HOSPITAL DESIGN
Versatility
I can do different things in it
Modifiability I can change it
Convertibility It can change
Scalability
It can grow or shrink
Flow
Air, resource and people flow
Easy
Difficult Easy
No physical modification New
functionality Minor
modification with movable components
Difficult Easy Major
modification with
infrastructure changes
Difficult Easy
Difficult
Expand/ contract with new or temporary construction
While in the typical FleXX Framework these attributes might occur sequentially over years, in a pandemic situation they could work concurrently and cyclically, rather than on a linear basis, over days and weeks.
and further evolved in the FleXX Contagion report6
released earlier this
year, and applied a Surge Scenario, to examine how these modes of flex need to operate in a pandemic situation. Our FleXX Hospital: Surge Scenario model explores the optimum design of a hospital for pandemic preparedness. It has been compiled using real-world findings from the current pandemic, informed by resources for healthcare facilities from the Centers for Disease Control and Prevention (CDC) and Public Health England (PHE), and is based on learnings from the rapid adaptations that have been made to facilities in the UK and US since spring 2020.
Key attributes
The key attributes enabling the framework are Versatility, Modifiability, Convertibility, and Scalability. Under the Surge Scenario we added a fifth element:
Flow, as the consideration of air, resource, and people – critical circuit breakers in a pandemic situation. While in the typical FleXX Framework these attributes would happen over different periods of time, in a pandemic situation they could all work concurrently, short term, and on a cyclical, rather than linear, basis.
As well as the FleXX Principles and Framework, we established three Pandemic Considerations which will act as circuit breakers for contagion:
Protecting the threshold
In a pandemic the thresholds of space become critical protective barriers. Thresholds appear at the site boundary, the building envelope, and the infectious or ‘red zone’ entrances. Each of these thresholds must be carefully
choreographed and controlled to ensure the safety of staff, patients, and the public. They are the first ‘circuit breakers’ of
contagion. It is important to note that ‘protecting the threshold’ will look quite different for different viruses – depending on how contagious they are, and the method of transmission. The key is to design in these buffer zones, and prevent patients from being deterred from attending the hospital.
Separation of Flows
A hospital needs to be able to separate people and resource flow through distinct entrances, as well as horizontal and vertical circulation within the facility, without impacting access to Red ‘infectious’ and Green ‘non-infectious’ Zones. By separating the flows, ‘circuit breakers’ of contagion are implemented, and the spread of infection within the building is restricted, allowing routine activities in the Green Zone to continue. During a pandemic of an infectious disease, separation of air flow is also critical. The HVAC system must be designed to provide protection from pathogen circulation, eliminating risks from recirculated air across Red and Green Zones. Air flow systems must also appropriately filter the air of harmful pathogens and pollutants.
Signposting risk and required behaviours
The FleXX Hospital prototype in peak response to a pandemic surge, with the hospital divided into ‘Red’ pandemic, and ‘Green’/non-pandemic-related care, and with all pandemic principles enabled.
Wayfinding and signage are always important in a healthcare environment, but in a pandemic period it is even more critical that users of, and visitors to, the facility must be clearly and knowledgably guided around and through the building. A simple ‘traffic light’ system would clearly denote the three areas: Green – non-pandemic-related care, Amber – threshold between conditions, and Red – care and triage of the infected. In a thoroughly pandemic-prepared facility, the locations of these zones at different stages of the pandemic would be known ahead of time, and could improve the ad hoc nature of signage used during this pandemic.
March 2021 Health Estate Journal 49
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