Paper_Menglin Cao

A Study of Transformable Design of Hospitals and other Health Care Facilities to Optimise Flexibility and Sustainability

by Menglin Cao

Abstract High energy consumption, high cost of construction and low satisfaction of healing environment have been the most prominent issues in healthcare estate. Unfortunately, climate change, increasing health issues and rising ageing population as a booster, are escalating the negative impacts. Furthermore, the performance of healthcare estate still makes people disappointed. Consequently, it is evident that the method with unconventional wisdom which can efficiently, economically, automatically meet those challenges is an acute demand. Transformable Design with employing its principles has the potential to be this method. The goal of this research is to establish and apply transformable design as an innovation technology and design method in sustainable hospitals and other health care facilities which automatically makes healing environments more flexible as well as efficiently enhances performance of sustainability. In order to achieve it, the definitions including sustainable hospital and other health care facility, transformable design, and flexible environment are represented to exactly define this research.

Investigating typical projects and assessing systematic literature are employed to discover the fundamental and crucial issues regarding healing environment and sustainability. Additionally, the technology and knowledge utilised in transformable design are analysed and chosen to actively and felicitously apply in sustainable healthcare estate within solving the problems. To substantiate this, models are instituted which simulate the performance of transformable design in environments of sustainable healthcare estate. Moreover, the schedule has been considered carefully which requires three years as transformable design would be employed in a practical project. Accordingly, based on this research, transformable design will establish a new platform which not only enhances the performance of sustainable healthcare estate itself, but also can automatically and economically archive the flexible environment by addressing the urgent challenges.

Key words: sustainable hospital and health care facility, flexible environment, transformable design

Background High energy consumption following high cost of construction but with terrible healing environment as a tattoo embodies in the current healthcare estate. Recently, the rapidly growing ageing population brings pressure of tremendous environment and resource for the existing and future healthcare estate. Health issues caused by poor performance of buildings and climate change are increasing beyond exception.

Suddenly, sustainability as a goal is paid more attention by architects and engineers. Specially, healthcare estate achieving assessment of sustainability seeks high quality of healing environment with low energy consumption. As a result, varied strategies and processes of designing more sustainable, more efficient, more welcoming healthcare estate with less cost, less energy consumption and less negative impacts, are researched, such as Evidence-Based Design, Lean Process Methods, Post-Project Evaluations, and Six Sogma Approach (Phiri and Chen, 2014). However, even those strategies bring diverse benefits to meet those challenges, there are still three questions making me confused which are as follow: 1. As the limitations of sustainability standards or rules are location and climate zone, even the building achieved these, subsequent modifications are required which is the waste of human labour, time and resource. So, why do we need to apply them for healthcare estate design and which kind of 1

method can solve those limitations as well as achieve the same goals?

2. Most of the methods or processes mentioned above are established by exploring and analysing history and experiences from designers, managers or patients (e.g. Evidence-Based Design).

Meanwhile, the vital elements relating with social, human, time and place restrict the extensive use (e.g. perceptual versus rational). So, which kind of method or scheme can meet varied demands as well as obtain the best choice and data from history and experience?

3. Regarding climate change, ageing population and health care issues, the requirements of function, facility and environment have been always changing (e.g. temperature will grow up by more patients coming in). So, which kind of method can automatically modify or change components of building to meet diverse requirements at anytime and anyplace?

To answer those questions, the best way is to keep the peace with global and innovative notion with interdisciplinary research. For instance, “Big Data” revolution which is successfully applied in IT and commerce is adopted in health care system to transform the result of what is benefit for patients and ecosystem. Transformable technology is employed in facade of buildings to accomplish various demands (e.g. vision, function) which have the potential to use in healthcare estate. I believe utilisation of transformable design and technology based the concept of Big Data is the approach to make the environment flexible and make more sustainable in healthcare estate.

