Leveraging Opportunities in Hospital Design for Resiliency

Resiliency has emerged as the buzzword du jour, nearly surpassing the popularity of sustainability. More importantly, it’s become a top priority for many of our clients. Designing for resiliency naturally encompasses sustainable design principles that allow buildings to reduce reliance on building systems that may fail in the event of an emergency, relying instead on passive strategies or renewable energy sources that can be self-sustaining. Resiliency in architecture has become an immediate focus of many of our clients following major natural storm events of the last ten years that have impacted major metropolitan areas of the east coast of the United States, and as our federal government and international organizations continue to advocate for strategies to combat climate change.

It is particularly interesting to consider hospital design in the context of resiliency as the building type both presents unique challenges in its occupancy requirements, how it functions in the event of an emergency and many of the design principles that are inherent to good hospital design also lend themselves easily to principles of resilient design. Every aspect of hospital design can be examined through the lens of resiliency, from large planning moves such as selection and location of building systems, to the organization of electrical panels for flexibility and redundancy. There are four aspects of healthcare design that easily come to mind that each naturally addresses both hospital design and resilient design needs: community centered design , landscape design for both healing and security, building system redundancy and incorporation of passive systems into the patient environment.

Contextual and Community Responsiveness
As preventive healthcare and a focus on wellness become more integrated into our healthcare delivery processes, hospitals are becoming more than places for surgeries or the critically ill. Programs that encourage healthier lifestyle choices and advertise preventive health screenings and services are seen as ways that healthcare providers can reduce costs by eliminating costly emergency room visits and catching conditions at their earliest stages. Hospital designers can assist in furthering these goals by building open, welcoming facilities that serve as anchors in their communities. The hospital as community anchor is a trend in healthcare design that again fits well with the goals of resilient design.

Designing hospital spaces that are open and welcoming to the greater community leads to the careful consideration of context by architects. Context in this case extends beyond whether it is an urban, suburban or rural site, and the scale of nearby buildings. For designs to be resilient, response to cultural and climatic patterns must be included. Response to climate is a cornerstone of both sustainable and resilient design. For resiliency, building design must respond not only to the current climatic conditions, but anticipated future conditions as well. Hospitals are buildings that are expected to last much longer than other building types, and as resilient architecture and anchors of communities, buildings that can respond to changing climatic contexts will serve their functions longer and better. If the architecture of hospitals can respond to local cultural contexts as well, they will more easily serve their communities and be seen as desirable places to seek out help.

An example of this kind of climatic and cultural responsiveness in hospital design, that ultimately make a hospital more resilient, is the use of courtyards for waiting spaces at the Aga Khan Hospital in Karachi. Courtyards are used throughout the hospital as the main waiting areas for patients, families and visitors. The courtyard is an element of Islamic architecture around the world, and is commonly used for multiple public gathering functions. In this case, a space that is responsive to its cultural context is also designed to be responsive to climatic conditions in Karachi. Shade trees and water features are provided throughout the courtyards, and roof forms of surrounding buildings are designed to capture prevailing breezes. The resulting courtyards are comfortable outdoor spaces in an often oppressive climate. The implementation of outdoor space for these types of public waiting areas reduces the reliance of the hospital on air conditioning for these spaces, allowing the hospital to focus energy resources on critical spaces and reducing the hospital’s reliance on an inconsistent city power supply.

Natural elements as healing gardens and security measures
The healing garden is an element of hospital design that has both a long history and an increasing body of evidence showing their benefit to patients, staff and families. Many hospitals can take advantage of campus settings to develop landscaped zones that enhance views from patient environments and give respite for patients and families who are able to go outdoors. Depending on the climate and context, landscaped areas of a hospital campus can be used as part of patient therapy, rehabilitation and recovery programs, and as public amenities for visitors, families and the community.

