Welcome to Architecture for Health Lecture Series in 2026.

Today we have John Dale, principal in Architecture and planning at synchronous and also president of the council, Council on Open Building.

John has been involved in the master planning, programing and design of public and private educational projects throughout his 30 year career.

His diverse experience includes district wide master plans, small learning communities and sustainable high performance schools.

His design for educational facilities have been honored with numerous awards, and his leadership in the practice of school design earned him his AA fellowship in 2008.

And to talk a little bit about the Council on Open Building.

The council focuses on concept of open building, which embeds adaptability into design, constructing a built environment that keeps pace with our changing patterns of living, learning and caring.

Open building can be constructively integrated into residential, educational or healthcare environments.

So please help me welcome John Dale.

Thank you very much, Roxana.

I hear a little bit of echo.

You do.

But I'll try.

Move forward.

I won't go through the learning objectives, but I think they'll be available after the talk as part of the slideshow.

And actually, I'm going to just briefly touch on this slide because Roxana did a very nice job introducing open building.

But the council advocates on behalf of systemic reforms that will lead to a more responsive and enduring urban environment.

We want societies to use open building strategies for cities made up of resilient, flexible structures, ready to face an unknown future.

Just briefly.

Open building is a movement that was actually founded in the 1970s by John Bracken, pictured here.

The late John Bracken, a Dutch architect who was also very active at MIT for a number of years.

He's pictured here with Stephen Kendall, who is the co-founder of the Council on Open Building, with me and really the leading expert in health care.

So I consider myself to be John and Steve's emissary today to talk about this important subject.

Cities endure when they can change part by part.

The same can be said about long lasting buildings.

They incrementally adapt.

The question is, are our design skills and regulatory processes opt for the task across different project types and scales in order to balance permanence and change.

I'm quoting here from a distinguished healthcare designer, John Penn Graziano, who was a principal at NB and I believe is at least semi-retired now on many health care campuses of the United States today.

One can encounter a collection of buildings, each built for a specific use by a different architecture office, sometimes awkwardly linked to other buildings, and then unable to adapt easily to evolving programmatic needs.

Clients and health care facilities increasingly recognize that medical centers must be designed to embrace change by planning for it to facilitate both internal change and growth, and to avoid wasteful and ultimately more expensive cycles of demolition and rebuilding.

And of course, ultimately the healing and of patients their well-being in a sustainable environment is of utmost importance.

And then this client, an important client, which we'll talk about later from canton, Bern, Switzerland, says the only thing that lasts is change.

This is a commercial advertisement from a demolition contractor.

One of the worst aspects of having to demolish buildings had become obsolete, particularly hospitals, is the incredible environmental hazards that are associated with that operation.

So I'm going to talk a little bit about the opportunity for health care that comes from an open building approach, structural flexibility with a minimum of permanent partitions, modular design allowing for easy adaptation and integration, easily accessible building subsystems providing flexibility for future changes in retrofits, increased efficiency of floor plates and construction, and, very important, a loose fit for multiple decision makers, allowing for an extended building life.

So in order to achieve open building, very important to separate systems into different levels of control, to disentangle the elements and responsibilities between those different levels.

To support autonomous control and decision making within the subsets of a building, and performing capacity studies to understand a range of uses before the building is even built.

Under levels of control.

Higher levels set the stage for lower levels.

For example, a fitout can change without forcing the base building to change.

This has been conventional for some time in office buildings, retail and other facilities.

The defined professional roles, regulations and financing.

And it works when control enables play within each level.

Disentangling.

Disentangling access disentangling systems for clarity is a huge thing in long term adaptability territorial autonomy.

So if you have an ICU unit in a hospital, can it operate?

Can it change?

Can it adjust without disturbing the the departments above and below it or next to it?

And capacity studies given a standard structural bay, what functions can be accommodated even by someone else?

So getting into the habit of testing change in buildings again before they're built leads.

And then there's a financial consideration.

If you look at the light blue.

Imagine a big investment for a hospital at a certain date and time.

Almost as soon as that investment has been made and the building is up and running, obsolescence starts to creep in.

Changes are necessary and the value and utility of that building starts to decline until there is a point where new investment must occur, or possibly even demolition.

The dark blue represents the open building approach, which is to suggest that incremental change, constant incremental change, reinvestment in a facility.

