It is not the strongest or the most intelligent who will survive but those who can best manage change. --Charles Darwin
The ability to adapt has long been a foundational principle in science, and recognized in the business community as critical in order to remain competitive and to thrive. It's the basis for Liberal Education; defined as an approach to learning that empowers individuals and prepares them to deal with complexity, diversity, and change (The American Association of Colleges and Universities). The current healthcare landscape perhaps best exemplifies the context for this approach: the pace and scope of changes in medical practices, delivery models, regulations, technology, patient demographics and economic pressures require an unprecedented degree of adaptability. Architectural design must ensure a system infrastructure that can support multiple and changing uses: flexibility is the key.
Hospitals and health systems are increasingly forced to economize, at the same time as consumers expect and demand greater convenience. Architects are being brought into the planning process earlier than ever, to help ensure that new or renovated facilities provide the greatest possible degree of flexibility and efficiency in layout, function, and cost-effectiveness.
As genetic mapping starts to create treatments on the subcellular level, treatment modalities will change on a faster basis and less predictable manner than before. Designing for future change will become impossible to predict, so flexibility needs to be considered, more than ever, in all the work we do. E4H is at the forefront of this design trend, utilizing Smart Facility Design. There are various ways to achieve this, one example being the growing trend in some parts of the country of microhospitals, which include an emergency department, surgical and primary care, diagnostic, radiology, and labs, all within a small footprint and with a shorter lead time to build than traditional hospitals.
Another approach is to consider all the spaces surrounding expensive infrastructure. When a hospital of the present needs to enlarge or convert its facilities, planning for the near future should include positioning "soft space" such as administrative departments in immediate proximity to adjacent "hard spaces" such as operating rooms or intensive care units. This design scenario allows the expensive infrastructure to expand into the surrounding less expensive space if needed.
Designing standardized spaces is yet another option. They can be easily repurposed or converted from one function to another, from medical-surgical to intensive care as an example. In addition the use of modular components, removable partitions and furniture also answer the needs for future adaptability and flexibility. A modular partition system can allow for future change by reconfiguring partitions and services and increase the speed to market that plagues many of today's projects. Usually as planners we limit our thinking to the project at hand, but a study of the entire facility should be performed to maximize project dollars by providing flexibility for the future.
It isn't possible to anticipate every change in medicine, technology, care delivery, policy, or environmental and economic models that is to come. We can know with certainty, however, that there will be many. Architectural design that encompasses the widest possible range of these evolutions is the rational way to move forward.
Chip Calcagni
Chip is a managing partner of E4H Environments for Health, a nationwide architecture and design firm exclusively focused on healthcare. A practicing architect for over 27 years, Chip's experience includes the design of high-end medical and research spaces and laboratories for major healthcare institutions. He has led the design of cancer centers, inpatient beds, surgery centers, and emergency departments.
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