Literature Review The primary reason of climate change is the performance of building. Guenther and Vittori (2007) asserted that it is necessary and momentous to supply the concept of sustainability in healthcare estate as it is a building type of the most high energy consumption. However, although the theory of sustainability was involved before the earliest Neolithic settlements, sustainability has only recently been considered by healthcare facility designer (Verderber, 2003). Shepley (2010) assessed that there was no any essays related with sustainability in healthcare buildings on real significance until 2000 the book named “Sustainable Healthcare Architecture” was published. Phiri and Chen (2014) summarized the current manners and approaches for sustainability design and reviewed healthcare technical guidance and tools, subsequently investigating healthcare buildings. They claimed five emerging issues for their topic based on sustainability and evidence-based design including “dangers ignoring the past”, “public versus private sector involvement”, “national versus international standards”, “prescription versus performance standards” and “self-assessment versus independent” (Phiri and Chen, 2014). In view of the current situations, it is strongly recommended that sustainability forces should be rapidly and efficiently extend its power with innovation in healthcare architecture.

Depending on sustainability, creating flexible environment is the other key objective to improve the performance and reduce adverse effects from external factors mentioned before in healthcare estate.

The Maggie’s Centre as a series of cancer care centre is a telling example to illustrate the essential of friendly and flexible environment for health care. Until now, there are numerous Maggie’s Centre in the UK and other countries designed by famous architects. Figure 1 shows the Richard Rogers’ Maggie’s Centre located in London which won the Stirling Prize in 2009 and got countless praises due to the high quality environment design (Hudson, 2012). The welcoming, family and comfortable environments of this cancer care centre are the gravitation toward both the patients and their families which architects have the responsibility and obligation to design it.

2

Figure 1 Maggie’s Centre, London (visit in the first time) Maggie’s Centre in London creates the welcoming surrounding isolating the noise from the adjacent street. The first picture represents that patients are reading and enjoying here.

Transformable design has the potential to achieve those goals. The research centre, institution and company exploring transformable design and technology can prove that it is operational implementation.

For instance, MIT and Harvard University established a lab to research transformable design. “Solstice” is the achievement of transformable design in the Harvard University. Hoberman is a professional architecture company designing transformable buildings, such as Hoberman Arch in the USA, POLA Ginza Building Façade in Japan (see Figure 2-3). Lee (2012) reviewed and synthesized the exciting literature and projects who insists that transformable design is a benefit of sustainable architecture. To investigate transformable design deeply and comprehensively, Asefi (2010) analyzed and introduced the recent technologies and structures of transformable buildings. There has been a growing trend that developing the innovation of technologies, concepts, and systems are the primordial force propelling transformable design. For example, Meteorosensitive Pavilion designed by Computational Design (ICD) at the University of Stuttgart was established by strategies of computation and materialization which transform itself by modifying the structure of material to responsive the climate change (Figure 4).

Figure 2 Hoberman Arch, Salt Lake City, USA (Kronenburg, 2007) By applying transformable design and digital design, the Hoberman Arch is successful to achieve the objective which is “a magical, artistically engineered performance–including music, lighting, and dancers–to signal the start of the each evening's medal ceremony, witnessed by an estimated 3.5 billion people worldwide” (Hoberman, 2002). The performance of it cannot be supported by traditional design methods.

Figure 3 POLA Ginza Building Façade, Japan (Hoberman, 2009) It is undeniable that this transformable facade applied adaptive shading system which is controlled by photo sensors can save the annual consumption of HVAC energy by 30.

Figure 4 Meteorosensitive Pavilion (Achim Menges, 2013) The principle of this work is the moisture content.

The first picture shows that it is closed at high relative humidity. It will open at low relative humidity (second picture).

The recent approaches cannot efficiently enhance the performance of healthcare estate. Instituting new method in healthcare estate relaying on interdisciplinary research is required to meet the challenges of sustainability and environment. I believe that it will bring new light to patients by the way in which transformable design is applied in sustainable hospitals and other healthcare facilities.

3

Methodologies & Research Schedule Four strands support the methodologies of this research, namely:  Strand 1: Definition (sustainable hospital and other health care facility, transformable design, and flexible environment)  Strand 2: Issues (sustainability, flexible environment)  Strand 3: Solution (transformable)  Strand 4: Practice (model and project) The methodologies are illustrated below: 1) Definition: Literature Review is utilised to delimiting the scope of this research which focuses on historical and contemporary records in sustainability, environment, and development of technology and design in transformable.

