Trust maximizes its clinical space to accommodate more resources and upgrade its hospital facilities, resulting in increased mobility with patient checks and reduced wastage

Synopsis

The project was to:

• Design and build a new facility for the services provided at the Royal National Throat Nose and Ear Hospital (RNTNEH) and the Eastman Dental Hospital (EDH),
• Manage the move of those services into the new facility
• Manage the decommissioning of the EDH and its handover to its new owner.

The team included project management, capital, estates, facilities and communications as well as contractors.

We worked with the clinical teams to ensure the new facility would achieve their clinical ambition and improve patient care. We also worked with the local authority, build contractors, local residents and patients.

Ambition

In 2012, the Royal National Throat Nose and Ear Hospital (RNTNEH) transferred from the Royal Free NHS Trust to UCLH. As part of this transfer, a commitment was made to create a new centre for the treatment of conditions effecting the head and neck - combining the Eastman Dental Hospital (EDH) with the RNTNEH plus other services from UCLH - amounting to over 200,000 appointments each year.

Our project - to design, build and commission a new patient-centred facility - was to fulfil this ambitious commitment. The project was complicated by the fact that site for the new facility was significantly smaller than the two existing hospitals: we had to design a facility that could accommodate the existing 40,000m2 of clinical space in 10,000m2,

The speed of construction was important: the RNTNEH and EDH facilities were outdated with failing infrastructure, for example, plumbing, heating and lifts as well as clinical equipment like dental chairs. The hospitals were also hard to navigate, especially for patients with additional needs or mobility requirements.

While we owned the EDH building, we were leasing the RNTNEH and both buildings had elements which were listed, limiting what we could achieve at the sites. As a result the Trust took the decision to invest in a brand new facility consummate with the high quality care delivered by the clinical teams.

The impact of achieving this project for patients and staff were significant we are now able to deliver high quality care in a modern purpose built environment. Furthermore, by moving the services from Gray’s Inn Road to the new facility, they are now firmly embedded as part of the wider University College Hospital campus area. This makes it easier for staff to join up care for patients and limits the need for patients to go to different parts of UCLH for their appointments. Within the facility, we are also seeing dental and ENT teams working more closely together, helping to start more working practices amongst staff for the benefit of patients.

Outcome

Since opening the new facility on 1 October 2019 the following outcomes have been achieved:

• Over 25,000 patients (Oct and Nov data) have been seen in the new facility
• Over 700 staff moved from hospitals on Gray’s Inn Road to new location
• new office accommodation set up for admin staff and a new dental education centre established with state of the art training facilities
• Equipped the new hospital with 15,000 items 14,000 post completion. This included 88 Dental chairs, 42 X-ray machines and 573 Bins. All of the equipment in the building had to be integrated in the design, requiring extensive engagement between design and build, procurement and clinical teams.
• Staff from different teams are now working in shared clinical and staff areas. This has allowed increased interaction between teams to discuss clinical cases and provide cross specialist support.
• Snagging issues with the new facility have been resolved and continue to be managed
• The new facility management providers have bedded in
• Over 30 tonnes of waste from the old sites disposed of and medical records and dental moulds sorted and archived safely and appropriately
• The Eastman Dental Hospital has been vacated and handed over to its new owner.

Staff have provided the following feedback about the new facility (collected in surveys, face to face interviews)

• New modern building brings us all together
• Multi-disciplinary working
• Better location
• Purpose built
• No leaks!
• Better heat and air con
• New equipment
• Cleanliness
• Cafe and reception area really welcoming and open
• Views from the upper floors on staff and patient corridors
• Murals in lift lobbies
• Specially designed storage

Patient feedback:

We are collected patient feedback through the friends and family test. Patients have also commented on the new facility:

“Excellent staff, friendly with patients, great care and fantastic state of the art facilities”

“It was my first visit to the new building and liked what I found.”

“Lovely new hospital location”

’The doctor was excellent and that’s why I would recommend the clinic. The building was brand new, clean and made you feel at ease. The only issue was that there was not enough staff at the Ent reception”

Spread

The hospital opened in October 2019. We have already been visited by a number of other organisations, including Leeds Dental School, the Chief Dental Nurse, NHS England, commissioners and the Royal College of Surgeons during which we have shared learning.