Allows an asset to increase in value over time and remain useful for maybe centuries.

So just to summarize this section, open building is a reality for all kinds of everyday building types.

And you can see that plainly in this set of images.

Now I'm going to talk briefly about some buildings that are in health care just to help set the stage.

I'm starting with the main building group at MIT, which is now over 100 years old and has stood the test of time.

Built in pre functionalist times, it's an excellent example of a resilient and open building.

And this complex you can see it's a neoclassical complex with courtyards traditional looking architecture.

But look at the way it was built.

It was built in a modular way with a concrete frame, so that all the partitions within the building are movable.

And that's meant that this building has remained successful and at the core of a growing, complex, dense campus at MIT.

Oh, I just wanted to.

Yeah.

And finally, these are images of a building that's constantly in change, whether for classrooms, labs, workshops, gathering spaces.

It remains vital, and it's just been renovated with the expectation that it will last another 100 years.

One more education project.

And then we're going to get into the case studies for medical facilities.

But this is a building I worked on personally, which is why I wanted to show it, because it's not just a matter of the principles of open building, but what are the strategies you use to accomplish open building?

So this is a new facility in a campus where most of the buildings are becoming obsolete because they are too rigid, and to set on a model which is no longer valid for education.

A very complex program, everything from classrooms to a central kitchen to dining, to a actually to an Olympic size swimming pool, underground parking all layered in a what we're calling a loft building, a flexible loft building, and part of the process of understanding the capacity and potential for long life is outreach and agency for the user group.

So the workshops which test the capacity of the floor plates planned.

And in this case, we had to start designing the building before we had a program fully defined.

So that agility and that interac These are the strategies that we used for this discovery building at Santa Monica High School a capacious structural grid 32 by 38, actually a moment frame horizontal circulation, which is completely flexible, vertical circulation which is at the perimeters to leave the floor plates open and flexible, a footprint which brings in lots of natural light but keeps large areas for redesign.

Distributed vertical mechanical shafts and raise floors.

Raise floors are not a great option for hospitals, but they are an example of how to distribute within your own territory without disturbing neighbors.

Siphon drainage is something is in medical facilities which helps to root plumbing through the space being served, as opposed to above or below it.

So this is the prefabricated steel moment frame that was used for discovery.

And this is a system which is commonly used in hospitals.

A steel moment frame that's like an erector set with collars and sleeves that allows very rapid construction.

In our case, the raise floor was invaluable to allowing return air and supply air and all the power and data to work within an existing tenant space, shall we say.

Very simple zoning of spaces, of learning spaces and commons and capacity studies.

This is how you do a capacity study.

You look at different scenarios to see whether the project you've designed really is flexible and adaptable.

And just a side note, the building was starting to change even before it was completed.

So halfway through construction, the program changed and labs were turned to classrooms.

And this was done very easily with the systems we had in place.

Just some images of the finished building, how this lot works with very, very different varied spaces.

You can see the underfloor system working in the lower left hand corner science lab.

You can also, with this moment frame, cut big holes in the floors and interconnect floors together for assembly spaces.

So let's get into some health care examples.

I'll start with the Oregon Health Center, the center for Health and Healing in Portland, Oregon.

It was completed in 2019.

The architect of Zimmer Gonzo.

Frasca a floor area of over 400,000ft².

Pretty common kind of scale.

A moment frame structural steel moment frame with typical bays of 43 by 28 15ft.

Florida floor, giving you lots of space to maneuver, two off center elevator cores and centralized shafts for the main MEP system that gives you a primary base building, which is fixed for all time.

Then there the secondary systems defined by non load bearing partitions, distributed MEP systems making use of the base building structure to do routing and plumbing and columns.

And of course the tertiary system are movable and fixed mechanical equipment, office equipment, computer technology and furnishings.

So just a few comments about this facility.

Very important were giving agency to the user group so that capacity studies could be made while the building was being designed.

So there were a series of nine rounds of integrated design events with hundreds of stakeholders.

And you'll see images of that.

They allowed multidisciplinary groups to develop and test options for different units within the building.

You can get to see a listing of the very varied medical programing, from sterile processing to labs to pharmacy to operating rooms.

All arrange vertically.

Here is the kind of workshop going on, and you can see that all the spaces where accounted for in playing cards, which could be deployed and tested in different arrangements.

