Resilient Hospital Design: From Crimean War to COVID-19.

OBJECTIVES: Serious COVID-19 nosocomial infection has demonstrated a need to design our health services in a different manner. Triggered by the current crisis and the interest in rapid deployable hospital, this article discusses how hospital building layouts can be improved to streamline the patient pathways and thus to reduce the risk of hospital-related infections. Another objective of this work is to explore the possibility to develop flexible and scalable hospital building layouts through modular construction. This enables hospitals to better cope with different future demands and thereby enhance the resilience of the healthcare facilities. BACKGROUND: During the first wave of COVID-19, approximate one-seventh to one-fifth COVID-19 patients and majority of infected healthcare workers acquired the disease in NHS hospitals. Similar issues emerged during the Crimean War (1853-1856) when more soldiers died from infectious diseases rather than of battlefield casualties in Scutari Hospital. This led to an important collaborative work between Florence Nightingale, who looked into this problem statistically, and Isambard Kingdom Brunel, who designed the rapid deployment Renkioi Hospital which yielded a death rate 90% lower than that in Scutari Hospital. While contemporary medical research and practice have moved beyond Nightingale's concept of contagion, challenges of optimizing hospital building layouts to support healing and effectively combat nosocomial infections still pose elusive problems that require further investigation. METHODS: Through case study investigations, this article evaluates the risk of nosocomial infections of airborne transmissions under different building layouts, and this provides essential data for infection control in the new-build or refurbished healthcare projects. RESULTS: Improved hospital layout can be achieved through reconfiguration of rooms and concourse. Design interventions through evidence-based infection risk analysis can reduce congestion and provide extra separation and compartmentalization which will contribute the reduced nosocomial infection rate. CONCLUSIONS: A resilient hospital shall be able to cope with unexpected circumstances and be flexible to change when new challenges arise, without compromising the safety and well-being of frontline medical staff and other patients. Such an organizational resilience depends on not only flexible clinical protocols but also flexible hospital building layouts. The latter allows hospitals to get better prepared for rapidly changing patient expectations, medical advances, and extreme weather events. The reconfigurability of an existing healthcare facility can be further enhanced through modular construction, standardization of building components, and additional space considered.

Enhancing BIM security in emergency construction projects using lightweight blockchain-as-a-service.

Rapid design and construction of mobile cabin hospitals (MCHs) have become imperative in the COVID-19 response. However, due to unique design specifications (e.g., parallel design and model pre-revision), collaboration in emergency construction projects (ECPs) like MCHs presents data security vulnerabilities, including a lack of traceability and transparency. These hazards invariably reduce design effectiveness, leading to undesirable rework and project delay. Blockchain technology is a potential solution to address the aforementioned security issues in ECPs because it offers immutable and traceable data storage. Nevertheless, directly implementing blockchain in ECPs is impractical, for the blockchain has a complex deployment process and provides limited functions supporting BIM-based design. Therefore, this paper develops a lightweight blockchain-as-a-service (LBaaS) prototype to enhance the ECPs design efficiency by securing and automating information exchange while eliminating the difficulties of deploying and using blockchain. This paper contributes three elements: (1) Security vulnerabilities of design in ECP are identified. Taking an MCH in Hong Kong as an example, this paper investigates its design process and determines two design characteristics and associated security flaws. (2) Key technologies to support easy deployment and usage of blockchain in ECPs are developed. New technical elements, including a Multi-to-One mapping (MtOM) kit for easy blockchain registration, an integrated workflow retaining existing design practices, and smart contracts for secure interaction with blockchain, are developed to support LBaaS functionality. (3) An LBaaS prototype is validated and evaluated. The prototype is illustrated and evaluated using design examples based on actual MCH project data. Results show that the LBaaS is a feasible and secure approach for ECPs collaboration. This paper deepens the understanding of data security issues in ECPs and offers technical guidance in establishing blockchain solutions.

A Conceptual Framework for Blockchain Enhanced Information Modeling for Healing and Therapeutic Design.

