How healthcare systems will be rebuilt for the next crisis


After struggling to cope with an overflow of patients during the pandemic, many hospitals are now remodeling to prepare for future crises, writes Debra Kamin for the New York Times.

How traditional hospital design hampered care during the pandemic

According to Kamin, traditional hospital design usually has separate, specialized areas for the most vulnerable and contagious patients. These areas also have features not typically found in regular stationary spaces, including changeable airflow systems; end caps for electrical, gas and appliance mounts; and more space for specialty equipment like ventilators.

During the pandemic, there weren’t enough of these specialized rooms, and many hospitals had to struggle to make room for sick patients and ration the necessary equipment. In the early months of the pandemic, many hospitals had to set up overflow tents in parking lots to cope with the sudden onslaught of Covid-19 patients.

With the way many hospitals are currently designed, intensive care units often didn’t have enough beds, healthy and sick patients had to share the same corridors and waiting rooms, and ventilation systems “became ducts for airborne pathogens,” Kamin writes.

“The general impression I get is that this isn’t a one-off situation that we’ve just been through with Covid,” said Jocelyn Stroupe, co-director of health facilities cannon design. “It’s just one of many infectious diseases we’ll see in the coming decades.”

Hospitals are turning to more flexible spaces to prepare for the next big crisis

To better cope with new crises, many hospitals are now choosing to remodel their spaces with more flexible designs that allow them to adapt areas as needed for different purposes at different times.

So many planners are now thinking about how to quickly convert traditional inpatient rooms into isolation wards if needed. Some changes include upgrading or replacing heating, ventilation, and air conditioning systems, using more durable materials that stand up to industrial-level cleaning, and ways that allow specialized spaces to be insulated when needed.

“When the pandemic came along, it really changed the way we design healthcare,” said Nicholas Holmes, COO of Rady Children’s Hospital in San Diego, whose campus is currently undergoing a $1.2 billion transformation. “And one of the main things we’ve learned over the past few years is to be as flexible as possible in the design process.”

Rady originally designed a rectangular floor plan for a new seven-story tower that will house an intensive care unit and emergency room, but designers have since moved to an X-shaped design. In the new design, the tower will have 60 beds, which can be converted into 20 fully isolated rooms for contagious patients if necessary.

“Rather than looking at it on a per-room basis, when you think of maximum flexibility, you think of rows of rooms,” said Holmes. “If you see it through that lens, you don’t have to move patients who are moderately ill to critical ICUs.”

Other organizations that have also introduced flexible design into their spaces include: Doylestown Hospital, Barnes Jewish Hospital, WellSpan Health, Ballantyne Medical Center, Grady Memorial Hospitaland CHA Hollywood Presbyterian Medical Center.

Many of these hospitals have added new rooms that can transition into intensive care units, enlarged their rooms to accommodate additional equipment, and upgraded their ventilation systems to prevent harmful airborne particles from reaching other areas.

“The pandemic has shown the importance of flexible space,” said Jim Brexler, CEO of Doylestown Health. “The impact of having a proper critical care space was critical and you don’t want to build out everything and not be able to use it for other purposes.”

“This is the future of hospitals,” he added.

According to John Swift, who leads the healthcare sector at Office Happold, an engineering and design consultancy, this shift to flexible design was not limited to hospitals. “We’re seeing these trends not just in healthcare, but in every facility where we work, from laboratory buildings to institutional buildings on college campuses,” he said.

Experts believe that over time, changes inspired by the pandemic are likely to be enshrined in legislation, similar to those guaranteeing wheelchair access and earthquake structural requirements.

“This is no different than the code updates we go through every time there’s an earthquake in California,” said Carlos Amato, health architect at CannonDesign. “Lessons learned after the pandemic will eventually be incorporated into building codes.” (Kamin, New York Times13.9.)


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