1. Feb 1997
00:00
1. Feb 2004
15:02
Summary of the Development Plan RIT 2000 (1997)
The Development Plan explains the need for modernization of the University Hospital in Trondheim (RiT) and sets out the objectives for the development of a university hospital based on the patient’s perspective.
The objective of RIT 2000 is to develop RiT as an organization of high quality, efficiency and professionalism. This means a hospital based on teamwork in an integrated health service, with medical expertise, nursing and care based on the patient’s perspective.
RiT is a university hospital where patient-centred work, research and teaching should be integrated parts of the total operation. These activities depend on each other. They should be organized to create synergy that benefits the patient.
In August 1995, the Sør-Trøndelag county council chose the architectural competition entry named “RiT-laekkert” as the concept for the Development Plan. Since then, a great deal of planning and analysis has gone into checking all aspects of the proposed solution and completing the details.
The winners of the competition have taken part in systematic and extensive collaboration with many working groups from various disciplines. In this way, RiT and the Norwegian University of Science and Technology have participated in the planning, developed the concept and carried out quality assurance, helping to reach agreement on an overall centre structure for RIT 2000.
In the same way, the project secretariat has worked in close cooperation with the Ministry of Health and Social Affairs as well as the Ministry of Education, Research and Church Affairs, and other ministries, the Fylkesmann [chief administrative officer] of Sør-Trøndelag, the county municipalities of Møre og Romsdal as well as Nord-Trøndelag, and Trondheim municipality.
The content of the Development Plan is based on comprehensive studies and descriptions of the concept behind RIT 2000 as well as the future organizational structure and the anticipated dimensions of the hospital. These studies have been carried out under the auspices of the RIT 2000 project organization with extensive participation by the hospital and other expert groups.
The Development Plan with the associated studies and reports forms the basis for the planning, development and expansion to be carried out. The RIT 2000 development on Øya did not initially include psychiatry. The Fylkesting [county council] subsequently decided that a psychiatric centre offering an acute and short-term care should be included in RIT 2000’s centre structure. The Development Plan therefore includes the construction of a psychiatric centre at an early stage of the project. Detailed planning of the centre will be undertaken separately; the project will be managed by the RIT 2000 planning team.
RIT 2000 is grateful for the enormous and enthusiastic effort made by everybody who has contributed to the Development Plan, and hopes that the plan will answer the questions that arise when the decisions are to be taken and the planning work is continued.
Trondheim, May 1997
RIT 2000
Inge Fottland
Project director
OBJECTIVES OF THE RIT 2000 DEVELOPMENT PLAN
In December 1991, Sør-Trøndelag county council decided to develop a combined plan - a Development Plan - for the organization, operation and extension of the University Hospital in Trondheim (RiT). In August 1993, the Norwegian Government announced its support for the preparation of the plan.
In August 1995 the county council decided to use the competition entry “RiT-laekkert” as the basis for further work on the Development Plan. An in-depth appraisal and review of the proposal for a new organizational and operational model for RIT 2000 was carried out in cooperation with user groups at RiT and the Norwegian University of Science and Technology. In the same way, the redevelopment model in the prize-winning design was revised and refined in collaboration with planning and environmental protection authorities at local, regional and national level.
THE RIT 2000 DEVELOPMENT PLAN IS:
- a reference document for the agreement between Sør-Trøndelag county and the State, as an annex to the agreement.
- a reference document for use in evaluating the progress and results of the project.
Under the agreement with the State, the RIT 2000 Development Plan aims to provide Sør-Trøndelag county and the Norwegian parliament with a foundation for decisions on initiating and implementing the organizational and redevelopment measures for RIT 2000 that the development plan proposes, and the resulting decisions on budgets and schedules.
In the RIT 2000 Development Plan, the name RIT 2000 applies both to the revised version of the winning competition entry, and to the RIT 2000 development project.
SUMMARY
- Part I describes RiT today and the background to the Development Plan. It explains the need for the modernization of RiT, and sets out the objectives for developing a RIT 2000 based on the patient’s perspective.
- Part II presents the specific details of the RIT 2000 development project.
- Part III deals with RIT 2000’s output in patient flows and the number of students, as a basis for estimating floor space and costs.
- Part IV discusses the progress and organization of the project.
PART I: BACKGROUND, PERSPECTIVES AND OBJECTIVES
BACKGROUND
UNIVERSITY HOSPITAL AND REGIONAL HOSPITAL
The University Hospital in Trondheim (RiT)is the regional hospital for central Norway, and functions as a general and local hospital for Sør-Trøndelag county. The regional hospital, Sør-Trøndelag Psychiatric Hospital (STPS) and the Faculty of Medicine make up the university hospital in Trondheim.
RiT has several national and regional specialities.
As well as patient treatment, it provides specialist training for doctors, research and teaching activities for the Faculty of Medicine, Sør-Trøndelag College (HIST), the Norwegian University of Science and Technology (NTNU), and the Norwegian College of Physical Education and Sport.
