The New Dunedin Hospital

The New Dunedin Hospital offers a unique opportunity to start completely new and design a more fit-for-purpose, future-ready hospital without the restraints of an old structure.

Now scheduled for completion in 2026 (Outpatient Building) and 2031 (Inpatient Building) the ‘project’ has utilised user engagement and clinical insight in various forms since its early inception. The Clinical Leadership Group (CLG), formed in 2017, developed the original overarching clinical and operational direction that fed into the early stages of the new hospital design. Now it is known as the New Dunedin Hospital Clinical Transformation Group (CTG).

CTG Chair, Dunedin Anaesthetist, Dr Sheila Barnett, describes the CTG as a clinical peer review group for the project. “Our overall aim is to make sure we’ve got a balanced product at the end of it. To inform the New Dunedin Hospital Project Team on how the design and digital work align with clinical and service needs and fit with what the building is designed to do. More recently the group provides clinical stewardship for the transformation and transition towards moving in, reflected in the name change.”

Who are the Clinical Transformation Group?

The group represents a broad range of staff – clinical, administrative, service management, nursing and allied health, as well as consumer group representatives.

Sheila became the Chair in 2022, but her involvement started in the early stages of the project “I was the day surgery unit clinical lead at the time and first got involved in sense checking the number of operating theatres proposed. I saw it as a good opportunity to get involved in something really special. My involvement has grown over time and I now hold a 0.5FTE position as Chair, in addition to my clinical work.”

In the early stages of the design there were 50 user groups with more than 500 users across staff, consumer and patient representatives. Engagement was coordinated by a Southern Project Management Team.

“The range of voices has been valuable in this” Sheila explains. “Staff met directly with project managers and health architects to work through their units together. They’d share insight into what would work best and what should sit beside what. It was a unique model of user engagement and new to many of the architectural team.”

“In the design stages, the original CLG were the clinical gatekeepers. We received design requests from our clinical colleagues, checked with experts, national guidance and literature, and then provided a recommendation for the project.”

“A key part of the job has been balancing the traditional view of clinical advocacy (fighting for the best outcome possible from a clinical perspective), with the full realities, complexities, and restraints of such a large project. It’s been a very different experience for me.”

The CTG continues to advise on the redesigns, but time restrictions have inhibited the extent to which the user groups could be involved in the 2022 and 2025 redesigns, compared to the early stages of the project.

“User engagement has been more limited through the subsequent redesigns, but the historical user input has been retained in documents and plans. We have continued more targeted consultation with key operational and clinical leads for each area.”

Over the years, when large scale cuts were proposed, the CTG submitted clinical impact statements for each of the proposed redesigns.

“These are large reports we compiled in partnership with our Southern Project Management, and operational and clinical colleagues. It was important that decision makers understood the clinical consequences, costs down the line and operational impacts of each decision. We reported to the project leadership and, by invitation, communicated directly with the Ministers of Health and Finance. These reports have been an unexpected role our Southern team had to fulfil and a huge task over a short amount of time. Together with the campaigning by the Southern community, we believe that they have directly contributed to scaling back or reversing many of the proposed cuts.”

“It’s been a long journey with design reworks, repeated reviews, and changes of government, but we are confident the New Dunedin Hospital is better for the consistent Southern engagement that we have brought.”

Designing a future fit hospital

Describing the hospital as a ‘complex machine’ Sheila points out how being future fit is mostly about efficiency and patient flow. “Keeping patient flow moving, letting spaces flex to accommodate variable demand, and being adaptable for future changes in use.”

“Our [the Southern team’s] general principle has been ‘long life, loose fit’. We keep this in mind for every area – What does this space need to do now? Can it be made flexible for other uses? What might it need to do in the future? Is there anything we’re doing that’s going to disrupt future flexible use? Everything else is mobile, flexible and changeable.”

“The Australasian Health Facility Guidelines (AusHFG) is a ‘recipe book’ of standard components that is informed by clinical experts, health planners and health architects. We’ve followed this as a base unit unless there’s been a good reason not to. Then applying the Dunedin and Southern context and considering the potential future use to guide our recommendations.”

