Open Building et Open Room: de nouvelle perspectives pour la conception des chambres d'hospitalisation

According to the World Health Organization (WHO), the environment is defined as ‘an integrated system of human and physical factors exercising a significant effect on health, considered not only the absence of disease but as a complete physical, mental and social state’. One of the most important challenges that architectures for health must cope with is to be resilient to social, economic and clinical changes and, meanwhile, to ensure that the healthcare system, services and assets respond to the constantly changing needs and the specificities of several country’s healthcare system and organizational models. The rapid evolution of medical knowledge and technological tools determined healthcare facilities’ unsuitableness after few years of their construction. Therefore, scholars and professionals, involved in hospital design, are called to look at new strategies in order to respond to the current and future challenges. Starting from these needs, the more consolidated approach is to ensure flexible health facilities. Flexibility is the ability of a building to respond to service change to different time cycles. In relation to the health issues, the flexibility in hospitals should include a multi-scale vision ensuring real efficiency of the services provided with respect to continuous changing systems, social and economic needs, epidemiological trends. Flexibility can range from the planning level to the local services’ network system, from the health buildings in which delivers all the services to the mono-functional environmental units; all these layers should be structured with respect to organizational and managerial levels in an adaptive and resilient way. In recent years, the knowledge in flexibility to adapt to service change has been developed and analysed by several scholars from different study fields: it is the ability of a structure to be able to change its functions and environments in the short, medium or long term, based on the costs and users’ needs. This capacity for transformation can be ensured only by a building designed in the pre-design phase in accordance with technological, structural and plant engineering criteria specifically oriented towards the flexibility of the entity itself. As a consequence, flexibility has become an essential key point which all the operative and future hospitals must achieve. In recent years research in the healthcare building sector has been focusing on systems highly adaptable from the technological to the structural scale, from the building plant engineering to functional level. Several research groups are developing design strategies to improve the flexibility for the design of significant spaces which are essential to ensure high levels of quality to the growing number of new demands. Then it is clear that hospital project, often unsuitable to meet the organizational complexity’s needs of a healthcare facility, is subject to changes over time. It is necessary to define technological and constructive solutions that permit the environmental flexibility to guarantee future changes with minimal impact on the entire building systems and users. Currently, several scholars are deepening the Open Building approach: it deals with a strategy based on constant surface flexibility, the ability to change and to adjust to new layouts without increasing its area. There are spatial and functional redistributions and the attempts to design inner spaces with a high level of adaptability. By reducing excessive and useless dependencies and entanglements among these components of the project, it is possible to ensure their operation without interference or damage to the others. A preliminary distinction between durable elements and those that are more prone to be changed, allows easier, quicker and low cost actions and a greater level of customization. Sometimes, this kind of approach can be useful when dealing with quickly changing regulations and strict bureaucracy that does not suit the long timeframe of the designing and constructing process of complex structures, such as healthcare facilities. For the application of the Open Building approach to healthcare facilities, it is necessary to individuate three systems: Primary System (the Structure), Secondary System (the Components) and Tertiary System (the Equipment). Starting from this approach, a research work is giving rise to a prefabricated module system for hospital environments able to guarantee maximum adaptability in inpatient wards. Starting from the know-how on prefabricated bathrooms and operating rooms, as well as several prefabricated hotel rooms, it is possible to imagine and design a prefabricated inpatient room during the construction phase. It can be of easy installation and replaceable in case of changes for maintenance and/or modification of the function. This is easily seen that several existing hotels and office buildings are designed with prefabricated rooms that change for different users and present possible variations in creating the interiors by combining colours, materials, lighting, furniture, etc.