In an ‘era of radical transformation’, every system is likely undergoing changes, and the healthcare structure is no exception. Healthcare sites have always been spaces ‘in a nearly continual state of flux’. ( S. Verderber and D. J. Fine, 2000) The continuous need for change and expansion is a recurrent theme, if the hospital is the setting where healthcare diagnosis and interventions are provided and if the diagnosis and interventions are undergoing developments at their own scale.
‘How can the NHS improve productivity, increasing efficiency and effectiveness, whilst maintaining its focus on equitable access to and ethical delivery of healthcare services?’ (Carr, Sangiorg, Cooper and Busher, 2010)
How can healthcare infrastructures deliver effective and efficient care to patients over time and across settings?
Healthcare service provision changes over time. Short-term refurbishments and once-off adjustments cannot be any longer sustainable against whole-life cycle healthcare infrastructure value. Physical, technological, social and economic driving factors must be taken into account.
The more specific designed a space is, the less future adaptable it would be. The fewer constraints a healthcare infrastructure has, the more adaptive its reuse will be. If a speciality department implies a bespoke and tight-fit design, the space refurbishment and reuse does necessarily have constraints related to the clinical specialties. If the same amount of space is organised, designed and built around acuity levels, the space refurbishment and reuse can be adapted to different specialities belonging to same/similar acuity level. In this case, the constraint is related to the clinical service rather than the built environment. Shape and size elements may need to be retained, refined or transformed over time to ensure long-term adaptability, as clinical procedures evolve and space does not fit for purpose any longer.
The process through which reaching flexibility, the capital cost to be invested to make an healthcare infrastructure flexible to adapt to future clinical changes are both issues, but the existent constraints are given by the space itself. If soft space is added into a project design to allow future changes, it will then result quite easy to find flexible solutions. The capital cost, the time required and the space availability rise the need for alternative, cost-effective and time-efficient strategy solutions.
The reconfiguration/ refurbishment appraisal system is intended to help policy-makers and design teams, to achieve more optimum value and more responsive healthcare infrastructures in the short, medium and long term healthcare service reconfigurations.