We don’t only need flexibility to be able to go into pandemic mode, we need to be able to move beyond it too. “A lot of the things we are upgrading now are very specific to the virus that we’ve been fighting, and they’re not necessarily a reflection of all the improvements that are needed,” says Sarah Wallwork, principal consultant in WSP’s UK healthcare advisory team. “We need to design space that can be used for alternative purposes when it’s not required for a pandemic. When additional intensive care unit beds are no longer required, you could potentially use that area as a high-dependency unit or a paediatric ICU or as an overflow ward in winter, even for training. As long as you have a building that is built to the required standard and specification, it could be used for a number of things.”
Around the world, work is already underway to review building regulations and standards, not only on hospital buildings but the guidelines that govern their operations too. This is an essential part of not only formulating solutions but making them affordable, says Steve Eiss, executive director of facilities development at Banner Health in Arizona. “If you want to create flexibility in design, you also have to create flexibility in use, or the cost curve is going to get bigger and bigger. The rules are very structured on what type of patients are allowed to be in what type of room, so you could spend more money to make certain areas flexible, but lower the types of patients that are allowed to be there, and your utilisation ratio is going to get smaller.”
Under the current circumstances, any extra spending at all might seem like a very big ask. But COVID is forcing governments and healthcare providers to make major investments today, and we can’t afford to waste this opportunity. “In South Africa, there is a long list of facilities that are inadequate or that needed additional capacity even before COVID-19, but there was no funding available,” says Jabulile Nhlapo, an associate at WSP in Johannesburg. “The pandemic has brought these challenges to the forefront and it’s forcing the public sector to address these running issues. Attaching a field hospital can provide capacity that’s been needed all along, so when designing we’re thinking about the future use, both in the building materials and the building systems.”
Nhlapo has noticed that clients are a lot more receptive to new ideas, such as prefabrication using lightweight steel and modular buildings that can be adapted or relocated after the pandemic. “Right now the facility would be used for a COVID ward, but in future the walls can easily be rearranged in order to create a long-term layout or to provide a general ward.” Some structures may be dismantled and individual modules recommissioned as clinics in remote communities. She says that they have been proposing these building methods for some time, “but there is a stigma – if it’s not brick and mortar, it’s seen as substandard. Now there is a lot more acceptance, which is going to help in the long run. This is the type of innovative thinking that has been required to address the capacity issues we are facing.”
In Hong Kong, WSP engineers were among the inventors of a method for building a fully functional isolation hospital from containers in just six weeks. “By using modular integrated construction, we could fabricate these containers quickly and safely off-site, allowing full inspection and fine-tuning before transferring them to the hospital site,” says Thomas Chan, executive director of building MEP at WSP. “Not only are the containers stackable, but they can also be converted into a variety of configurations for offices, laboratories and other purposes – all connectable and easily transported by sea or land.”