Nature and Rate of Change in Clinical Laboratories

In response to the accelerating changes in the healthcare field, there has been a great deal of attention devoted to creating flexible designs and furnishings in hospital-based clinical laboratories. Even so, the hypothesis that hospital laboratories require a high degree of flexibility has been essentially untested. This study aims at confirming or negating this need for flexible designs and furnishings as well as providing guidance for addressing flexibility in future hospital laboratory constructions and renovations.

On a theoretical level, an environment-based approach to studying how buildings are used over time inspired this study. Building on Frank Duffy’s “Time-layered perspective” and Stuart Brand’s “Shearing layers of change,” the framework for this study was developed around the specificity of the hospital-based clinical core laboratory. The premise of the framework is that it is important to look at the multiple physical layers in the laboratory in relation to the internal forces (the activities that are housed in them) and the external forces (the technological processes, market forces, and healthcare practices) that define or influence the activities.

To explore the nature and rate of change in clinical laboratories, a multi- methodological approach employing both survey research and case study research was used to triangulate conclusions. Self-reported data was collected from a total of 240 hospital laboratory staff from the Clinical Laboratory Management Association’s (CLMA’s) membership list using an interactive web-based questionnaire. The sample represents a national cross section of clinical laboratories in community- based hospitals. Case study research was also used to explore three common laboratory typologies—a compartmentalized laboratory, an open/flexible laboratory, and an automated laboratory—with the intent of documenting specific examples of types of changes considered or completed by clinical laboratories.

Findings are organized in three areas: specific activities, technological processes and the physical environment. The physical environment is further divided into three physical layers: infrastructure systems, space plan, and contents in the laboratory. This research supports the premise of planning and designing clinical laboratory environments that are flexible, and versatile to support multiple laboratory applications. The goal of this study is to contribute to a body of knowledge that will help reduce the recurring problem of obsolescence in healthcare buildings by understanding the relationship between activities, the technological processes and the physical environment.