“One example of this was recommending lift sizes. The Health Technical Memoranda provided UK-based international lift sizes that are quite old, and the ICU group was concerned they were too small. So they mocked up a lift with clinical scenarios and found they couldn’t safely manage certain patient groups in that size of space. CTG took the recommendation back to the project and key lifts were upsized.”

“We’ve also looked at emerging technology, national guidance, and local expertise and taken a lot of learning from previous builds in other locations by watching how they’ve aged over time.”

Future-proofing the theatres

“Future-proofing the theatres has been about improving efficiency by utilising turnover times, reducing potential bottlenecks and standardising the theatres themselves.”

“Making spaces like the pre-op holding and post-op care as flexible as possible will improve patient flow and efficiency on the theatre floor by allowing us to share the space. We’ve allowed for the pre and post- op areas to be co-located and the bays to be multipurpose for different stages of a patient’s journey so we can flow into each other during busy times of the day and flow back when it’s quieter.”

“We’ve also prioritised spaces like set-up rooms that facilitate parallel tasking in areas as throughput driven as theatres.”

“The 23-hour unit will also be on the theatre floor. It will offer short overnight single-stay care for predictable elective surgery, but those beds could also be stage 2 or 3 recovery beds offering continuous flexibility of spaces.”

“All of the theatre suites will be the same size and orientated in the same way with the ability to facilitate all orientations. This standardisation will allow them to be easily switched to a different specialty in the future if needed.”

“As the day surgery lead I have a particular interest in the day procedure unit. This will be four theatres and four procedure rooms in the outpatient building and I think it has the potential to become semi-autonomous – where day surgery is a speciality in itself. We have a great day surgery team already and I’m looking forward to being able to provide really positive patient care with them. Where there’s a sense of wellbeing for our patients associated with coming in for your procedure.”

“At the moment we have a small day surgery unit, disconnected from other perioperative areas. The theatres aren’t big enough to do the work we need them to do and there are inefficiencies in patient flow.

How will this improve healthcare in Dunedin?

The flexible spaces will allow Dunedin to move and embrace future models of care.

“A key benefit of designing a whole hospital, instead of one department or block at a time, is that we can design a unified building that’s fit for purpose. Departments are purposefully located to optimise efficiency of movement and patient flow. Dedicated facilities, like the 23-hour and day surgery, will enhance elective surgery, allow us to do more complex operations and help a wider range of patients.”

“The patient spaces have all been designed with a balance of safe oversight and privacy. The majority of the patient rooms will be single rooms with an ensuite and a pulldown bed for a family member, which will make a world of difference in patients’ experiences.”

“We’ll also be fully digital when the inpatient building comes online, documenting patient information and their stage in their journey more visibly, coordinating care appointments (both were key issues identified by our consumer reps) and automating our inefficient paper trails.”

“Other digital solutions include the use of automated dispensing cabinets throughout the entire hospital which should reduce drug errors and better protect staff. As well as patient check-in kiosks, digital wayfinding and digital scheduling for outpatient clinics.”

“So much of this is going to be a game-changer.”

A new view and the final outcome

“Through this work, I’ve gained a real appreciation for the complexities of running the hospital, how everything works together and for my colleagues, particularly service managers and general managers. We’re all a small cog in such a big machine.”

“I also have a deeper understanding of getting involved in change and finding a way through an issue by breaking it down into manageable steps and identifying who we need to talk to in a productive way. And a little more about media and politics.”

“We’re pleased with the outcome of the most recent announcements. It was the best result we could have hoped for. We’re building the New Dunedin Hospital and we’ve gained back some of the space we lost a couple of years ago. There is some redesign to come and compromises will need to be made, but overall it’s a very good outcome for this stage in the game.”

“The outpatient building is taking shape now too. It’s looking really good and I know people will be pleased to see activity restart on the inpatient site after all we’ve been through.”

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