Welcome home: take a look inside the new Mediclinic Stellenbosch
Posted on 28 June 2019
When Mediclinic decided to build a whole new hospital in Stellenbosch, the company brought together multiple specialists in a wide variety of fields. The thread that joined them all? A spirit of innovation.
The latest addition to the Mediclinic stable of hospitals in South Africa, Mediclinic Stellenbosch, is now open for business. It’s an enormous yet beautiful space: the facility, which sits on a 15 000-square-metre plot reflects the natural majesty of the iconic mountain range behind it.
A spirit of innovation has guided the project since its inception, as it does every new enterprise. The team tasked with infrastructure at Mediclinic Southern Africa amounts to 30 members of staff, and manages 15 new projects, countrywide, at any given time. “There are very few hospital groups in Africa with a team that large,” says Kobus Jonck, General Manager: Infrastructure of Mediclinic Southern Africa. “How do I justify such a large team? By constantly improving.”
The need for a new Mediclinic in the Stellenbosch region arose in 2013, when doctors and surgeons at the original hospital teamed together to offer the latest specialist orthopaedic care – and were restricted by the space and facilities available.
“We had specialists and sub-specialists in every possible facet of orthopaedic and rheumatological care,” says Carol van Zyl, Hospital General Manager: Mediclinic Stellenbosch. “They were able to offer innovative procedures and high-level treatments, and they wanted to grow further, to set new clinical standards and in time, to create a certified centre of expertise. And this is something they could not do within a general hospital environment.”
“I’ve written a document on how we manage new projects,” says Jonck. “We call it the milestone manual. There are so many details crucial to this process. For instance, plaster: what kind of plaster is acceptable? What is suitable for an office building is not suitable or appropriate in a hospital space. We need samples, we need guidelines. We need to agree to these standards beforehand, and stick to them all the way.”
The result? Today, patients in the region are well served: the new hospital offers 102 beds, five surgical theatres, a fully operational 24/7 Emergency Centre and a co-located Day Clinic, while on the older site, Mediclinic Winelands Orthopaedic Hospital will be home to top experts in orthopaedic surgery and rheumatology care when it opens in August 2019.
Building a new hospital is a multi-stage process that must take into account feedback and approval from many stakeholders. The Inception Phase consists of 23 painstaking steps, from an initial request for a viability study to investigations for possible alternatives and enquiries into the project’s financial feasibility. Separate committees within Mediclinic are responsible for overseeing these steps to ensure proper processes are adhered to – new project requests may be, and often are, passed back to the drawing board during this exploratory phase.
That’s followed by Stage 2: Concept & Viability, which kicks off the exploratory design process: for a project of this magnitude, the conception must satisfy the executive committees of both Mediclinic Southern Africa and Mediclinic International that the proposed execution will satisfy the original need and come in within budget. From there, the Design Development stage ensures those plans are put in place and approved by local municipalities and the Department of Health, and it’s only after the final stage – Documentation & Procurement – that construction finally
kicks off in earnest.
In this case, the need for a new project came from the existing hospital, says Jonck, who put in a request to the Mediclinic operations committee after noticing they had the necessary specialist skills and potential to set up a centre of expertise in orthopaedics and rheumatology – but lacked the necessary space and facilities within the existing general hospital space, which had recently celebrated its 25th birthday. “There were many options,” says Van Zyl. “For instance, we thought we could perhaps relocate the entire hospital. We thought we could convert part of it, or build on a specialist section.”
In the end, Van Zyl says, the concept came full circle. “We looked at all these options together with the infrastructure team, and we were left with two viable options: to build a new, standalone orthopaedic facility, or to construct a whole new multidisciplinary hospital on a new site.”
The deciding factor: a new hospital, on a new site, would allow Mediclinic to develop further as needed. “There is no use putting down a footprint for a new hospital that can only grow for another five or 10 years. We must build with a full 20 or 25 years’ worth of expansion in mind.”
The grandest designs are built on the smallest efficiencies, says Jonck. A hospital of this size and capacity must be concerned with every electrical unit and every litre of water
– or see its ambitions thwarted by waste.
For a new hospital aiming to provide for expansion on that scale, space is everything. The site itself was of critical importance. “Developing the concept for this new hospital took about four months,” he says, “but we had been looking for a suitable site for about four years. Finding property in Stellenbosch is not easy. There were 11 sites on our list.”
The hospital is located along the popular R44 that connects Stellenbosch to Somerset West, and lies back against the Hottentots Holland mountain range. This site came with a few major bonuses, says Jonck: lots of natural light, and the ready availability of groundwater.
Abundant light and water are crucial in a hospital environment – and the hospital is specifically designed to save and harness both. As it is situated on the north-south axis, it was convenient to situate the entrance ways at the south end of the building so as to benefit from maximum light with limited associated heat gain. “Cape Town had the worst drought in its history just last year,” says Jonck. “So water recycling is of major importance to us. We have installed a borehole, and when we started construction, we found a lot of seepage water from the river. So we installed subsoil drains below the building to keep this water away from the building, and we’ve used permeable paving around the building so rainwater runs into our storm drains – all of that water is caught and recycled into our plumbing and irrigation systems.”
