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When the pandemic hit last year, Swedish hospitals jumped into action. At Huddinge, home to one of the two parts of Karolinska University Hospital, White Arkitekter had just completed a 29,000-square-metre extension to house high-tech medical devices and procedures. Within ten days, the extension, with its 23 operating theatres, was transformed into 64 intensive care beds, with all the support systems that were required.

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Speakers from left to right: Sophie​ Crocker, Charlotte Ruben, Christopher Shaw and Lianne Knotts

There could scarcely be a more ringing endorsement of the value of flexible design in accommodating the unexpected. Charlotte Ruben, architect and partner at White Arkitekter, was one of the speakers at the AT webinar on new perspectives in healthcare design. She explained the design of not one but two buildings for the hospital, on each of its sites, as part of Sweden’s ‘huge investment in healthcare over the past decade’. Karolinska has recently been rated the seventh best hospital in the world.

On the second campus, at Solna in Stockholm, the practice designed a 330,000-square-metre new facility with proximity of vital elements as a guiding principle. The hospital also forms part of a new urban centre. Ruben described it as a generic and adaptable structure with clear divisions between acute and elective care, and a high level of separation of flows. There is the option to have multiple external entrances, knitting into the surroundings, but the hospital can also function with a single main entrance.

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Interior Light shaft with art installations in wards at White Tengbom Team’s NKS Karolinska University Hospital Solna, Sweden (ph: Fredrik Sweger)

The general ward plan consists of single-patient rooms in five core buildings. The ward towers are supported by logistics, elevators and other essential services. And, essential to the success of the building, it is flooded with light. During the pandemic, it only took four months to convert single-bedded spaces into multiple occupancy.

Sophie Crocker, architect and health researcher at HKS, is also concerned with flexibility. Her practice has undertaken research to develop the FleXX model for hospital design, and updated it for the pandemic. ‘Long-term flexibility should be part of a sustainability strategy,’ she said. The most sustainable building is one that isn’t built.’ And, she added, ‘Buildings have to be capable of evolving.’

The structure of the FleXX Hospital strictly adheres to a regular grid size to accommodate a variety of clinical and non-clinical functions (cgi: HKS)

Language is important, Crocker said. There are four modes of FleXX: versatility, modifiability, convertibility and scalability. Typically, the first two will apply in the early years of a building, the others later. It is essential that clients and designers are using language in the same way. The approach is deliberately prescriptive in order to maximise flexibility. There is a prototype building which can vary to suit particular sites and needs, but demands an unfailingly regular grid, the use of some additional space, and a prefabricated cladding system where walls can be swapped in and out or used elsewhere. The method has already been used in the US, and HKS hopes to apply it here as well. The next step will be a cost benefit analysis to show how it would work over the lifetime of a building.

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During a pandemic scenario, the FleXX Hospital can separate flows and create a zone for the care of the infected and a non-pandemic related care zone (cgi: HKS)

Staff welfare and retention is a growing concern. Charlotte Ruben talked about the importance of recreational space, particularly for staff, and of connections to the outside. At Huddinge, for example, there are views over a park, and an outdoor gym. And at the practice’s project at Moorfields in London, with Penoyre and Prasad and AECOM, the practice is responsible for the public realm, including a roof terrace for staff recreation.

Connection to the outside is also central to the work that Lianne Knotts, director at Medical Architecture, has been doing on mental health facilities. ‘We know the benefit that access to daylight brings, she said. ‘Good acoustics can help calm us. Daylight helps with circadian rhythm. Access to outdoor space increases wellbeing.’ The practice has been redesigning facilities with courtyards where residents can stroll, sit or even run circuits, and also adding roof terraces where appropriate. An additional benefit is that the external walls of the buildings provide the containment, reducing the need for hostile walls and fences which have a depressing impact on those both inside and outside.

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Clock View Hospital in Liverpool designed by Medical Architecture (ph: Jennie Webb)

Knotts’ colleague Christopher Shaw, founder of Medical Architecture, talked about changes to acute hospitals. They are, he said, becoming larger, with the pressures of academic training and the need to consolidate expensive equipment and growing specialisation. Shaw identified several drivers for change. Sustainability changes not only the way that buildings are designed, but also where they are positioned and the transport links. The pandemic, he said, has been a ‘wake-up call’ about how low bed numbers have become. And, he added, it has led to the ‘triumphant return of Florence Nightingale’s principles around ventilation, with airborne virus being a problem’.

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Medical Architecture’s RVI Great North Specialist Care Hospital, Newcastle Upon Tyne (cgi: Medical Architecture)

The pandemic has also pushed us towards remote consultation and monitoring, and this is just one of the ways that digital technology is changing hospital design. At the same time there is a recognition of the need to mitigate our reliance on accident and emergency, by alternative options, and also by ramping up integrated care and increasing social care. This should lower the admission numbers of the frail elderly.

Many of the ideas that were discussed are not new, especially among health professionals. What has changed now is that the need to move from ideas to realisation is being accepted more widely.