Open building for a kaleidoscope of care: a new conceptual approach to open scenario planning

Open scenario planning, in a market such as healthcare infrastructure where change at every scale is inevitable, provides a significant opportunity. Healthcare, which comprises a complex mix of people, technology, buildings and other forms of infrastructure, is facing huge pressures. As such healthcare trusts are looking to make better use of resources; decrease carbon emissions; and re-think how they can act in a more sustainable and integrated way. Within the UK National Health Service, “taking care closer to home” and “saving carbon, improving health” are two of a number of Department of Health (DH) initiatives to improve healthcare and respond to the need for sustainable, accessible, efficient and effective services. Furthermore these are also the drivers for integration between health, social care, local authority, independent and third sector providers which is creating blurring between spatial scales and roles. Against this backdrop it is not surprising that the effective life span of buildings is continuing to shorten, which is significant in a sector that has infrastructure that is one of the most expensive to operate, maintain and replace. As such the notion of “change ready” is key. This paper through a state-of-the-art literature review introduces and explores the potential and conceptual linkage between infrastructure, capacity and scalability within open building and planning extending (Astley, 2009; Kendall, 2009). The authors’ collaborative and action research has contributed to the development of a new approach and this research has identified the need for a flexible, dynamic and scenario based approach to planning that goes beyond estates strategy and beyond master planning and which precedes open building. The diversity of care pathways across a changing healthcare planning environments is demonstrated using a case study review, which raises the importance of a hierarchy of decision making, principles and process within an open planning approach. This paper further provides a review of existing business case development processes and capacity planning tools that are prevalent in healthcare strategic planning and operations management, but not so in adaptability research. Scalability as a concept that can bridge the healthcare and estates infrastructure domains is also introduced.