FLEXIBILITY for ADAPTATION; Background, Definition and New Guidance

1. THE XXXIInd INTERNATIONAL PUBLIC HEALTH SEMINARof the UIA-PHG and WHO Public Health Work Programme22nd-24th March 2012, Oslo, Norway FLEXIBILITY for ADAPTATION;Background, Definition and New Guidance Peter Scher BA (Arch) RIBAArchitect-Research-Consultancy London, England

2. Seminar in Florence 2008 Adaptation of 18th century ward block to 21st century Cancer care Centre

3. Seminar in Buenos Aires 2009 The Report “There is a need for more sophisticated research . . . We must understand what ‘flexibility and adaptability in the built form’ amounts to and how . . . we can recognise ‘the potential to accommodate future changing needs’.” ARCHITECTS for HEALTH A linked society of the Royal Institute of British Architects (RIBA)www.architectsforhealth.com

4. Nightingale to Nuffield 1863 1955 Page 146 Flexibility and Growth

5. Accelerating Change – from c. 1950

6. Growth and Change and Flexible Layouts 1 1965 Growth and Change studies, Cowan 1970 Northwick Park Hospital, Weeks 2007 (Greenwich Hospital) 1969 Greenwich Hospital

7. Growth and Change and Flexible Layouts 2 Growth Templatesflexible layouts 1975 ‘Nucleus’ System

8. “Futurology” “The hPod Project will fine-tune and choreograph research, new technology and products to deliver optimum healing environments for patients, using purposed-developed tools including an emotional mapping design tool . . . “

9. CHANGE We know there will always be change. We cannot specify for each building or space –whenthe change will be needed,whatchange will be needed,where in the building will need change. We are asked to make designs flexible to meet future changes of use - unspecifiedchange. This will ensure the designs are ‘Sustainable’!

10. Defining terms - 1 Adapt, adaptation, adaptable When it is possible to adaptto a change in any set of circumstances the outcome is the adaptation. No conceivable set is adaptable to every conceivable change. The term adaptable should only be applied to each specific set and specific change to it. (E.g. this nursing unit is adaptable for change to an outpatient clinic.) Adaptation applies to change in the function of the building i.e. what users do in the building; it describes a transformation from one use to another.There may be an infinite variety of potential but uniqueadaptations of a building or space from one use to another.

11. Comparative Measures Permeability(commonly symbolized as κ, or k) is a measure of the ability of a porous material to allow fluids to pass through it. The SI unit for permeability is m2. A traditional unit for permeability is the darcy (D), or more commonly the millidarcy (mD) (1 darcy 10−12m2). Visibilitywas first defined for meteorological purposes as a quantity to be estimated by a human observer, and observations made in that way are widely used. However, the estimation of visibility is affected by many subjective and physical factors. The essential meteorological quantity, which is the transparency of the atmosphere, can be measured objectively and is represented by the meteorological optical range (MOR). Adaptability ????? The term “adaptability” implies a variable quality that may be measured on a scale; it is not, and its use should be avoided.

12. Defining Terms - 2 Flexible, future changes of use, flexibility we can design buildings using building elements that are flexiblein that they may be more or less readily and independently reconfigured. Future changeswill always remain unknown. Claiming that a design is ‘flexible to adapt to future changes of use’ that cannot be identified with any certainty makes no sense. Flexibilityapplies to the building/built environment; it may be defined as a variable quality of the process required for adaptation.

13. Assessing Flexibility An adaptation will have a measurable cost, take a measurable length of time to be implemented, effect a measurable saving in energy usage, effect a measurable change in operational efficiency, and so on. We assign values to these measures in option appraisals but a single combined value cannot be expressed for an adaptation. The value of each specific measure (cost, energy use, etc) may represent alevel of flexibility for the adaptation.

14. Duration My proposal is to assess flexibilityusing time or duration as the key variable. This is because the duration of the adaptationprocess is of prime importance to every stakeholder. The time from end-date of existing use to start-date of changed use affects all users of the building, the operational managers, the design teams and the construction and specialist contractors.

15. Design for Adaptation I believe we can design for specific adaptation. For example –we may design an outpatient department that can be adapted as an emergency centre. Of course this must be done when it is designed – not afterwards.The adaptation would be planned in advance and all the hospital operational consequences and all the changes to the building and services would be worked out –i.e. duration between end of use as an outpatients department and start of use as an emergency centre;hospital staff changes and operational system changes;all temporary and permanent construction work;and all costs.

16. Levels of Flexibility - Table 1

17. Levels of Flexibility – Table 2

18. Sustainability “Sustainability” in guidance for the British NHS includes “Future proofing investment” “Robust and flexible planning for change” “Whole life investment, expansion/contraction”. Required before the unpredictable dissolution of the NHS now taking place in the UK! Our politicians predict that the NHS as we have known it for over 60 years will soon be “unsustainable”.

19. Growth The London Hospital Kings College Hosp. London Westmead HospitalSouth Australia Countess of ChesterHospital

20. Clear communication I would like to recite a few terms of high-grade humbug we should try to do without - future change, future-proofing, hospital of the future The terms we use in professional practice and in academic work must have precise and distinct meanings if we are to make sense in communicating with our communities and with each other. I will recite again the important key terms - flexibility, adaptation, growth, change, sustainability. I hope I have helped a little.