Space planning
multi-purpose room. My concern is that, in the pursuit of cutting space, we are also cutting functionality; are we asking too much of a multi-purpose space, and do we expect the environment to deliver too many differing functions?”
Zoning and built-in flexibility Building on the approach taken by the DH Healthcare Premises Cost Guides (HPCGs), which link to the ADB, Health Building Notes, and Health Technical Memoranda, clever use of zoning could improve hospital design, increase inherent flexibility, and reduce lifetime costs. DH cost guides for each specialty are produced as an overall cost/m2
, and are based on a new zoning
approach of public, staff, and clinical zones. Designing facilities with in-built flexibility within zones allows for efficient, straightforward, adaptation over time. Good healthcare facility design
integrates functional requirements with the human needs of its users. Hospitals inherently comprise different functional zones and departments that take into account the workflow of inpatients, outpatients, visitors, staff, and equipment. Traffic is segregated according to patient type, sterility degree, urgency, and other criteria. Healthcare facility zoning can also be
used to control the movement of users and equipment in order to segregate ‘clean’ and ‘dirty’ traffic (and therefore create restricted zones accessed by staff only). Zoning assists in keeping inpatient and outpatient movements separate, and in providing functional proximities and departmental relationships and adjacencies that optimise staff and patient movement.
Infection control Zoning for infection control factors can define activity spaces as low/medium/ medium-high/high risk (from offices – ‘low’, to intensive care units – ‘high’), allowing planners to identify appropriate flows and adjacencies, and eliminate unnecessary risk of contamination. DH Healthcare Premises Cost Guides (HPCGs) provide a cost/m2 for building and
engineering services costs, calculated by costing exemplar briefing schedules in detail. Spaces are differentiated such that public, clinical, and staff spaces, are recommended to be grouped together to create separate zones within facilities. A vital issue in enhancing unit flexibility is ensuring the continuing ability to provide functionally appropriate facilities as operational changes demand, say, more clinical support space. Grouping similar types of space in separate zones enhances long-term flexibility. The zoning approach very much encourages in-built flexibility at room level too. DH guidance states that consideration
should be given to forms of construction, storey heights, structural grid, floor
In an era of increasing patient choice, the environmentmatters, and can ultimately impact on a provider’s financial viability.
loadings, fire stair, and riser locations etc which, in conjunction with a modular approach to room sizing, can result in buildings that have increased residual value, should needs change in the future. A loose-fit, non-bespoke approach to space planning will lead to flexible buildings that are suitable for conversion to alternative uses. This is particularly useful in schemes where building costs may not be fully recouped during the lease period, or where significant reductions in service provision are anticipated.
‘modular approach’ It follows that Health Building Notes recommend adoption of a limited number of room sizes that will lead to building layouts that use economic structural spans, stack efficiently, and allow for natural cross-ventilation. As well as encouraging simple layouts of rooms around a central corridor, with standardised building spans and grids, the modular approach can be extended to provide additional benefits, including off-site fabrication for elements such as standard plumbing modules (which Capita Symonds used for theWhiston Hospital and St Helens Diagnostics & Treatment Centre projects). Other ‘flexible and adaptable forms
Extending the Simon Corben
of construction’ recommended by the DH include: acoustically-treated folding partition walls; changeable signage; mobile, rather than fixed, equipment and furniture; wireless technologies; use of framed construction to allow partition walls to be altered; installation of surface- fixed trunking; provision of adequate spare plant and service access space to provide sufficient capacity to accommodate future M&E expansion and equipment replacement, and developing a modular approach to planning and construction. We are currently exploring innovative,
proactive ways to take the HPCG and Health Building Note zoning approach
Simon Corben, business development director in the Capita Symonds Health team, has worked both in the public and private sectors. He joined the team in 2003, and has since been responsible for a team of project managers, healthcare planners, and strategic and business analysts, while continuing to work for clients on a consulting basis. Since 1993 he has been responsible for the delivery of a wide range of projects – ranging from the restoration of historic buildings, to ‘high-spec’ clinical, diagnostic, and surgical units, and other modern-day health facilities. He has good experience of, and has developed skills in, estate strategies, business cases, due diligence, town planning, construction project management, and many other areas of the development and approval process. He is currently providing strategic
support to a number of high profile NHS Trusts within the London area. In addition, Simon Corben continues to develop his skills as a medium-risk gateway reviewer, including for the Department of Health.
Health Estate Journal September 2013
31
forward.We believe it will enable better strategic planning for long-term sustainability and flexibility, and should provide schedules of accommodation in terms of types of spaces suitable for a wide range of activities, enabling adaptations over time to make best use of existing adjacencies, engineering, communications, and access provision. Most importantly, it will improve the experience of patients, visitors, and staff, not just in the here and now, but over the lifetime of healthcare facilities.
References 1 HaCIRIC project. Optimisation of spatial layout in healthcare facilities. The Health and Care Infrastructure Research and Innovation Centre. (
www.tinyurl.com/nz4ob3d)
2 Harvey TE Jr, Pati D, Evans J,Waggener L, Cason C. In: George Elvin ed. AIA Report on University Research Vol. 2. Washington, DC: American Institute of Architects, 2008.
Courtesy of the NHS Photo Library
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