Flexibility of the built environment in healthcare: a systematic literature review

Abstract

ABSTRACT This paper provides a comprehensive view of the concept of flexibility in healthcare design from a discussion on design strategies to achieve flexibility, ways of searching strategies, results achieved, theoretical approaches, and other analyses necessary for its understanding. Healthcare services are complex environments that must be flexible to meet the demands caused by emergency situations. For example, the COVID-19 pandemic showed that the lack of incorporation of the concept of flexibility prevented the efficient adaptation of space to support high demand, which caused high contamination rates in these environments. Towards a comprehensive view of the concept, the systematic literature review method was used in line with the Preferred Reporting Items for Systematic reviews and Meta Analyzes method. Based on that, the flexibility concept is divided into three levels, respectively: flexibility for adaptation (concentrated on the room scale), flexibility for conversion (focused on the building layout) and flexibility for expansion (coupled analysis of the buildings and land of the entire complex). Design requirements were structured at each level, however, more case studies are needed to collect quantitative data to facilitate its application in design, which is scarce in the literature. Collection of such quantitative data can boost the development of flexibility assessment tools in design, thus facilitating the application of this concept in healthcare environments.