During a crisis, hospitals are a place of refuge. When confronted with an extreme event, whether anticipated or unexpected, hospital administrators are challenged to maintain seamless operation of facilities and staff while serving as a “command center” for the community. An increased frequency of extreme events, coupled with rising public awareness, has created a new demand for resilient strategies in the healthcare environment.
Before considering resilient design strategies, we must first consider the two types of potential impact: acute shocks and chronic stressors. Acute shocks are quick impacts from extreme social, environmental, and economic events spanning everything from civil unrest and cyberattacks to extreme rainfall, hurricanes, and tornadoes. Chronic stressors are lingering impacts from repeated exposure to social, environmental, and economic problems such as homelessness, poverty, air pollution, and drought.
Once the various types of potential impacts have been evaluated, there are three questions to consider when applying a resilient lens to hospital design. First, what are the relevant projections in your area? Then, what are the vulnerabilities and cascading consequences that could potentially result from those projections? Finally, how does your design solution address those vulnerabilities?
As healthcare planners and designers, it is important to understand which challenges hospital leaders think are most likely and/or will have the highest consequence. For example, if disease outbreak is a serious concern, the team may plan an emergency department with additional isolation capacity—or create a full isolation nursing unit instead of individual isolation rooms in each unit. Likewise, in an area prone to large-scale natural disasters, well-planned spaces that function as public education areas under normal circumstances can be transitioned for press conferences or clinical care in emergency situations.
In Dallas, we have seen a rise in temperatures; increased spans of drought; a greater number of intense storms and rain events, including flash flooding; and significant impact on the natural ecosystem. In this case, resilient strategies may overlap with other sustainable design tactics, such as minimizing solar heat gain with shading devices and overhangs, and minimizing heat-island effect through increased green spaces, cool roofs, and vegetation.
Drought-resilient strategies might include low-flow or no-flow fixtures, native landscape, and use of captured storm water for potable uses. Flash flooding may be prevented with oversized roof drains and increased permeable surfaces on site. And, adaptive plants that acclimatize to warmer temperatures and provide a habitat for local species can help preserve the integrity of the local ecosystem.
With thought and foresight, it is possible to minimize risks and avoid loss by creating healthcare facilities that can adapt and thrive in a changing environment. A resilient design approach forms strategies based on diversity, adaptive capacity, redundancy, nested scales, and self-organization—potentially resulting in improved safety and stability; reduced physical risks; reduced premiums associated with operations, insurance and financing; and an ability to maintain operational continuity during and after a crisis.
Julie Frazier, AIA, ACHA, RELi AP, LEED AP, is an architect and associate principal in the Dallas office of global architecture and design firm Perkins+Will. She specializes in resilient design.