ARCHITECTURE & DESIGN
Designing more resilient hospitals for the future
Following the coronavirus pandemic and the rapid construction of an emergency hospital in Wuhan, Burkhard Musselmann, Managing Principal and healthcare architect at the UK office of architectural practice, Stantec, and Maria Ionescu, senior healthcare architect at the company’s Los Angeles office, discuss ‘what we’ve learned from Wuhan, other locations, and the UK response’. They also examine how we can take those lessons and the existing NHS infrastructure to build resilience into healthcare environments that offer scalability and flexibility for times of extreme need.
There is an ancient Chinese curse that says ‘May you live in interesting times’, and, as we’ve seen this year, there is a reason why the phrase is termed a curse rather than a blessing. Since the first cases of COVID-19 were reported in Wuhan, the spread of the coronavirus, and its escalation to the level of a global pandemic, mean that the times we live in have never been more ‘interesting’, or more worrying. At the time of writing, several European countries, including the UK, are in lockdown, the global financial markets are plummeting, and both the human and economic costs of the virus worldwide are still growing. Hopefully, by the time of publication, we will have moved beyond the ‘What can we do about it?’ phase towards a ‘What can we learn from it?’ approach to embedding a new culture of resilience in our healthcare estates. There will be a lot of lessons in terms of the politics, science,
Triage
Virtual care consultation
Home care and outside hospital facilities
and economics involved, along with questions of operational resilience and managing demand for services at a time of crisis. There are also lessons to be learned in how we design and build hospitals to cope with the curved balls that life can throw at us, including how we go about adapting the assets we have, alongside building new healthcare facilities and mobilising field hospitals.
The interesting times we’ve lived through this year not only include the global pandemic, but also storms and floods. Although casualties from these extreme weather events were, thankfully, minimal, they were a reminder that global warming will create a need for a responsive healthcare system that can adapt and answer both routine requirements and a range of urgent needs. We cannot predict the future, but, through considered design best practice, we can
ensure that we equip hospitals with the agility required to respond quickly and effectively to unexpected and severe patient needs.
Learning from Wuhan
The COVID-19 pandemic is not the first time we have seen buildings complete construction in record time; China’s tiger economy has depended on a rapid growth in infrastructure and the built environment. The country has also demonstrated its ingenuity and resourcefulness with showpiece rapid build programmes before. This time, however, rapid construction was not about unlocking commercial potential or creating a platform for global PR; it was about saving lives. In a city of 11 million people, within a province of 58 million, there was an urgent need for hospital beds, and, apparently, a plan in place not only to build that
Triage compartment
Walk-in entry
Triage
Public health preparedness clinic
Isolation compartment Negative Quarantine
Fever entry
Positive Triage
Decontamination and triage
outside facility
Ambulance entry
Hospital Figure 1: Flow & compartment zones, as per the Singapore model. September 2020 Health Estate Journal 57 Buffer Zone
Trauma resuscitation compartmentation
Contact Buffer Zone Sub zone Sub zone
Treatment cubicles
Buffer Zone
Isolation overflow
Resuscitation overflow
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