In the context of resiliency, landscape can be viewed as an amenity that can do more than improving the healing environment; it can also ensure that the hospital is a functional and safe place in the event of an emergency. Just as landscape should be designed to fit the climatic context of a site to allow it to be a sustainable element of hospital design, in coastal or flood prone contexts, landscape can serve as an essential buffer zone to protect hospital buildings or mitigate flood risks through groundwater retention contributing to the reduction of environmental risks that impact whole communities.

Resilient design must also consider man-made threats as well as natural ones, and this is especially true for hospital design. In context in which security against terrorist threats is a priority and hospitals must remain a safe haven to treat victims, landscape elements such as a ha-has, strategically placed benches, planters and walls, and grading can be designed in such a way as to double as security barriers. The advantage of using landscape for these types of resilient security features is that they often present a more welcoming and open appearance to patients and communities while still proving effective deterrents and barriers to those who would endanger the continued function of a hospital.

Building Systems
When most hospital facilities managers and designers think of strategies for resilient design, their first thoughts understandably go to building systems. One of the essential traits of most hospitals is that their critical departments can continue to function seamlessly in the event of systems failures that would cripple other buildings. We can all understand the desire for spaces like operating theaters and imaging suites not to experience power outages while dangerous procedures are being performed. We can relate to the desire for life saving equipment like ventilators to remain functional regardless of exterior conditions. For these reasons, hospital building systems are by default designed with the support of emergency electrical generators, uninterrupted power supplies and redundant mechanical systems.

Many recent natural disasters, like Hurricane Katrina in New Orleans or Superstorm Sandy in New York, have proven that even this level of redundancy is not enough to satisfy the requirements of resilient design. In order to truly design building systems for resiliency, designers must consider strategies that provide building systems with the functionality that hospitals require, but look more carefully at how these systems are designed. First, hospital designers must examine where systems are located within a building protect from flooding, damage and attack, requirements which often eliminate locations within hospitals where these systems would be located, such as basements. Additionally, hospital designers can advocate for sustainable and site-generated sources of energy as innovative ways to create redundancy for emergency systems. Power generated by solar panels, although likely only able to produce a fraction of the power for a hospital on a given site, have the potential to generate power longer than a traditional diesel emergency generator and without the support of a grid. With the continued development of renewable energy technologies, such systems may become increasingly viable options for hospitals that desire full energy independence.

Passive design elements in the patient environment
Historically, passive design strategies have been a part of hospital design since there was such a building type as a hospital. In these historic examples natural ventilation was particularly important to the patient care environment, a design strategy that was also championed by founders of modern medical practice such as Florence Nightingale. While natural ventilation of patient rooms is not accepted by North American code standards for healthcare design, it is much more common in European and other international hospital projects.

It is worth considering how the introduction of passive design strategies such as operable windows in patient rooms, can be put in the service of both sustainability and resiliency goals for hospital design. Explored from a resiliency perspective, not including operable windows in essential spaces like patient rooms seems risky. In many of our international projects, particularly those with an unreliable energy supply from the local grid, including operable windows in all spaces is the standard of care. If we could ensure that patient rooms are properly ventilated without relying on emergency power supplies, then those resources could be directed at truly critical hospital functions in the event of a power failure, reducing the capacity required for backup systems.

Designing hospitals for resiliency is essential to allow them to continue to function and serve our communities in times of emergency and disaster. Beyond the basic requirements of building systems function and redundancy, healthcare designers can look for many opportunities in other aspects of good hospital design that reinforce resiliency: design elements that improve healing environments, reduce energy consumption and connect hospitals with their larger communities.

References
Editorial: New approaches needed to solve hospitals’ productivity woes
Is Designing For Resiliency The New Normal?

Related:
Cultural Shifts Transforming Healthcare Design: An Introduction
Does Remote Health Monitoring Mean the End of the Exam Room?
Adapting Healthcare Design to Accommodate Future Generations
The Future of Flexibility in Healthcare
DMB UNITE: Healthcare Environments
A Challenger to Proton Therapy?
Inpatient Care Units & Wireless Telemetry
Healthcare Trends: Looking Back to Move Forward
Impacts of the Affordable Care Act on Hospital Design