Flexible design isn’t a new phenomenon. Nor is flexibility in healthcare environments. But the velocity and scope of technological changes, shifting consumer demographics and value-placed health policy has sparked a renewed interest in the concept of a flexible, adaptable environment.
As clinical staff, facilities managers, administration and design professionals engage in this dialogue, many are asking questions: What exactly does flexibility mean? How does the desire for flexibility influence design? And is flexibility a real, meaningful advantage or a hollow promise?
Key Drivers: Technological Innovation and Operational Changes in Healthcare
Technological innovations will affect all aspects of care from prevention, to diagnosis and treatment, and patients and providers alike are keen to adopt many of these breakthroughs, seeking better care quality and quality of life. But the physical plant of today – and the past 60 years - wasn’t designed to respond to constant iteration. Rather, longevity was the key design criteria and for good reason: health facilities are an expensive investment, both in time and financial capital.
While some future adjustment was expected, planning for the exponential pace and scale of technological advance wasn’t a consideration. The Fourth Industrial Revolution, characterized by artificial intelligence, the Internet of Things, robotics, materials science, quantum computing, etc., is producing the need for operational, policy and regulatory revisions.
How does one successfully address what’s necessary today and anticipate what might be required 10, 20 and even 50 years in the future? The bottom line is that we can’t fully know how health will be delivered in the future, but healthcare environments that are flexible will enable providers and systems to be more agile.
We aren’t suggesting that healthcare facilities will become obsolete, but we have already seen a change in clinical operations. For example, the health ecosystem has adjusted to the normalcy of outpatient surgery, and the list of appropriate outpatient procedures is growing. Overall, the industry is seeing medical care moved to distributed outpatient clinics and increasingly, the home.
Additionally, healthcare providers are more attuned to cost as a function of value and want to ensure that investments – in buildings, spaces and furnishings – will continue to serve their needs long into the future.
Redefining Flexibility
As a result, flexibility is a growing aspiration for facility design, however, flexibility has a loose definition. Sometimes flexibility is used when people want to change a space – by adding a wall or a curtain to create two distinct spaces. Sometimes flexibility means a table for meals that can also function as a desk, or a sofa that serves as a bed for guests in a patient room. But there are far more nuanced needs and desires, which are shaping the definition of flexibility in healthcare environments.
For example, when designing a hospital or clinic, it may be useful to have the ability to move walls and create different spatial configurations, but it might be even more useful to easily respond to technological changes. In addition to a quick installation, the advantage of modular casework and walls is the ability to alter supportive features to change a room’s program and access the wall’s interior with minimal disruption—both in terms of construction and operational costs—to have access to cords and power. Flexible walls then become a tool for operational agility, allowing a health system to upgrade rapidly its service delivery to providers and patients.
A Framework for Flexibility in Healthcare Environments
Steelcase Health, with the Center for Advanced Design Research and Evaluation (CADRE) (HKS Inc.’s nonprofit arm), is working to create definition around the notion of flexibility in healthcare environments. The yearlong collaboration between the organizations has led to the development of an emergent framework with the core tenets of flexibility defined as: versatility, modifiability, convertibility and scalability, which will be published as a white paper in late 2018.
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The framework is built upon foundational existing healthcare and architectural literature and surveys of key stakeholders, such as architects and designers and can be applied across multiple scales – from site and building planning to wall systems and furniture.
Currently, designing for health requires an operationally responsive, iterative perspective to attend to change. As we noted, the heath experience is shifting to outpatient and home care, while the acuity of inpatient populations continues to rise. And although the drivers – changes in health policy, consumer-driven expectations, changing demographics, disease complexity and medical advances – are known, the implications aren’t.
Designing for several “preferred possible futures,” is the new key design criteria.
Michelle Ossmann, Ph.D., MSN, Associate AIA, is Director of Health Environments at Steelcase Health. Seth Starner, MDM is the Advanced Explorations Lead at Steelcase Vertical Markets.
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