Understanding the drivers to better space utilisation

Posted on: March 19th, 2012 by matthew_bacon

It is now becoming increasingly evident that NHS Trusts need to achieve better utilisation from their facilities. The Kings Foundation recently produced a report that identified that there is circa 2.0m square metres of unused or under-utilised floor space in the NHS, equivalent to the combined floor space of Sainsbury’s and Waitrose.  In a separate report, Cost Consultants E C Harris noted that under-utilised floor space in the NHS accounts for a life-cycle cost approaching £500m per annum.  This is the equivalent build cost of a major acute hospital, or 2% of the governments QIPP target (see http://www.improvement.nhs.uk/Default.aspx?alias=www.improvement.nhs.uk/qipp).

In numerous discussions with NHS Estate leaders we have been struck by a common issue that repeatedly arises in those conversations which can be rhetorically expressed as: “we usually know where we are inefficient, in terms of space utilisation – but what we do not understand enough of are the drivers that lead that space utilisation“. Our own reflection of these concerns is that to understand these drivers, we need to understand the processes that drive the utilisation of each facility.  The process will have considerable influence in terms of who, when and why different users makes use of a particular facility.  We need to understand the resource constraints, the process constraints and the key variables that influence utilisation.  Our research has also identified a number of issues concerning different working practices that can be directly correlated to patient flow and staff efficiency.  These become evident in patient dwell time, particularly for Outpatient visits.  Dwell time is the time that a patient spends in the process – a substantial proportion of which can be spent waiting.  It is often the working practices used by a specific clinical specialism that are the key drivers behind these issues.

Inevitably, these issues can be complex to resolve.  Often the factors are interdependent.  This is where OCCUPANCY ANALYTICS ™, a science developed by The Conclude Consultancy brings clarity, because it enables the clear correlation between driver and outcome – between working practice and space utilisation.  We presented some of our work at the NHS Sustainability 2012 conference and here were a few comments published on the post-conference debate web site:

“Absolutely inspiring and eye opening presentation”

“Excellent presentation. Great delivery, had data, strong conclusions. Should have been a plenary presentation”

“Absolutely fascinating. If we are to meet our 2050 outcomes, this IS the way forward. Best session of the day!”

“It’s rare to recognised a ‘Damascian Conversion’ moment at a conference. This was a worrying one, and I fear for how little this is known, understood and applied. Excellent! “Reset the course of the oil tanker”?”

If you would wish to understand how The Conclude Consutancy can help you achieve better space utilsation in your hospital facilities, then please do use the contact form on our web site.




Sustainable hospital ventilation system design

Posted on: November 16th, 2011 by matthew_bacon

Here at Conclude our research led, evidence based approach to low carbon design for hospitals enables us to explore innovative solutions to the low carbon challenge.  Those of our readers who have been following our work on OCCUPANCY ANALYTICS ™ will already understand the significant impact that this work is having on engineering design of ventilation systems.  We have been reflecting on how traditional approaches to ventilation design can be counter-productive to achieving low carbon outcomes. Our article in Building Better Healthcare (http://www.bbhealthcare.co.uk/show.php?page=feature&id=2010&story=2010) sets out an alternative proposition. You can also find a copy of the article here: http://www.conclude.org.uk/?attachment_id=319

We have also produced a PowerPoint presentation to accompany the article.  The presentation was delivered by Professor Bacon to the Leeds University, School of Healthcare three day course held on the 6-8th November 2011: Specialised Ventilation in Healthcare Premises.

If any reader would like a copy please do contact us.



Sustainable European Healthcare Infrastructure

Posted on: September 17th, 2011 by matthew_bacon

Professor Bacon has been invited to address the European Health Property Network workshop to be held in Bologna in October.  The 2011 workshop will present exemplar projects and case studies in these areas, but also examine the evidence for and against the effectiveness of current policy initiatives.

The context for the workshop is the EU Commission’s 2020 strategy, which speaks of:

… an urgent need for Europe’s economies to achieve ‘smart, sustainable, inclusive growth’, and in particular emphasises a need to shift towards a more resource efficient and low-carbon economy.  As a major consumer of resources and hydrocarbons, the healthcare built environment has a particular responsibility in this area…

Professor Bacon will be explaining his pioneering work in Occupancy Analytics, which promises to fundamentally change the way in which hospitals are designed in the future. Key impacts on hospital design are:

  • Space planning and space utilisation forecasting
  • Spatial capacity forecasting including crowding potential
  • Vertical circulation planning
  • HVAC and Controls design optimisation

For more information please use the Contact form on our web site.