Over and above the hospital’s solar heating capacity, Jonck describes a complex heat-exchange system that allows the hospital to dissipate warmth efficiently throughout the building without wasting or generating an oversupply. “Outdoor air is either very cold or very hot. Treating that – to make it suitable for the indoor environment – can be highly inefficient. We have installed a system where we can pre-mix the air to the perfect temperature as it enters the building. Imagine your car radiator, which uses water on one side to cool air on the other? This is air and air. Our surgical theatres feature single air handling units, which allow us to reuse heat in our hot-water systems.”
Another innovation that promises to improve efficiencies: CO2 sensors in waiting rooms. “Regulations put strict limits on how much clean air must be filtered into these areas, depending on how many people are inside. This can be very difficult to monitor however – so our sensors keep a continuous eye on that level, and kick in to adjust the filtration if needed.”
Drawing in early morning light, planting waterwise vegetation, keeping the interior cool, using occupancy sensors and high-efficiency LED lighting … the list goes on. This extensive array of environmentally friendly measures have been developed in past projects, says Jonck, and is becoming a key part of the Mediclinic infrastructure philosophy.
THE PATIENT EXPERIENCE
“Our design must match the Mediclinic values: we always put the patient first,” Jonck says. He and his team have worked hard to ensure the hospital matches its surroundings: heat-guarding screens erected on the west facade were designed to match the trees along the nearby river, interior acoustical design in the reception area uses local wood to carry sound upwards and out, and wide windows with broad views ensure a quiet, peaceful environment, while allowing patients to benefit from the naturally picturesque landscape.
Another major benefit for Mediclinic Stellenbosch patients comes in the form of a co-located Day Clinic. “As a company, Mediclinic identified the need for a streamlined, cost-effective healthcare model some years ago,” says Van Zyl, “and day clinics allow us to work towards that, in some cases. There are a range of cases that simply do not require the traditional, acute route. Mediclinic proposed the concept of a standalone day clinic located alongside an existing multidisciplinary hospital, where doctors can perform certain treatments and procedures quicker, without compromising on our standards of clinical care.”
A new blueprint for these facilities was conceptualised when Jonck and his team visited three hospitals in the United States, and came home inspired to do better. “We visited Rush University Medical Center, Virginia Mason Hospital and Seattle Children’s Hospital back in 2015, and we looked at how they manage their surgical day cases. We realised that we had room for improvement and that we could draw on their innovations.”
Jonck identified critical points of delay in the patient journey and set about finding ways to minimise or eliminate these. “If you look at the day clinic process, there is admission, surgery in theatre, recovery and discharge. Usually we have staggered these stages: our patients wait at the pre-theatre stage before moving back to recovery, then going back to the ward. These delays and disruptions are wasteful – they waste the patient’s time, they waste the hospital’s space and they waste precious resources.”
The revamped system prioritises aspects of the journey that the patient finds most important: privacy, short waiting times and consistent quality care. Mediclinic Stellenbosch Day Clinic is the first Mediclinic facility to make use of this new “cubicle design” in its rooms – in which traditional six-bed units are divided into individual-patient private cubicles.
“We want to ensure the transition between patients being admitted and those being discharged is as smooth as possible,” says Jonck. “Wasted time is expensive. Yet we can’t compromise on clinical care: we also have to ensure the design allows for a constantly sterile environment.”
The cubicle design divides each unit into on-stage areas, accessed by patients and the public, and off-stage areas, occupied by clinical staff. It also optimises patient privacy while improving clinical oversight by offering nurses a central station and a full view of their patients before and after surgery.
WHAT’S OLD IS NEW AGAIN
Mediclinic Stellenbosch is a monument to medical innovation in SA, bringing a spirit of constant improvement to life. It has also allowed the older site to flourish into something new. The Mediclinic Winelands Orthopaedic Hospital, together with the Institute of Orthopaedics and Rheumatology, brings cutting-edge, specialist care to patients in need.
“This is a first for Mediclinic,” says Van Zyl. “I think many people believed their only option was to travel overseas to receive these kinds of outcomes – and building the new multidisciplinary hospital has allowed us to focus this facility on orthopaedic and rheumatology treatments. We’ve had specialists, and sub-specialists, and now we have super-specialists, all dedicated to innovating in these fields for the benefit of our patients. The hope is that we will be able to compete in the global arena of specialist musculoskeletal surgery and care, but really, our aim is to achieve better clinical outcomes for our patients.”
Two new facilities, risen from a shared spirit: to constantly improve for the sake of our patients. “We are very proud of what we have built here,” says Jonck. “But not because of how it looks or the statement it makes. We’re proud of what this hospital can do.”