טכניון מכון טכנולוגי לישראל
הטכניון מכון טכנולוגי לישראל - בית הספר ללימודי מוסמכים  
Ph.D Thesis
Ph.D StudentPilosof Nirit
SubjectPlanning for Change: Evaluation of Hospital Design
Strategies
DepartmentDepartment of Architecture and Town Planning
Supervisor Professor Emeritus Yehuda Kalay
Full Thesis textFull thesis text - English Version


Abstract

Sustainable hospital architecture requires a design strategy for future change. A whole life-cycle approach to the hospital operation must take into account the constant and rapid change of healthcare environments resulting from transformations in medicine, technology, and sociology. Since the 1960s, architects have developed theories and methods to design hospitals for maximum flexibility and expansion. Yet, many hospitals, which were designed to be ‘infinitely’ flexible and dynamic, did not fulfill their original vision, and have become obsolete and face demolition after only thirty years. Given the high cost and complexity of healthcare, hospital directors and designers can no longer afford to let prediction of hospital performance over time drive investment and design decisions. They are demanding proof that the design strategy chosen will support hospital performance over time. This research proposes to develop a method to help evaluate hospital design strategies for change, by testing ‘what-if’ scenarios. It will simulate not only whether the building can be physically changed, but how the change would affect the future operation of the hospital.

The research comprises a theoretical background, a case study of post-occupancy evaluation of hospital change over time, development of a system for pre-occupancy evaluation by simulation, and an implementation trial to test the system. The case studies include evaluation of different what-if scenarios in an existing hospital inpatient internal medicine unit at the Sammy Ofer Heart Building at Tel Aviv Sourasky Medical Center, and a comparative evaluation of design alternatives for new construction of hospital ophthalmology outpatient clinics at the Rambam Health Care Campus in Haifa and the Meir Medical Center in Kfar Saba.

            The case studies demonstrated a systematic approach to evaluate the complex and dynamic use of the hospital in a pre-occupancy phase. The results of the simulations, in term of Key Performance Indicators (KPI), were analyzed to evaluate the implications of the design in three main categories: procedures efficiency, utilization of space, and user’s experience. The evaluation system, as part of Evidence-based Design (EBD) framework, provided valuable insights about the future impact of the physical environment on the organization outcomes. The transparent, data-driven process, which visualizes the physical, social and behavioral dynamics of the hospital after it has been changed, promotes collaboration between inter-disciplinary members of the project team to optimize the design strategy for future change. In addition, multi-criteria evaluation, reflecting different stakeholders design goals, enhances knowledgeable decision making during the design process and throughout the life-cycle of the hospital.