Developing a Flexible Healthcare Infrastructure

Why: Healthcare infrastructure typically has a lifespan of 50-100 years or more. A fair number of hospitals in the Eastern United States are still operating at least partially in facilities constructed in the early 20th century. A significant number of facilities still in operation today were built during the Hill-Burton Act funding cycle for hospital construction beginning in 1946. The changes in healthcare that have occurred over the past 50-100 years are immense and how healthcare is delivered today could not be imagined when many of the healthcare facilities currently in operation were conceived and built. At the same time, the rate and scope of change in healthcare is rapidly accelerating and it is impossible to imagine what, how, and where healthcare will be delivered over the 50-100 year lifespan of the infrastructure being built today. Therefore, it is even more important that the healthcare infrastructure built in the future is designed to flexibly accommodate changing needs, including both those that can be anticipated and those that cannot even be imagined.

What: > The white paper’s recommendations come partially from the team members and also the literature and best practice review. The fundamental principles outlined follow a conceptual framework laid out by Steward Brand, organizing building elements in such a way as to accommodate shearing layers or change. This means designing and positioning the most stable elements, i.e., the structure; building envelope; primary mechanical, electrical and plumbing (MEP) systems; and primary circulation in such a way as to not impede the more frequent change of volatile and dynamic elements (the space plan of functional areas and FFE). Another way to visualize this is through a systems separation framework that organized these elements into three basic levels: System Level 1 – base building; System Level 2 – tenant upfit or space plan; and System Level 3 – fixtures, furnishings and finishes.

How The process consisted first of identifying a team of industry leaders and subject matter experts that represented a cross section of healthcare industry constituencies, including healthcare provider organizations; design and engineering professionals; and construction industry professionals with extensive and diverse experiences in healthcare facilities operations, planning, design and construction. A preliminary literature and best practice case study review was
initiated and several foundational readings were recommended to the panel. This was followed by the preparation of an interview questionnaire. Interview questions covered the definition of flexibility; the forces that drive the need for flexibility; where they found that change occurred In healthcare infrastructure and to what degree; recommended strategies for achieving flexibility; and tools and processes for implementing a flexible healthcare infrastructure. The facilitator interviewed team members individually by phone. The findings from the interviews, literature and best practice case study reviews were then compiled into the white paper.