As the coronavirus pandemic continues to unfold across the globe, the importance of resilient design solutions that ensure critical buildings remain safe, flexible, and fully operational during an emergency event, and quickly recover afterward, are now more than ever pointing the way toward the future of healthcare design.

Although a global tragedy of unprecedented scale, COVID-19 is without doubt putting all of our best thinking around resilient design to the test and providing important real time learnings for practitioners, policy makers, healthcare systems big and small, and indeed everyone involved in creating the future of healthcare in our new reality.

The good news is that we’ve actively layered in resiliency across all aspects of our design for the last decade. With that in mind, we’ve called on our design leaders to share their thoughts and experiences and have examined elements of recent ZGF projects for clues to what might come next.

We’ve outlined them below, but in short: Ensuring space is both flexible and prepared to handle surge populations is crucial for saving lives in the face of a pandemic. In the immediate term, the ability to quickly adapt or convert existing spaces—healthcare or otherwise—is key to treating more patients and saving more lives. Longer term, the flexibility of modular construction offers a potential pathway to speed up construction of treatment spaces. Finally, the promise of big data is expanding exponentially our ability to make data-driven design solutions rooted in real outcomes, under the leadership of our new data strategist, Dr. Flavia Grey.

Seattle Children’s Hospital: From Ebola to COVID-19, Flex Space Saves Lives

In a recent blog post, long-time ZGF client Seattle Children’s explained their response to this quickly evolving global health issue. Our team designed the Emergency Department and inpatient units to have the space and flexibility to make configuration changes in a pandemic situation as well as continuously ensure the safety of patients and staff in the hospital’s special isolation unit (SIU). Prototyped and tested in 2011, our ED and SIU design strategy proved ahead of its time, as it was compatible with protocols that were newly required three years later during the 2014 Ebola outbreak.

“The ED was designed with a ‘dirty’ entry and a ‘clean’ entry in case of a pandemic,” says Mark Gesinger, a principal in our Seattle office who works closely with Seattle Children’s. “This enables the hospital to quarantine large portions of the space with a fire barrier wall and separate air flow. A special decontamination entry enters the dirty side, so it is accessible without going through the main lobby.”

Curbside screening helps identify new patients quickly and determine whether those experiencing COVID-19 symptoms should be admitted to the SIU. The unit has capacity for approximately 20 patients, with ability to expand.

In the inpatient units, Gesinger explains, “All patient rooms are single rooms for acoustic separation and infection control, but they were sized to have double headwall capacity in case of an emergency event like this. They are also zoned with a patient zone, family zone, and staff zone to don and doff protective equipment.”

Additionally, supply delivery is done offstage, minimizing the need for nurses and staff to enter a room if a patient is in isolation. Supplies can be replenished, and soiled linens can be collected, without exposure to the patient room environment.

Resilient Solutions in Combination at B.C. Women and Children’s Hospital, Teck Acute Care Centre

There is no one-size-fits-all response when designing for resilience. Flexibility and infection control are certainly critical factors, but a comprehensive understanding of a range of inputs including client and end-user needs, building codes, technical systems and so much more play into a carefully considered final design outcome.

ZGF worked closely with the provincial health authority, caregivers, staff and patients at Teck Acute Care Centre (TACC) in Vancouver, Canada to develop an elegant and utterly resilient response for the design of this 230-bed children’s and women’s inpatient tower. The facility combines design features that allow it to withstand a natural or man-made disaster, such as a viral outbreak, including:

Emergency operations center: A conference room, two computer labs, and a classroom are fitted with equipment and storage that anticipates their conversion into an operations hub during an emergency. They include folding room partitions, moveable furniture, lockable storage and floor boxes for power and data, an AV cabinet, projector and screen, wall-mounted monitor, and card reader access.

Flex space for surge populations: Patient rooms at TACC have double headwall capacity to provide 50% more space for surge populations, on demand.

Decontamination: The ambulance canopy can be quickly converted into a three-lane mass decontamination shower with cold, warm, and hot zones. It’s equipped to hold 11,900 gallons of water. The decontamination suite provides additional storage for disaster/ambulatory supplies.