2) Issues: Literature Review, Case Study, Video Review, Site observation and Interview play a significant role in the aspect finding out the issues. Firstly, literature provides the opportunity to collect and classify problems in sustainability and flexible environment. Secondly, the actual and latest challenges and awareness would be investigated in typical and the most successful present cases. To understand diverse attitudes in different times and places, video review is a terrific manna made up of comments of performance of buildings from designers, users and occupants. Moreover, site observation is used to comprehend and analyse the quality of design. Interview is the way in which contrasts opinions between designers and users.

3) Solution: Literature Review, Case Study, Video Review are applied to analyse and survey transformable design (e.g. material, technology) to lead design in sustainable healthcare estate. The work principles are easily and clearly presented and understood by Video Review.

4) Practice: Simulation software employed for establishing models is to investigate the performance of transformable design in sustainable healthcare estate (e.g. Ecotect. Firefly). The data of environments will collected based on Big Data system in health care. Moreover, to be more practical and authority, transformable design would be utilised in a project which the client supports the application.

The research schedule will be arranged at the most three years. Figure 5 illustrates the time-table for this research relating on the management of the methodologies. In the first stage (2014-2015), literature review and video review including transformable design, technology and sustainable healthcare estate would be applied to profoundly develop the proposal and evidently define program. Moreover, communication with my supervisor is essential to guide the schedule and the performance of this research. The first stage lays the foundation of this research to lead the further three year assignments.

To prove the conclusion of theory in the first stage, the cases will be chosen in the second stage (2015-20116) following the investigation by site observation and interview. The lessons from those cases are the reason of modifying the design which applied the transformable design. To analyse and compare the performance of design between the before and after modification, simulation method will be utilised in the third stage (2016-2017). Transformable design will be applied in practice to achieve this end. Design and analysis based the practice will be presented in the dissertation.

4

Figure 5 the schedule with methodologies

Results and Discussion To identify this research, the three key definitions are emphasized below: 1) Sustainable hospital and health care facility Regarding this research, the definition of the sustainable hospital and health care facility is that: architecture belonged any types of health care estate supporting medical and health care functions or facilities is established based on and passed assessments of sustainability standards or rules for healthcare estate (e.g. LEED, BREEAM).

2) Flexible environment In sustainable healthcare architecture, the definition of flexible environment is that: the surrounding is dynamic to meet and respond the requirement of patients, doctors and occupants in what respect physical environment (e.g. temperature, humidity, ventilation), function (e.g. private, public).

3) Transformable deign In this paper, the ‘transformable’ means that stimuli from exterior or interior leads to transformation of shape, function and character to adapt demands based previous settings. In terms of sustainable healthcare architecture, the definition of transformable design is that: to make the healing environment flexible, design the interior assembly of architecture component being automatically transformable by utilizing transformable technology (e.g. material, structure, and tool).

In regard to benefits of applying transformable design in sustainable hospitals, three aspects are considered for now. Firstly, due to the feature of transformable design, the interior assembly of architecture component can transform itself by responding the changes of surrounding to set up flexible healing environment which compensates for the weakness of sustainability in standard or rule (e.g. international versus national). Furthermore, as the principle of transformable technology is to transform by relying on modification of shape, structure and capability of material which is under the control of the performance of itself, it is a rational and intelligent scheme decreasing the interferences of human element such as diverse experiences. Finally, considering the flexible alteration with unlimited time and location, transformable design is in the best interest of the flexible and friend healing environment.

I try to recognise and observe these urgent and typical issues of sustainable healthcare estate from another standpoint associated with artificial intelligence. Transformable design is a good case in point which should be supported by revolutionary theory such as ‘Big Data’ (Manyika et al., 2011). It not only supplies an efficient strategy and improves the performance of sustainability to achieve flexible environment, but also establish the knowledge bridge between architecture design and artificial intelligence.

