Designing Safety-Net Clinics for Flexibility
A building that lacks flexibility and adaptability can quickly become obsolete. This is especially true in health care, where changes in user populations, services, equipment, technologies, and treatment methods have occurred rapidly in the last several decades. These types of changes affect the experience of the patient as well as the ability of the provider organization to offer care. The costs to modify existing structures can be prohibitive. Under these conditions, the need for flexibility and adaptability is paramount.
Flexibility and adaptability are not synonymous, however. Adaptability can be defined as the ability to change in response to internal or external developments, approaching the problem from the top. Flexibility involves a more solution-oriented process within a limited set of alternatives.
Adaptability allows incorporation of new and different uses over time (e.g., adding behavioral health programs), while flexibility addresses ongoing changes within the original vision or business plan (e.g., providing multipurpose rooms for increased capacity during peak periods and space for evening community programs). Adaptability is a continuing necessity in clinics, many of which began in structures originally intended for other uses.
This paper addresses the conceptual framework of flexible and adaptable design, considering the perspectives of both patients and provider organizations. An overview of several studies from acute care environments includes applications and examples of clinic design, with attention to the organizational response or business case. The intent is not to be prescriptive, but to offer a strategic approach to flexibility and adaptability that will facilitate a clinic’s development and growth. Despite limited research on flexibility and adaptability in health care, and none specific to clinic design, lessons from other industries and acute care environments can be extrapolated to design recommendations for facility renovation, expansion, or replacement.