The design of a new hospital is typically used as a catalyst for change, redesign and implementation of new work processes to improve health services. Perceived outcomes after relocation may be linked to the success of co-design and stakeholder engagement processes. Especially in striking the right balance between the building (Bricks), processes and supporting IT (Bytes) and work processes (Behavior). Even when stakeholders are engaged in the design that is not to say that their needs will be safeguarded during trade-offs in various phases of decision-making. Furthermore, the time window between engagement and project delivery may contribute to a mismatch in perceived outcomes after relocation. This study aims to gain insight into the possible causes for the perceived mismatches as expressed by ward managers some 12 months after relocation. This was altogether some 6 years after the design of the facility was completed. It will increase our understanding of the complexity of design, construction and transition processes that have to deal with a gap in time between design and use. We adopt an interpretive case study approach in which in-depth interviewing has been combined with an extensive analysis of documents collected over time. We found transformative change requiring an integrative approach to the Bricks and Bytes throughout the whole process of designing, constructing and taking into use, with stakeholder engagement as a key element. Additionally we found Health Care Worker Behavior not well enough considered in a predominantly rational design and implementation process focusing on patient centeredness.

The COVID-19 pandemic placed healthcare design at the heart of the crisis. Hospitals faced challenges such as increasing their ICU-capacity and enabling physical-distancing measures to prevent infectious spread. They also needed to co-house (suspected) COVID patients and non-COVID patients with different requirements enforced separate entrances and routes to keep staff and patients safe. It is suspected that even in a fully vaccinated world other pandem-ics are waiting in the wings. In a design brief, flexibility is typically mentioned as an important target, and single occupancy in-patient accommodation may be considered as a way to enhance flexibility. To gain insight in and to inform future hospital design, this study evaluated what oper-ational coping strategies and design solutions were considered important enablers to increase ICU capacity and to support different patient flows and what design solutions enabled physical distancing. We have collected data from 30 Dutch hospital organizations, including from some recently opened hospitals, with 100% single occupancy in-patient accommodation. Using a practice-based approach, in-depth interviewing was combined with document and multimedia analyses to analyze and compare successful operational strategies and design elements that helped provide the flexibility needed in this recent crisis. As we looked at existing facilities and alterations made to allow hospitals to operate in ‘crisis mode’ during the COVID-19 pandemic, we present emerging design considerations for future healthcare facilities that, preferable, can also be implemented in renovations of refurbishments. We add the perspective of staff as a limiting factor to a hospital’s pandemic preparedness.