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Circulation in multiservice facilities: A quick reference guide to the implications of different organisational diagrams on the utility, amenity and cost of shared facilities.

Circulation in multiservice facilities: A quick reference guide to the implications of different organisational diagrams on the utility, amenity and cost of shared facilities. Increasingly public services both within healthcare (such as GP practices, dentistry, treatment & therapy) and other local services (such as housing, social work, police, leisure) are working closer together and being housed in the same facility. Although the service benefits of co-location are well understood, improving accessibility for the public and co-ordination between disciplines, the means by which the physical infrastructure can support this and offer additional benefits and efficiencies are often less well defined. Bringing a number of separate services into one location can offer opportunities for: • Sharing support services and spaces, such as meeting rooms, FM, reception, records, etc • The flexibility to allow overcapacity in one area to be used by another. If well designed, an integrated services building can provide space for all the services in a smaller total area than had the services been located separately, thus reducing the environmental and economic impact of the development. It can also, due to the opportunities of increased scale, provide opportunities for additional amenity (a central zone could be used for exhibitions or community meetings) and greater future flexibility. However, realising these potential benefits requires early consideration of how the different services relate to one another, and the means of both public and staff circulation between the services. This study aims to explore the opportunities and challenges of different organisational forms to help those involved in briefing, budgeting and early design make informed decisions about the building and its performance as a whole. The study focuses on three alternative design approaches to a midsized integrated services facility, with several different types of user, grouped for clarity in this study into three types of space usage: • Service providers; largely working through contact with the public within the facility, such as GPs, treatment, dentistry or legal/advice organisations (indicated on the plans as SPs) • Peripatetic teams; largely using the building as a staff base for services in the wider area, such as community nursing and social work


• Support facilities; admin, toilets, plant etc.

The building has been designed three times (based on a real project), each with the same brief and schedule, but modelled around three different commonly used organisational circulation diagrams. This enables direct comparison to be made around costs, functionality, user experience and opportunities for flexible use and future change and expansion. The challenges and opportunities raised by each model emerged from a discussion between representatives with different areas of expertise including procurement, construction, and service provision from several NHSScotland boards. This report contains details of each model, including plans and sketches, and discussion of the challenges and opportunities each model presents in operational terms. These include flexibility in use, ventilation and lighting, internal environment, wayfinding and differing needs of service providers, and key drivers such as sustainability and future flexibility and expansion. It also includes basic construction and lifecycle cost information, referred to within each section but available in more detail in the appendix. To facilitate fair comparative analysis, each Model Schematic Layout has been developed from the same brief and assumed design parameters which include: • A fixed schedule of room requirements, net of any circulation allowance

• A single point of entry for public access

• A 3-storey building format to minimise building footprint and walking distances • The adoption of a standard economic floor span for block widths, to save variance from single and double loaded corridors • The adoption of a standard 1500mm clear width for all circulation routes • A policy of maximising the use of natural daylight and natural ventilation.

The only variables in the core accommodation was the changes in circulation space necessitated by the different models and the allowance for plant space in each model, which varies due to the different opportunities for daylight and natural ventilation in each model, and consequential demand for artificial supplementation. The three basic models (top) Wing Atrium Courtyard


Use of this quick reference guide This guide can be used to raise issues and widen understanding and ambition at several different points in the design process.

• Brief development – promoting discussion around the objectives of co-location and how the development brief may embed those principles established for service change and integration

• Early assessment of site options – understanding the likely implications of different diagrams being applied to the site before the detailed layout is worked out.

Site selection –consideration of how site factors such as size, shape, orientation, topography, access and local built form might influence or limit the options for different diagrams to be accommodated on the site, and the implication of this on the long term utility of the development

Notes These designs should not be taken as the “correct” or “only” way to work or used as design templates; they are models rather than fully designed buildings, but they have all been designed to a greater level of detail than is shown to check that they are likely to comply with current healthcare design guidance. Cost information is based on the specific layouts described. Cost information should be used only to allow comparison between models, not to inform the likely costs of any real project. It should be noted that these layouts have been prepared without reference to any individual site and inevitably site factors will be a very important consideration when looking at the merits of the models being compared in this study.