OCCUPANCY ANALYTICS ™: A study in hospital space and equipment utlisation

Posted on: August 31st, 2011 by matthew_bacon

OCCUPANCY ANALYTICS ™, the new method developed at The Conclude Consultancy, has been bearing rich fruit.  We have been just completed a fascinating study into outpatient facilities for the Brighton & Sussex University Hospitals NHS Trust.  The Trust’s concern is that all too often there is too much space assigned to outpatients departments, which could be better utilised.  The over-provision of space is a reflection of  the inadequate analysis tools available to hospital planners. OCCUPANCY ANALYTICS ™ is the solution to these challenges.

The study has enabled the Trust to compare forecast demand of patients with the planned provision outpatient accommodation.  The study has also included a probability analysis of capacity forecasts, based in different variables.  Through OCCUPANCY ANALYTICS ™ the Trust now has the data that it needs to consider alternative operational scenarios that balance forecasts of patient demand, staffing and accommodation provision. With outpatient space costing in the region of £4,500/m2, and a typical consulting room requiring about 15m2 of floor area,  the commercial benefits of this study are obvious.

The analysis has also been applied to imaging equipment forecasting, so that we can now analyse the amount of imaging equipment required to meet forecast demand.  The analysis enables the Trust to alter key variables and so understand the impact of these variables on equipment utilisation. Understanding equipment utilisation also enables us to analyse the energy consumption profile of each item of equipment.  The significance of this will be explained in later posts.

Grey Water re-use in hospitals – developing the science

Posted on: August 9th, 2011 by matthew_bacon

Following The Conclude Consultancy’s research into Grey Water re-use (please see: http://www.conclude.org.uk/research-development/) Professor Bacon has now been appointed to develop a business case for the re-use of Grey Water at Brighton and Sussex University Hospital.

Most Infection Prevention Control specialists would strongly argue against the re-use of Grey Water.  However, Bacon and his team contend that as there is no specification in existence that controls the use of Grey Water, such arguments must be challenged. The team are developing a specification for Grey Water re-use and this specification will also consider the microbiology and well as the virological issues.

Bacon holds the view that the potential for reducing water consumption in UK hospitals, through Grey Water re-use, is often readily dismissed because of opinion which is he believes is all too often founded in myth.  He cites for example, Reverse Osmosis waste water, which is effectively potable water.  Yet it is regarded as ‘Grey Water’.  The purpose of the business case is to investigate the science as well as the potential for re-use, whilst ensuring human health. Water treatment manufacturers will be consulted in the process and a Life Cycle Costing Analysis will also be carried out as part of this study.

August 2011 update: A meeting has now been held with the Department of Health to review our strategy. The department is now supporting the project in order to understand what lessons can be learned from it.  A peer review team is also being established.

For more information please contact Professor Bacon through the contact form on this web site.

Speaking engagement: HaCIRIC International Conference 2011 – Manchester

Posted on: August 9th, 2011 by matthew_bacon

On the 26th September 2011 at the above mentioned conference, Professor Bacon is to present a paper written in collaboration with Professor Duane Passman (Brighton and Sussex University Hospital NHS Trust) and Mrs Karen Hicks (Laing O’Rourke plc) titled: Integrated Decision Support –  A new approach to the design of hospital facilities to optimise low carbon performance.

The paper introduces some of the key elements to Bacon’s strategy for low carbon performance, which is being implemented on the £400 million hospital redevelopment in Brighton. Of particular focus will be the Occupancy Analytics work, which apart from being used as a new basis for low carbon design, is also demonstrating substantial opportunities for achieving improved efficiency in the utilisation of accomodation and imaging equipment.

For further information please refer to: http://www.haciric.org/events/2011/09/26/HaCIRIC-2011-International-Conference-/programme/

Occupancy Analytics: Team meeting in Atlanta

Posted on: May 30th, 2011 by matthew_bacon

Professor Bacon met his Occupancy Analytics team in Atlanta, Georgia last week. A two-day workshop enabled the team to review the latest development work in this exciting new area of low carbon design.  The meeting was attended by the Brighton & Sussex University Hospitals Trust analyst, Hazel Belfield-Smith.

The Occupancy Analytics Team, gathered at Georgia Tech University, Atlanta

A highlight of the meeting was the presentation of an animation of the facility processes which drive occupancy profiling.  This enables non-experts to develop a very good understanding of the impact of alternative operational scenarios on facility performance. Conclude are currently investigating the wider use of simulation technologies to simplify decison-making proceses in complex facilities.

Where is the innovation in CSR Reporting?

