofit option. “Robots need space. To retrofit robots into a building would be challenging. You need to think about the space and how the robots interface with different systems such as fire and lifts.”
And more automation is on its way at Forth Valley. In October the hospital will introduce a mail sorting machine that scans mail at high speed with an optical lens and then posts it into pigeon holes.
The robots work off an advanced wireless network which exists throughout the building and extends into the car park and supports a variety of FM activities such as the real-time data transfer for PDAs. For example, housekeeping staff order patients’ food on PDAs, usually at the preceding meal that information is immediately received by the kitchen. This ensures that food waste is minimised.
Asset tracking is also a key issue: MacKay and his team are in the process of putting RFID tags on key equipment. This includes motion sensor RFID tags so they can tell whether, for example in the case of a wheelchair, it is in use. The tags also have a temperature sensitivity so they can monitor temperatures within areas — for example in fridges, so they can be monitored centrally. Eventually, food temperature monitoring will also be done wirelessly.
Other technology innovations include one card which acts as a security access control card, opens automated lockers and provides the staff subsidy in the impressive canteen.
From the outside, the building looks different from more traditional hospitals. Its circular structure is reminiscent of Bexhill’s De La Warr pavilion but owes its shape less to architectural desires than practicality.
The hospital was built from the inside out, unlike other buildings which are typically designed the other way around, explains Mackay. The clinical adjacencies took priority over everything else. The theatres are all together in the core of the building with the other services and departments designed around them. This makes for more efficient use of space and it is also very logical from a maintenance perspective.
The theatre ceilings are sealed for infection purposes and so the plant is situated on the floor above, all in one place, making it easier to service and maintain. Expansion has been built into the design — it can easily accommodate another ward should the need arise. The wards can also be converted to single rooms.
A dose of good design
Infection control has been taken very seriously in the design phase — the blinds in every room, for example, are placed within the double glazing; the patient TVs can be fully submerged in water; 50 per cent of the rooms have single beds; and there is a minimum 2.2m between beds (this used to be 2m). Microfibre cleaning, disposable curtains and ozone disinfection are also used to control the risk of infection.
The patient areas of most hospitals in the UK face south so the patients can benefit from the sunshine. At Forth Valley, they face north because the sun sets so low in Scotland that it would result in glare and blinds would then be used which would shield the view. It also prevents the patient areas from overheating in summer. Huge windows mean the whole building is infused with light and views across to the Forth Bridges and the Lomond Hills and of the hospital site itself where there are woodland walks, ponds and landscaped courtyards.
The building has also been cleverly designed with all users in mind. Walk down one of the main clinical corridors and windows of different size and shape, looking out over the internal courtyards and atrium, ensure that patients in wheelchairs, on a trolley or walking all get a view of the outside.
The Forth Valley Royal Hospital is the first UK hospital to have a Starbucks and also a break in tradition for Serco, which doesn’t often use third party coffee providers. But the move has been popular not just for visitors but also for patients — when their visitors take them down to the Starbucks (which is every inch the same as the high-street equivalent) they feel as though they are having a break from hospital environment which can be hugely beneficial.
Under one roof
The building is one of the largest NHS construction projects ever built in Scotland and one of the most modern and well equipped hospitals in Europe. Due to its sheer size and scale, services have moved across to the new site on a phased basis. On 2 August last year, acute services from Falkirk and District Royal Infirmary moved into the building, followed by mental health services last September.
The Quick Facts
spaces when complete
The third and final phase involves the transfer of acute services from Stirling Royal Infirmary, including A&E, which will transfer on 12 July 2011. Stirling and Falkirk Infirmaries are being redeveloped as community hospitals. Mackay and NHS Fit Out will be handed over the third phase of the building in April. When complete, the hospital will have 860 in-patient and day care spaces.
Serco is part of the project team led by Forth Health, a joint venture between John Laing and the Commonwealth Bank of Australia, which includes Laing O’Rourke as the design and construction partner, who have funded, designed, built and shall provide the hard and soft FM services for the next 31 years. The FM services, which have been procured under an output based contract, will be market tested, either by benchmarking or full tender, every seven years.
Work in progress
Mackay acknowledges that the building needs some minor modifications. A wall in the service tunnel is being knocked down and the tunnel configuration slightly changed to improve the efficiency of the robots. At the same time the waste compound, which currently has three sides will be completely enclosed because of low temperatures for the staff working there.
Despite his obvious passion for technology, Mackay is circumspect about the application of the technology in the hospital: “You can have all the toys and technology but at the end of the day, it’s the people who make the building exceptional.”