“Wing” model Renfrew Health and Social Work Centre

Introduction This model takes the form of separate linear wings of accommodation connected by a central entrance zone. Public access leads directly to the main reception area and from there the reception areas for each Service Provider are clearly visible and immediately accessible. From these main public areas the circulation leads to the individual rooms through double loaded corridors extending into each wing. Girvan Community Hospital

Although an “H” formation is shown, the wings could be at different angles to one another, or all on one side of the entrance space, in response to the site constraints. Examples in practice RENFREW HEALTH AND SOCIAL WORK CENTRE, GLASGOW 3 wings off one side of the entrance area. GIRVAN COMMUNITY HOSPITAL, GIRVAN Several wings of different sizes and figurations off a curved main entrance corridor.


Operational Assessment Wayfinding in the building is simple and clear. Individual service providers can have a strong identity, and each provider’s area can be easily locked down securely when not in use, without affecting access to other areas with different hours. The front of house facilities can be shared, if a suitable IT system is in place, and this allows savings on staff numbers, and enables easy control of access to and movement around the building. The model generates long corridors accessed only from one end, which maximises walking distances for public and staff to consulting areas and shared facilities. Staff service access also uses the same areas and corridors as the public. As it is primarily corridor, the quality of the environment of the public areas will be poor and may be subsequently hard to maintain over the building’s life. The model can result in additional staircase and circulation requirements, with dedicated escape stairs in each wing and clear stair and lift access for the public to the upper levels. If space is available on site the layout provides an opportunity to expand by extending or adding wings, though this should be considered carefully so that the wayfinding travel distances and public environment is not unduly affected.


The self-contained wings can promote compartmental attitudes and lack of staff interaction between providers, particularly if building is oriented so that entrance access is through rather than between wings, as working relationships are not naturally promoted through proximity. The separation of providers can also result in duplication of staff areas and facilities which will also reinforce this. The amount of external space produced allows opportunity for breakout spaces and recreation areas as part of the facility provided privacy planting is part of a larger quality landscaped strategy. The model has a larger land take-up than other options and requires an extensive flat site to accommodate DDA requirements economically. The model creates a large exposed building perimeter and large semienclosed areas that could raise security issues. Summary – Wing Model This layout provides a strong identity for each service provider, but at the cost of limiting the opportunities for shared space and day-to-day flexibility. The building form’s reliance on long corridors increases walking distances and limits the useable public space. Whilst the form is flexible and can accommodate different site shapes, it does require a greater site area than other models, with large areas of land that need landscaping and security. Passive lighting, heating and ventilation strategies are effective, but the large amount of external wall increases heat loss and drives up construction costs.

Second Floor Plan First Floor Plan Ground Floor Plan


“Wing� model Renfrew Health and Social Work Centre

Likely uses This model is suited to large flat greenfield sites. Due to the extent of exterior wall it would be less appropriate on a constricted urban site directly adjacent to roads or pedestrian routes for privacy and security reasons. Optimally the site access should be from the short side providing clear routes into the centre of the building. As each wing would be generally intended for one service provider, these would preferably be of a similar size and unlikely to require extensive flexibility in use.


“Atrium” model The Arches


Barrhead Health and Social Work Centre

The Atrium Layout incorporates all service providers arranged in close proximity around a central roofed atrium space which runs through all storeys. Public access at ground floor level leads directly to the main reception area located within the atrium and from there access is clearly visible and readily gained via primary circulation to the reception and waiting areas of each Service Provider on the ground and first floors. Secondary circulation routes then lead to consultation spaces. Examples in practice “THE ARCHES” BELFAST A large central atrium provides access to all facilities, overlooked by waiting areas. BARRHEAD HEALTH AND SOCIAL WORK CENTRE, GLASGOW Facilities wrapped around a central atrium with views out towards the surrounding hills.


