DESIGNING FOR RESILIENCE Variable Intercept


Mandatory securing of beds for COVID-19 patients 0 = no


1 = yes


Additional purchase of ventilator 0 = no


1 = yes


Installation of negative pressure room 0 = no


1 = yes Variable Intercept


Increased accommodation capacity for COVID-19


patients 0 = ≤0.1


1 = >0.1


floors to ensure that the facility can accommodate as many infected patients as possible with minimal renovations during the surge phase of a pandemic. A flexible layout can enable hospitals to transform quickly from routine care areas to areas suitable for emergency response while providing safe patient isolation, where HVAC systems maintain air quality and filter out contaminants.2,3


Hiroshi Yasuhara


Hiroshi Yasuhara MD is a healthcare director, who takes a wide-ranging view of the whole healthcare system. He has served as President of the Healthcare Engineering Association of Japan (HEAJ) since 2019, and was Chairman of the Japanese Society of Medical Instrumentation (JSMI) from 2014 to 2017. Before starting a career as a healthcare director, he spent over 25 years as a surgeon and a Professor at Teikyo University and The University of Tokyo in Japan. He was Medical director of the OR Department at the University of Tokyo Hospital. After a successful career treating many surgical patients, he worked as director of Tokyo Teishin (Telecommunications) Hospital from 2019 to 2022.


Improved readiness A flexible design would also allow us to be ready for future pandemics. Although we cannot predict the exact nature of the next pandemic, future-focused layouts should include clinical zones that allow easy expansion, supporting shifts in service delivery and patient demographics. For pandemic preparedness, it is imperative to create hospital buildings that can accommodate a sudden increase in infected patients with minimal expense and disruption. Large organised structural bays with adaptable walls and floors could enable hospitals to ensure the admission of infected patients with minimal renovations once a pandemic occurs.


Clinical preventive practice COVID-19 patients Figure 3: Mandatorily


securing beds for COVID-19 patients


proved one of the most


effective ways to increase


the number of patient admissions.


28 Health Estate Journal May 2025 Vaccination


Patient healthcare Staff behaviour


Standard precautions


COVID-19 Pandemic


Treatment of


Estimated Standard Odds ratio Df P value coefficient


-3.58 2.25


error 0.51


0.56 (95% CI) 1 <0.0000 9.45 (3.16-28.24) 1 0.00006


Conclusions Promptly securing accommodation capacity for COVID-19 patients must be commensurate with infection risk. We should incorporate infection control into the architectural design of hospitals to ensure a speedy a response to events such as a pandemic. A flexible design could be an effective solution in preparedness for future pandemics.


References 1 Yasuhara H, Atarashi H, Nakajima A, Takashina M. Remodelling hospital facilities during COVID. IFHE Digest 2024; 33-36.


2 Humphreys H, Vos M, Presterl E, Hell M. Greater attention to flexible hospital designs and ventilated clinical facilities are pre-requisite for coping with the next airborne pandemic. CMI 2023; 29:1229-31.


3 Van Heel L, Pretelt M, Herweijer M, Van Oel C. Perspectives on assessing the flexibility of hospitals for crisis mode operations: Lessons from the COVID-19 pandemic in the Netherlands. HERD 2024: 17(1):34-48


4 Ma M, Adeney M, Long H. Functional settings of hospital outdoor spaces and the perceptions from public and hospital occupant during COVID-19. Healthcare 2021; 9(11), 1534. Available from: https://doi.org/10.3390/healthcare9111534


Infrastructural adaptation Facility management


Management of medical devices Bed management


Human resource management


During the last pandemic, hospitals used outdoor space


in the hospital premises by converting it to temporary areas to accommodate medical activities. This approach also assisted with the shortage of beds and treatment rooms, and heavy traffic in the earliest stage of the pandemic.4


1.35 0.4215 3.84 (1.68-8.78) 1 0.001 0.90 0.3341 2.46 (1.27-4.73) 1 0.007


Estimated Standard Odds ratio Df P value coefficient


-2.55 2.33


error 0.35


0.39 (95% CI) 10.24 (4.79-21.85)


Beow: Table 4. Logistic model for cluster episodes using stepwise procedure.


1 <0.0000 1 <0.0000


Left: Two logistic analyses. (Df: degrees of freedom; CI: confidence interval.)


Top: Table 3. Logistic model for increased accommodation capacity for COVID-19 patients using stepwise procedure.

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