Road to Flexibility: Strategic Interventions

This three-part series explores the topic of flexibility in architecture. The first article examined the main reason for flexibility: change. The second article explored the three types of flexibility (convertibility, adaptability, and transformability) and how they can be beneficial to the healthcare field. This third and final article studies incorporating flexibility into the design process, along with specific architectural flexibility strategies.

Hospital facilities are always changing. Without leadership, a clear vision, and guiding principles that specifically target flexibility, healthcare facilities can become oversized and develop inefficient circulation and complex wayfinding. A holistic, facility-wide approach to flexibility will create a cohesive campus, and reduce costs and downtime during future construction projects, as well as lengthen building lifespans. 

Although the specific ways in which a facility will evolve can’t be predicted, there are some basic assumptions that can help a design team prepare a hospital for future growth and expansion. 

In this article, architectural strategies for flexibility are presented at two scales: micro and macro. At a micro level, the strategies operate within circulation approaches, zoning, and programming. At a macro level, the strategies affect site placement, building shape and orientation, and vertical and horizontal expansion considerations. 

Micro approaches
Circulation
For buildings that are planned with the potential for horizontal growth, the inclusion of open-ended hallways facilitates future expansion. Instead of the traditional approach of placing programmed space at the end of a hallway, open-ended hallways extend to the building’s façade.

This approach reduces overall circulation efficiency and is a little more expensive than regular corridors, because space that otherwise would be revenue-producing becomes circulation.

However, when horizontal expansion is needed, the new circulation can connect directly to the existing circulation, and interior demolition work is reduced because no programmed space prevents the connection.

Zoning
The identification of “hard” and “soft” spaces and their strategic placement within a healthcare facility’s layout is a simple method to provide flexibility. “Hard” spaces are difficult to move and expensive to build; “soft” spaces can be relocated relatively easily and are comparatively low in cost.

This method of zoning adequately accommodates future growth while maintaining critical adjacencies. In addition, investments for relocation and renovation projects are lower than costs for new construction. However, the spaces that are relocated can lose critical connections to other areas and functions, and its operations are severely disrupted while relocating.

Other design elements that need to be considered for this strategy to be effective are mechanical systems, walls, and structure. These need to be compatible with both the start state and end state.

A healthcare facility increasing operating room capacity by adding an additional suite will do so more easily if the ORs are next to an easily moved function. The same task might be considerably more complex if the OR area cannot grow in an adjacent direction, or would have to relocate more expensive services, such as imaging.

Boundaries
The inclusion of soft boundaries can also help a facility in terms of flexibility. Locating like-type programs near each other provides the opportunity for shared spaces, especially if hard boundaries are eliminated.

For example, locating clinics with similar programmatic requirements in an adjacent manner allows them to share spaces, and enables the clinics to grow or shrink as patient volume changes. Potential challenges with this strategy include code and regulation limitations that might prevent sharing support spaces.