Operational Assessment All Service Providers are clearly visible and easily accessed from the central atrium space, controlled by the main reception point. The central atrium area can be a genuinely shared dynamic space for staff and public, forming a “town centre� environment and emphasis can be placed on centralised vertical circulation, animating the space and encouraging healthy behaviour. There is clear primary circulation to each service provider and controlled secondary circulation thereafter facilitates short routes from reception/ waiting areas to rooms providing services. Staff and core public areas are equally accessible and servicing can be carried out using secondary circulation route away from main public areas. The areas around the atrium can work either as smaller rooms with a secondary circulation route, or be more open plan, connecting the atrium with the outside walls. The waiting areas which look onto the Atrium rely upon the quality of the Atrium environment to be pleasant and welcoming. This layout is more readily adaptable to change of main axis than other models and has the least land take up. Lock-down for out-of-hours use is more difficult to achieve on a provider by provider basis. The compact floor layout with key stakeholders in close proximity encourages dialogue and working relationships between users, joint working and use of shared spaces. 10

Second Floor Plan First Floor Plan Ground Floor Plan

Proximity of Service Providers to each other and connected secondary circulation routes offers flexibility for changed use requirements. Room sharing is very straightforward as each sub reception can serve a variable number of consulting rooms , aiding flexibility in use and potentially resulting in less rooms being needed (right). Care is required in the selection and planning of the internal rooms to ensure their uses are appropriate, make the environment as pleasant as possible, preserve privacy and consider servicing needs. The design of the galleries requires consideration of vertigo and visibility, and the potential inclusion of elements such as seating to reduce safety concerns. As the model generates a compact inward looking form, it can be difficult to extend and so future expansion must be considered at the outset. Summary – Atrium Model This layout can combine high levels of flexibility and dynamic shared space, with clear wayfinding and interaction onto a compact and efficient site. To do this it does require increased mechanical ventilation and considered design to avoid excessive use of internalised rooms and privacy issues. Whilst the feel and function of the building depends upon the quality of the atrium area, it minimises the use of corridors and is a real opportunity to create a vibrant, functioning community space.


“Atrium� model The Arches

Likely uses This would be the best model to use for integrated facilities with many small service providers, or where the room and facility requirements for the providers are likely to change or need to be flexible. The compact from is particularly suited to constricted urban sites where roads or pedestrian access limits expansion. As it has the opportunity to have larger spaces within the building, it can also incorporate peripatetic providers with different space needs.


“Courtyard” model Waterford Health Park


Kaleidoscope - The Lewisham Child and Young People’s Centre

This Model has all accommodation arranged around a large central courtyard that is open to the air. The public entrance zone only facilitates the inclusion of two major Service Providers in immediate proximity to the entrance on each floor, meaning that some Service Providers may have their reception/waiting areas located remotely from the main entrance. The circulation is through a corridor that forms a complete circuit on each floor. Examples in practice WATERFORD HEALTH PARK, The renovated and extended building surrounds and incorporates a healing garden and cloisters. KALEIDOSCOPE – THE LEWISHAM CHILD AND YOUNG PEOPLE‘S CENTRE, LONDON A single loaded corridor wraps around 3 sides of an external courtyard through which you enter the building.


Operational Assessment The courtyard is an opportunity for secure good quality landscaped areas with the option of extending use for recreation and break out use, subject to preserving privacy. There is little external space that is not directly overlooked, and all ground floor rooms face onto useable outdoor space resulting in privacy issues both ways. If the route around the courtyard is not a complete circuit, there is opportunity for additional use of the external space and increased views. As it is primarily corridor, the quality of the environment of the public areas will be poor and may be subsequently hard to maintain over the building’s life. Single loaded corridors (rooms only on one side) would improve the circulation environment providing views, potential external access and aiding wayfinding. Due to the lack of separation between circulation and rooms, there may potentially be issues with privacy and noise. Due to the need to walk through other provider’s areas, some parts will be very disrupted and others seem isolated. This may be exacerbated by the circulation being shared between public and staff use. Main entrance front of house facilities can be shared with good control of public access and wayfinding initially.


There can however be potential problems with control of public movement through the building. Walking distances can be long, and way finding can be confusing, particularly on exiting a room when visitors will be less orientated. Direction through the building will be heavily reliant on sub receptions and appropriate staffing. It is very difficult to securely shut down any particular provider’s area due to the need to walk through it. The model makes it difficult to share space and facilities between providers, and reliance on double loaded corridors generates a form that is not hugely flexible. It is also difficult to extend. Almost all rooms can have good natural daylight levels with an open outlook from the windows. The majority of the ground floor rooms have the opportunity to connect directly to the outdoors. The model requires a flat site to be built without additional economic costs and design considerations, and a large land take up. Summary – Courtyard Model This layout can combine high levels of flexibility and dynamic shared space, with clear wayfinding and interaction onto a compact and efficient site. To do this it does require increased mechanical ventilation and considered design to avoid excessive use of internalised rooms and privacy issues. Whilst the feel and function of the building depends upon the quality of the atrium area, it minimises the use of corridors and is a real opportunity to create a vibrant, functioning community space.

