Commercial and Healthcare Design: Comparing typologies and design considerations

One would expect commercial and healthcare design to be different in almost every way – with the only common denominator being that something eventually needs to be constructed. In many ways this holds true, but surprisingly, there are a few significant parallels to be found between these two typologies.

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December 12, 2024

Commercial and Healthcare Design: Comparing typologies and design considerations

Within the built environment several building types exist like retail centres, intermodal transport hubs, hospitals, apartments and commercial offices. One would expect commercial and healthcare design to be different in almost every way – with the only common factor being that something eventually needs to be built. In many ways this holds true but surprisingly there are a few significant parallels between these two architectural types.

Adjusting one’s design approach from a commercial design mindset to one more focused on healthcare architecture has been a daunting experience. Knowledge of the so-called ‘design formulas’ that are often a requirement for successful commercial projects seemed irrelevant in the face of the highly technical, process-driven and regulation-heavy hospital designs that I now faced. Infection control or the importance of departmental adjacencies were never as critical a consideration when approaching commercial office buildings. Daunting.

Diving into healthcare design head-first, it became clear that being intimidated was the correct response to what lay ahead. There was much to learn and much to un-learn. In time, the differences and similarities would become clearer, eventually crystalising into a set of tools that could be used to enhance the design process for both typologies.

Complexity

The provision, co-ordination and scope of building services in healthcare facility design has proven more complex than what I’d experienced in commercial building design.

Although most commercial buildings require HVAC, electrical and data connections, healthcare buildings additionally need medical gasses, oxygen, treated water, varying air-conditioning types for different areas, even unique lighting levels. These examples only touch on the technical complexities – there are layout requirements, operating differences and more, all of which widen the gap between these typologies.

“Graceland Architects’ knowledge of complex building systems means we can co-ordinate services in the most efficient, user-friendly manner, helping to reduce a commercial developer’s capital outlay.”

Approach

Historically, healthcare facility design has been approached from a physical requirement perspective: a patient’s physical health would often take precedence over their mental well-being. Research has proven that a patient’s mental state during their stay in hospital will directly affect their healing times: positive mental state means improved clinical results.

Commercial architecture has experienced a shift towards a focus on mental health in the workplace. Good mental health and well-being helps teams improve their productivity and creativity promoting job satisfaction – leading to enhanced mental wellbeing. A well-designed space will help to reinforce this positive cycle.

The similarity between healthcare and commercial architecture is evident: people-centric design that positively influences physical and mental health improves clinical outcomes and boosts the productivity of those who work there.

“Our experience in the healthcare sector enables us to provide our commercial clients with a distinct, fresh perspective when undertaking a commercial development.”

Budget

Both commercial buildings and healthcare facilities include several budgetary intricacies and financial influences play a determining role in the service provision of each. This similarity allows us to approach both commercial design as well as healthcare architecture from a communal vantage point.

Within each building typology there exists a variety of budget sub-categories and these may vary broadly from project to project.
While healthcare buildings are generally more expensive per square metre than most commercial buildings, there are likenesses between the two typologies that remain consistent. Attributes like construction rate per square metre, minimum required return on investment, construction period, complexity, regulatory requirements and services all require careful interrogation to ensure the building is fit-for-purpose yielding its intended return on investment.

Tenant fitouts are prevalent in almost all commercial developments. The incorporation of tenanted areas, like doctors’ suites or radiology departments, within the overall healthcare facility results in a further design commonality between the two typologies.

“This exposure to commercial leasing protocols within the healthcare sector means we can offer the same experience in the office architecture realm.”

Two major comparable budgetary metrics exist for healthcare and tenanted commercial buildings. For hospitals, the bed efficiency ratio is considered one of the primary feasibility metrics, whereas the gross lettable area ratio is utilised for an office building.

Both ratios give an indication of the initial project feasibilities. For hospitals a simple square metre per bed ratio may be used whereas the ratio of lettable area to non-lettable area is applicable to commercial developments.

With hospitals, the bed efficiency metric is broad and can be misleading as there are several important differentiators that exist. One cannot compare an advanced oncology hospital with exceptionally expensive equipment to a general hospital.

