S7 EP 10: Shari Blanch, Summer Series

Shari is a Health Design Research Architect who explores the importance of Post Occupancy Evaluations and the need for more reviews to ensure stronger outcomes in future projects

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Transcript

[00:00:00] David Cummins: G'day, and welcome to the Australian Health Design Council podcast series, Health Design on the Go. 

[00:00:23] I'm your host, David Cummins, and today we're speaking to Shari Blanch, who is an architect at Jacobs Australia and based in Queensland.

[00:00:30] As a Health Architect, Shari is also a health design researcher. Her newly published article in her journal, entitled, ' Understanding Post Occupancy Evaluation Processes for Public Health Care Facilities in Australia and New Zealand', is why we're here today. 

[00:00:45] Shari has been working across Australia within the private and public sphere and is currently working on the new Women's and Children's Hospital in Adelaide. We welcome Shari today to talk about her latest research. Welcome Shari, thank you for your time to be here. 

[00:00:57] Shari Blanch: Thanks David. Nice to be here.

[00:00:58] David Cummins: Congratulations on getting your article published. That's an amazing feat. I'm just so, so happy for you. It's something that a lot of people strive to do and can never achieve, so congratulations. 

[00:01:07] Shari Blanch: Thank you. Yeah, it's really exciting. I've never had a paper published before, so hopefully more to come. 

[00:01:12] David Cummins: So for those that have not yet read it, 'cause I know it's relatively new, do you mind just explaining to people what your research is?

[00:01:19] And for those who are listening maybe around Australia and around the world who don't actually know what post occupancy evaluation actually is, just to bring people along the journey. 

[00:01:28] Shari Blanch: Yeah, absolutely. So I guess the big picture behind all of the research is looking at, are our public hospitals and healthcare facilities in Australia and New Zealand really achieving what we as architects and designers are hoping that they achieve?

[00:01:45] Are we improving clinical efficiencies in layouts? Are we providing an environment that clinical staff thrive in? Are patients getting better quicker in our hospitals? 

[00:01:54] And so post occupancy evaluations are a technique that can be used on buildings to essentially evaluate a building and it's just as the name suggests.

[00:02:04] So it's, After a building has been occupied, they can be evaluated. And in most literature, that usually happens about 12 months after a building has been occupied. And that's for a couple of different reasons. So firstly, because it gives the staff enough time to become accustomed to their facility. 

[00:02:23] So if there are any change management procedures that need to occur, 12 months gives them enough time for that to happen. 

[00:02:29] The other reason is that 12 months gives four seasons of the year for the building to experience. So say you're evaluating the HVAC system air conditioning efficiency on the building, you need to know how that works throughout the seasons.

[00:02:43] It can also have a big impact on the clinical operation of a facility. You've got peaks and troughs during different seasons of the year, you might have cold and flu season and you need to know how your facility operates at that time of year.

[00:02:55] So generally 12 months after a project's been finished, we'll do a post-occupancy evaluation.

[00:03:01] I'm really interested in that field of study, primarily because when I first started working in health architecture, I was always really curious as to why planning was done the way that it was done why the decisions were made the way that they were.

[00:03:14] I couldn't quite understand what the evidence base was behind a lot of those decisions. And not a lot of people could tell me why, obviously we have the Australian Health Design Guidelines, which are a fantastic source that started probably around 2007 and a lot of projects use those guidelines.

[00:03:31] But I'm more interested in what backs up those guidelines, what the evidence is within Australia and New Zealand, as to why we're designing hospitals the way that we are. 

[00:03:39] That's where this research comes in. When I started at Jacobs, I connected with one of my colleagues, Annabelle Fraser and we were both really interested in this topic together.

[00:03:48] So we embarked on this research project and we undertook some focus groups with every state and territory in Australia and one in New Zealand, so about nine focus groups, and we spoke with people from that were employed by the government. 

[00:04:04] So they worked within capital infrastructure development and a lot of them had experience somewhat within the evaluation space as well.

