The evolution of a hospital planned for change
This chapter explores the Open Building approach in the context of the Sammy Ofer Heart Building at the Tel Aviv Sourasky Medical Center in Israel, a building, whose initial design process began in 2005, and that was still under construction in 2018. The chapter documents the evolutionary process of the building from its initial design, and illustrates the changes that were made to the spatial and technical environment resulting from demands for specialized medical units, advances in medical technology, transformation in social healthcare norms, and adaptive health policy standards. Changes are classified by their typology, the level on which the change occurred, the reasons for the change, and the consequences of the change on hospital operations. This information is based on an analysis of architectural documents, hospital data collection, field observation, and expert interviews. The hospital design strategy is analyzed and evaluated to determine whether the design methods were sufficient to support the hospital’s need for change. The research demonstrates the importance of the Open Building approach, as it enabled significant changes during all phases of the project (design, construction, and occupancy). The approach also supported the development of different functional programs, and enhanced the design process over a period of time when managers, planners, and consultants changed. The chapter also points out the conflicts that occur when decision-making in the design of one system level restricts the capacity of the other system levels, requiring constant and time-consuming collaboration between interdisciplinary project teams working in different offices, and which change over time.