Building for Change: Comparative Case Study of Hospital Architecture

OBJECTIVE: This study assesses how architectural design strategies impact the flexibility of hospitals to change over time. BACKGROUND: Most hospitals are designed for highly specialized medical functions, which is often in conflict with the need to design the hospital facility to accommodate evolvement and change of functions over time. Architectural design strategies provide different approaches to the need to design for a specific medical program while planning for its future change. METHODS: The study compares two hospital buildings with a very similar configuration and medical program but with significantly different architectural design strategies: One was designed for an unknown future medical function, and the second was designed for a specific medical function. The study analyses the two hospital buildings by their design strategy, planning, design process, and construction by phases and compares their change in practice over the last twelve years. RESULTS: The design strategy to fit a specific function limited the hospital affordance to make changes during the design process, construction, and occupancy phases. Systematic design of system separation for an unknown function, in contradiction to a "tailor-made" approach in the design for a specific function, was found to support a variety of changing medical programs. CONCLUSIONS: Architectural design strategies developed in an early stage of the design process has a major impact on the future evolution of the hospital facility. The different results between the two projects also demonstrate the greater influence of healthcare policies, hospital organization culture, and infrastructure funding models on the architecture and flexibility of hospitals.