[00:04:13] The structure of a lot of those state and territory governments are quite different and that had a bearing on the results as well that I might talk to later... 

[00:04:21] But we got a wealth of information as you can imagine from talking to that many people for nine hours. That's a lot of qualitative data to sift through, but it was really fascinating to hear all of the different stories behind POEs in each of the states and whether or not they're occurring and What the barriers might be to undertaking POE's, what their frameworks are that exist what they find the value to be as well in POEs and lastly, how they might disseminate the information if they are undertaking any POEs on a facility.

[00:04:54] David Cummins: Can I just ask a question? Is post occupancy evaluation a legal requirement, or is it more just best practice? Do the guidelines recommend it, or is it just something that the architects take on board themselves?

[00:05:07] Shari Blanch: It varies in each of the states. Through our research, we found there was only one state that actually mandated that process for healthcare facilities.

[00:05:15] It should be considered best practice, and I know for architects, when we're at university and training, it's something that we talk about as being best practice, but whether or not that actually happens is kind of a different story.

[00:05:27] And when I talk to the results, there are lots of different barriers as to why that might occur.

[00:05:32] David Cummins: And who actually drives it? Is it the client, is it the hospital, is it the designer, is it their project team, is it the project director? 

[00:05:39] I must admit, my mind is boggling for how many projects I've built around Australia. I've never been part of a post documency evaluation. 

[00:05:46] It's something I've heard of, I see the benefit, but I've never been part of it. So who should be driving it? How does that work? 

[00:05:51] Shari Blanch: That's consistent with exactly what we found is that it's something that we talk about in the industry, and it doesn't often happen. 

[00:05:57] The main result that we found was that there are only five, of the nine jurisdictions, that actually undertake any form of POE.

[00:06:04] And within those five, there's varying frequencies as to how often they actually undertake POEs. So yeah, as I said, only one of them really mandate the process. 

[00:06:15] David Cummins: So who actually is responsible or who should be responsible for implementation of a post occupancy evaluation?

[00:06:23] Shari Blanch: That's a really good question.

[00:06:25] In my opinion, It's the state governments and jurisdictional governments that should be responsible for undertaking those post -occupancy evaluations. And when I say responsible, I mean, funding the process and making sure that that actually happens.

[00:06:38] Whereas the team that's involved in undertaking that could involve external consultants, undertaking that process. 

[00:06:45] David Cummins: Sorry to interrupt, but it's not actually run by the architects themselves. It's run by an independent?

[00:06:49] Shari Blanch: If the process happens at all, it's usually governed by the state government.

[00:06:58] And then occasionally they'll involve external consultants in the process. 

[00:07:02] David Cummins: So in my very simple brain, someone comes into the public sector and reviews the architectural design and operations to confirm certain things were done well, or could have been done better. 

[00:07:17] Is there a certain standard marking criteria or certain checklists of lighting, patient experiences, staff satisfaction, or is it pretty much just free for all around Australia and there's no standardisation? 

[00:07:29] Shari Blanch: It's a really interesting topic you've brought up because there's no standardisation and that's another result of our research.

[00:07:36] I actually don't believe that there should be standardisation because one of the challenges we found is that every state and, and territory is so different in the way that they deliver their healthcare facilities. 

[00:07:48] In addition to having such different amounts of populations and different amounts of capital infrastructure, that any kind of standardisation actually just, I think it would fall flat because you're measuring such different scales and sizes and projects.

[00:08:00] So there isn't a standardised guideline but what you've touched on is really interesting because when talking to each of these focus groups, they all spoke to quite different understandings and areas of scope that a POE would take. 

[00:08:15] So some of them spoke to a more physical building element POE, which is what you've mentioned where you're talking about finishes or areas of rooms or that kind of aspect of a POE, it can actually evaluate a myriad of different things. 

[00:08:30] You can talk about clinical efficiencies and operational efficiencies. So not only are you measuring something more physical, but you're looking at staff turnover rates and how that might correlate to the built environment as well.