5

Conclusions and Recommendations To the end, utilising and applying transformable design in sustainable healthcare estate is an intellectualized method to enhance the performance of flexible environment. However, there are limitations which should be researched and solved in the future. Firstly, data of the environment satisfied people which is the foundation of transformable design should be collected in a wide range of healthcare estate and classified by different types of healthcare estate. For instance, the special hospital has the typical range of age which requires individual data. Big Data as the innovation in health care system should be applied. Secondly, as transformable design requires the characteristic technology and knowledge, cooperation with other institutions are essential. Finally, the biggest challenge is extent of wide utilisation of transformable design. The owner will consider economical impact which hampers the development of it in healthcare estate. So, it is essential to balance the performance and economy. All in all, I believe the benefits of transformable design will demonstrate it is imperative to be employed in sustainable healthcare estate to create flexible environment for human.

References Achim Menges, O. D. K., Steffen Reichert (2013) 'HygroSkin: Meteorosensitive Pavilion', [online], available: http://www.achimmenges.net/?p=5612 [accessed Asefi, M. (2010) Transformable and Kinetic Architectural Structures: Design, Evaluation and Application to Intelligent Architecture, VDM Publishing.

Bell, J. and Godwin, S. (2000) The transformable house / guest-edited by Jonathan Bell and Sally Godwin, Architectural design: 70/4, Chichester : Wiley-Academy, 2000.

Brand, S. (1995) How buildings learn: what happens after they're built, Penguin. com.

Capolongo, S., Buffoli, M. and Signorelli, C. (2011) 'Sustainable High Quality Healthcare'.

Crichton, D., Nicol, F. and Roaf, S. (2012) Adapting Buildings and Cities for Climate Change, Routledge.

Edwards, B. (2010) Rough guide to sustainability.

Goldsmith, E. (1972) A blueprint for survival.

Guenther, R. and Vittori, G. (2007) Sustainable healthcare architecture, Wiley.

Hoberman (2002) 'Hoberman Arch', [online], available: http://hoberman.com/portfolio/hobermanarch.php [accessed Hoberman (2009) 'POLA Ginza Building Facade', [online], available: http://hoberman.com/portfolio/pola.php [accessed Hornsby, J. A. (1913) The Modern Hospital, WB Saunders Company.

Hudson, J. (2012) Architecture : from commission to construction, London Laurence King Publishing.

Kronenburg, R. (1995) Houses in motion: the genesis, history and development of the portable building, Academy Editions London.

Kronenburg, R. (2003) Portable architecture, Routledge.

Kronenburg, R. (2007) Flexible : architecture that responds to change, London : Laurence King.

Lee, J. D. (2012) Adaptable, Kinetic, Responsive, and Transformable Architecture: An Alternative Approach to Sustainable Design, unpublished thesis Manyika, J., Chui, M., Brown, B., Bughin, J., Dobbs, R., Roxburgh, C. and Byers, A. H. (2011) 'Big data: The next frontier for innovation, competition, and productivity'.

McCullough, C. S. (2009) Evidence-based Design for healthcare facilities, Sigma Theta Tau International.

Menges, A. and Ahlquist, S. (2011) Computational Design Thinking: Computation Design Thinking, Wiley. com.

Mitchel, W. J. (2003) Me++: The cyborg self and the networked city, The MIT Press.

Monk, T. (2004) Hospital builders, Academy Press.

Nightingale, F. (1992) Notes on nursing: What it is and what it is not, Lippincott Williams & Wilkins.

Phiri, M. and Chen, B. (2014) 'Sustainability and Evidence-Based Design in the Healthcare Estate'.

Poletto, M. and Pasquero, C. (2013) Systemic Architecture: Operating Manual for the Self-organizing City, Routledge.

Schumacher, M., Schaeffer, O. and Vogt, M. M. (2010) Move: Architecture in Motion - Dynamic Components and Elements, De Gruyter.

Shepley, M. M. (2010) 'Developing evidence for sustainable healthcare'.

Stella Lowry, D. S. (1991) Housing and health, London: British Medical Journal.

Verderber, S. (2003) 'Architecture for health-2050: an international perspective', The Journal of Architecture, 8(3), 281-302.

Worpole, K. (2009) Modern hospice design: the architecture of palliative care, Taylor & Francis.

6