Why ageing physical healthcare infrastructure needs an uplift for the digital age

The COVID-19 pandemic highlighted deficiencies in global healthcare and motivated nations to reevaluate and invest in their own healthcare infrastructure. In a 2021 forum on the Future of Digital Healthcare after COVID-19, the Organization for Economic Cooperation and Development (OECD) concluded that: “the main barriers to building a twenty-first-century healthcare system are not technical, but can be found in the institutions, processes and workflows forged long before the digital era.”

The OECD highlights an often-overlooked challenge of healthcare transformation: we can’t graft a new digital, platform-based healthcare system onto healthcare infrastructure designed to support traditional operations and care models.

A number of countries have recognized the transformative potential of digital health technology and have rightly invested significantly in the digital transformation of healthcare – expanding from 3% of the overall healthcare expenditures in 2018 to an estimated 8% by 2030, according to OECD data. Australia, for example, has committed AUS $537 billion to healthcare over the next four years, with an emphasis on digital health infrastructure. Similarly, the European Union launched the €5.3 billion EU4Health Programme, which, among other goals, will be "reinforcing health data, digital tools and services, [and the] digital transformation of healthcare.”

Meanwhile, the UK has begun an ambitious £2 billion initiative towards the digital transformation of the NHS. According to one UK health leader quoted in The Guardian, “We operate 21st-century healthcare from 19th-century buildings – increasingly unsustainable.” Attention must be paid to the bricks-and-mortar infrastructure required for the healthcare system of the future.

The US healthcare system faces similar challenges. A significant number of US hospitals were built right after 1946, when the Hospital Survey and Construction Act provided national funding for healthcare infrastructure. The most recent report on the state of US health infrastructure from the American Society of Health Engineers shows that the average "age of plant" – a financial measure of how well a hospital is keeping its facilities up-to-date – has grown over the past three decades, indicating facilities are degrading and need additional investment.

Healthcare needs transformation. And to truly transform healthcare, we must simultaneously build physical and digital frameworks to meet the evolving needs of patients worldwide.

It is a mistake to think that we will not need a substantial number of hospitals in the future. While many efforts are underway to keep the world’s population healthier, there are few scenarios that do not include sickness and the need for hospital-type care. More broadly, we must determine the types of facilities we will need to support a transformed healthcare system, where patients alternate between digital and in-person care. There has been a decrease in hospital-bed density and acute-care capabilities in North America and parts of Europe. We are now at a point where nations must determine whether the existing remaining infrastructure can adequately serve the needs of their populations, support the digital transformation of healthcare and have the resilience to withstand another healthcare crisis.

Instead of repairing ageing facilities or creating more hospital beds, governments and providers should develop and invest in a cohesive strategy for digital and physical healthcare, where each hospital bed represents a highly adaptive, data-centric and comforting place to give and receive care.

We must think innovatively about what the future of physical healthcare could and should encompass. Given that the need for hospitals will not go away, but evolve to seamlessly integrate digital care, outpatient care, in-person care, home hospital care, remote monitoring and telehealth – sometimes all for one episode of care – nations will need to integrate all of these physical and digital models.

The following are key design principles to consider when planning the hospital of the future:

Facility design has a significant impact on patient and staff satisfaction, as well as physical and mental health outcomes. So, future facilities and care models must be designed around the needs of staff and patients. As we at Mayo Clinic launch Bold. Forward. Unbound. – a once-in-three-generations opportunity to transform healthcare with new physical space and integrated digital capabilities across our campuses as part of our overall transformation of healthcare – our plans place the hospital as part of a larger healthcare platform, supported by data and artificial intelligence to personalise diagnostic and treatment approaches for patients.

Space for digital staffing models will also be integrated into our designs. We will support our virtual nursing programme, for example, where remote nurses use sensors, AI and video technology to work hand-in-hand with the patient’s bedside care team to reduce their physical and cognitive burden, while improving outcomes and patient comfort.

Our future spaces need to be fit-for-purpose and warm and promote healing and well-being through meaningful human interaction. In our own work, interviews with hundreds of staff members told us the importance of designing spaces to promote human interaction, with technology playing a supportive role. When we captured patients' voices, one key finding emphasised the importance of designing care models to ensure seamless connectivity to Mayo Clinic through a patient’s entire medical journey. Our caregiver research has provided insights on family-member needs around meals, respite and reflection while loved ones are receiving care. All of these viewpoints will be incorporated into our plans.

According to the NGO Health Care Without Harm, if the health sector were a country, it would be the fifth-largest emitter on the planet. Our future designs must reduce environmental impact. Mayo Clinic, along with more than 120 other organizations, is part of the US Department of Energy’s Better Climate Challenge. This commits to reducing our emissions by 50% by 2032. Building using carbon sequestering, super-efficient mechanical systems, climate-friendly alternative energy sources, bio-based materials and many other approaches are essential for us to meet this target.

The future practice of medicine requires even more data and analytics capabilities. As we move healthcare from pipeline to platform, we must integrate new technologies, such as AI, robotics, augmented reality and 3-D printing, with traditional in-person care, remote monitoring, telemedicine and mobile health. This will require us to think differently about the design of our hospitals and clinics. Spaces cannot be easily retrofitted to accommodate such a transformation in the practice of medicine.

The pandemic showed us the importance of flexible spaces within an existing hospital footprint to handle surges of patients with different needs – for example, having ventilation systems set up to accommodate patients needing isolation and allowing rooms to be reconfigured quickly. Realistic-yet-flexible design is needed to balance construction expense with design principles, such as modular design and taller floor-to-ceiling heights. This is critical not only for future healthcare crises, but also to provide the space our successors need to deliver the best care to patients using models and technologies yet to be discovered.

As we envision and build healthcare systems around platforms that decentralise and democratise healthcare, we must simultaneously invest in our physical healthcare infrastructure. It is the only way to achieve the full promise of digital transformation.