Flex your health estate – Because change is the only constant
Change is coming. Always.
Policies shift. Technology evolves. Patients do their own thing.
The last thing we want is to be rebuilding hospitals, reconfiguring rooms, or rewriting strategy every time the system moves.
Like many other words, ‘flexibility’ gets thrown around a lot in healthcare estates. But what does it actually mean?
To me, flexibility isn’t just movable walls, multi-use rooms, or a well-designed estate (though that is a huge part). It’s about spaces, places and systems that adapt, processes that iterate, and strategies that evolve as the world around them changes.
True infrastructure flexibility is resilience.
It’s responsiveness.
It’s scalability.
It’s what stops a health system from snapping when the world bends.
I’m going to suggest 4 different types of flexibility when it comes to health infrastructure.
1. Spatial flexibility: Spaces that refuse to stand still
Spatial flexibility is simple - spaces that serve more than one purpose, and can evolve as needs change.
A reception that doubles as triage. Clinical rooms that are used in multiple different ways across the week. Walls that move. Furniture that folds. Equipment that’s shared. Smart storage.
It’s about making every square metre count. No space is sacred. Wherever possible, every space is designed to enable a second, third, or fourth life...
Build big receptions, shared waiting areas, and plenty of consulting rooms. Put mix-and-match at the heart of the design.
The easiest building I ever worked on? It had a big, open reception. Shared waiting areas. Twenty clinical rooms. Attempting to reconfigure it was as almost as easy as moving desk pedestals and changing door signs.
The hardest? A patchwork of ‘kingdoms’ - each with its own reception, boundaries, and personally tailored departments for a variety of non-specialist services. When the system shifted, those once-perfect little empires became cages we’d built for ourselves.
So, when in doubt (and when you can) - design for breadth.
Focus on change, not certainty.
2. Operational flexibility: Contracts, staff, and systems that bend
If the building is the skeleton, your people and processes are the muscle. Operational flexibility is what keeps day-to-day delivery flowing even when the environment shifts.
You want landlords who flex with you, not against you.
Staff who can wear multiple hats without burning out.
Building and delivery contracts that are mature enough to let you grow, shrink, or pivot without ripping everything up (or ending up in mediation).
Project managers who understand the world of strategy - and strategists who understand the world of projects.
Dynamic booking and room-allocation systems that can change at the click of a button.
This is flexibility in motion - adaptable design backed by adaptable people.
Iteration should be the operational expectation, not the exception.
3. Strategic flexibility: The ability to pivot -not just adjust
Operational flexibility keeps the engine running. Strategic flexibility lets you change the destination.
This is the part that often gets missed - the ability to shift long-term direction, reallocate resources, redesign service models, or reshape the estate without starting again from scratch.
Strategic flexibility is:
The capacity to scale services up or down based on demand
Estate plans that support clinical transformation in symbiosis, not conflict
Business cases and investment models that anticipate change
Governance that allows robust and rapid decision-making, not months of bureaucracy
Long term plans built around options, not single pathways.
If operational flexibility is about motion, strategic flexibility is about optionality - keeping the organisation ready to pivot when the environment changes.
Don’t design strategy for a single future. Design it for many possible ones.
4. Iterative flexibility: Creating EVERYTHING for change, not stability
Policy shifts. Governments change. Technology leaps forward.
Another pandemic. A new neighbourhood health centre programme. The next big master plan.
The list never ends.
If your buildings, systems, and strategies can’t iterate, you’re back to square one every time.
Replanning. Rewriting. Reshuffling. Rebuilding.
Slow. Expensive.
Avoidable.
So instead -design and build everything for iteration.
Workflows that flex. Rooms that shift. Staff that can step into different infrastructure roles. Systems that plug-and-play. Policies that adapt faster than they age. Cultures that expect and embrace change.
Change is inevitable. Build for it. Don’t just hope to survive it.
What buildings teach us about flexibility
Buildings outlive funding cycles and strategy documents. They are the longest-running test of our spatial, operational, strategic, and iterative flexibility, and the most honest teachers in the system.
Rigid estate reveals what we ignored - creativity, lateral thinking, and the need for connections.
Siloed layouts show the cost of control and predictability over experimentation and movement. In contrast, flexible buildings anticipate the unknown, adapt to patient needs, and allow future growth without tearing everything down.
The best estate does more than serve the present - it anticipates the future, without trying to pre-empt it. Fit for purpose, yet built to evolve and embrace the unexpected.
Learn from these spaces. Embed spatial, operational, strategic, and iterative flexibility into every layer.
Leave room for the unknown. Design with humility, not certainty. Build systems that move with the world, not against it.
Change will come.
From politics.
From progress.
From people.
Sometimes through reorganisation, sometimes through natural evolution - of services, populations, technologies, and expectations. (Right now, we’re facing both).
When change comes - will your systems and spaces move with it, or be left behind by it?
So what?
Flexibility isn’t a luxury anymore. It’s the job.
If you work in health estates, your role isn’t to build something that lasts forever - it’s to create something that can evolve forever.
We shouldn’t design permanence. We must design movement.
We must build to iterate, not rebuild. Design for motion, not a fixed moment in time. Make everything resilient, adaptable, and alive.
Because the only constant in healthcare? Change.
And if our buildings and infrastructure can’t flex with us, they’ll hold us back.