Revolutionising Healthcare (Part 1): Flexible Working

I’ve recently had the pleasure to visit a hospital in The Netherlands on a research trip and was very impressed with the ways in which the Orbis Medical Centre in Sittard was organised – spatially as well as culturally. Orbis clearly aims at doing things differently in Healthcare and as such can teach us a thing or two about space and organisation and new ways of working. Therefore I thought I’d share some of my insights and experiences at Orbis in a series of blog posts. This is part 1 on ‘Flexible Working’. Enjoy!

The Orbis Medical Centre is a relatively new hospital, opened 3 years ago; it is located in Sittard in the south-east of The Netherlands, not far from the German and Belgian borders. Management at Orbis wanted to build a ‘hospital of the 21st century’, and one of the things they’ve achieved wonderfully is to really make flexibility work in their outpatient departments. Inspired by the way in which airports function as flexible and multi-use spaces, the hospital was designed around the idea to provide whatever people really need, both patients and caregivers.

It took a variety of unusual and at first unpopular steps, as I was told:

  • Process first, then space: The management team talked to caregivers across the board to decide how patients will be treated, what they will see, who they will meet, in which order things will happen. From this they created a standard process, before even thinking about how to accommodate this in space.
  • Standardisation of access: In addition to the ‘one-process’ idea, workplaces were standardised. I know this sounds astoundingly old-fashioned and could go horribly wrong (more like 19th century than 21st), but wait and see how it spells out: in essence every caregiver in the outpatient clinics gets access to everything without letting status rule who gets assigned which space. As a matter of fact, no spaces are assigned at all. Not a single space, well, apart from a locker that is. All work is flexible and takes place where it ideally suits the task at hand. Access in this case means two things: access to a big back-of-house space, called a ‘Knowledge Centre’ (dedicated to an outpatient clinic, or shared among two clinics), and access to all information needed (for everyone to fulfill their tasks) via  computer terminals.
  • IT systems to support flexibility: All information needed including all patient files as well as access to specialised knowledge (databases, literature, etc.) is accessed electronically. Staff use their access card to activate a workstation (any workstation anywhere within their knowledge centre) and then have their individualised and customised screen, patient files, information and databases at hand. When they are finished with a task (e.g. charting), they take their access card, which automatically logs them out.
  • Diversity of spaces: Standardisation of access only works in combination with choice of spaces. Each knowledge centre offers a wealth of different workstations and desks – at a bar standing (the so called ‘Charting Galley’), within an enclosed office, in an open workspace, in a cubicle, in a seminar room. In easily accessible and integrated locations as well as tucked away and segregated. Whatever the task, the mood of the person, their personality – they can choose where to work. Every minute, every hour, every day.
  • Fresh minds: Orbis commissioned architects (Bonnema Architecten) who have never designed a hospital before. This allowed Orbis not having to battle against preconceptions of what a hospital is supposed to be and look like.

It seems amazing that this should work, but it does. And brilliantly so. When I visited Orbis, the Knowledge Centres were buzzing with people working at all sorts of different things and the atmosphere was very good. Communal, high levels of visibility, easy access to other caregivers and their knowledge, but still professional and concentrated. Everyone I spoke with loved it, patients are very happy too, and the hospital is one of the most profitable ones in the Netherlands, I was told.

Good visibility in the split-level layout of the ‘Knowledge Centres’ at Orbis

High degree of choice of different workstations in the ‘Knowledge Centre’ at Orbis

Being able to communicate quickly and easily is key to the working culture at Orbis

Booth for concentrated working in the ‘Knowledge Centre’ at Orbis: one of many different places to choose for getting work done

This is quite different from the ‘usual’ look and feel and spatial setup in healthcare environments. We’ve all seen the personally owned rooms of medics that have a double function as exam room and private office of the physician. This is where they keep their weighty tomes and reference books of all medical knowledge; personal files and folders; posters of the human body and anatomy; skeletons; models of the brain, heart or lungs.

In contrast, this is the personally owned space of Dr Ton Hoofwijk, a surgeon at Orbis. He would happily argue that this is all he ever needs and actually hardly ever looks inside, since all important information is accessible on a computer.

Dr Hoofwijk in front of his own ‘office’: a locker

It seems extraordinary to introduce radically new ways of working for a classically traditional and possible conservative clientele such as doctors. Still it seems that Orbis was able to dramatically change the way in which people perceive space – not as a symbol of status, not as an assertion of ownership and identity, but quite pragmatically as a tool to assist people in their daily working process, which for most caregivers means being able to access patient files, discuss patient cases with their colleagues, exchange knowledge and learn so that they can provide the best care for patients.

So if this works in healthcare, why shouldn’t it be possible to make flexible working work in other industries, other workplaces and other countries?

I should add a last word of warning: flexibility is not for everyone. By this I don’t mean to give stubborn individuals who are married to the status quo a good set of arguments why they should resist change. I rather want to underline that buildings have to serve the purpose of an organisation. And if work processes and cultures do not go well with flexibility, then there is no point in insisting that everyone everywhere needs to work open-plan and flexibly. If this simple rule is not adhered to – that buildings need to help an organisation grow – flexibility won’t work either.

3 thoughts on “Revolutionising Healthcare (Part 1): Flexible Working

  1. Pingback: Revolutionising Healthcare (Part 2): The patient – caregiver interface | spaceandorganisation

  2. Pingback: Revolutionising Healthcare (Part 3): Privacy and Community in Wards | spaceandorganisation

  3. Pingback: Five Things You Might Not Know About Offices: 2. Electronic Contact Mirrors Face-To-Face Contact | spaceandorganisation

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