It’s not if, but when: Designing healthcare spaces that support pandemic response
March 24, 2020
March 24, 2020
What can we learn from Singapore’s response to COVID-19? How does it impact the next generation of hospitals?
In 2003, the small city-state of Singapore was one of the hardest hit by the SARS epidemic. Of 238 cases, 33 people lost their lives—40% were healthcare workers. This left a deep and lasting impression, with Singapore taking serious steps to be better prepared for “the next big one.” The solution: establishing the Disease Outbreak Response System Condition (DORSCON), a national prevention and response plan. The system’s color-coded framework shows the current disease situation and provides general guidelines for prevention and infection control. This plan has been tested in recent years by the MERS (62 suspected, all negative) and H1N1 epidemics with good results.
While working as a healthcare architect in Singapore from 2016–2019, years after DORSCON was created, hospital design and operations continued to be impacted by the program.
As soon as information emerged about suspicious cases of pneumonia in Wuhan, China, in late December 2019, Singapore started getting ready. Not only did they have a plan, but they executed it with almost military precision. In early February of this year, the country activated DORSCON Orange (second-highest level of alert), which is still in place.
Several international public health agencies, including the World Health Organization (WHO), have praised the Singapore model, some calling it “the gold standard.” Similar models were applied in Hong Kong, Taiwan, and South Korea—all countries that were also hit hard by SARS.
The key is to intervene early and act fast, from the highest levels of government.
Let’s look at ways these countries successfully implemented public awareness campaigns and activities for the mass health crisis situations, including the COVID-19 pandemic:
The key is to intervene early and act fast, from the highest levels of government. Then test, trace contacts, enforce quarantines, and require social distancing.
This disciplined approach has allowed normal life to continue during the COVID-19 pandemic for those who do not show symptoms. It keeps people out of the hospitals and enables schools to remain open (with restrictions on distancing and gatherings). This is nothing short of remarkable, for a city with a population of nearly 6 million.
With the response infrastructure in place, we can design in support of those activities. My experience in Singapore provided valuable lessons in designing health spaces and facilities that can quickly respond in a time of crisis.
The first project I worked on was the new Emergency Department at Block H9A on the Singapore General Hospital campus. Central to their design brief from day one was “It’s not if, but when”—echoing the country’s public-awareness campaign for crisis situations ranging from health concerns to terrorist attacks—supported by a commitment to address and implement at every design stage. I learned that the same approach extended to other facilities on the island-city, following a well-defined national strategy.
The most important design aspects may not be new to a healthcare design professional. However, what sets the Singapore approach apart is the scale at which they are willing to implement and the significant amount of resources the country is willing to allocate for these efforts.
I expect that in the aftermath of the COVID-19 crisis, the way we design healthcare spaces will be forever changed. It will start with how we deploy virtual care. Beyond that, we will see more focus on designing facilities for resilience and increased responsiveness.
Healthcare is a global concern. If we want to keep people safe and save lives, we need to look to the crises we’ve encountered before for learning and inspiration.