THE HEALTHCARE ESTATE
services, and there are minimum clearance heights required for key technical rooms such as MRI and operating rooms. Also, column grids designed for cellular spaces can constrain the planning of healthcare departments, some of which require a range of specifically-sized spaces with large column-free areas. Structural floor loadings are far less for
offices than some of the spaces required for healthcare, particularly when locating imaging equipment. Ground and/or upper floors may require strengthening, depending on the services being considered, and vibration may well be a factor too. Other challenges include the typically limited space available to locate adequate mechanical and electrical plant and equipment for more highly serviced clinical/medical uses, while the vertical riser sizes necessary for the increased services distribution can eat up valuable floor space.
Retail space-related issues Retail has its own issues that need careful consideration. It is a typology that traditionally has very little external wall area. If you think of a retail space, it normally has a shop front (window), and behind this, deep plan spaces that lack natural lighting and ventilation. There are, of course, healthcare facilities that require ‘black box’ type conditions,
e.g. MRI and other imaging, and so lend themselves better to these buildings. This leads me to how, as part of the building assessment, you need to understand the healthcare design requirements for the types of ‘clinical’ space being considered, and the key relationships that they need with each other. Being able to carry out a ‘test fit’ based on sound healthcare functional and technical design knowledge is essential to determine the building’s suitability ahead of any major capital or revenue outlay. To help clients select suitable buildings quickly and efficiently for repurposing we use assessment criteria, built on our wide range of experience in healthcare and retrofitting. The criteria include standard planning grids that allow us to assess whether a building lends itself to a certain type of healthcare provision. For one client we have developed a specific ‘kit of parts’ of planning and technical elements to be used with property agents assisting in building search and selection. Ultimately, each of our healthcare
repurposing projects involves assessing a unique opportunity, building, and context – and our assessment criteria allow us to start piecing together that puzzle. For example, a current project we are working on involves taking a large department store and effectively transforming it into a small community hospital that brings
together a mix of facilities, including surgical, diagnostic, treatment, inpatient bedrooms, and outpatient clinics.
Testing the capacity Our healthcare knowledge helps us to quickly test the capacity and functional suitability so that the required departmental sizes and key relationships can be achieved to support the desired patient pathways – from arrival through assessment, diagnostics, treatment, recovery, and discharge/departure – all this while overcoming a relatively low floor-to-external wall ratio posing a challenge for planning inpatient areas. With a new-build project, there would usually be more flexibility in shaping these pathways, as you would have more control over the perimeter and plan of the facility. However, with existing buildings, you largely work with their limitations, and this is where experienced input is invaluable to determine if the right configurations of spaces and capacity can be achieved. Sometimes, even when using the
above strategies, it won’t be possible to accommodate everything a brief requires, so there is also an iterative and collaborative process of re-shaping briefs. This could involve working with the client to adapt the scale and/or mix of services the facility was originally intended to provide. Typically, a project starts with a
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October 2023 Health Estate Journal 101
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