HOSPITAL DESIGN
pandemic patient care, while allowing two-thirds of the regular beds to continue operating as normal.
Obviously, there is no department that a hospital could just ‘do without’, but when planning this facility, we also considered which clinical activities you would not want interrupted based on their treatment of long-term health risks and conditions. These included Obstetrics, Emergency Surgery, Mental Health, Cardiac Emergency, Renal Dialysis, and Oncology. These departments would need to be planned and distributed in such a way that they would not be impacted by the zoning of the facility.
While any healthcare estate developer’s dream scenario is a cleared site, we recognise that the chance to build from scratch is not the reality in most cases. Much of the billions of pounds pledged by the UK’s government is not going toward brand-new builds, but rather towards upgrades and developments of existing hospital buildings. This framework and its principles are designed for maximum adoptability.
Transcending differences The success of the FleXX approach does not depend on it being designed into a hospital from the foundations up; it can still be effective when applied across estates in various degrees of completion, and to those that are undertaking reviews into their current services and operations. The principles should transcend country, policy, and budgetary differences. The approach goes beyond the architecture and design of a healthcare estate, and into every aspect of operations and management. Even a light touch can still benefit Trusts and hospitals: if you are looking to upgrade your air systems, what small action could be taken to make it safer or easier to segregate? How could you redesignate service distribution routes to ensure they are less invasive? Can you reshape your facility’s entrance and egress routes or external spaces to allow for better threshold protection?
Just as sustainability or patient-centred care have previously been the measures of new building and operation standards, pandemic and ‘mass emergency’ preparedness needs to be the lens through which all developments and reviews are now seen. We are in the process of developing a costing report to enable Trusts to adopt the FleXX Hospital framework, principles, and Surge Scenario considerations, in a more modular way, and we would welcome conversation with Estates managers and Trusts to help us continue our work.
The strategies and modes of operation set out in our FleXX Hospital: Surge Scenario provide a guidance document
and a toolkit of ideals to support the aim of adaptable functionality in healthcare estates, but this is not a finished project. The more we look into it, the more prepared and eager we are to deal with the next set of questions that come out of stakeholder engagement or design briefings.
Need for a co-ordinated approach It’s also not something we can make happen on our own. We are well aware that for change to be successful, corresponding work to uniformly improve lengths of stay, reduce discharge delays, and increase staffing resources in hospitals across the UK, needs to happen to ensure that we are consistently operating at less than the current 90% capacity. This will require a coordinated approach at all levels of community and healthcare across the country. However, in 2020 the ‘great event’ happened, and very few of us were ready for it. We cannot miss this opportunity to learn from it now. As a generation of designers and the wider healthcare community, we must re-think our approach to building design and infrastructure, accelerating it beyond where we are now, and into a future we cannot see. We must plan for the un- plannable.
Only in being flexible can we give ourselves and our future generations a fighting chance against whatever the world throws at us.
See panel on the previous page for a case study of how this has been applied at Baptist Health Hamburg Campus in Lexington, Kentucky, USA.
References 1 Gallagher, J. Covid vaccine update: When will one be ready? BBC online, 11 January 2021.
https://www.bbc.co.uk/ news/health-51665497.
2 Unwinding the National Covid Service: Why the NHS will not be back to normal for a very long time. The Economist online. 23 May 2020.
https://tinyurl.com/y2ujnfte
3 Pressure points in the NHS: September/October 2020 analysis online. British Medical Association. Updated 20 January 2021.
https://tinyurl.com/y2d8hzbv
4 NHS England. Adjusted: Monthly A&E Time Series, July 2020.xls.
https://tinyurl.com/y3eg2m65
5 Office for National Statistics. Deaths registered weekly in England and Wales, provisional. [Internet]. 2September 2020.
https://tinyurl.com/y48vjjjw
6 Centre for Advanced Design Research and Evaluation. FleXX: A Study of Flexibility (Contagion Special Edition). [Internet]. 2020. Available from:
https://www.cadreresearch.org/ flexx-contagion
Dan Flower
Dan Flower, ARB, is a Principal and Design director at the HKS London office. Combining creativity and design thinking with a sophisticated approach to material and technical solutions, he brings over 15 years’ experience to his role as design lead on major EMEA region projects. He has applied his knowledge of both architectural design and masterplanning to a variety of sectors, including a number of health projects, and is dedicated to delivering innovative, efficient environments for patients, visitors, and staff.
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Sophie Crocker
Sophie Crocker, ARB, EDAC, WELL AP is an architect and Health Design researcher at HKS. She helps produce healthcare designs, and assists in conducting and coordinating cross-sector research from Europe, the Middle East, and North Africa. A former HKS Health Fellow, she views architectural design as a public service that can improve people’s health.
March 2021 Health Estate Journal 51
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