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Designing for Healthcare Environments

Designing for Healthcare Environments

ISBN: 978-1-405-19505-8

Aug 2018, Wiley-Blackwell

224 pages

Select type: Paperback

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Open-ended design helps future-proof buildings for maximum flexibility, long-life and low whole-life cost. This gives better value investment for clients and investors over the life cycle of healthcare facilities.

This book provides knowledge and understanding on the issues, principles and practices relating to the briefing, design, construction processes and the use of open-ended buildings to create a more robust healthcare environment.

Physical change is a subject of concern at an international level for healthcare organisations because of the rising costs of construction and the needs to control those costs of adaptation over time. Building management systems and CAD modelling will provide much support in managing information flows over time but healthcare planners, designers and facility mangers need to enable the culture of change with key performance briefing strategies for inter disciplinary project teams to provide the leadership necessary for ‘change ready’ facilities.

Contributors from academia, research and industry from Europe and USA are brought together in this book and the lessons learned provide benefits to organisations in charge of procuring and managing health and other infrastructure facilities and services.

Chapter 1 Introduction: Open Building and the changing procurement context .

Dr Herbert Robinson, Property, Surveying and Construction, London South Bank University.

Key drivers of open-ended design and buildings, relevance of open building thinking to new procurement systems and construction relationships in healthcare – private finance/public partnerships, the business cases for flexible and future mixed use developments, planning and sustainable whole life value, the forces for change: cost and affordability, changing workforce ,impact of ICT etc. overview/structure of the book,.

Chapter 2 Loose Fit and Universal space: evolution of ideas for open ended design and engineering concepts.

Rosemary Glanville, MARU (Medical Architecture Research Unit), London South Bank University.


Tracking and explaining the evolution of ideas of open ended healthcare building and readiness for clinical and technological change. In the UK this history spans over 50 years of design and engineering coordination led by large scale R&D general hospital projects in the UK NHS. Relate to parallel developments in the US and Canada including the Veterans Hospital system and planning principles including McMaster Hospital and continued at such practices as NBBJ, Ellerbe Becket, WHR. In Europe, French construction plateau techniques for Groupe 6 architects, continual site masterplaning for mixed uses in Sweden and change management strategies in the Netherlands..

Chapter 3. Masterplanning for Open Urban Environments: healthcare case studies.

Phil Astley, Medical Architecture Research Unit, London South Bank University.

Professor Ake Wiklund with White Architects.


Sweden has led analysis of mixed use building strategies for healthcare over the last 20 years, and is currently undertaking the largest healthcare urban redevelopment masterplan in the world at the Karonlinska Hospital and University led by White Architects. In the UK generic briefing and space utilisation for mixed use sites are informing new integrated healthcare networks for compact healthcare building in urban environments at a community level. Accessibility and transport infrastructure as well as the interface with biomedical research and education and housing will compare planning approaches with a European wide case study perspective as well as an appraisal of the role of strategic masterplanning for open ended design..

Chapter 4. Open Building Patterns: levels of distributed healthcare systems.

Professor Steve Kendall, Ball State University.

The key points of open ended design can be embodied in information management tools that recognise three factors: hospitals are never finished; design responsibility is usually distributed, and change occurs on levels of intervention. In large health care systems with many facilities distributed over a large area, raising the standards across the system require good information sharing and good procedures, thus managing both top-down and bottom-up decisions. To avoid each project starting from scratch, the health system must be able to mandate certain design decisions but also must avoid rigid templates. Open building patterns are ‘parametric’ design moves that, while embodying certain invariant principles, are also malleable to each site. All must address the change ready-hospital..

Chapter 5. Systems Separation Policy: Cantonal Building Department and Bristol University Hospital case studies.

Giorgio Macchi, Canton Bern Office of Buildings and Properties.

David Powell, North Bristol NHS Trust PFI Project Director.


The development of leadership and a clear systems separation policy is crucial to the success of open ended building system implementation. The Canton Bern (Switzerland) INO hospital project is an example of the implementation of such a strategy. It focuses on high tech tertiary care within an existing hospital site based on open ended building strategies – what lessons have been learned, what are the comparative policy, construction and design lessons are transferable. Bristol University is currently developing these ideas in planning for a new Children’s Hospital..

Chapter 6. Dynamic Facilities Management: focus on healthcare.

David Hasnichak, Massachusetts General Hospital.


The operational commissioning of a building is recognised as an integral part of information planning at the strategic planning stage to ensure that facilities management principles for life cycle costing of principle elements, material selection, health and safety, control of infection, waste management are considered at the outset. An explanation of these principles of planning for services and operational policy coordination are written into open ended building design and management strategies..

Chapter 7. Managing Change and Project Management for Open Ended Building.

Sarah Slaughter, MIT.

Ad den Otter, TU Eindhoven.


Healthcare buildings are divided around key performance indicators with the management of risk. These might take the form of gateways for change against future management performance..


Chapter 8 Architecture of Open Building.

Dietmarr Eberle, Baumsschlager and Eberle.

Richard Barton, Senior Director Avanti Architects London.


The development the District General Hospital historically formed site boundaries as a large generalist healthcare hub. New models and managed networks of care and the increase in day surgery procedures have optimised and compact models of care. The need to plan for healthy places has moved designers to consider thinking for the integration of other uses such as Academic Science Parks, housing for key workers etc. Service planners are required to adapt business strategies over the implementation of a capital project, Hard commercial decisions may be made in that change funding and delivery vehicles requiring the coordination of cross cutting mixed use space principles to allow for different operational and revenue phases. This requires different architectural response and forms to ensure flexibility for change..

Chapter 9 Decision Tool Support for Open Ended Systems.

Professor Stephen Kendall, Ball State University.

Phil Astley, Medical Architecture Research Unit, London South Bank University.

Anne Symons, Design Management Director Balfour Beatty PLC.

To create impact, the aim is to draw together taxonomy of the chapters with the aim to produce a tool that will support CEOs, key senior officers and decision makers in the planning of open ended building with a particular focus on healthcare facilities..

An outline audit tool with key briefing performance indicators to support project directors and planners from a multi disciplinary perspective will highlight factors to be taken into consideration..

Chapter 10 Conclusion and Future Horizons