Posted on: May 21st, 2011 by matthew_bacon

It seems that the growth in CSR reporting has attracted little innovation, and neither does it seem that it has created sufficient impetus to change the way in which buildings are operated in the drive to reduce carbon emissions.


The Royal Academy of Engineers report: Engineering a low carbon environment, published in 2010, laments that buildings today perform little better than they did back in the 1990’s.  Even the National Audit Office has expressed grave concern about the performance of the public building stock.

PWC advocates greater use of such reporting.  But in reporting without corresponding corrective action, the environmental basis on which these businesses operate is highly questionable.

To quote Geoff Kendall, Development Director at SustainAbility:

“To prosper with any certainty in the long term, businesses must attain a level of organisational resilience and adaptability that can only come from embedding sustainability into their very DNA: every process, every product, every person…”

Embedding sustainability into every process, every product, every person…absolutely right.  The significant implication here is the need for data integration between the different parts of the organisation. Accurate, verifiable reporting is just one step on a journey in the striving for sustainable prosperity.  It is here at The Conclude Consultancy where we provide the tools not simply to measure performance, but tools that will perform the diagnostics across our customer’s facilities to analyse the opportunities for driving down carbon emissions in the organisation’s processes.

We believe that what is unique in what we do is to correlate business practice and the associated business performance measures with the resulting carbon impact. We achieve this by utlising powerful simulation technologies that enable organisations to experiment with alternative scenarios.  We believe that this will lead to new innovation in CSR reporting so far as an environmental perspective is concerned.  It will lead to a closer integration between business performance outcomes and the associated carbon impact of them. We are also exploring how we can use virtual reality technology to bring a new dimension to this aspect of sustainability.  If we are to engage with people and cultivate changes in attitudes, then the day of the ‘enterprise dashboard reports’ are over – a ‘one size fits all’ type CSR reporting system does little to engage and inspire…innovation is needed, and this is what The Conclude Consultancy does best.

Professor Matthew Bacon


Occupancy Analytics – A new basis for low carbon design

Posted on: May 17th, 2011 by matthew_bacon

The Conclude Consultancy has now completed the first stage of its Occupancy Analytics project for the 3T’s Programme in Brighton for the Brighton & Sussex University Hospitals Trust.  Professor Bacon and his team has developed this radical new approach to briefing for complex facilities.  The approach is founded in a Facility Activity Model that models all key processes and activities associated with them. The Facility Activity Model is managed in an on-line database.  The processes and data for the model was collected and analysed by the BSUH Trust’s analysts. Professor Bacon and his team created what is in effect an open source solution, enabling this data to be re-used for different stages of the hospital development process.


In the illustration above the relationships for each facility function are identified.  These relationships are dynamically constructed from the database, processed by the logic that defines the patient pathways and clinical processes.

Using this data the team is also able to forecast occupancy anywhere in the facility and this in turn informs the engineering design.  This new science developed by Professor Bacon and his team in the United States, also enables the design of the mechanical engineering systems to be optimised by ensuring that the system design and specifications are founded on a comprehensive understanding of how the facility will perform In-Use.

Occupancy analysis for a major circulation space

The illustration above shows the peaks of occupancy in a major circulation space though different times of the day.  The forecast is based on a comprehensive understanding of the patient pathways and clinical processes.  The data from these studies is now to be processed in what Professor Bacon refers to as a ‘Whole Facility Energy Model’. It is this model that will correlate operational processes with carbon performance. It means that for the first time users will be able to understand the carbon impact of operational decisions.

“This is the first time that this approach to modelling occupancy and energy in-use has been applied to healthcare facilities in the UK.  It has been a source of bemusement to me for some years that we do not make more use of the tools available to ensure that we are creating optimised environments for patient care.  Teaching hospitals are large, complex organisations and this work is giving us an opportunity to simulate the building in use.  In the current financial climate, the Trust must ensure that it is delivering the optimum solution for the pressing need to develop the hospital and thereby create optimum value for the public purse.

We have much more to do but I believe the approach that we are taking as a team will provide future healthcare planners with new tools and knowledge to create better facilities based on modelling and evidence rather than theory and supposition based on what we have done in the past.”

Professor Duane Passman, 3T’s Programme Director

For more information about this exciting innovation, please contact Professor Bacon.


International Association of Sediment Water Science

Posted on: May 8th, 2011 by matthew_bacon
Dr Phil Greenwood has been invited to present a component of his hydrology-based research at the IASWS conference; (12th Symposium on the Interactions between Sediment & Water, Devon, UK on June 11th 2011) the aims of which are to contribute towards the sustainable management of ‘catchment to coastal’ water-sediment systems.