In the face of the health challenges caused by the COVID-19 pandemic, healing and therapeutic design (HTD) as interventions can help with improving people's health. It is considered to have great potential to promote health in the forms of art, architecture, landscape, space, and environment. However, there are insufficient design approaches to address the challenges during the HTD process. An increased number of studies have shown that emerging information modeling (IM) such as building information modeling (BIM), landscape information modeling (LIM), and city information modeling (CIM) coupled with blockchain (BC) functionalities have the potential to enhance designers' HTD by considering important design elements, namely design variables, design knowledge, and design decision. It can also address challenges during the design process, such as design changes, conflicts in design requirements, the lack of design evaluation tools and frameworks, and incomplete design information. Therefore, this paper aims to develop a conceptual BC enhanced IM for HTD (BC-HTD) framework that addresses the challenges in the HTD and promotes health and well-being. The structure of BC-HTD framework is twofold: (1) a conceptual high-level framework comprising three levels: user; system; and information, (2) a conceptual low-level framework of detailed content at the system level, which has been constructed using a mixed quantitative and qualitative method of literature analysis, and validated via a pre-interview questionnaire survey and follow-up interviews with industry experts and academics. This paper analyzes the process of BC enhanced HTD and the knowledge management of HTD to aid design decisions in managing design information. This paper is the first attempt to apply the advantages of BC enabled IM to enhance the HTD process. The results of this study can foster and propel new research pathways and knowledge on the value of design in the form of non-fungible token (NFT) based on the extended advantages of BC in the field of design, which can fully mobilize the healing and therapeutic behaviors of designers and the advantage potential of HTD to promote health, and realize the vision of Health Metaverse in the context of sustainable development.

Effect between Trust in Communication Technology and Interorganizational Trust in BIM-Enabled Projects

Building information modeling (BIM) and its associated digital tools have been widely adopted in designing, constructing, and operating infrastructures, particularly during the COVID-19 pandemic. However, the influence of these communication technologies on the interorganizational trust among project team members is unclear. In this study, BIM and its communication tools were conceptualized based on the perception of trust in communication technology, to examine their influence on interorganizational trust. The effect of trust in communication technology on interorganizational trust was investigated through the mediation of obligatory cooperation and voluntary cooperation. In addition, partial least squares structural equation modeling was used to explore and predict the causal relationships of the model. The results show that trust in communication technology has no direct effect on interorganizational trust, but it positively affects the relationships via the mediation of obligatory cooperation. In comparison, trust in communication technology significantly impacts voluntary cooperation, which does not considerably influence interorganizational trust. Lastly, the findings of this study contribute new knowledge to trust theories for construction teams that use communication technologies to collaborate in BIM-enabled projects, and provide an explanation for the development of trust by communication technologies through improvement of the interorganizational trust in BIM-enabled projects. © 2022 American Society of Civil Engineers.

The Relationship between Sustainable Built Environment, Art Therapy and Therapeutic Design in Promoting Health and Well-Being.

At present, a smart city from the perspective of the United Nations Sustainable Development Goals (SDGs) emphasizes the importance of providing citizens with promising health and well-being. However, with the continuous impact of coronavirus disease 2019 (COVID-19) and the increase of city population, the health of citizens is facing new challenges. Therefore, this paper aims to assess the relationship between building, environment, landscape design, art therapy (AT), and therapeutic design (TD) in promoting health within the context of sustainable development. It also summarizes the existing applied research areas and potential value of TD that informs future research. This paper adopts the macro-quantitative and micro-qualitative research methods of bibliometric analysis. The results show that: the built environment and AT are related to sustainable development, and closely associated with health and well-being; the application of TD in the environment, architecture, space, and landscape fields promotes the realization of SDGs and lays the foundation for integrating digital technologies such as Building Information Modeling (BIM) into the design process to potentially solve the challenges of TD; and the principle of TD can consider design elements and characteristics from based on people's health needs to better promote human health and well-being.

Ultra-rapid delivery of specialty field hospitals to combat COVID-19: Lessons learned from the Leishenshan Hospital project in Wuhan.

With the outbreak of the 2019 novel coronavirus (COVID-19) epidemic in Wuhan, China, in January 2020, the escalating number of confirmed and suspected cases overwhelmed the admission capacity of the designated hospitals. Two specialty field hospitals-Huoshenshan and Leishenshan-were designed, built and commissioned in record time (9-12 days) to address the outbreak. This study documents the design and construction of Leishenshan Hospital. Based on data collected from various sources such as the semi-structured interviews of key stakeholders from Leishenshan Hospital, this study found that adhering to a product, organization, and process (POP) modeling approach combined with building information modeling (BIM) allowed for the ultra-rapid creation, management, and communication of project-related information, resulting in the successful development of this fully functional, state-of-the-art infectious disease specialty hospital. With the unfortunate ongoing international COVID-19 outbreak, many countries and regions face similar hospital capacity problems. It is thus expected that the lessons learned from the design, construction and commissioning of Leishenshan Hospital can provide a valuable reference to the development of specialty field hospitals in other countries and regions.