The Magic of Flexibility

Growing up in a family of seven, our day-to-day life revolved around our kitchen table. Of course, like many families, we ate our meals together there, circled around an oval block of wood where we shared food, stories and laughs.

But our kitchen table held a piece of magic though, not too different from how a child can turn a simple refrigerator box into a castle fit for a princess – it was flexible to meet all our needs.

For my mom, it was a seamstress shop to sew Halloween costumes and a workspace to keep our large family organized and running smoothly through a system of binders and calendars. For my dad, it was a shop where he could work on DIY projects.

For me and my siblings, it was where we would complete our homework assignments, much more often than on the desks in our quiet and separated rooms. There was not much that kitchen table couldn’t do, including taking on the purpose of other furniture pieces and spaces in the house.

Yet when I moved into my first apartment alone, I intentionally excluded a kitchen table. It was the first time I could decide what furniture I needed and how I wanted my space to function. When thinking about how I would use my space, I worried that eating alone at a kitchen table would feel lonely and, ultimately, like a waste of space. I forgot about the magic my family’s old kitchen table had provided with its flexibility.

Instead, I chose to get a desk. And like the desk from my childhood, it went mostly unused other than as a surface to place my belongings. I struggled to make that desk useful for my needs and it left me with a sense of regret for one of the first investments I had made.

A few years ago, my co-workers and I undertook a study on flexibility via our non-profit CADRE with Steelcase Health called “FleXX: A study of Flexibility in Outpatient Settings” – developing a framework to address flexibility in the built environment. I never realized that my kitchen table was a great example of a specific attribute of flexibility – versatility. Versatility is the ability or intention for a space to be used for multiple functions with little to no change, allowing users to “do different things in it.”

However, versatility is just one of several flexibility attributes. Modifiability also allows for quick adaptability and the ability to return to the original state if needed. It welcomes users to physically “change it”. Like a baby crib that can modify into a toddler bed, providing a different use based on time-specific needs, but able to return to a baby crib for future use.

Convertibility allows for flexibility — “it can change” — but often requires facility intervention to fundamentally convert from one purpose to another. Consider a shipping container — its original purpose was to secure goods for shipment but can be converted into tiny home, a store front, or an emergency shelter.

The final flexibility attribute, scalability, also requires facility intervention and allows a building to “grow or shrink.” While expansion is the most common example of scalability, in future years, the need to contract to minimize our physical footprint may become more commonplace. Take for example the International Space Station (ISS). It is designed to expand or contract through modular units offering different functionality and new technology.

Flexibility, after all, isn’t magic or a catch-all buzzword. It’s intentional and precise to meet a variety of needs and adapt in response to an unpredictable future. In health care design, the need for flexibility is very important, but we must be precise in how we address this. There is an industry need for a shared definition and an actionable framework that can serve as the foundation for conversations between users and designers on how to plan and then mobilize flexibility to derive the full benefit.

Flexibility, after all, isn’t magic or a catch-all buzzword. It’s intentional and precise to meet a variety of needs and adapt in response to an unpredictable future. In health care design, the need for flexibility is very important, but we must be precise in how we address this.

The outpatient clinic at Texas Scottish Rite Hospital for Children in Frisco, Texas, designed by HKS, is a great example of a versatile facility that allows multiple specialty clinics to easily rotate on any given day of the week. 

This was accomplished with standardized processes, patient rooms, and work cores, equipped for any of the different clinic’s needs. For example, while a mirror is commonly used for patient exams in prosthetics and physical or occupational therapies, it typically isn’t during a concussion exam. By incorporating a mirror in every patient room, this provides the necessary equipment needed by a portion of the specialties, while not affecting the process of the others.

The NICU at Norton Women’s & Kosair Children’s Hospital in Louisville, Kentucky, includes open bays, sized to a patient room size, promoting community connection between families. This space exemplifies modifiability by the incorporation of mobile walls that can provide privacy to nursing mothers.

At ProMedica Health & Wellness Center, a multi-specialty clinic in Sylvania, OH, clinic modules were zoned with a standard module layout. This enables future convertibility to different specialties within the clinic for potential future needs with little construction.

Children’s Hospital of Richmond Pavilion in Richmond, Virginia was designed with future scalability in mind. The initial building is comprised of a pediatric, outpatient facility, with the capability to grow vertically by six floors, through oversized structural elements, and horizontally onto the adjacent site. Within the addition, there is also planned shell space, allowing for additional patient beds as the facility demand grows in the future.

From our FleXX study, we found that stakeholders rated versatility and modifiability as having greater importance than convertibility and scalability for outpatient design. However, they believe that flexibility is a fundamental affordance of good design. More than 70% of stakeholders believe that flexibility should not increase costs. The only level of flexibility they were willing to pay for, up to 22% more on average, was scalability. Designing for flexibility is an investment that requires early discussions to avoid over designing and under-utilizing potential flex affordances.

When starting a conversation around flexibility, consider discussing service offerings, human experience needs, operational strategy, and resource requirements in relation to the following:

Type of flexibility required:

  1. Versatility- “I can do different things in it
  2. Modifiability – “I can change it”
  3. Convertibility – “It can change”
  4. Scalability – “It can grow or shrink”

Ease of change:

  1. Timeframe for desired adaptability (minutes, days, weeks, years)
  2. Timing of investment over the building’s life cycle
  3. Layer of the built environment that needs to flex (e.g. furniture, space planning, MEP systems)