UCLH is opening another significant new Surgery and Cancer facility in 2020 and we are actively sharing learning between the projects. We have presented at the Trust’s Leadership Forum and to Senior Directors and are completing an After Action Review which will be shared widely. Changes are already being made in the next build project as a result of our learning and many of the project team members will work on both, to increase the learning benefits.

We have also received media coverage in a number of journals where the learning from our project has been shared with the construction trades. These have been complimentary about our project and its success in comparison to other NHS hospital projects. The project has also been successful in building awards.

Value

The capital budget for the project was set in 2015 through a robust business case process approved by the UCLH board. Throughout the project there were challenges to this budget and the capital team had to ensure that stakeholder understood the cost of making design or procurement. Examples of areas where we had to make difficult decisions included removing some internal windows, as well as build methodologies and significantly we had a very short handover period for commissioning. The project did end up with an overspend of around 5%.

We were able to extend our value via our charitable partnerships, which enabled us to secure artwork on each clinical floor, which enhances the environment. There are also barisol light box ceilings in dental treatment bays and treatment rooms to aid distraction and relaxation for patients receiving treatment. The UCLH Charity donated £145,000 and the UCLH Friends donated £64,000.

As the project involved significantly reducing the clinical space available (from 40,00m2 to 10,000m2) the design of the building was critical. To maximise clinical space, we put services in the centre of the building, with patient and staff areas on the perimeter of the building. This means patients wait in areas with natural light-the opposite of the typical setting with patients in waiting areas without windows and consultation and treatment rooms with windows but these are obscured with blinds for privacy. As well as maximising the footprint, this design also reduces circulation. We were also able to separate the adult and children pathways so that there is the minimum cross over and provide purpose built children’s facilities.

Ultimately, patients are now being seen in a modern purpose built environment which is a vast improvement on our previous facilities. The waiting rooms on floors above ground are along the edge of the building, with views to the outside and ample natural light. Previously new dental patients needed to travel long distances between their clinic and the x-ray department. We have designed the building so they are adjacent to each other, improving the access and ease for patients.

In the long term, the project will save the Trust significant money in reduced maintenance costs by no longer needing to complete frequent and large estate remedial work in our previous old buildings.

The reduction in square meterage of the new building also represents a long term benefit from asset utilisation and overhead costs.

Involvement

Designing, building and moving services into a new hospital cannot be done in isolation.

For the residents impacted by the construction we sent weekly email updates and held regular meetings. Feedback about the project has generally been positive, with some specific issues, such as limiting light pollution, now the hospital has opened which we have resolved.

We involved staff and patients through design user groups. These continued for many months as the different stages of the design and build were achieved.

The staff and patient workshops highlighted the importance the environment and acoustics for patients with hearing difficulties. We also responded to dental patients’ frustration at having to travel across a large old hospital building to have a dental x-ray. In the new building, the first-patient appointments area and dental x-ray department are located next to each other.

Staff and patients were also involved on the following: wayfinding, staff facilities and furniture. Over 140 staff visited the building while it was being constructed and dental teams were able to visit “mock up rooms” of the dental treatment bays and rooms.

The dental teams were highly involved in the procurement of the dental chairs. They led a robust decision making process with support from procurement and design colleagues to ensure procurement rules and design needs were met.

A wellbeing review of the building took place which led to increasing the size of the female changing room and the number of lockers.

The final phases of the project - commissioning the building and moving staff into it - were very significant and potentially disruptive.

With only four weeks to complete the commissioning a range of different teams from medical physics, build contractors to cleaners and move companies had to work very closely together. Twice daily huddles were held, with visual trackers of successes and tasks at hand.

The move was managed through a detailed plan for all services. This required over 700 staff and 18 volunteers staff to understand their role in the move and what impact it would have on their service.

Matrix working was key to these successes; with a clear governance structure, defined responsibilities and regular cross cutting programme meetings, we streamlined and focused on our tasks. While this time was challenging, all involved have credited the efforts from their colleagues and felt a great deal of satisfaction from the end result.