The role of design guidelines for accident and emergency facilities in South Africa

Abstract

This study is focused on design guidelines (DGs) for healthcare facilities development in South Africa which date to the apartheid era, the consequence of which is inadequate provision of healthcare facilities in urban areas where the poor black majority live and work. It aims to assess the role of DGs in the development and provision of healthcare facilities; and more specifically to assess the role of design guidelines for accident and emergency facilities (DGAEF) so as to make recommendations on how to improve their design and project development process. Informed and guided by philosophical and theoretical frameworks and a conceptual model of DGAEF, the empirical research was conducted between 2006 and 2007 using the following methodologies: questionnaire and interview surveys, floor plan analyses and observational studies. Owing to geographical, financial and time constraints, the study was restricted to two case study accident and emergency (A&E) facilities—Chris Hani Baragwanath Hospital (CHBH) in Soweto, Johannesburg and Pretoria Academic Hospital in Pretoria. The information gathered was analysed using descriptive statistics, content analysis, Space Syntax analysis, hierarchical task analysis and link analysis. A SWOT (Strength- Weaknesses-Opportunities-Threats) analysis was also conducted. The main findings are that there is inadequate policy attention to DGAEF update; lack of integration of the project brief, design and construction processes; excessive timeframes for project development; quality issues; and lack of post-occupancy evaluation (POE). Thus, the findings underscore the need to develop and introduce design quality indicators (DQIs) and key performance indicators (KPIs) in the general and specific design requirements in the DGAEF used for space design and provision, functional suitability and spatial relationships. The key recommendation of this research is that, to improve access to adequate A&E facilities and achieve measurable positive outcomes in healthcare services delivery in South Africa, the DGAEF should be updated based on evidence. To this end, research-based guiding principles, based on Planetree principles, are presented—which emphasise improved project communication approaches; understanding of value systems; participatory design processes; constant use and update of information systems through technology innovation; standardisation of the overall project development process from briefing through to POE; and institutional transformation based on societal change.