The Road to Flexibility: Adaptability, Transformability, and Convertibility

Throughout this three-part series, we’ll explore the topic of flexibility in architecture. The first article examined the main reason for flexibility: change.

In this second article, we present three types of flexibility (adaptability, transformability, and convertibility) and how the healthcare field benefits from each.

The third and final article will study incorporating flexibility into the design process, along with specific architectural responses to various flexibility strategies. To view part one of the series, please visit: http://www.healthcaredesignmagazine.com/article/road-flexibility-understanding-change. To read part three of the series, please visit: http://www.healthcaredesignmagazine.com/article/road-flexibility-strategic-interventions.
 

Does flexibility in modern architecture apply to healthcare?
Historically, efforts toward flexible architecture have focused on building typologies outside of the healthcare sector, which tend to be less regulated and are less influenced by operational processes. Two modern theories by Peter Eisenman and Mies van der Rohe recognize infrastructure elements such as columns, vertical circulation, and floor penetrations as fixed and unchangeable components. 

In van der Rohe’s open plan theory, certain elements contain the infrastructure that is fixed between start-state and end-state conditions. Other components, such as the skin and interior partitions, are less dense and easily removed or adjusted to compensate for a defined range of functions. 

Eisenman’s theory focuses on section, not plan. His blurred zone concept prioritizes the control of the void: These are spaces that can be used for future expansion and growth. The blurred zone creates an interstitial space between levels and the opportunity to use the void for different conditions on each floor. 

Healthcare facilities face more challenges in providing a flexible built environment than other types of architecture. Healthcare institutions no longer can afford for individual spaces to have one particular function throughout the lifespan of a facility; they must be flexible to respond to a variety of potential changes. 

As a result, an increasing number of healthcare institutions are focusing on flexibility when designing their buildings to prevent early facility obsolescence. The ability to accommodate changing standards of care and space requirements reduces service disruptions, medical complications, and the need for capital expenditures to construct new facilities.

Although it is impossible to predict what future needs will be, there are several drivers of change (discussed in the first article of this series) that can be analyzed when designing for flexibility: increasing or decreasing volume, changes in service lines, changing patient mix and standards of care, increasing or decreasing size, and medical discoveries. 

It is important to note that change is an indispensable element for flexibility. As Georgia Institute of Technology professor Craig Zimring, PhD, explains, “Flexibility is not an innate architectural quality, but the ability of the built environment to accommodate change between a defined start-state and end-state.” 
 

Flexibility Types
Flexibility is defined within three types:

• Adaptability
• Transformability (including two subsets – moveable and responsive)
• Convertibility               

Each type of flexibility not only refers to the amount of change that occurs in the built environment, but addresses the degree of permanence of that change as well.