Amira Osman presents lessons learned from the construction of the INO Hospital in Bern, Switzerland using "open building" practices. Presented at the SAFHE/CEASA 2011 conference in Johannesburg, South Africa.

1. Open Building for Healthcare Facilities: Lessons from the INO
Hospital, Bern, Switzerland
Amira Osman
CSIR Built Environment, South Africa

2. • Would you buy a car if the tires were
moulded to the wheel rims, and the wheel
rims welded to the chassis?
• The first time your car needs a tire change,
you would have to destroy the entire
vehicle – although it still drives perfectly
well – to make it fit for the road.
• This procedure has always been followed in
the construction sector. Cables are
sometimes buried into concrete load-
bearing ceilings.
• When you need to replace them you have to
destroy the intact building fabric.
•
•
GEISER
•"Spaghetti junction"

3. dynamic societies require agile architecture.
two alternatives face clients with dynamic requirements:
•scrap and build practices
•stock maintenance practices
the later is called “open building” among some
practitioners internationally

4. •DISENTANGLEMENT INDUSTRIAL FLEXIBLE DEMOUNTABLE BUILDINGS IFD
•SLIMBOUWEN MASS CUSTOMISATION FORTH DIMENSION IN BUILDING
•OPEN BUILDING DESIGN FOR DISMANTLING/DISASSEMBLY DfD
•DESIGN FOR COMPATABILITY DfC LEAN CONSTRUCTION

5. life cycle of a building
•a building is never quite finished
•it changes over time.
different service lives of the individual
components of a building
where different components are interconnected and interdependent
an assembly of elements can only reach the
age of its shortest-living component.
•parts must not be physically connected in a way that causes destruction when one part or the
other is removed or replaced
•this notion of separation or “disentanglement” contradicts the usual conventions of the
planning and construction process.
GEISER

6. Introduction of Technical Systems into Building Construction
1800 1850 1900 1950 2000 Kendall
Wood Frame Construction
Steel Frame Construction
Concrete Frame/Slab/Column
1840's piped water supply
1875 vented trap
1890 flush toilet
1880 public sewer systems
PIPED
1890 natural gas for heating/cooking
SYSTEMS
1920 fire sprinkler systems
gas for illum
1880 steam heat 1925 hydronic heating
1935 ducted heating
DUCTED
1935 air conditioning systems
SYSTEMS
1920 mechanical ventilation
1890 electrical power cabling
CABLED 1890 data cabling
SYSTEMS
1950 cable television
1950 security systems
ERA OF ENTANGLEMENT
SEARCH FOR DISENTANGLEMENT
ERA OF OPEN BUILDING

7. GEISER/KENDALL
INO Hospital, Bern, Switzerland
Insel University Hospital
Managed by the Canton Bern Building Department
“After many conventionally procured buildings, they realized that it is impossible to design a project
based on a fixed program of requirements because the program inevitably changes in response to
new medical procedures, new regulations, and new market and insurance conditions.”

8. each year, certain events prevented them from fixing the program:
•new medical procedures were introduced
•a new head of surgery was hired who had new staffing, space, and
equipment requirements
•the market for services changed
•new regulations were introduced
•a paediatric facility was scheduled to be expanded
•and so on.....

9. problems of change
distributed design and construction responsibilities
the INO is the first known project to apply these principles
rigorously in healthcare architecture
•sets a new standard for adaptable medical facilities
•offers an alternative paradigm for meeting critical needs in the field of healthcare architecture

10. the group adopted an entirely new planning process recommended by Urs Hettich, architect and
director of the Canton Bern Building Department
long-term utility value
•the ability to optimize adaptability in the face of changes in technical, social, or political
circumstances
•such facilities are too dynamic and cannot be planned and built as if they are
programmatically static
rather, the “whole” emerges over time, incrementally

11. a competition was held to select a
design/building firm for three distinct "levels“
•the primary level, intended to last 100 years
•the secondary level, intended to be useful for 20-plus years
•the tertiary level intended for 5 to 10 years