In 1995 RiT had 958 regular beds, of which 111 were allocated to units at the Betania and Munkvoll rehabilitation centres, and at Roros Hospital. In addition there were 38 specialist beds including incubators and high-dependency beds.
That year, RiT treated 40 330 patients, using 296 707 bed days. The average occupancy level was 91.4% for the year. The hospital has been filled to more than 100% of its capacity for long periods, with many patients sleeping in corridors.
Outpatient services have expanded considerably in recent years. In 1995 RiT treated 234 890 outpatients. Because of shortages of space and staff, the hospital was unable to meet the demand for outpatient treatment and day surgery in full.
THE FACULTY OF MEDICINE
When RiT started training medical students in 1975, it covered only the clinical aspects. Since 1993, a complete medical education has been available in Trondheim. The initial admission was 40 students a year, but this has subsequently been increased to 90. The new University Hospital is intended to accommodate 120 students.
The Faculty of Medicine hosts a number of students from other parts of the university, who work on their dissertations or theses within the faculty’s departments. The faculty provides extensive continuing and advanced courses in collaboration with the Norwegian Medical Association (Den Norske Lægeforening, DNLF).
The Faculty of Medicine currently rents an area of about 7 000 m² in the hospital, and has about 7 700 m² in the Medical Technology Centre, a total net area of 14 700 m². This includes areas used for teaching as well as research. In addition, students and staff use areas in the hospital. The size and location of the rented areas is not optimal in relation to their functions.
BUILDINGS AND FACILITIES AT RiT
The RiT buildings have a total gross area of 123 000 m². The hospital currently presents an image with many contrasts. Continual alterations and extensions to buildings that are sometimes old and impractical have resulted in long and circuitous internal transport. Tight budgets have made it difficult to choose flexible solutions. Buildings and facilities are starting to fall into disrepair because there is not enough money for adequate maintenance.
There are extensive problems with the working environment at the hospital, and the Directorate of Labour Inspection has ordered a number of modifications and improvements.
THE UNIVERSITY HOSPITAL AND ITS SURROUNDINGS
The hospital is in a central area of Trondheim with many houses. Many people work in the area as well, mainly in teaching and research.
EXTENDING THE HOSPITAL IN CENTRAL TRONDHEIM
RIT 2000’s idea competition in 1995 gave the county municipality a great deal of insight into the opportunities and the limitations involved in a total restructuring of the regional hospital on the Øya peninsula. An important prerequisite was that the hospital should remain fully operational throughout the period. In its assessment of the RIT 2000 design competition as a whole, the jury said: “The competition has produced a winning entry that convincingly proves that today’s RiT can be developed into a patient-focused university hospital of high quality based on the existing facilities at Øya.”
The 1995 municipal plan for Trondheim states that “From the point of view of transport policy and urban planning economics, it is a great advantage for the regional hospital to remain in its central location, close to public transport arteries as well as pedestrian and cycle routes.”
PERSPECTIVES AND GENERAL FEATURES OF THE DEVELOPMENT
Significant trends will influence the planning of RIT 2000:
- demographic changes
- changes in disease profiles
- technological development
- demands for greater patient influence
- higher expectations from users
- sharper focus on management and control
- the need for fundamental organizational changes
- changes in activities and responsibilities
Along with molecular biology, medical technology has made a great contribution to the advances in medicine of the past 30 years. The National Committee of Deans of Faculty and the University Council have recommended that Trondheim should become the centre for medical technology development in Norway.
The university hospital must train more doctors than it does today. There is a great shortage of both general practitioners and specialists, which is expected to worsen in the years ahead. Progress in medical technology increases the intensity of treatment during hospitalization, resulting in an even greater need for doctors.
OBJECTIVES AND KEY TASKS
The concept of patient-centred care includes both a holistic view of the patient and a production-oriented approach to the organizational structure of the hospital. The organization of services should be based on the needs of the individual patient or groups of patients. The objective is that as many of the services as possible should be provided close to the patient, by the staff that the patient has day-to-day contact with.
ASSUMPSONS UNDERLYING THE DIMENSIONS OF RIT 2000
The plans are based on the assumption that RiT will, generally, carry out the same functions and maintain the same distribution of activities in relation to the other services offered in the healthcare region and the county as today.
PATIENT BASE
The expected catchment population and patient profile in 2010 is based on a relative distribution of disease and of treatment needs in the population that is similar to the reference year of 1994. Some growth is expected in particular disease groups as a result of a changing demographic profile, with an increasing proportion of elderly people in the population, as well as changes in travel patterns. Diseases related to lifestyle and the environment, such as cancer, asthma, drug abuse and injuries, are expected to increase. Growth in the numbers of patients suffering from chronic diseases and mental diseases is also forecast.