Also, they used an off site 30,000 square foot warehouse to provide opportunities for the workshops, but also full scale testing.

You know, cardboard mock ups of full scale rooms, procedure centers.

This is the base building, not completely clean because it sits on a parking garage and was subject to zoning requirements.

But this is an upper floor of a base which is much bigger.

And, you know, here's level seven, an outpatient stay and a level a typical clinic unit.

The Night Cancer Institute, occupying the 11th and 12th floor.

So where you place course, how you get access is very important to long term adaptability.

And just some images giving you the character of the building.

Obviously patient patients are at the perimeter where there's ample light and views.

Very important part of healing.

And then the tertiary systems that sometimes create spaces of themselves, imaging and so on are focused in the center core of the building.

Another project, this time in Tel Aviv, Israel, the Sami Offer Hospital.

This was developed by two architects working in tandem, Randy Sis and Sharon Architects, and this has an ongoing history of change.

It's now a 753,000 square foot building.

It's added 200,000ft² in the last starting in 2023.

So the history of this building stretches from two 2008 to the present.

It has a base building with a 25 by 25ft structural grid and central core elevators, dedicated MEPs shafts and a glazed, distinctive glazed screen which is part of the permanent base building.

The secondary fitout, similar to the Oregon Case study, has flexible non load bearing partitions facilitated by a moment frame that allows freedom of floor use.

And of course the FFA is the tertiary system.

You can see again the varied labs I'm going to reference.

The fact that.

Like the Oregon Center, there were UN designated spaces kept open within the building so that as individual departments got rearranged, there is a place to move temporarily to keep operational.

Very important.

Some comments on the collaborative process of the two architectural firms.

They initially developed capacity studies to test the flexibility and adaptability of each floor level, and these documents were repeatedly returned to by users at a later date.

When you look at the complexity, the 13 medical floors, 404 underground parking floors which are convertible to a 650 bed hospital, which, incidentally, is resistant to chemical and biological warfare and initially designed as a cardiac care plus surgery and clinics on three main floors, then two floors for internal medicine and outpatient clinics.

Seven additional floors were initially open for future programing and fit out without being defined, and five phases from underground up to the mechanical penthouse allowed construction to finish around 2018.

Now three additional floors are being added as we speak.

So again, a base bell.

You can see a very clean organization, a square grid throughout the floor and in this case, a centrally located core reached from the perimeter.

And again you can see the variety of configurations that are possible with this approach.

Everything from cardiac hospitalization to research labs.

So again, just some quick images of the character of the space.

And I'm on my last pair of case studies.

I hope I'm doing okay for time.

But this is a very innovative, very open building example.

Starting with the health care facility master plan of the University Hospital in Bern, Switzerland, by hand architects.

The client in this case is the Canton of Bern, who has been responsible for 20 open building projects over the last two decades.

This campus serves 44,000 inpatients, 6400 employees and 900 students, with a current footprint about 3,000,000ft² planned to more than double to over six point almost 6.5 million square feet, with an implementation period stretching from 2010 all the way to 2060.

Now, this is an interesting program because.

The master plan is deliberately loose and flexible.

And I'm going to reference some notes on that.

There's a concept called topography.

The buildings are greatest, have the greatest density in the middle of the campus.

They're the tallest and the biggest footprints.

And then as you get to the edge of the campus, the buildings are lower and relate to neighboring districts and residential areas around the campus.

There is a concept called kneading dough, which is that there's a framework for building in each plot designated plot for development, but it doesn't define build two lines.

It defines a density and overall height limitation, and within that buildings can be shaped quite independently.

There's also a concept called crop rotation.

Throughout this long term redevelopment of the campus, certain plots are left open so that as new needs come up and new programs are defined, buildings can be quickly developed without interfering with the operation of the overall hospital complex.

And then a final concept is the interconnectedness.

There are a lot of small, relatively small blocks on this campus, and they can all be interconnected below grade or above grade, so that we can do system separation from pedestrian traffic to vehicular traffic, emergency and goods transport.

The campus is defined by quarters that are characterized by historic buildings on open space preserves that have specifically been left to give identity to the campus.

Here you can see the kind of chess game going on as plots are developed and some buildings are are eventually demolished and replaced, but you can see continuous activity almost year by year.