Second Floor Plan First Floor Plan Ground Floor Plan


“Courtyard” model Kaleidoscope - The Lewisham Child and Young People’s Centre

Separation of public and staff access and movement around the building can simplify circulation

Likely uses This model is the most difficult to use when accommodating a large or complex brief. It is most suited to a smaller number of Service Providers on each floor, where circulation can connect into the courtyard to aid wayfinding and orientation (such as in Kaleidoscope, The Lewisham Child and Young People‘s Centre, London). Depending on the layout within the building, the model is suitable for providers of different sizes, but not a large number, or if the size of these frequently changes, due to the need for appropriately placed sub-receptions and waiting areas. It can accommodate providers with different space needs, such as open plan or larger rooms, but these would have to be included at the outset, as the building might be difficult to adapt without affecting circulation routes. The need for the public to travel around corners and become disorientated may be avoided if public access areas and peripatetic areas are separated within the building (top left).


Appendix This appendix includes:

• Comparative summary figures for the three models (below).

• M+E considerations, both general and model specific (model specific points already included in comparisons)

• Additional construction cost information (calculated March 2011). These costs are based on the models shown, and assume for this purpose that all standard consulting rooms in the facilities are finished to a medical standard. Standard costs per m2 of Health/ Medical Centres inclusive of BREEM Excellence and MCP and Risk % Allowance as noted should be in order of circa £1900-£2100/m2 of GIFA


M + E Service Review All buildings The building envelope should be considered as a climate modifier rather than solely a means for excluding climatic conditions The envelope has 4 main functions: • To reduce heat loss, maximise solar and internal heat gains and recue uncontrolled air filtration losses in cold weather • Minimise solar heat gain and avoid overheating, using window shading and thermal mass to attenuate heath gain in warm weather

• To allow optimum levels of natural light

• To allow optimum levels of natural ventilation

Choosing the optimum orientation to maximise daylight and minimise summer heath gain and winter heat loss can have a significant impact on energy efficiency North facing windows offer very little solar gain and benefits are often gained by having the major building axis pointing East/West East/West glazing is harder to shade form direct sunlight as the sun angles are low at certain times of the year Wing model ADVANTAGES • Natural ventilation strategy possible for considerable area of the building

• Natural daylight optimised (max 6m from the perimeter)

• Local environment under the control of the user

• Opportunity to provide “night purging” for majority of building to reduce overheating and minimise air conditioning DISADVANTAGES

• Higher level of heat loss due to increase in perimeter area

• Risk of overheating due to soar gain. Orientation is critical

• Local/remote plant space access required. Less efficient than central plant space


• Increased risk of unwanted infiltration due to extent of building perimeter

Atrium model ADVANTAGES

• Reduces heat losses

• Enhanced use of daylighting into the building core

• Ability to pre heat ventilation air

• Possible use of atrium as a thermal flue to promote air movement through the rest of the building • Natural day lighting and ventilation strategy possible to perimeter spaces (within 6m of the perimeter) DISADVANTAGES

• Risk of overheating due to solar gain and lack of conduction losses

• Mechanical ventilation required to spaces overlooking atrium

• Less of daylight compared with courtyard model (min 20% loss)

• Shading within the atrium required to minimise heat gain

• Increased levels of ventilation required within the atrium

Courtyard model ADVANTAGES

• Lower heat loss in comparison with wing model

• Increased natural daylight penetration into building

• Unwanted solar gain can be reduced by careful consideration of orientation and shading by courtyard • Opportunity to provide “night purging” for majority of building to reduce overheating and minimise air conditioning DISADVANTAGES

• Higher heat loss in comparison with atrium model


Cost Analysis (calculated March 2011)



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Circulation in Multiservice faciltiies - A quick reference guide  

A quick reference guide to the implications of different organisational diagrams on the utility, amenity and cost of shared facilities.