AVERAGE STAY AND OCCUPANCY LEVEL
The average hospital stay is expected to last 6.0 days in 2010. For patients under observation, the figure is expected to be 24 hours, and four days in the Patient Hotel. The planned occupancy rate for regular beds is 85%.
ORGANIZATION OF TREATMENT
It is assumed that a systematic move away from in-patient treatment in favour of day treatment and the use of patient hotels will occur. Observation beds will be introduced to avoid unnecessary admissions, and the right conditions will be created for improved professional and administrative collaboration with the municipal health service and specialists outside the hospital.
TEACHING AND RESEARCH
Problem-based learning (PBL) forms the model for teaching at the Faculty of Medicine. This involves integrating teaching with clinical activities. Students spend time at the hospital from their first semester onwards.
With an intake of 120 students per year in the Faculty of Medicine and the same use of the university hospital by the other NTNU faculties as at present, there will be about 975 students in the hospital per year. Sør-Trøndelag College will have 272 students at RiT.
The increase in student numbers will create more positions for researchers and technicians.
The hospital’s in-house programme of continuing and advanced training includes specialist training for nurses.
OTHER ASSUMPTIONS AND GENERAL CONDITIONS
It is assumed that the regional council will function as the owner and provider of hospital services, and that the current division of responsibilities and roles between central and regional government will be maintained in relation to the financing and provision of university facilities.
PART II: RIT 2000 - A DEVELOPMENT PROJECT
NEW ORGANIZATIONAL MODEL
RiT is currently organized along departmental lines, determined mainly by the established clinical specialities. The services offered to the individual patient are split up into many disciplines and specialities, often produced in units outside the patient’s own department.
RIT 2000s organizational structure will follow the clinical service delivery chain. The resulting improvements in efficiency should bring substantial benefits.
RIT 2000 will be developed as a patient-centred hospital. It will be organized into six clinical centres, and each centre will contain bed clusters, outpatient clinics and day-treatment units, theatres and associated functions.
The centres will have access to medical service functions such as X-ray, anaesthesia and intensive care. There will also be six interdisciplinary centres serving the six clinical centres.
CLINICAL CENTRES
The six clinical centres at RIT 2000 will be:
- The Womens and Childrens Centre, covering gynaecology, obstetrics, paediatrics, paediatric surgery and some of the psychiatric services for children and adolescents.
- The Neuro Centre, with ear, nose and throat, ophthalmology, neurology, neurosurgery, maxillofacial surgery, rehabilitation, geriatrics and stroke unit.
- The Mobility Centre, organized primarily for orthopaedic, rheumatology and plastic-surgery patients.
- The Abdominal Centre, where internal medicine and surgery expertise are located together for treating gastroenterology and endocrinology patients. Related disciplines such as urology, nephrology and vascular surgery are located in the centre.
- The Environmental Centre, organized primarily around the oncology and haematology departments. This centre includes the disciplines of dermatology, as well as occupational, infectious and sexually-transmitted diseases.
- The Cardiothoracic Centre, including cardiology, cardiac surgery, thoracic surgery and respiratory medicine.
INTERDISCIPLINARY FUNCTIONS
The concept incorporates six interdisciplinary centres: the Emergency Centre, Laboratory Centre, Administrative Centre, Supplies Centre, Teaching and Service Centre, and Patient Hotel.
CLINICAL SUPPORT FUNCTIONS
The new organizational model will bring diagnostic and therapeutic services close to the patient, especially in the disciplines of radiology, anaesthesia/intensive care, physiotherapy and occupational therapy. This will be an operational model with decentralized services, but with central disciplinary units within areas such as radiology and anaesthesia to ensure coordination, standardization and monitoring of devices, and continuing education.
NON-MEDICAL SERVICE FUNCTIONS
In addition to a central supplies centre with central stores, the non-clinical service functions consist of:
- administrative services
- central kitchens
- waste management and sorting centre
- decentralized portering services
- service functions for patients and staff
- childcare facilities
- technical functions including IT.
The Administrative Centre will house the central administration of the hospital.
DEVELOPMENT MODEL
The planning concept highlights the importance of adapting RIT 2000 to Øyas town planning scheme. The major building programme has been divided up into smaller units in a coherent, decentralized facility, with an open grid structure to suit the urban surroundings.
The decentralized development model reflects the organizational model, with independent clinical centres and multidisciplinary centres - in principle, one centre in each block. The strategy enables development in phases, causing the least possible disturbance to patients and staff during the development period.
BUILDINGS
The buildings are simple and versatile. Most of them will probably be five storeys high.
PARKING
The hospital will have 1000 parking spaces. There will be 250 spaces in an underground car park beneath the road in Olav Kyrres gate, 500 in the hospital grounds and 250 at the old railway yard at Marienborg. The underground car park will be finished in 2000.
HELICOPTER PAD
The helicopter pad overlooks the Nidelven river, allowing for approach paths over the river in order to minimize disturbance to the surrounding residential areas.