Similarly, there can be very little comparison between a low-level sub-urban office building and a high-rise building in the centre of a spatially constrained economic hub. The requirement for highspeed elevators or multi-level parking basements exponentially influences the GLA of the high-rise in comparison with the low-level offices.

Space-planning

Effective and efficient space planning is crucial in both typologies although for different reasons. In commercial design, this approach ensures the maximum possible gross lettable area for the developer, allowing them to maximise their potential monthly income from a tenant lease. In healthcare design, this approach to planning reduces the time it takes getting care to where it is required, potentially saving a life. Reducing unnecessary floor area also reduces cost and increases the bed efficiency thereby improving the potential return on investment.

Some basic overarching principles include reducing unnecessary circulation, aligning public bathrooms across floors and incorporating multi-use areas.

“Remaining vigilant of the gross lettable area and the associated costs, becomes an asset when developing efficient spaces in the healthcare design sector.”

Formulas

As with commercial architecture design, there are some elements one might define as “formulas” in healthcare design as well.

These present themselves in the form of adjacencies of different functions and a regulated minimum requirement for almost every function in a hospital. The designer now knows what needs to be included and where in relation to each other but must still fit all the different requirements within a typically severely constrained space. This is where the formula differs from commercial design, which is more forgiving or flexible in its layout possibilities, with far fewer applicable considerations. Once these formulas are understood, the designer can deliver the best possible layout in a much more efficient manner.

Regulatory Requirements

Although all buildings must respond to standardised building codes, there are some additional regulations that buildings in the healthcare sector must adhere to. In the private sector regulations like the R158 or the P187 are applicable, while in the state sector, standards like the IUSS are frequently applied. It is important to note that the IUSS, while regularly used has never been formally promulgated.

Working with experienced fire consultants over many years means we are able to conceptually design and make provision for the fire consultant’s safety requirements early on in the design phase for every type of building.

Summary of Similarities and Differences

The table below highlights the similarities and differences outlined in this article. Interestingly, there are more similarities than differences, although the level of complexity between healthcare facilities and commercial buildings remains marked.

Healthcare vs Commercial Design
Category Healthcare Design Commercial Design
Complexity Vast and varied interconnected systems. Many different layout requirements, considerations. Simple services requirements. Few layout requirements, considerations.
Approach Design based on positive physical and mental outcomes. Design based on maintaining and developing physical and mental well-being.
Budget High cost per square meter. Bed Efficiency as driver. Dependant on shareholder approval. Cost per square meter varies. Gross Lettable Area as driver. Dependant on shareholder approval.
Deliverables Fully operational day one, with certain areas available to lease out. Often a grey box / white box.
Space Planning Effective and efficient to reduce delay in providing treatment. Effective and efficient to enhance lettable floor area.
Maintenance Daily maintenance / cleaning required for infection control. If and when necessary. Facility management is required to maintain building serviceability.
Material Functional and legislative criteria are primary factors. Budget-dependent, with aesthetics being a factor.
Regulation Dedicated regulations and minimum requirements. Very little required beyond standard building regulations.

Conclusion

The cross-pollination of perspectives in commercial and healthcare space-planning and approach are significant. When combined with an understanding of the differences in complexity and budget, a new level of engagement with clients and end-users reveals itself.

This knowledge enables us to reach a design that better addresses both spectrums of needs – from budget to beauty, by understanding what each stakeholder needs and wants.

Having been a part of Graceland Architects for a few years now, I’ve realised that my experience with commercial buildings in combination with Graceland Architects’ healthcare experience can be effectively used to assist in the design and development of elegant and responsive commercial buildings that are fit-for-purpose, spatially efficient and budget-friendly.

Our next article will discuss the similarities between retail architecture and healthcare architecture and how we positively apply our expertise in both sectors.

Hugo Oosthuizen – Professional Architect

Hugo Oosthuizen, a professional architect at Graceland Architects, looked into the design parallels between Healthcare facilities and commercial buildings. His experience in each typology enables Graceland Architects to tackle both offices and healthcare buildings with a unique perspective that adds significant value to our client’s development goals.

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