Introduction At the height of the Covid-19 pandemic, healthcare Trusts were stretched to capacity, utilising existing Intensive Care Units (ICU) and general wards to treat severely ill patients in respiratory distress. Current design guidance and healthcare infrastructure has had to accommodate these new needs, with little flexibility within the current system to cope. However, the facilities and clinical teams have confronted this challenge, doing a crucial job brilliantly whilst in difficult circumstances. Objectives The pandemic has raised three issues; why are ICU facilities inflexible, a major problem pre-pandemic but compounded by the last 18 months? How can medical advancements still be achieved while addressing the backlog of patient referrals and outpatient procedures? Finally, how fit-for-purpose is our current design guidance legislation? Concentrating on the ICU model, we will question how flexible it can be to meet future patient requirements, including personalised medicine, while maintaining effective isolation within intensive care. Methodology Current ICU designs will be evaluated, and hypothetical clinical models for care will be developed for testing and investigation. These are later analysed for suitability, effectiveness and versatility, at clinical and patient level. All findings will inform recommendations for changes to design guidance. Conclusion This paper seeks to examine what can be achieved while working outside the constraints of the current clinical model and design guidance. With flexibility at its core, can the current ICU clinical design be updated to allow for the needs of current and future requirements?

Health and well-being have a very direct relationship. The purpose of this research is to understand the impact of design of the healthcare facility to the recovery of those inside it. The most apparent differences between healthcare facilities built with human-centric approaches and those built with a broader or more ‘number-centric’ approach, is found when the exemplar facilities being compared, belong to different eras. For this research, the first facility chosen is one built during war- a promptly designed and promptly set-up hospital where patients were mostly nameless, faceless soldiers considered most important for numbers in the army- and the second, a hospital of the twenty-first century, one built involving residents, psychology, nature and aesthetics. This research compares the buildings on various architectural as well as general factors, including ideology, humanity of approach, design, materials, construction techniques, context and setting, aesthetics, socio-cultural parameters, morals and overall medical treatment merits. It concludes with an analysis of the similarities and differences of the two approaches, the changing requirements of a post-pandemic world, and what the latest definition of “future-ready” means for healthcare infrastructure.

The study examines the implementation of a new model of remote care by telemedicine technologies at a COVID-19 acute psychiatric unit. Remote care by telemedicine technologies accelerated during the COVID-19 crisis, not only for outpatient care but also for hospital inpatient care. To enhance the safety of the staff in the COVID-19 units, conserve PPE, and provide a method for communication with experts and families, hospitals developed a new model of in-patient telemedicine. The model was implemented in an acute psychiatric unit for COVID-19 patients in Israel with a control room and audio-video system to remotely supervise, communicate, and treat the patients in the contaminated unit. The study is based on semi-structured interviews of medical staff, architects and digital technology directors, and observations in the COVID-19 unit in June - December 2020. The study illustrates the impact of the built environment on the implementation of telemedicine technologies for inpatient care. It demonstrates limitations caused by the location of the audio-video system to avoid vandalism and the complexity of the system due to the dynamic movement of patients in the unit. The results indicate the system's dependency on the collaboration of patients and the need for coordination between caregivers. While inpatient telemedicine holds potential to enhance the quality of care and safety of patients and staff in COVID-19 units, its implementation in acute psychiatric units requires further development in the integration of digital technologies with the design of the built environment to address unique challenges of mental health.

The emergence of the COVID-19 virus has forced humanity to rethink the design of hospitals and prepare for probable future outbreaks. Even before the pandemic, there was a causal link between the design of hospitals and the spread of nosocomial infections. Also, previous studies have revealed correlations between climate change and the increased rate of the spread of infectious diseases. Hence, this review created a framework of strategies for pandemic resilient and sustainable hospitals while emphasising the role of architects in health promotion. The study conducted a qualitative content analysis of existing studies on the design of healthcare facilities post-pandemic to build the framework of strategies. The research was organised into short-, medium- and long-term measures for pandemic resilient design. The study has demonstrated that the framework for the space planning, ventilation and material specification of hospitals must be revised for pandemic resilient hospitals. The findings reveal that most of the design strategies that can control the spread of infection in a healthcare facility could also be a panacea for decreasing the carbon footprint of the hospitals. Nonetheless, the paper has established the need for further interdisciplinary study on design strategies for impending pandemics and applicable to all building typologies.

A new approach to health system planning has been developed for the Australian Health System and piloted for Queensland Health. The pilot project has demonstrated exciting results achieving a sustainable, adaptable and integrated health system. It now forms part of a new strategic plan for health services across the State. Sustainability of the health system has been a topic of increasing awareness and focus for many years. Where previous studies have fallen short of quantifying actual outcomes, this planning study has articulated the new health system. A more sustainable system due to reduced capital and recurrent cost, more integrated with the community and more accessible for patients. Enabled by an advanced digital health network which supports virtual care and navigation, this jurisdiction can realise a reduction of 30% demand on their acute hospitals over the next decade. New, more appropriate care typologies were developed to suit the defined health need. These were positioned in the right location to improve access and experience. Adaptability was a key focus for facility design to respond to a community health profile changing over time. Keeping the patient need at the centre of the planning and design process is at the heart of creating a truly integrated, sustainable health system.