Flexibility during the covid-19 pandemic response: Healthcare facility assessment tools for resilient evaluation
Journal article, 2021

Healthcare facilities are facing huge challenges due to the outbreak of COVID-19. Around the world, national healthcare contingency plans have struggled to cope with the population health impact of COVID-19, with healthcare facilities and critical care systems buckling under the ex-traordinary pressures. COVID-19 has starkly highlighted the lack of reliable operational tools for assessing the level sof flexibility of a hospital building to support strategic and agile decision making. The aim of this study was to modify, improve and test an existing assessment tool for evaluating hospital facilities flexibility and resilience. We followed a five-step process for collecting data by (i) doing a literature review about flexibility principles and strategies, (ii) reviewing healthcare design guidelines, (iii) examining international healthcare facilities case studies, (iv) conducting a critical review and optimization of the existing tool, and (v) assessing the usability of the evaluation tool. The new version of the OFAT framework (Optimized Flexibility Assessment Tool) is composed of nine evaluation parameters and subdivided into measurable variables with scores ranging from 0 to 10. The pilot testing of case studies enabled the assessment and verification the OFAT validity and reliability in support of decision makers in addressing flexibility of hospital design and/or operations. Healthcare buildings need to be designed and built based on principles of flexibility to accommodate current healthcare operations, adapting to time-sensitive physical transformations and responding to contemporary and future public health emergencies.


Assessment tool




Healthcare facilities


Andrea Brambilla

Polytechnic University of Milan

Tian Zhi Sun

Polytechnic University of Milan

Waleed Elshazly

Polytechnic University of Milan

Ahmed Ghazy

Polytechnic University of Milan

Paul Barach

Polytechnic University of Milan

Thomas Concrete Group

Sigmund Freud University

Göran Lindahl

Chalmers, Architecture and Civil Engineering, Building Design

Polytechnic University of Milan

Stefano Capolongo

Polytechnic University of Milan

International Journal of Environmental Research and Public Health

1661-7827 (ISSN) 1660-4601 (eISSN)

Vol. 18 21 11478

Subject Categories

Production Engineering, Human Work Science and Ergonomics

Health Care Service and Management, Health Policy and Services and Health Economy

Environmental Analysis and Construction Information Technology





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