There’s a Lowe’s commercial that depicts a woman dashing around and adapting her space to various life stages just by ripping away one surface, rolling up another and (my favorite) sliding back a wall to reveal new French doors. While it would be beyond cool to have buildings adapt to change that easily, the commercial did get me thinking about all of the ways we can design for adaptability and flexibility that we either shy away from like emerging technology, or don’t pay enough heed to such as good planning strategies. Especially when designing a building that will continue to grow as well as adapt in use over time, like a hospital, agility is a crucial feature. But you already know that. The next step is to actually make that a priority in your next project:
Build yourself a cushion: Design to provide pocket shell space surrounding key growth areas to allow departments to expand without major renovation having to take place. There’s nothing worse than the unfortunate addition of ten thousand square feet or so on a single story to accommodate the urgent growth of a department. That bump on the side of your building will just create roadblocks to future, master planned (ahem) expansions. Also look at ways to organize the department to expand capacity through utilization and operational changes before you have to consider more built space.
Balance the peaks: Speaking of organizational strategies, it’s already common within a department to have flexible space, such as surgery bays that can be used for either prep or recovery. But what if you thought about departments less as silos and more as all part of the same set of resources? Those same perioperative bays could become an observation unit or ED overflow after surgery volumes dwindle down in the late afternoon.
Cluster for conversion: placing related functions together can allow spaces such as an interventional room to be converted to an OR easily in the future if volumes change. Again, this challenges prevailing notions of department and silos and requires thinking more about properties of a space and patient flows.
Modularize the Master Plan: Think beyond today’s project, even if you are just dealing with the need to expand one department right now. Immovable, difficult or expensive to relocate items such as structure, vertical circulation, shafts, stacked IT, Data and electrical rooms should be kept to the perimeter to allow maximum flexibility within the floor plate for reconfiguration. Also think about circulation as part of a master plan- expansion should extend the route, not distort it or create dead ends that are confusing to navigate. Modularized construction allows technology and infrastructure to be plug ‘n play, easily extendable and expandable.
Recalibrate your metrics: Too many organizations measure performance and outcomes by department, reinforcing competitiveness and policies that make one department’s numbers look good at the expense of another’s. Unless your goal is to have competition within the facility equal to or greater than the one you have with other facilities, this is a problem. Foster a more team-based, collaborative approach by setting institutional goals, not department based ones and challenge staff to determine ways they can work together to achieve them.
What does this have to do with design? Well, maybe one day soon, architects won’t be designing emergency departments, surgery departments and interventional departments, but instead patient intake areas that will route patients through a series of procedures leading to either their admission or discharge. Maybe one day there will only need to be one access point for patients where they can access all services conveniently. Maybe form can follow flow, not just a presumed set of functions.