99 Ways to Flexible Hospital Design

By Dr Harm Hollander

Harm Hollander – eternal student!

Harm Hollander is a Principal with Conrad Gargett and has a desire to advance improvements in the health care environment. A Fellow of the Australian Institute of Architects, Harm has also lectured in Construction, Professional Studies and Design at various universities.  He has developed comprehensive skills in leading large projects from commencement to completion, working meticulously through brief, design and delivery challenges. As a recent graduate with a Doctorate of Creative Industries, Harm remains the student in seeking further improvement towards better design outcomes.

ORCID 0000-0003-0234-976X

Design flexibility and adaptability inside hospitals

Design flexibility inside a hospital building serves as an enabler for a health service to clinically progress.  The definition of flexibility has, however, had a disparate response from various researchers and a lack of a universal understanding has led to a restricted over-arching view.  This resulting level of comprehension directly affects a potential design.  Design, being a responsive solution to a set of issues, attempts to develop a synthesis from a wide range of inputs.  The more comprehensive the inputs, the more enhanced the design solution can be.  This research investigated the relationships of flexibility categories inside hospitals, recognizing the subject consists of physical solutions, human behavior, wider systems, accessibility towards ready-change and prioritization.  In the first instance, it presented a summarized, objective-based, open-ended, method of approaching flexibility inside hospitals.

The research framed and collated divergent existing knowledge.  This mapping formed a basis to respond to the future with innovative designs, by first allowing an understanding of both the objectives and techniques of flexible design.  The resulting publication,  99  ways towards flexibility inside hospitals, communicated the synthesized and collated catalogue of available methods.  Design opportunity could therefore follow as a response.

An example of design opportunity: Premanufactured volumetric construction

An often-cited constraint of a premanufactured module system is its tendency to be delivered with non-flexible, load-bearing walls or at least, with added bracing inside the partitions to face the harshness of transit. Any such hindrance towards future change to walls is certainly not flexible and does not allow the hospital to keep up with the health service. A health service nowadays is fast-developing, and the building which accommodates it needs to be responsive to the accelerating need for change. In some premanufacturing projects, this first barrier to flexibility has been overcome by providing an independent structural frame, rather than load bearing walls. The need for the additional bracing has also been overcome by making these elements redundant (or at least, relocatable) after the building modules are assembled on site. Designers must, of course, remember to clearly identify the expendability of the bracing so that it is clear to ongoing trades who open up walls in the future. 

However, hospital flexibility is more than the ability to move the internal walls.  Once the changeability of partitions has been tackled, there are many further adaptability opportunities in modular construction. These include:

  • Consistent presentation:  It is an advantage for hospital users to utilise repeated building elements. An example may be a uniform consulting room. The uniform presentation ensures familiarity and a universal procedure[1], reducing a risk of errors (in health care, a small lapse of attention can be significant). Prefabricated building units have a greater chance of keeping their elements similar because of their regular set-out and the factory technique embedded into the nature of production.  
  • Universal rooms[2]: Generic rooms which suit multiple functions. For instance, a bed room may be structured to suit a regular patient, mother, child or obese patient. Each function can swing with little alteration.  With the room being suited for multi- purposes at the outset, it is likely to be rounded to a size which suits the multipurpose function and this again coincides with modular construction where the regular manufactured component is also expediently rounded. The result of the premanufactured module technique is a planning layout which is more likely to serve multi-use universality.
  • Modular planning:  The technique allows zones to capture a number of varying suites or rooms. Examples may include a series of operating suites or imaging modalities. Unlike universal rooms, this technique is more an allocated floor allowance, requiring a level of construction to move from one state to another. The technique is significant because it allows evolving change to clinical needs. Again, premanufactured construction is more modulated by its nature and has a greater predisposition towards modulated planning allowances.
Approaches to flexibility

The informed and collated flexibility offered by prefabricated modular building systems represents the opportunity. Naturally, these advantages do not just fall into place. Designers will need to develop informed planning priorities to gain the benefits. Each new design should strive to improve the last. This process will incrementally increase value as well as the ability for hospitals to better face the future.

Innovative contribution to policy and practice:

Since global approaches to hospital design have substantial commonalities, this research contributes to enhancing the design of future universal hospital stage-sets. The potential provides founding information to design continued improvements in clinical outcome, efficiency, value and satisfaction.

[1] There is ongoing opinion on whether reverse handing or mirroring layouts present enhancements or hindrances.

[2] Some variances on this theme are loose-fit rooms, the ‘duffle coat’ approach (reference to a limited range of incremental sizes of a coat in a few select sizes, to fit all) and multi-purpose rooms.

This is the first in a series of posts that Harm will write for this blog about designing hospitals for flexibility and adaptability!

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