September 14, 2018

Flexibility and adaptability not only play an integral role in improving performance across the healthcare design spectrum, but also in providing value-added design to our clients. Given the ever-changing healthcare landscape, it is vital that hospitals and outpatient facilities are designed to be both flexible and adaptable to support future growth and change.

I recently had a “water-cooler” conversation about the subject with my colleague Margaret Sutton, a senior architect and healthcare principal at Gresham Smith. In today’s post, I share some highlights from our discussion.

Margaret Sutton (MS): How would you explain the importance of designing healthcare spaces for flexibility and adaptability to the layperson? 

Pat Burke (PB): I think I’d start with the adage: “The only thing constant is change.” That old saying is especially relevant when it comes to incorporating flexibility and adaptability into the design of a healthcare facility—whether it be a midsize hospital or a freestanding emergency department. Of course, we can only hypothesize what tomorrow will bring, but it’s critical that we design healthcare spaces with an eye on the future and that means planning for change.

I think perhaps the most important question to ask is: What are the ramifications if you don’t design for flexibility and adaptability? And nine times out of 10, the answer is cost. If a hospital or outpatient facility hasn’t been designed to grow and adapt to inevitable change, it can become so limited in its ability to accommodate future needs that the operator simply can’t afford to do anything about it.

(MS): Lean design is especially useful in helping a client plan clinic spaces that are flexible and adaptable to change. But there can also be a downside. In your experience, what is the danger of designing too tightly around a specific process in a healthcare space?

(PB): There is obviously a genuine need—and almost a sense of urgency—to weed out any potential waste, which is at the heart of the Lean design approach. When you take that to an extreme, however, you also take out the flexibility for future change and how a healthcare facility might accommodate that change.

Over the past year, I have frequently heard the term “loose-fit programming” in association with designing spaces so there is adequate “soft space” between, around or within so certain components can be manipulated or relocated in the future. To demonstrate the theory behind this trend, I like to compare it to having a custom-tailored suit—it looks great, but only if you maintain your current weight. Conversely, if you buy a suit off the rack, it might not look quite as good, but it has more adaptability as you gain or lose a few pounds. The same principle applies to loose-fit programming.

(MS): To that analogy, if you design too tightly to current standards, you can get boxed into a corner very quickly. And it could end up costing the client more money than they were initially saving.

I think it’s important to note that planning for future growth isn’t just limited to the inclusion of additional hospital beds or clinic space somewhere down the line. Everything must grow when a hospital grows, including support services. And you must build in that flexibility from day one.

(PB): I also think it’s vital to have candid and intentional conversations with the client from the onset regarding their expectations. It is our responsibility as designers to help our clients understand the implications of the long-term use of a building.

(MS): Knowing that future changes are inevitable, I believe that a hospital must have a master plan that has a clear business driver.

(PB): Agreed. And when a hospital talks about a master plan, the first thing an architect wants to know is the client’s strategy. That’s because a facility master plan is typically uninformed. At the end of the day, a master plan must be responsive and supportive of an institution’s strategic plan. And the strategic plan ties back to an organization’s short- and long-term goals for their facility.

(MS): A master plan must also support performance excellence. It achieves this by considering leadership’s goals, vision, strategy for growth and financial stability as well as operational efficiencies, the needs of customers, the workforce and key stakeholders. It’s a 5 to 10-year roadmap that guides the development of the campus. When developing a campus master plan, it’s important to understand healthcare trends, the demographic of the market, opportunities and challenges for growth, and the space requirements of the services to be provided.

Too Great a Cost
Ultimately, healthcare systems are shifting from the care management of individuals to the health management of populations. This shift is concurrent with declining reimbursements for services provided. If these healthcare systems cannot adapt to accommodate structural changes in our healthcare model they will undoubtedly fail, just as healthcare facilities not effectively planned for change will become outdated and dysfunctional faster than those designed for flexibility and adaptability. And this is a cost we must all work tirelessly to avoid.