And this shows you the idea of a kind of very loose framework within which buildings can fit.

You can see more clearly here how those big frames define anywhere.

You can put a building on a given plot of land, but the buildings take shape independently within it, and this is an example of a competition.

So once the master plan was defined, each building block is a separate competition, with multiple competitors characterizing what they can do within the the loose constraints of the master plan.

Now I'm going to talk about one completed building, and this is the final example in my talk.

The Inno Intensive Care facility at the University Hospital, which had three different architectural firms, Kam and Kuning working on the primary Eden and on the secondary and WP on the the tertiary system are furnishings.

So a 500,000 square foot facility in the heart of the campus.

We've talked about the different architects.

I had quoted earlier in the talk.

Jojo Mackey, the chief architect and director for the Office of Real Estate and Public Buildings in Bern, Canton, built from 2007 to 2013 with a concrete frame 27.5 by 27.5.

Precast concrete columns in situ slabs with knockout panels at the center of each column bay.

That's an interesting intervention for the base building.

So here are the approach.

This Mackey, the architect for Bern Canton, Bern, dedicated to the open building system and separation of different layers.

So long term, medium term, short term for spatial organization clearly defined by different architects working in sequence and parallel to that, a technical system organization also broken down into three distinct levels primary, tertiary, and secondary systems.

And here is the footprint of the building.

So you can see this uniform structural grid and breakout panels in the middle of each structural grid.

They're not necessarily all holes through the building, but they could all be holes through the building.

And here's a cross section which shows you how those some of those, those breakout panels become vertical light shafts to organize circulation throughout the building or shallow ones light up amenity areas, more public parts of the building on the upper floors.

And this is an example of a capacity study in effect.

But for the.

The base building is a given.

What kind of layouts are possible at a secondary level.

And in this case each of these footprints represents a different competing architect offering different solutions for how this building footprint can be organized and arranged.

Case in point, the surgical suite was designed as a secondary system within the building, and within one year of opening, the head surgeon resigned and a new surgeon came in and wanted a completely different organization of this floor.

The system allowed it to happen in a matter of months.

So finally, just a few images.

This is shell space, so the building always has shelf space available so that things can be moved during the course of construction.

Columns on roughly 27ft grid.

There are sleeves for sleeves at each column for the routing of pipes and conduit.

And then you can see the breakout openings in the slab above.

There's also a sacrificial slab for the secondary system.

So the operation suites the inpatient care can be organized on their own floor.

And when they have to be redesigned or reconfigured, that slab can be cut out and report one when the new configuration is determined.

So again, the columns designed for flexibility, the bays designed for flexibility, how those light wells work to kind of give light and amenity to circulation zones within the building and an amenity space.

And that is where we are.

Open building is for planners and policy makers, urban designers, developers, public agencies, architects and engineers.

In other words, people committed to a resilient future.

So I hope these examples have given you a sense of what the possibilities are there as a whole history of health care projects around the world which use open building principles.

Sometimes they're discovering they've used open building principles after the fact.

But anyway, I'm happy to answer any questions.

They were amazing case studies.

Thank you so much for presenting those for us.

So we have a good level of time available for discussions regarding the overall concept of open building and applications to healthcare, so I will leave it to our students.

Danny at the back.

Okay.

Let me find a way to get that microphone to you.

Thank you.

Well, thank you for your presentation is great.

My question is you mentioned that raised floor systems aren't ideal for healthcare environments.

And I was wondering if you could explain more what the drawbacks are.

Basically, disease control is the issue.

The fear that medical designers and practitioners have is that, you know, for instance, fluids can get into the floor and may not be detected very easily.

And and then potentially a source of infection can can occur.

So I don't know, I think that there might be ways of dealing with that.

It may you know, there's an interesting example of a medical cardiovascular center in Buffalo designed by cannon and the Astana studio.

And they mix clinics with research.

And so the research spaces would definitely benefit from raised floors.

And it's possible that you could design a hybrid system where race FAS are used weather where appropriate but insensitive medical areas maybe not.

Thank you so much.

Great question.

Any other questions?

So John, while our students are thinking and there are in the process of coming up with their questions, I want to talk a little bit more about the project.

The final case study, which focused on the design of operating rooms and surgical suites, and especially when the configuration of the whole surgical suite changed.

