Challenges facing healthcare: The role of a physical environment in the digital age

Shane Dineen, Managing Director at Archus, discusses some of the key challenges facing healthcare systems. He emphasises the importance of fostering a mindset that prioritises people’s best interests to enable sustainable solutions that improve care quality and patient welfare

There is no shortage of criticism of healthcare provision in any country; an adjacent, endless stream of thought leadership, articles, and reports from various stakeholders – with differing motivations, values, and views – floods the discourse. This wealth of information from think tanks, policymakers, and experts emphasises the complex challenges facing healthcare. Yet, while information, literature, and research have never been more accessible, without proper augmentation and analysis, it can be overwhelming and contribute to dysfunction in health systems, burnout, and poor decision-making.

Many publications indicate that the healthcare sector is headed towards a crisis unless a paradigm shift occurs. History shows that in times of global unrest, such as pandemics or world wars, everyone, but low-income citizens especially, suffer poorer health outcomes. The World Health Organization highlighted that lower- middle-income countries represented 40% of the total global health spending, which in 2018 reached US$8.3tr. (1) Social determinants of health, such as poor housing, income, physical activity, and access to nutritious food, lead to greater inequalities in health for the most deprived. Reports indicate that poor social determinants have reduced the global average life expectancy by up to two years. At the European Healthcare Design Summit, one professional starkly proclaimed, “Live well and die quick!”

In England, the 10% most deprived areas experience major illness diagnoses a decade earlier than those in the 10% least deprived areas. (2) The evidence is compelling: population health, including mental health, is declining, and the focus is shifting from length of life to quality of life. Health systems are already at capacity, and further investment seems to yield diminishing returns. Evidence suggests that relying on ever-larger hospitals is unsustainable due to financial, workforce, and safety challenges: ‘super hospitals’ are also not conducive to healing environments, considering factors like infection control, accessibility, running costs, and staff and patient experience.

Despite significant efforts to find solutions, issues like demand management, the prevalence of conditions across demographics, equitable access, mental health, funding, infrastructure, and legislation (such as net-zero carbon) remain ever-increasing burdens globally. There is a widespread feeling of discomfort and dissatisfaction about reliable access to quality care. This global challenge requires a coordinated approach to address the documented negative impacts on quality of life, outcomes, and overall wellbeing. After all, hope is not a strategy; serious action and consideration are needed to address the tsunami of challenges facing healthcare systems today and in the future.

Opportunities, collaboration, and innovation

In times of crisis, people come together, setting aside organisational boundaries, bias and prejudices to become innovative. The pandemic demonstrated how having a common goal and purpose brought out the best in humanity, often leading to life-saving innovations and ideas. We saw the adoption of digital technology accelerate at an unprecedented speed, prompting questions about its long-term impact.

While healthcare revenue isn’t shrinking, funds are reactively moved to match population needs or address key priorities, a practice that is unsustainable in the long run. We must find solutions and leverage what already exists. There is no shortage of innovative solutions in this digital era, with real-time information, the Internet of Things, and Machine Learning advancing both clinical and non-clinical operations. These advancements improve efficiency, patient outcomes, and the environments for those involved in care and wellbeing.

The keys to progress will be collaboration and a shift in perspective. All participants, including citizens, must recognise their role in promoting wellbeing and civic responsibility. This involves valuing skills, experience and knowledge, and importantly, fostering a mindset that places people’s best interests at the forefront.

A long-term plan to address population health and wellbeing needs to be developed, with global principles and frameworks guiding consistent measurement of health outcomes. This includes tracking the impact of deployed assets on population health, similar to climate change approaches. Such efforts must span political cycles (and agendas) and operate across global, national, and local levels over 30 to 50-year planning horizons.

Infrastructure, assets, and equipment as key enablers to quality care

Infrastructure, assets (human, digital, physical), and equipment are critical enablers of good quality care. In an era where digital advancements outpace previous benchmarks, the role of the built environment must adapt. The challenge lies in providing smarter, flexible, and intelligent infrastructure while improving asset and equipment management to meet evolving care needs. This is particularly challenging given that digital technologies and AI in clinical care are constantly and rapidly evolving, while traditional infrastructure and assets, depreciated over five to 60 years, struggle to keep up.

To health systems, data will become a resource as essential as drinking water, it will be a key to informed decision-making and resolving current challenges. Data can help to improve revenues and efficiency, and reduce costs, but ultimately, financial resources are finite, and the distribution of wealth can exacerbate the inequality of care. However, coupled with a health and well-being focus, data can inform decisions about prioritisation, investment, disinvestment, development, design, funding, and ongoing management of infrastructure and assets. These data-driven decisions have potential to improve quality, inform policy, and guide the optimal deployment of resources.

The impact of patient-centred design on clinical outcomes

In 2004, a research report (3) sought to establish how hospital design impacts clinical outcomes. The findings documented how various design characteristics – such as single rooms versus multi-bedded rooms, reduced noise, improved lighting, better ventilation, ergonomic designs, supportive workplaces, and improved layouts – can reduce staff errors and stress. The report also noted improvements in patient sleep, reduced pain, and decreased medication requirements. When Roger Ulrich’s findings are adopted in practice, as seen in Maggie’s Cancer Centres, well-designed, patient-centred buildings positively impact mental, social, and physical well-being. (4)

At Archus, we are fortunate to work globally on pioneering programs with fantastic clients, academics, partners, and stakeholders. Our work spans the full spectrum of health and care systems, including clinical and non- clinical components. From government policy and research to technical guidance, building standards, and digital adoption, we are deeply involved in shaping the future of healthcare. We understand the responsibility of putting people, communities, and populations at the heart of everything we do. The outcomes of high-quality healthcare work far exceed the contributions of any one organisation.

Setting standards: the importance of high-quality standards and best practice

Maintaining high standards, skills, experience, and expertise is crucial for accelerating improvements in healthcare. There is a significant difference between standardised approaches and high-quality standards that set best practices. It should never be about quicker, faster, or cheaper approaches that lead to a race to the minimum. It’s about people – the legacy of our contributions and the value added, which is the foundation of our responsibility for a better future.

At Archus, we believe in partnering with people and organisations that share our ethics, ethos, and values. We aim to actively bring people together to deliver the positive change needed to address the challenges facing healthcare.

References

1. Global spending on health: Weathering the storm, World Health Organisation, 2020

2. Health inequalities in 2040 Current and projected patterns of illness by deprivation in England, Health Foundation, 2024

3. The Role of the Physical Environment in the Hospital of the 21st Century: A Once-in-a-Lifetime Opportunity, Roger Ulrich, 2004

4. The Architecture of Healing: 12 Maggie’s Centres by Gehry, Hadid, Heatherwick and More, Eric Baldwin

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