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From an energy point of view the

‘outside/in’ approach is ideally suited to take into account energetic properties that are not directly related to activity levels of the hospital. Independent of actual activity levels most energy calculations that are needed can be performed. It is often via this approach that MEP/HVAC systems are designed and dimensioned. The typical energy use of a hospital as found in several case studies in STREAMER, is more related to seasonal changes than to changes in activity levels. This gives a good starting point for optimisation studies to reach the 50% reduction goal. To do this, we need the other approach. The ‘inside/out’ approach starts from the

lowest level; individual spaces and its use. It is based on the categorisation of units depending on the relationships, interdependencies and functional aggregative configurations of single spaces in each unit. In turn, the building typologies is categorised according to the schemes of relationships, interdependencies and functional aggregative configurations of units in each building. The same method is applied up to the district level. Starting from the technical properties of

spaces (single spaces, rooms, etc.) allows the definition of energy performance at the early stage of analysis, entailing a classification of spaces on the basis of energy-related features. Moreover, data on energy-related features of single spaces depend on a smaller number of parameters, which can be defined unambiguously. Therefore, the definition of energy-related features at spaces level allow a better control of the energy efficiency indicators at the highest level (building and district level). This would also be the starting point to

map the right configuration on MEP/HVAC- systems at the lowest levels and allowing in different steps in scale to also consider different MEP/HVAC systems solutions. On the other hand, the ‘inside/out’

approach jeopardises the definition of the functional aggregative configurations based on the proximity and the interdependencies between spaces and functions, as the aggregations of spaces with equal energy- related characteristics do not correspond to the units of a hospital building. In addition, the technical properties of the single spaces are not enough to define the overall energy- related characteristics at the units, building and district levels, therefore different parameters should be analysed at each level. Outside/in and inside/out approaches

generate two different design criteria for the classification of spaces that cannot be added up (Fig. 2). The outside/in approach could operate a

classification of spaces in terms of the layers approach at building and district level (level 3 and level 4). This classification does not strictly depend on energy-related features, rather it depends on functions. The classification of spaces is not homogeneous


Approach for Taxonomy Analysis of Space Units (SU)

Outside - In Approach Spatial features


SU “Hot Floor” Energy Efficiency required E1

SU “Hotel” Energy Efficiency required E2

SU “Office” Energy Efficiency required E3

SU “Industry” Energy Efficiency required E4

Inside - Out Energy-related features Su

Su Su

C1 C2 C3

Su C4

Space unit Class 1

Space unit Class 2

Space unit Class 3

Space unit Class X

Figure 2: Categorisation of spaces in the outside/in and inside/out approaches.

Space units - Classification based on Functional and Energy-related features

Patient Room

H/Pr +

Functional (F) Classification Typology = Hotel (H) SU = Patient room (Pr)

Patient Room


Energetic (E) Classification

Typology = Class 1(C1) SU = Operating theatre (Ot)


Patient Room


Energetic (E) Classification

Typology = Class 2 (C2) SU = Patient room (Pr)

Patient Room


Energetic (F) Classification

Typology = Hot Floor (F) SU = Operating theatre (Ot)

C2/H/Pr Patient


Functional and Energetic Classification

E/Typology = Class 2 (C2) F/Typology = Hotel (H) SU = Patient room (Pr)

Patient Room


Functional and Energetic Classification

E/Typology = Class 1 (C1) F/Typology = Hotel Floor (F) SU = Operating theatre (Ot)

Figure 3: Categorisation of spaces according to the crossing methods.

from the ‘energy-related point of view,’ entailing a difficulty in the definition of EeB Performance Indicators to be applied to the different levels of the typology models (District/Building/Units/Spaces) On the other hand the inside/out

approach starts from the analysis of the energy characteristics and performances of the single rooms at level 1. Therefore, classifying the spaces on their technical

‘There are two distinctive ways in which hospitals are designed – the ‘designers’ way and the ‘engineers’ way. These two ways need to be brought together.’

properties and energy-related features (e.g. Class of energy performance) could frustrate the definition of the functional aggregative configurations based on the proximity and the interdependencies between spaces and functions. Aggregation of spaces having the same energy-related characteristics could be not corresponding to the units of a hospital building. STREAMER proposes a design methodology based on the combination of these top-down and bottom-up approaches to typology, with the aim of adopting them in parallel. A method for analysing and classifying the spaces (level 1) compatible with the two approaches can be implemented crossing the criteria of classification (the one based on the functional categories of the Bouwcollege method and the one related to the energy features). STREAMER is taking the units (level 2) as

the common denominator for the definition of the typology model. The units, i.e. the groups of spaces characterised by their homogeneity and interdependencies between functions hosted (wards, operating theatre





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