Contact Information

This research was conducted by Natália Ransolin, Carlos Emilio Stigler Marczyk, Rafael Parmeggiani Gering and supervised by Prof Tarcísio Abreu Saurin and Prof Carlos Torres Formoso.

The resilience of healthcare services had not been tested as it was during the COVID-19 widespread. The lack of resources and supplies, and the sudden surge in demand, combined with the uncertainty of a new disease, posed major concerns for health institutions. Healthcare services had to enhance their resilience abilities (anticipate, monitor, respond, and learn) to cope with the pandemic [1]. A central challenge during the pandemic has been to ensure the match between capacity and demand. The physical infrastructure assumes a key role in this conflict since the built environment capacity can hinder or support the resilient performance in providing care for a grown demand [2].

After passing through the peaks of the COVID-19 waves, takeaways for the design and operations of the built environment for resilient healthcare services can be operationalized. Lessons learnt by a leading private hospital in Southern Brazil were devised using the lens of resilience engineering [3]. Caregivers of front-line patient care and managerial positions were interviewed to understand the work as actually done in a period in-between pandemic waves (i.e., December, 2020). Walkthrough sessions on (COVID and non-COVID) patient flow allowed the understanding of the built environment to cope with the pandemic. Despite the substantial financial support, the hospital has been severely challenged by the pandemic, reinforcing the need for long-term thinking on resilient healthcare services.

Focusing on how the built environment has supported the resilient performance of healthcare services during the pandemic crisis, six main lessons for supporting resilient healthcare were associated with the four resilience abilities. The takeaways were grouped according to their implications for the design and the operation phase of healthcare facilities.

The design of the built environment is critical to preparing the facilities for disruptions in normal conditions. The two main lessons learnt for this phase correspond to the resilience ability of anticipating and responding, as follows:

1. To design flexible workspaces to accommodate different functions other than their everyday use. For instance, the use of wards for the hospitalisation of regular in-patients being adapted to admit critically-ill patients [4]. The built environment design can anticipate the need for attending patients demanding resources that otherwise were exclusive of intensive care units. The HVAC systems should be designed to allow a quick expansion, adjustments of air direction, and the easy flow of the medical gases throughout the building structure [2].

2. To shorten the flow of infected patients in order to reduce the possibility of contamination. The main hospital entrance, emergency department, and a portion of the intensive care units should be designed preferably on the same floor [2] or connected with dedicated elevators for patients with highly contagious diseases.

In turn, major threats once unanticipated in the design phase must be faced during the operation phase of the built environment of healthcare systems. Thus, lessons learnt for this phase are mostly related to the resilience abilities of monitoring and responding:

3. To save financial resources for acquiring scarce supplies in a competitive market. Purchasing drugs and equipment demanded worldwide, the construction of new spaces, or the adaptation of existing facilities are costly measures that might be necessary to cope with unexpected events [5];

4. To develop internal capabilities for the best use of available resources, including quick reallocation when necessary and training a multi-skilled workforce to cope with demand surges. For instance, elective surgeries were suspended, thus allowing for the reallocation of beds and staff to other hospital units accommodating COVID patients;

5. To invest in wayfinding and visual management strategies to effectively announce changes in the built environment or hospital flows, avoiding misunderstandings that may put users at risk of contamination [2]; and

6. To encourage the creation of multidisciplinary committees in charge of monitoring processes and deploying responses by using and adapting the resources of the built environment to cope with unexpected events [5].

The influence of health teams' experience and learning acquired from past events is worth mentioning to support resilient performance and mitigate eventual unintended outcomes. This previous knowledge is a contextual source of evidence to be regularly consulted and reviewed when designing and operating the built environment of services. Ideally, the takeaways should be incorporated into their strengths and weaknesses to reinforce their resilience potentials. Future studies might focus on updating the lessons learned as the pandemic evolves and in-depth retrospective studies after it subsides.


[1] Bertoni, V. B.; Ransolin, N.; Wachs, P.; Righi, A. W. (2021). Resilience, Safety and Health: Reflections about Covid-19 Assistance. In: Nancy L. BlackW. Patrick Neumann Ian Noy. (Org.). Lecture Notes in Networks and Systems: Proceedings of the 21st Congress of the International Ergonomics Association (IEA 2021). 1ed., v. 4, p. 239-245.

[2] Capolongo, S.; Gola, M.; Brambilla, A.;Morganti, A.; Mosca, E. I.; Barach, P. (2020). “COVID-19 and Healthcare Facilities: a Decalogue of Design Strategies for Resilient Hospitals.”ActaBiomed., Vol. 91, Supplement 9: 50-60. DOI: 10.23750/abm.v91i9-S.10117.

[3] Ransolin, N.; Marczyk, C. E. S. ; Gering, R. P. ; Saurin, T.A ; Formoso, C.T ; Grotan, T. O. (2021). The Built Environment´s Influence on Resilience of Healthcare Services: Lessons Learnt from the Covid-19 Pandemic. In: 29th Annual Conference of the International Group for Lean Construction (IGLC29), 2021, Lima. Proc. 29th Annual Conference of the International Group for Lean Construction (IGLC29).

[4] Saurin, T.A ; Viana, D. D. ; Formoso, C.T ; Tommelein, I. D. ; Koskela, L. ; Fireman, M. ; Barth, K. B. ; Bataglin, F. S ; Coelho, R. ; Singh, V. ; Zani, C. M. ; Ransolin, N. ; Disconzi, C. (2021). Slack In Construction - Part 2: Practical Applications. In: 29th Annual Conference of the International Group for Lean Construction (IGLC29), 2021, Lima. Proc. 29th Annual Conference of the International Group for Lean Construction (IGLC29).

[5] Polanczyk, Carisi A. et al. (2020). “Getting Ready for the Covid-19 Pandemic: Experience of a Brazilian Hospital.” NEJM Catalyst Innovations in Care Delivery, v. 1, n. 5.

add one

Natália Ransolin is an architect and PhD candidate in Civil Engineering at UFRGS (Brazil). Her main thesis goal is to integrate the resilient performance of staff and patient flows between hospital units, accounting for the complexity of built environment requirements through Evidence-based design and BIM approaches.