07 Dec COVID-19: sparking a new revolution in hospital design?
Authors: Roberto Bologna, Nicoletta Setola, Luca Marzi, Eletta Naldi and Maria Vittoria Arnetoli (all at the TESIS Centre, University of Florence)
COVID-19: sparking a new revolution in hospital design?
As the current coronavirus crisis has revealed, many modern hospitals and healthcare organisations lack the flexibility to accommodate sudden surges of patients due to unexpected healthcare situations. Hospitals have been running out of space and resources to treat COVID-19 patients with severe symptoms, whilst simultaneously caring for those groups presenting mild symptoms or being asymptomatic, who pose an infectious risk to healthcare workers and other patients.
To meet this challenge, hospital architects have identified new design opportunities for healthcare systems – which have historically been constructed to support lean and efficient care operations, with a focus on delivering health services closer to patients’ homes, within community settings. Healthcare organisations and hospitals had three principal choices to make in how to transform their environments in response to COVID-19, in relation to their local settings.
Reorganising the healthcare facility itself
To better accommodate COVID-19 patients within a hospital, spatial and organisational adaptations have been implemented, including the reorganisation of internal ‘foot traffic’ routes and flows to separate those infected by coronavirus from those without the virus. For example, in Argentina, the municipality of Rosario’s General Directorate of Hospital Architecture and Engineering worked in collaboration with the local Ministry of Public Health to harness the built environment of hospitals as a way to protect patients and healthcare workers from COVID-19 transmission. Across the municipality, over 50 public and private healthcare centres and hospitals adopted a joint strategy to differentiate routes within their internal environments for patients who presented symptoms of COVID-19 (i.e. fever) from those with non-coronavirus needs. Using colourful signage and special demarcations on floors, patients displaying symptoms of coronavirus are directed along special interior routes to dedicated testing clinics near the entrance of each centre, to minimise the flow of people into the hospital and thus reducing the risk of nosocomial infection.
The COVID-19 pandemic is also exposing new needs for hospitals that neither open wards nor more flexible capacity can address. Hospital designers and architects have identified the need for touch-free control for lighting, temperature, and other building functions, to help avoid spreading diseases on these highly used surfaces. Building with materials that are less hospitable to microbes may also reduce the risk of surface transmission – M Health Fairview Bethesda Hospital in Minnesota (United States) removed hard-to-clean carpet throughout the hospital and replaced this with more durable floorings. Some hospitals have already eliminated window curtains, which can become easily contaminated, by installing windows made of e-switchable privacy glass — also known as e-glass or smart glass — which can switch between translucent and opaque and are easy to clean.
Some healthcare organisations decided to dedicate entire buildings to COVID-19 patient care and so redeveloped non-health areas within their campuses (such as staff gyms and storage units) which were either underused or abandoned. In Jeddah (Saudi Arabia), the King Faisal Specialist Hospital & Research Center established a ‘drive through pharmacy’ in a previously unused mobile unit, located in the hospital’s carpark (see photo, above right). This pharmacy has helped to ensure that vulnerable patients with chronic illnesses will no longer have to enter the hospital to receive their medication and so reduces the risk of COVID-19 infection.
Creating emergency temporary structures
In addition to internal changes in the hospital, many emergency structures have been created externally to the hospital. Some healthcare organisations have installed prefabricated modules (containers, shelters, or new modules) designed and modified to respond to the needs of the COVID-19 emergency. For example, at Taipei City Hospital (Taiwan), outdoor hard-sided tents were set-up across each of the organisation’s eight entry points to screen patients for COVID-19 symptoms, prior to entry to the hospital.
The major challenge faced by designers with temporary structures is that procurement, production and installation time can typically take up two weeks to one month and important considerations must be given to their suitability in relation to the level of care provided. (Even if hard-sided, outdoor tents, for example, are particularly helpful for time-limited processes, like patient screening but would not be suitable spaces for on-going treatment for critically ill patients).
Reconverted existing non-health structures
In response to the coronavirus pandemic, some healthcare organisations took action to convert non-health structures – typically ‘urban containers’, such as exhibition centres, conference centres or railway stations – into centres for patient care. In the United Kingdom, the National Health Service built several major field hospitals to specifically treat COVID-19 patients and ease pressures on regional healthcare services. One of these hospitals – NHS Nightingale London (see photo, right) – was established in the capital’s ExCel exhibition, creating space for 4,000 patient beds. The framework for individual bed bays were made from material usually used to make exhibition stands due to its lightweight design and could be constructed quickly. The ExCeL’s existing electrical infrastructure was modified to ensure the power supply can cope with demand, whilst temporary generators and oxygen tanks, to supply the beds, have also been installed.
When converting non-health structures into patient centres, it is crucial that location be considered as a key factor (for supplies and staff). Indeed, the ExCeL centre’s suitability for the hospital site goes beyond the functional characteristics of the building as it is served by public transport links. The nearby London City Airport can be used to bring in supplies and equipment and there is much hotel and university accommodation close by – should it be needed.
Looking beyond COVID-19
As discussed during the recent IHF Virtual Forum, going forward, hospitals will have to examine how their physical environments and technical infrastructures should be adapted to enable greater flexibility when responding to exceptional public health events which generate temporary, yet sizeable demand surges for healthcare services. In particular, hospitals and healthcare organisations should focus on:
- Increasing the flexibility and adaptability of physical structures and services, both at the level of facility itself and its network.
- Ensuring rapid, efficient, and high-quality interventions even in exceptional conditions (with a focus on the environmental quality of the spaces which, in addition to supporting the health response, is reflected in perceived quality on patients and operators).
- Integrating the emergency response into the ordinary planning of physical structures and services.
To support its global community to realise these changes in their own settings, the International Hospital Federation has established the IHF ‘Beyond Covid-19’ Task Force. With support from IHF members and strategic partners, on December 17th, the Task Force will publish a new report – ‘Building the ‘New Normal’ – capturing practical examples of where infrastructure changes realised during the COVID-19 pandemic have beneficially transformed healthcare services and so should be sustained in the future (including some of the examples listed in this article).
About the Authors
The authors of this article are members of the TESIS Centre based at the Department of Architecture at University of Florence involved in research and consultancy for healthcare facilities.
Roberto Bologna, full professor in architectural technology, director of TESIS, deals with resilience of building systems and investigates temporary architecture in response to emergency.
Nicoletta Setola, associate professor, is expert in spatial configuration analysis related to people flow, and investigates maternity spaces, primary care facilities and public spaces in hospitals.
Luca Marzi, researcher, deals with the management of the building assets of hospital structures and the issues of accessibility, with particular attention to weaker categories of users.
Eletta Naldi, PhD student, is developing a thesis on healthy neighborhoods and territorial healthcare, implementing Healthy City’ principles with social and health assistance focusing on older adults.
Maria Vittoria Arnetoli, PhD student, is developing a thesis on urban resilience and disaster vulnerability, in particular dealing with adaptation strategies for public spaces and the setting of preventive intervention scenarios.