Infection prevention and outbreak control: Six patient wings can be easily converted into pandemic outbreak control zones, isolated with partitions and doors, and negatively pressurized from the surrounding areas to mitigate the spread of airborne infections during an outbreak event. During an outbreak of a communicable disease, TACC can restrict access to specific departments, floors, or even the entire facility. Our design includes space for prescreening for airborne or droplet communicable disease risks at either a reception area or greeter stations located next to the public elevators on all inpatient floors.

MEP systems: The mechanical plant and air-handling system is sized for 100% outdoor air operations with 15% additional capacity, allowing for future clinical or long-term temperature changes. The active smoke control system allows for individual smoke compartments to be pressurized during a smoke event (shelter in place). Thus, procedures can continue and ICU patients can remain in place during an event without the loss of heating and cooling airflow.

The Next Phase in Flexibility: Modular Construction

As we have seen in recent weeks, many states and healthcare systems are thinking outside the box and devising creative solutions to repurpose existing facilities, build pop-up treatment spaces, mobile hospitals, and more. Modular construction has the potential to play a leading role in healthcare design solutions going forward, providing flexibility in design and savings in construction time that could enhance resilience across the board in healthcare facilities.

Jerry Foster, a ZGF principal and healthcare designer, notes that “Among other benefits, modular units can be ready for use faster than conventional construction. Being factory built provides greater quality control, and leased units can be financed through operating budgets rather than capital construction funds.”

The Hensel Phelps/ZGF design-build team was recently awarded the National Institute on Aging (NIA) Alzheimer Disease and Related Dementias Temporary Research Facility. Located at the National Institutes of Health (NIH)’s Bethesda, Maryland campus, the 24,000 SF completely modular facility will be delivered in under two years, driven by the urgent and compelling need for space to house 130 scientists and researchers focused on finding effective treatments for Alzheimer’s and related dementias.

Dr. Flavia Grey, ZGF’s new senior data strategist, says “While the coronavirus pandemic is undoubtedly a tragedy, it would also be a tragedy for us not to learn from this experience and be better prepared for the next one.”

She recently spoke with Healthcare Design magazine about how the crisis presents an unprecedented opportunity to dig into the data already being collected by healthcare systems, and pair it with design data, to see what insights can be generated. For example, how does healthcare facility design influence infection rates, recovery rates, and patient and staff experience.

The pandemic nature of COVID-19, coupled with the absence of cures, vaccines, or existing treatment knowledge, makes it possible to draw performance comparisons across different facilities to gain evidence-based design insights. Questions like these could be addressed with data-driven studies:

• What treatment facility size can better adapt to unexpected new demands?
• How does the number of entrances into the facility and waiting room impact infection rates?
• Which room design produces better results, e.g. large, flexible, open spaces or smaller, isolated rooms?
• How do biophilic interventions, such as access to natural light and outdoor views, affect patient experience and recovery rates?
• What is the impact of providing more efficient routes between nursing stations and patient rooms?

To pursue these answers and more, we need both healthcare systems and design firms to come together and share their data and knowledge. One potential pathway could be to establish an open-source online platform, like the AIA has done with the COVID-19 ArchMap, to collect project descriptions, key metrics, floor plans, and photographs of facilities, and then leverage machine learning algorithms to tag and compile a list of design elements for each facility.

In tragedy there is hope, and it is our duty as architects, designers and human beings to use our learnings from COVID-19 to push boundaries. Let’s test the limits of what we know to be best practices in design, explore the validity of our assumptions of how our buildings perform, and revisit current building codes governing much of what we can and cannot design into healthcare spaces.

As ZGF Partner Victoria Nichols put it, “Resilient design innovation sits squarely in our court. It’s up to architects and designers to chart their own approach, and it’s up to our healthcare systems to demand it. In situations like the COVID-19 pandemic, the value of being prepared cannot be overstated.”

Nor can the importance of our collective response as we craft resilient design strategies for the next pandemic.