What were the main challenges, especially with with changing the location of operating rooms and all the equipment with the booms hung from the ceiling or HVAC systems, just any major challenges and how the team addressed would be very helpful to us.

Well, I'm not intimately involved in that design, but I can tell you that the building facilitated the change, so I would guess that they probably had to cut out the sacrificial slab and start again with that for underfloor distribution.

The structure itself has a kind of redundancy to it.

It's a it's modular and the surgical suites are basically thought of as in a modular way.

There are no permanent walls within that space.

So rearranging is relatively easy.

And of course the spaces are defined in an in a surgical suite, the spaces are very much defined by the tertiary level, by equipment which is generally movable.

So, Roxana, you probably know more than I do about this question, but I'm I was told that the change occurred in a matter of months.

And with that shell spaces available in the buildings, when change is happening or renovation projects are in the process.

So these shell spaces are intentionally implemented in these buildings to allow for that adaptability if need be.

Correct.

That's absolutely correct.

So so if you've got you may have some interim period where you've completely uprooted a department and that department and at least partially relocate in shell space, well, their new space is being reconfigured.

That's wonderful.

I didn't mention, but actually the Oregon Health Center was also built with 6% of its floor space shelled from the beginning.

And how does that impact the overall costs of the projects, regardless of whether it is health care or non health care?

Well, I can relate specifically to that question to my own project, which is the Discovery Building at Santa Monica High School.

And in discussion with the client, we estimated that the open building strategies added maybe 5% to the cost of the building.

That number, of course, take with advisement.

It could vary hugely depending on the context and the the nature of the facility.

But in our case, there was a premium for the moment frame system, which was well made up for the fact that that during Covid it suddenly allowed a spirit of construction.

The whole steel frame went up in 12 weeks.

I was researching connects tech and they advertised.

A hospital building they had built going up in 90 days, their structural frame.

The other cost for us, which was not a normal feature for a school building where the raised floors and I think they're going to very much pay for themselves in the long term because of the inevitable changes that are going to occur in that building.

I see.

Thank you so much.

Okay.

Getting back to the students.

Any other questions?

It was like drinking from a fire hose today.

I know there's a lot of stuff I threw at you.

I can't hear you, Roxanne.

Even now, yes, I can.

Okay.

So we're working with the council to find ways, in a way, ways to implement this concept further into healthcare design and see how we can actually change the healthcare spaces and facilitate adaptability and flexibility further.

And this can be something that for those students.

So, John, we have PhD students here.

We have master's students here.

Some are graduating some some are still working on their projects.

It would be one of the concepts or frameworks that you can think about and focus on implementing your work, and see how it can facilitate your research or the work that you're developing for your final study, for sure.

And I have some resources that I can share with my students.

But John, please feel free to forward any additional papers information regarding the case studies that you just presented, and I can share it with our students.

The there is a slide with a with a series of resources where you can get those case studies.

I can go to that again.

Is that can you see that?

Here?

If you go to the website, the Council on Open Building, there are extensive resources so that you can there are case studies on the website, and there's a resource tab which takes you to all kinds of writings, a lot of it by John Bracken and Steven Kendall.

And I believe we're going to make this slide show available as well for distribution.

And, John, there's a journal that I searched for, a reviewer for a couple of papers.

That journal is also linked to the Open Building Council.

Correct?

It should be.

Are you talking about open House international or correct?

Yes.

Yeah.

That's just come out.

It's it's it's only available digitally I guess.

But I'm, I will look into whether do you know Roxanne and how you get access to that.

I was given a digital copy by Joshua Lee, the guest editor, but he said it's not for distribution yet.

Oh I see, yeah, that's how I received some papers from Josh.

So would it be okay if we share some of these papers from that journal with our students, or should we wait for the public publishing of those papers?

I think it's your call.

I'm not I'm not an academic, so I don't know the ins and outs of these things very well.

I will trust you to decide what's appropriate.

And I can talk to Josh about that.

Yeah, talk to talk to Joshua about that.

I think that that's probably the best thing to do.

Well, wonderful.

Thank you so much again, John, for joining us.

It was a pleasure.

The case studies were wonderful and I think we presented a lot of good information for our students to think about.

So hopefully we will see how you implement this concept further into your work.

Thank you again for joining us.

Thank you.

Thank you Roxanne.

It was a pleasure.