HOSPITAL DESIGN
The components of the FleXX Hospital prototype, demonstrating the FleXX hospital principles.
allowing faster interchangeability and adaptability.
on healthcare services will not be unique to pandemics. The current UK government has pledged billions of pounds to build, re-build, and upgrade, over 60 hospitals and increase funding to the NHS. It is vital that these healthcare design projects consider pandemic preparedness, as well as future readiness for long-term trends, to ensure the best result, as well as the best return on investment of public money. In the private sector, meanwhile, as witnessed in the US during this pandemic, reducing regular operation reduces income. Business continuity is vital for the health of the system, and the same strategies of ‘designing for flex’ in the short, medium, and long terms will benefit private health systems too. In the UK, any reduction in private capacity puts increased pressure on the already- stretched NHS.
It is important to note that the design of facilities was not the only issue in this pandemic: staffing levels were another strain. However, in the UK the ceasing of elective procedures was the single most impactful intervention for creating more beds and available care across the NHS. Next time – whether it is be a pandemic, or any other scenario that leads to a sudden increase in demand – we must be able to create the surge capacity when needed, without it being a detriment to other care provision.
Better prepared for mass-scale emergencies
So, how can hospital design be improved to make our healthcare facilities more prepared for mass-scale emergency scenarios, and how can this work with
48 Health Estate Journal March 2021
and within our current planning structures? At HKS Architects, we have been designing a framework for hospital design that enables a facility to be ‘future-ready’ – to respond to changes in medical processes and technology, shifting demands, and increasing use of telemedicine and remote consultations, over five, 10, and 20+ year periods. The FleXX Hospital challenges the notion that hospitals are fixed and static buildings. Its aim is to ensure that a hospital can continue to perform effectively for its full lifespan, and, as the needs of medical services shift, to provide for alternative programmes such as additional research and development space and ‘patient hotels’. With many general hospitals taking more than a decade to build – from initial concept to opening – the approach addresses the problems associated with rapid changes to service delivery, and the evolution of technology, which often mean that buildings are unfit for purpose even before they are completed. Initial briefs and Outline Business Cases (OBCs) are written to unlock financing from central government. They capture a definitive point in time, and therefore designs also respond to that frozen moment. This leads to buildings which are hard to adapt. Designing with flexible principles could enable change during procurement, and even the construction process ,with reduced cost implications. To achieve this, key principles for designing the facility are: n Strictly adhere to a regular grid – including key components such as operating rooms, consultation rooms, and all types of inpatient rooms,
n Pull the vertical circulation to the perimeter of the building – create a layout with the ability to modify or stop flows, and allow for cores to form new and alternative entrances/exits when the separation of flows for infectious/ non-infectious patients needs to happen.
n Pull the service cores to the perimeter of the building – vertical service distribution routes allow adaptation or maintenance per floor or per core without invading other areas.
n Standardise slab-slab heights as ‘High intensity’ and ‘Low intensity’ – simplify the rationale behind ceiling voids to reduce complexity in converting a space to another use in the future.
Room function easily changed This approach means that the interior of buildings can be much more effectively divided up, with the function of each area relatively easy to change. As adaptations are needed in the design, it is not too difficult to make them. By moving things like ventilation to the outside of the building you are not constrained, as any new risers – for example – are not going into the main building footprint. These principles were developed for a flexible hospital prototype that implements the framework over a long time period. What the past year and the COVID-19 pandemic have taught us is that hospitals also need to be able to respond far more rapidly – sometimes over a period of days – to provide surge capacity in beds, while breaking the circuit of infection through strict separation of flows. It is important to both maintain normal services, and to reduce the perception of the health service being closed, dangerous, or overwhelmed.
We used the FleXX Framework, which was developed in our original FleXX study
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