The technical core
The core of the ecosystem focuses on "hot" activities and brings together excellence, the most advanced technologies and the most sophisticated equipment, the most demanding techniques, as well as expert and rare resources to offer the best care to the most critical patients and the most complex and demanding cases. Organised around emergencies, imaging, interventional sites and critical care, it is structured according to the type of flows it receives, giving rise to a sectorisation with its own accesses. It is made up of an emergency sector, a scheduled sector and a high-turnover sector. It is connected, in a more or less direct and immediate way depending on the need, to third places which constitute the entry points to the technical heart.
As a technical building, it is made up of a "free-standing" structure and prefabricated facades that can be dismantled, allowing modules to be freely installed and reorganised, and connected by plug&play to technical innervation totems. The modules or groups of modules have their own immediate technical needs, and the building's installations complete them, connecting them to each other and meeting general needs via the totems. A general artery links the technical totems to an expandable and remodellable energy centre. Land reserves on the periphery of the building allow the totems to be extended and the structure to be extended to include additional modules.
Third places
The first alternative to hospital is the home , with In-Home Hospitalisation (HAH) and increasingly advanced medical care outside hospital. The activation of discharges in less than 24 hours, the use of digital technology and e-health will help to boost HAH activity, as set out in the highly instructive international overview produced by the ANAP: "HAH: (R)evolutions en cours, innovations mondiales, défis français" (HAH: (R)evolutions, innovations mondiales, défis français), which looks at the virtual hospital and the intelligent room (downloadable from the ANAP website). This development will strengthen the role of the technical core, which must ensure coordination, projection and steering with dedicated means, resources and organisation; a technical core that is also an operational coordination centre, a control and monitoring tower. Our role is to integrate this digital dimension into the technical core, so that it supports all the technologies required for digital uses, storage and security, in particular with data centres providing high availability and controlled security for data and data flows. We also need to support the move from hospitals to the home, which will have an impact on the design and equipment of residential buildings.
Outpatient care, both therapeutic and diagnostic, is being organised into other third places, ambulatory centres, autonomous, grouped together or not depending on the need for cross-disciplinary care, in networks, always connected to the technical core but with easy access for the patient, close to home or work, fully integrated into the urban fabric. These centres give rise to a variety of building types, from the simpler multidisciplinary health centre to the more technical radiotherapy, imaging, rehabilitation or outpatient surgery centres. The scale of these buildings ensures that the quality of the reception, the well-being of patients and staff, comfort, access to light and better integration into the town and its immediate environment are all taken into account. Scalability is ensured by the duplication, grouping and networking of ambulatory centres, which are themselves designed on the basis of standardised spaces capable of accommodating multiple, reconfigurable uses.
Although, as we saw earlier, alternative care is being developed, the remaining inpatient facilities are organised in independent buildings and positioned close to the technical centre or the outpatient centres, depending on care and medical needs. They are like patient hotels, with domestic dimensions and hotel codes for optimum comfort and welcome. They have human, medical and material resources with a coherent gradation of care, and are virtually connected to the technical heart of the hospital. It is up to the designers to offer a patient experience that breaks away from the aseptic and anxiety-provoking world of the hospital by drawing on their references and hotel experience, with spaces, atmospheres and materials that will contribute to the comfort and well-being of all.
All the tertiary spaces are grouped together in exclusively tertiary buildings, organised as a network of multi-purpose spaces, both individual and collective, connected and designed to bring well-being, creativity, exchanges and cooperation. They are located in the immediate vicinity of staff workplaces, while guaranteeing them a different, protected environment. They can accommodate other entities, other professional universes to support the decompartmentalisation of the hospital and its integration into the city.
Research is part of the tertiary spaces principle, within the limits of the technical nature of its laboratories. For the most technical and demanding laboratories, proximity to the technical core will be necessary.
The support functions will be grouped together by use, concentrating processes and organising themselves to manage automated and optimised supply flows. The scattered entities that make up the hospital only include branch offices and secondary warehouses supplied from the main distribution platforms and production sites.
