There is an urgent need for further research in hospital design and delivery to understand the integrative, nuanced and intricate nature of healthcare project delivery and design management. Historically, each new hospital programme develops a new delivery model that takes a different approach to the management of design. However, this approach is not sustainable. Hospitals have a significant complexity, which may be impacted by role changes and procurement methods which can result in significant errors, costly delays and lack of ability to learn from failure. A retrospective abductive, auto-ethnographic case study approach was taken in the examination of five major hospital projects of similar size and complexity reflecting five temporal periods was carried out by a project architect who subsequently became a construction design manager spanning a career of over 30 years. This variant of action research involved a retrospective mode of abductive reasoning applied retrospectively. An approach to hypothesis testing (using literature) is used to explain and theoretically frame historical practices. It was found that National delivery models (and their change over time) have had a significant influence on hospital project delivery and particularly on design and engineering systems integration. The role standards have played in design have also played a significant role, and in part may have constrained innovation and unduly increased cost. Recommendations are made for a new integrated healthcare delivery model that supports an approach to innovative design and construction of new hospitals responding to advanced clinical and technology approaches.

The current COVID 19 pandemic has highlighted the need for flexibility in the provision of nursing care of extremely ill patients. A new proposition for a clinical adaptability suite of rooms is presented which can be multi-functional to accommodate surgery, intensive care or isolation. A literature review of medical and nursing practice and requirements and a case study analysis are presented. We explore the physical changes to the built environment which have taken place during the pandemic and undertake an analysis of the environmental and infrastructure requirements of a clinically adaptable room. Finally, we present the initial ideas for an innovative case study which considers how we design, manufacture and assemble advanced, versatile and multi-functional hospital settings. The resulting proposed clinically adaptable room reflects new models of clinical care. We explore the common denominators which show similar requirements in terms of medical equipment infrastructure, ventilation requirements and sterile conditions. A more sustainable alternative scenario shows the potential for reorganization and alteration to existing facilities.

The interdisciplinary evidence to support healthcare building is insufficient. New innovation processes are needed that enable clinical, research evidence and practice-based design teams to apply research-informed and evidence based design. This article aims to challenge the basis for prioritizing the reconfiguration of eyecare to respond to patient backlog and develop an innovative di-agnostics hub. Ophthalmology, the busiest NHS outpatient specialty (7.9 million episodes; 2018-19), is perfectly suited to providing a testbed for rapid, research-driven innovation and to show how research in the built environment can better inform clinical and technological advancement. A clinically-led case study is described which reports the approach taken to bring together the de-sign, engineering and modelling expertise of multiple experts in the built environment. Various disciplines contributed to three clinical trials which saw three unique building configurations, which involved 3,000 patients across three iterations of the building layout design. Circa ~ 30 staff were involved in the interdisciplinary co-design process to encourage an innovative approach to equipment configuration, layout design and an emerging scientific evidence-base. There is a significant need to address the methodological, interdisciplinary and theoretical implications of evidence-informed healthcare building. We offer up a conceptualization of an evidence-based co-production process that optimized safety, efficiency of patient movement and staff satisfaction through iterative dialogues.