Flexibility and Adaptability: The Best Response to Healthcare Design

August 6, 2020

Written by: Stephanie Costelloe, Director of Healthcare, Asia; Managing Principal, Hong Kong, Principal


“Pandemic mode” will no longer be an optional “luxury” to be considered during the design process, it will be a compulsory way of thinking about how the hospital can quickly convert, physically as well as operationally.”

Hospitals around the world have weathered pandemics before. In just the past decade hospital design has been informed by lessons learned from SARS, MERS and H1N1, our hospitals have never been better equipped to treat people. Is there really anything more we can do?

More than a Numbers Game

The greatest challenge posed by COVID-19 was the sheer volume of patients that required treatment in the ICU. The number of ICU beds in a typical hospital is a relatively modest proportion of the overall bed number. It is calculated based on the maximum patient load on most days of a typical year, but is severely insufficient to deal with the patient surge or average length of intensive care required in the face of this crisis. Adding to the capacity challenges, even patients who do not require treatment in the ICU have to be cared for within an isolated environment with negative air pressure – meaning that the contaminated air in the room cannot pass to other spaces in the hospital. Such a specialized air ventilation system is only provided in a small portion of patient rooms – typically from five to 20 percent – rendering it impossible to safely accommodate all COVID-19 patients without increasing the risk of cross-contamination, most often to front-line workers who have suffered enormously during this time. Which brings us to a critical issue…

While the acuity of hospital capacity has been visible to all who have been reading or watching the news, an equally critical impact has been hidden behind the scenes. As hospitals responded to capacity challenges by converting every available space to patient care, staff areas have been reduced to an absolute minimum, exacerbated by the need to accommodate complicated procedures for gown-up/down to prevent cross-contamination.

So is the answer to increase the number of ICU beds? Add more specialized air ventilation systems? Expand capacity for staff areas? While these all seem very desirable today, they lock us into an assumption that the next healthcare crisis will follow the same pattern. Confidence in the face of uncertainty is always a risky strategy.

B+H’s Markham Stouffville Hospital Redevelopment

Flexible Design is not a Luxury

It goes without saying that the harsh reality of pandemics and other outlier events will be front and center in discussions about hospital design in the future, be that in the construction of new hospitals, or renovation and conversion of existing buildings. “Pandemic mode” will no longer be an optional “luxury” to be considered during the design process, it will be a compulsory way of thinking about how space can quickly convert and adapt – both physically and operationally.

In terms of permanent physical infrastructure, designing for future flexibility and adaptation is the best response to both the anticipation of another pandemic and the exponential change we are seeing in the evolution of healthcare. Advances in medical equipment, technology, treatments and patient expectations make the future of healthcare spaces almost impossible to predict with any confidence. Planning and designing spaces with a high degree of adaptability and “updatability” will enable structures to flex and respond to future conditions.

There is a misconception that such flexibility must come at a high cost, or compromise the “base” design solution, but in practice it can be as simple as the considered placement of corridor doors that allow for quick compartmentalization. Or providing rooms with a “soft” function that can re-purposed for staff gown-up/down at entryways to accommodate decontamination requirements.

The consideration of flexibility and adaptability in design extends far beyond the physical design of our designated hospital environments. More than any previous crisis, the COVID-19 pandemic has exposed the need to examine other building typologies in a new light. Consider how different our response would have been if buildings that serve other purposes had the ability to be converted speedily to provide additional capacity. Sports stadia transforming into screening and triage centers, exhibition halls providing large-scale patient care or recovery facilities, hotels and serviced apartments into quarantine facilities.

At B+H’s National University Centre for Oral Health in Singapore, patient waiting rooms are collapsible and can be converted into additional patient space as needed.

Designing Resilience into the Urban Fabric

Our greatest opportunity lies in building resilience throughout our urban fabric, harnessing other assets in our built environment, at various scales, to create a sustainable rapid response model.

Every building we inhabit has an impact on our health and wellbeing. The pandemic has forced all of us to re-evaluate the purpose of all our buildings – from our homes and workplaces, to airports, hotels, restaurants and public recreation spaces – and the quality of human activity we expect them to support.