[00:08:43] So there are quite a few different areas of scope. And what's interesting is that each of the States spoke to different things and that clearly makes you understand that there's not a clear definition of POEs and that misunderstanding is then going to generate confusion and perhaps a lack of value in the process because people really don't understand what it really is because there isn't a standard POE process at all. 

[00:09:09] And so the people that I know that have undertaken POEs before and some that I've read, they're all vastly different.

[00:09:14] And the value that you get out of those can vary considerably, especially depending on who's actually undertaking the POE, if they're well versed in doing rigorous research.

[00:09:24] As opposed to if they haven't been trained in that, they're going on one site visit talking to perhaps three people in the hospital and that forms their entire understanding of whether the building works or not. 

[00:09:33] So it can be really different depending on the process that you take.

[00:09:38] David Cummins: And would I also be correct in saying the hospital's needs would have to be considered whether, length of stay, patient outcomes, anxiety as well for certain patients and staff. 

[00:09:49] It seems just almost too big a topic to take on board for one consultant. Is that sort of correct?

[00:09:55] Shari Blanch: Yes, in a word. 

[00:09:57] I think another reason that there is such a barrier to undertaking POEs and some of the jurisdictions mentioned this in the focus groups, is that the task does seem insurmountable sometimes.

[00:10:09] I know one particular jurisdiction has their own kind of framework around POEs and it is pages and pages and pages long of Different criteria to to measure.

[00:10:20] There's another question as to whether that criteria is actually valuable or not.. 

[00:10:24] That's something I'd really like to research moving forward with this topic is what are the most valuable pieces of criteria to be measuring for a hospital? 

[00:10:34] For example, some of the mega trends in healthcare in Australia is that we have a workforce that's shrinking in healthcare.

[00:10:42] What can we measure in a building that can help us understand if there's parts of the built environment that are encouraging staff to stay and helping their wellbeing or vice versa, that, you know, we're not providing respite spaces for them.

[00:10:57] Those are the kind of thing that I'm thinking, I'd love to research metrics around what's going to be the most valuable thing for us to know moving forward with projects in the future. 

[00:11:07] How can we continue to improve because currently that feedback loop is just not there. We're just going to continue to build the same thing over and over again and if we're building things wrong, that's never going to get fixed. 

[00:11:19] So it's, yeah, it's an interesting topic that way. 

[00:11:22] David Cummins: And in that one jurisdiction that does do it, have those lessons learned helped improve design and clinical outcomes for patients and for the building? 

[00:11:31] Is that link there?

[00:11:33] Shari Blanch: For that particular jurisdiction, I'm not a hundred percent across how they feed that information through to say, briefing documents for another project or if there are lessons learned that go out to stuff generally.

[00:11:50] For each of the jurisdictions that we spoke to, they don't necessarily pass on any of the results for POEs to consultants or the wider public, and often that can be for political reasons. 

[00:12:03] They want to de-identify the research. 

[00:12:06] Ideally, what would happen is, if those POEs are being undertaken, one of the key areas that that evidence would be used is in the OzHealth facility guidelines.

[00:12:16] Because, most projects use that these days, whilst they're called guidelines, they're often written into the brief as something that we actually have to abide by. 

[00:12:25] So in my opinion, that's, that's really the link that needs to occur, but that's not the responsibility necessarily of the guidelines at all.

[00:12:32] They need to be fed that information from each of the states and so that's where it comes back on the state then to, to be undertaking those processes, but there are a lot of barriers for each of the jurisdictions. It's a difficult, complex thing to address. 

[00:12:45] David Cummins: I know I'm going to get in trouble somehow, but I'm pretty sure not all the Australian Health Facility guidelines are based on post occupancy evaluation. 

[00:12:53] I'm pretty sure it's based on lessons learned, it's based on conversation, it's based on visual, it's based on feedback. I don't know if they do incorporate that and if they do that's great, but I'm just not that fully aware.

