Interstitial space in health care facilities : planning for change & evolution

Abstract

Hospitals are most useful material for architectural research for they exhibit all the problems encountered in other building types in an acute and easily measurable form. Health Care Facilities house the greatest range of functions within their operations and are subject to continuous changes through their life spans, requiring specific design strategies aimed at flexibility. These functions include offices, training schools, factories, warehouses, residential buildings, restaurants, etc. as well as many specifically clinical departments like operating theatres and pathology laboratories. The range of functions demand first, a wide variety and highly sophisticated services, which amounts to more than 40% of the building volume; and second, a high degree of interdependence and uncertainty in future uses. In this context, there are three overriding requirements in hospitals: fast design, provision for change & growth, and lifecycle economy. Interstitial Space is considered as a solution to these demands and found to be an appropriate design response. The Systems Approach is used as the methodology to analyze and organize the design and construction process within the general frame of systems thinking. Sources of information include all major reports and studies on the concept of Interstitial Space published in US, Canada, and UK; and inputs from professionals of health care planning firms in New York and the Boston area on the general issue of flexibility, and on the Interstitial Space concept in particular. This thesis is organized in three parts, each with three sections. Part one provides a reference to the General Systems Theory, a description of the Systems Approach and the performance concept in buildings. Part two addresses the problem of hospital design: first, it presents the general process of hospital planning; second, it discusses the problem of changes occurring in Health Care Facilities during their life spans; and third, a summary of design strategies for flexibility follows. Within this frame of analysis, part three discusses the Interstitial Space concept. First, the basic arguments leadings to its application; second, the design considerations in light of the different subsystems building up the system; and third, life-cycle cost implications.