['FLEXIBLE WALLS' IN HOSPITALS - ASSESSING THE 'VALUE' OF SOCIAL IMPACT ON ARCHITECTURE]

: The development of hospital architecture is influenced by social trends, with mutual influence. Architecture enables 'organic-design' that leads to development, growth and adaptation of the structure to changing functions. A literature review reveals different perceptions of the flexibility of adapting hospital structure to changing needs, focusing on external forces pressures (expensive technologies, budgetary constraints limiting innovation implementation and regulatory barriers), as well as patients' demands. The degree of contribution of structural changes to the measured or perceived benefit to the patient and staff, has not yet been fully assessed. Expressions of this benefit are infection-control and increasing operational efficiency by energy saving and sustainability.

To examine workers' perceptions towards value-based-architecture in relation to the patient or staff in a hospital setting.

A survey was conducted among health care workers who underwent management training, using a structured questionnaire.

Sixty responders ranked hospital leadership and relevant professionals (engineers and architects) as key players in the decision to change architecture in a hospital; economists, doctors and nurses were ranked as less important, while patients and families were ranked the lowest. Among the factors that contribute to the 'value' of the decision were the agility to adapt to emergency, and to changing morbidity trends in an efficient way. Factors ranked as being of medium importance were the contribution to hospital profitability and, to a lesser extent, the contribution to branding and improved service.

'Flexible walls' (shifting rooms between departments according to clinical need) can provide a response to morbidity changes.

Hospital workers can play a role in the process of value-based architecture, thereby improving decisions concerning hospital construction and increasing their commitment to additional quality processes.