‘healthcare facility planners should be aware of future forecasts, in particular long-term ones, and prepare for it by being flexible
Flexibility and cost A good value-for-money healthcare facility needs to be flexible to allow effective adaptation to unpredictably changing circumstances. But, even though using flexibility could improve the value for money over the lifetime of the healthcare facility there is still no systematic approach to calculating the value of this flexibility. How much will flexibility cost? While choosing flexibility over customization may decrease costs in the long term, overbuilding may be a danger (see figure 1). Strategies to increase flexibility should be tempered with the following cost considerations: A project phased in over the long-term can be more expensive, as costs increase with each additional construction phase. Not only is there the cost of planning and designing for each construction permit, there are also the contractor’s mobilization costs as well as demolition and make-good-costs over and above the cost of construction itself The indiscriminate use of generically sized rooms could lead to increased programmed space and increased construction cost Healthcare facility planners and designers
who build flexibility into their facilities have to clearly demonstrate the economic value of flexible designs. Sometimes additional flexibility will come at an additional cost, which needs to be justified. However, flexibility can also help to save on initial capital expenditure.
Lifts
Public Health Security BMS
Space Layout Partintioning
Fire Protection Internal Finishes
Fabric/Structure Lighting Services Electrical Services HVACl Services IT & Comms
-0.5 0 0.5 1
Figure 1: The significance of costs incurred when modifying buildings services to cater to organization change. Possible range: 3 insignificant, 0 average significance, +3 significant. Source: “Designing for Flexible Building Services in Office-Based Environments”. CIBSE 2000
1.5
integrating Flexibility into the process The provision of a healthcare facility covers the entire working process from assessing the need for the facility to the successful use of it. It consists of many interdependent activities that could be grouped into four consequent stages: Planning, designing, constructing and commissioning. Even though all are important, clearly the crucial stage is the development of the planning stage. It is the time where all main decisions are taken regarding the best ways to use financial, manpower and facility resources and this is where flexibility should be integrated in to the building provision process. A frequent mistake made by the project
delivery team is spending minimal time in the planning phase and jumping quickly into the design phase. Unrealistic expectations, whether about cost, schedule or final outcome must be reconsidered before the design phase and real flexibility considerations should be taken into account. These considerations could be summarized as follows: The facility’s expected lifespan Building and site Provision of support services Diagnostic block and outpatient services Vertical vs. horizontal expansion
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