Tapping into nurses’ knowledge for more effective design

Design and construction firm, Paynter Dixon takes an innovative approach to ensure the aged care and retirement facilities it constructs most closely meet the needs of its aged care clients. The company employs experienced RNs in its project teams to liaise between the aged care provider and all members of the design team to ensure the completed buildings meet the needs of the residents, staff and management .

Both Sydney-based Robyn Cahoun (who has just left to take up a new appointment), and Erica Lambert in Brisbane, came to their roles with comprehensive backgrounds in nursing and in aged care. Cahoun had 18 years in aged care, and was CEO of Edina Aged Care, part of Uniting Care. During that time she commissioned about six new ACFS. Lambert was involved in senior management roles for Queensland Health, including as project officer in the 1997 aged care reform process. She was also Director of Care at a large Queensland high care facility.

Erica Lambert

The role of the RNs at Paynter Dixon is to act as a bridge between the client and the project team to develop a design that links the client’s philosophical approach and their operational model of care with both the design and construction processes. The client’s service delivery model directly translates into physical requirements for the facility, and is a focus of the design brief, both at master planning stage and during the more detailed design documentation.

“The value to the client is that Robyn and I understand the complexities of delivering aged care on a day to day basis, and managing aged care and healthcare delivery at a more strategic level,” Lambert says. “We understand the factors relating to care and service delivery, and how ultimately the building has to be part of the strategic and business planning equation. It’s a delicate balance of the relationship between the built environment and the organisational culture, and how they influence one another and the care and service delivery.’

An important part of the role is to revisit the design brief during documentation to ensure that important concepts and ideas expressed in both formal and informal dialogue with the client are captured. “Sometimes, simple ideas discussed over a coffee can develop into some very innovative approaches to traditional challenges in care delivery,” Lambert says. “The important thing is to give the client the opportunity over a period of time to express the subtleties of their care and service delivery vision, and then to ensure that these are translated into reality through the design and construction phases.”

Cahoun sees the role as “stepping across the gaps. The value of this role is in assisting the client to have as clear a voice as possible about the design outcomes. We ensure that the client’s expectations and needs around staff safety and client support are clearly enunciated in the design brief, so that the end product is what the client wanted.”

How does this work in practice?

Lambert and some members of the design team meet with the client over a number of weeks prior to formalising the design brief. ” We get to know the client, talk about the client’s past experiences with facilities, especially any problems,” Lambert says. “I put forward some ideas from my past and current experience, from my ongoing research and from the many visits I have to facilities – existing and new – across three states. I try to really understand their vision and their philosophy, their model of service of care, what their budgets are, and their expectations for life cycle planning for the building, plant and equipment. This is right at the starting point for the design process. It’s an holistic and ongoing approach even prior to the master plan, while it’s still at concept stage.”

The role can include providing project development workshops with the client and industry consultants to help the client define and clarify the direction they want to take with the building. Paynter Dixon has a range of inhouse specialist architects, quantity surveyors, project managers construction managers and tradespeople. They work closely with other consultants with a design, financial, or legal backgrounds, who work with the design team and the client.

Having worked in health and aged care for years, both Lambert and Cahoun know the value of communication, and most importantly the value of actively listening to the client and members of the design team, as Lambert says, ” to bring their area of expertise and share it with the pool of collective knowledge, contributing to their understanding of the making of an AC facility.”

She it really helps the client to know there is someone on the design and construction team who understands from first hand experience what is the context of care and the many nuances – legislative, professional, financial, quality, legal -all intersecting in aged care delivery and retirement village management.

Critical areas and risk points are managed during this process. These include:

  • Understanding exactly what the site issues are and how this will influence the building platform and the final delivery of care;
  • Balancing spatial relationships: – residential common areas to resident-only areas and how they link with the operational hub;
  • Ensuring sufficient space for particular aspects of care delivery such as storage;
  • Ensuring bathrooms work – “if you get the bathrooms wrong, the ramifications are huge for staff, residents and ongoing costs!”
  • Ensuring that you look after your care team – considering carefully staff rooms, training rooms, car parking.

During the design, Lambert says it is very important to look at the buildability of the facility — to look at structural issues as to how the building is put together and the long-term maintenance cost over the life of the building.”

An example of how the design process works is the recent client who needed to link an existing building to a new one. “The client had some preconceived ideas about how they wanted to do this which would not have resulted in the best longer term outcome in terms of site planning, We suggested that rather than just tacking it on, they analyse their whole site strategically, and consider where they wanted to be in five, 10, and 15 years,” Lambert says.

“When they did that and we workshopped the ideas with our team, the end result was completely differently from their original ideas. The result is, the client will do it as a staged development which will allow them to grow their business progressively in line with market and demographic data – an analysis that we did prior to master planning.”

Is this role a career option for RNs?

While there is no clear career path, both Lambert and Cahoun say it is an interesting and satisfying way of bringing together their nursing and aged care experience to influence the delivery of aged care. As well as liaising with clients and the design team, an important part of the role is research, keeping abreast of the latest developments in retirement living and aged care and the legislative and social changes that affect them.

“I like to really explore ideas outside the square with the client,” Lambert says. “I share with them best practice in nursing, retirement living and aged care, so we’re not just continuing to replicate designs but to innovate.”

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