[00:13:06] Is that correct? Do they do that? 

[00:13:08] Shari Blanch: They do incorporate the information they're given, essentially. 

[00:13:11] From what I understand, they do have representatives in each jurisdiction come together and discuss those kinds of updates for the AusHealth facility guidelines.

[00:13:20] If there are POE results that can feed into that, they do.

[00:13:23] I guess the problem is if they're not being undertaken, they're not able to be put into the guidelines. 

[00:13:29] And so the people that run the guidelines need to find some other way to maintain those updates. And they're a really strong team and I've spoken to them before about their updates.

[00:13:38] David Cummins: Yeah. That's really interesting. 

[00:13:40] Did your research lead you to overseas, does this exist overseas? It's like UK, Canada, does it actually exist, what do our counterparts do overseas? 

[00:13:48] Shari Blanch: The research didn't necessarily focus on anywhere outside of Australia or New Zealand.

[00:13:55] My hunch is that it doesn't actually occur many places at all. Obviously America's quite a different beast itself being quite a privatised healthcare system. 

[00:14:03] There is some research out of Canada about post occupancy evaluations and from that research, it's quite clear that in healthcare specifically, it's almost the same as here there's just not much being done. 

[00:14:16] There are a few procurement methods within the UK government that do have quite a light touch POE that happens after 12 months.

[00:14:27] It's quite different to the Australian context because often those POEs in the UK are measuring between what facilities they had previously, and what their new facilities are.

[00:14:37] But their old facilities were sometimes hundreds of years old, and we don't have that scenario here. 

[00:14:42] So the gap between what they had and what they have now is easily measurable and clearly beneficial. Whereas here, I think it's a bit more nuanced because we're just not that old a country and our facilities aren't as old.

[00:14:55] David Cummins: And just before we go, I know we've run out of time, like what would be your recommendation? 

[00:14:58] What would you like to see happen with this research? It's phenomenal research, almost too big to talk in one podcast. 

[00:15:04] What would you like to see happen? What are the next steps? 

[00:15:07] Shari Blanch: Yeah, so much. I didn't even get to touch on it.

[00:15:10] I hope people can go and read the paper itself and if anyone would like to, please reach out to me. 

[00:15:15] Moving forward, obviously, the main aim is to get POEs happening. There's a lot of different terminologies for POE. Lessons learned, building performance evaluation, and a lot of opinions about what they should be called, but essentially we should be doing evaluations of healthcare facilities so that us as designers can have some confidence in what we're designing is actually going to be working.

[00:15:37] It's going to be helping the staff, it's going to be making patients get better, quicker, all of those kinds of things. 

[00:15:43] We want some evidence base behind it. 

[00:15:45] David Cummins: Yeah, I 100 percent agree. That's like one of the points of this podcast, because if there's research to support it, then it can be implemented across Australia, if not the world.

[00:15:53] But if you don't have that research, it generally comes down to a subject of opinion, which I think the industry has been suffering from for way too long. 

[00:16:00] So I think your research is phenomenal. I think the plan is amazing. I think the task is. 

[00:16:05] insurmountable, as you said. 

[00:16:06] I'm so grateful for someone like you and your team to be putting the energy and effort in to make a change and actually be a beacon of research for lessons learned from a research point of view that we can actually build better and smarter for better clinical outcomes and building outcomes.

[00:16:22] So thank you so much for your research and your time and dedication to this topic. I think it is amazing. I think there's a few more steps to go, but with someone like you in charge, I'm sure we'll get there. 

[00:16:31] Shari Blanch: Thanks so much, David. I hope to come on in future and we can continue this conversation. 

[00:16:35] David Cummins: Lock it in, absolutely. Lock it in. Thank you so much. 

[00:16:38] You have been listening to the Australian Health Design Council podcast series, Health Design on the Go. To learn more about the AHDC, please connect with us on our LinkedIn or website. 

[00:16:47] Thank you for listening.