Imagine having cut the ribbon marking the opening of a new, state-of-the-art hospital in 1957. In your wildest dreams, could you have anticipated the social, clinical, technological, or economic change that would drive the operations of that same hospital today? Similarly, when you cut the ribbon on a new, state-of-the art hospital today, can you imagine what will drive health care in 2057?

Yet imagination is exactly what we need if we are to be successful in planning and designing a healthcare facility that will be built to last for 50 years—imagination and a physical planning solution that enables radical adaptability in the future. One solution is application of a universal grid planning module to the design of a healthcare facility that can be readily adapted from one type of facility to a radically different type, say, an inpatient hospital to an outpatient or research facility. Such a concept can not only assure future adaptability but reduce initial capital investment, offer huge speed-to-market options, and actually enhance design freedom.

While there is nothing new in the concept of modular planning per se, such concepts have rarely yielded a compelling advantage and have generally been rejected by the design community as utopian dogma. Likewise, modular theory has historically derived from building system metrics rather than functional or space planning criteria and often inhibited change more than enabled it. Universal Grid Theory (UGT), as advocated by this argument on the other hand, is in fact a concept developed around all known current state-of-the-art physical and functional parameters for over a dozen prevailing space prototypes in the health sciences environment.

Back from the future

Strategic facility planning essentially requires that we address three questions:

  1. When is the future?

  2. How do we imagine it?

  3. What does that mean for the way we design facilities today?

Perspective on the “when” question most easily derives from two viewpoints. One, major capital projects in institutional environments often take as much as 10 years from vision to fruition. Frequently, many—if not most— constituents who stimulated the initiative are gone by the time it is delivered. The “program” as such is, therefore, an artifact of previous leadership, based on aging data and developed around technologies that—in and of themselves—have half-lives of 10 years or less.

Yet, we characterize capital investment in bricks and mortar as “50-year investments,” and, indeed, in the absence of the concept of disposable buildings (the topic of another theory), institutional buildings are rarely mothballed before as many as 10 decades. Thinking in terms of anything less than 30 or 40 or even 50 years is simply reneging on our responsibility for both stewardship and leadership as professionals.

The “how” part of imagining the future is a bit more complex. We know that four main forces create change in the health sciences environment: (1) population demographics and patient demand; (2) technology, both medical and information; (3) basic science, which drives the development and evolution of technology and treatments; and (4) resources, including financial, human, and ethical (the latter perhaps the more esoteric but arguably most provocative: e.g., issues of access to care, regulations, efficiency of care delivery, healing philosophy environment). It is our investment in informed perspective on these variables and their interrelationship that fuels our imagination and our exploration and development of advanced prototypes, new processes and concepts like UGT.

Consider the issue of financial resources, for example. In the United States, the average annual financial expense related to healthcare operations breaks down roughly as follows: facilities—the “sticks and bricks”—accounts for between 7%-8%, whereas labor represents 57%-58%. Therefore, if we can plan and design a building that reduces labor expense by 15%, the building is essentially “free.”

While this is certainly an oversimplification, it helps drive home the point that planning a new health facility can be viewed as a catalytic event that requires our examination, not only of the impact of change on the structure, but also on operations. Even the most creatively designed traditional facility is fairly static—the walls, floors, and ceilings are not readily or inexpensively moved. So the real potential for adaptability arises from the ability to reengineer and improve the processes that occur within those boundaries.

Transformational planning

Exploring the impact of change, and how the healthcare facility and organization can respond to it, are best explored during an expanded, research-based programming phase. Moreover, when owners and the planning/design team alike come to the table armed not only with research-based forecasts about future opportunity and obsolescence, but also with imagination, aspiration, optimism, and mutual trust, it is the beginning of transformational planning. And it is the first step toward planning and designing a healthcare facility that is responsive to change throughout its anticipated 50-plus-year life cycle.

Ultimately, the success of a healthcare facility, both today and in the future, will be measured by its ability to contribute to improving quality and/or reducing cost—indeed, these are the two fundamental measurements of success in the development of any institutional project. Measuring success requires a baseline against which to measure results. Even more important, it requires that the owners and their design team consider whether the building they are about to design enables users to reengineer and improve the way they do things.

Radical adaptability

One solution to the elusive goal of “future-proofing” a healthcare facility is the application of a universal grid planning module (figure), which has been under development at this firm for approximately three years. The universal grid planning module comprises an optimum set of vertical and horizontal dimensions for the structural bay of a building. This module has been used as the building block, if you will, for prototypical designs of a wide range of healthcare facility uses, including multiacuity inpatient nursing care, ambulatory care, wet-bench research, clinical research, offices, surgery, and interventional radiology. In the process, it has been vetted for engineering soundness and efficient, cost-effective construction. The result of this R&D effort is a physical planning module that allows for almost infinite adaptability. Moreover, its application can help to reduce by 60%-80% the typical 10- to 18-month time span from planning to groundbreaking.

An example of the universal grid planning module

This is not to say that every healthcare facility designed using the universal grid planning module will look like a variation of a big-box warehouse. In fact, in applications of the universal grid in a half-dozen current healthcare projects across the country, it has proved to be responsive not only to a range of uses, but also to a range of locations, sites, and aesthetic considerations.

At Washington University Medical Center in St. Louis, ground was broken in less than five months for a new 750,000-square-foot biomedical research facility based on the Universal Grid Theory approach. The project will contain major hospital ancillaries and state-of-the-art basic research labs. It will be easily convertible to translational environment, ambulatory, and even acute care in the future. A new Cancer Hospital for Cleveland Memorial Hospital is UGT based. A new 600,000-square-foot “Center for Complex Medicine” for a major Midwestern academic medical center includes 100,000 square feet of surgical and interventional platform floors below multiacuity patient rooms in a project that will set the bar in this new building paradigm. All of these projects and others reflect unique site, programmatic, and aesthetic vocabularies while all reflect the unique adaptability of the UGT concept.

Continuing research and development of the theory is exploring pre-engineering and prefabrication options, as well as standardized infrastructure options for structure, vertical transportation, and systems distribution. UGT began with a simple premise but promises to be a foundation for a radical new approach to institutional building design. We believe that it will become one of the core concepts of the new value propositions driving revolution in the design and construction industry.

No one knows just what the future may bring. Building on the universal grid is one solution that brings imagination and objective research to bear on the challenges of strategic healthcare facility planning. HD

M. Kent Turner, AIA, AAA, AIBC, OAA, is a Principal with Cannon Design in its St. Louis office. He can be reached at 314.241.6250 or

kturner@cannondesign.com.

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