12. managing complexity
•Primary system fixed: •Secondary system adjustable: •Tertiary system flexible: COMPOSITE
•Site logistics •Interior walls •Furniture SYSTEM
•Building envelope •Floor covering •Mechanical equipment
•Structure system •Ceilings •Hospital supplies
•Interior logistics
•Primary system fixed: •Secondary system adjustable: •Tertiary system flexible: COMPOSITE
•Electronics •Equipment for head offices •Ports for apparatus SYSTEM
•Location of head offices •Installations •Room for specific
installations
•Installation structure •Illumination

13. •primary system determines the structure and establishes conditions for the other systems
•the interfaces are exactly defined
•independence of lower-level (secondary and tertiary) systems
•typical floor of primary
system
•8.4m x 8.4m structural grid
•a structural grid with square
“punch-thru” opportunities in
the concrete slab on each
floor, in the center of each
structural bay

14. Primary System
the presentation requirements for the primary system were very open for the
competitors except for the gross building area
•layout scenarios were not required
•competitors did not receive space-planning templates
it was up to the competitors to show the quality of their “open building”

15. The primary system
•service life of approximately 50 to 100 years
•a long-term investment and unchangeable
the primary system will accommodate various secondary systems in different cycles during
its service life
the primary system mainly comprises the following elements:
•-external site conditions site access, public utilities
•-load-bearing structures vertical and horizontal support structures
•-outer building structure facade, roofs
•-building services structure installation structure: concept of the technical access and location of
the central control rooms

16. •fixed mechanical systems risers are placed in each quadrant.
•fixed vertical circulation points
3.6m square “punch-through” opportunities: holes in the “swiss cheese"

17. •the primary system is, in effect, a low-tech
building for a high-tech content
•Phase 1 of primary system •West façade, showing double skin

18. Interior view of the top floor of the empty primary
system, showing skylights, openings for light-wells to the
floor below.
Precast columns with four sleeves at the base of each
column for possible vertical drainage piping.
Also visible is the inner layer of the
double skin envelope, showing
operable wooden windows.

19. The competition for the secondary system, likewise international and anonymous, was decided in
1998.
independent and logical concept
the project managers demanded solutions for distribution of mechanical services and layout
scenarios as well, showing typical patient paths
•The competitors for the secondary system received documentation of the primary system
•They also received the layout templates of the existing hospital
demonstrate—with drawings—how their proposed
fit-out systems could be
deployed according to a range of programmatic scenarios within
the given base building
(at that point already under construction).

20. the secondary system - with a service life of approximately 15 to 50 years - is a medium-term
investment and adaptable
subsequent install-ability, disassembly and reassembly are the key focal points for this
system level
the secondary system mainly comprises the following elements:
• -Finishing work interior walls, finish floors, ceilings
• -Building services installations central control rooms and technical access
• -Internal personnel, patient and materials movement vertical and horizontal
• access, transport systems

21. The tertiary system - with a service life of approximately 5 to 15 years - is a short-term
investment that can be changed without any major structural work. It is subject to rapid change and
is least predictable. The tertiary system mainly comprises the following elements:
• -Medical equipment
• -Fittings, furniture
After an international preselection process for the tertiary system in 2000, the "HWP
Planungsgesellschaft" from Stuttgart, Germany, was commissioned with the planning and
•acquisition of the tertiary system.

24. In OB, the built environment is considered in terms of who makes the decisions about its design
(physical and spatial articulation): groups and individuals that may intervene and in what way
•A democratic process in decision making has resonance in SA
•Participation is not always restricted to involving people in the early decision making process –
(Dewar: participation is not about asking people what they want as people’s expectations
are experientially determined)
•Participation should also be in the form of spaces and architectural forms that
allow continued interaction, appropriation and re-interpretation by the users
throughout the lifetime of the building
The built environment can be seen as a number of levels were different people have CONTROL in
terms of their ability to make decisions – spreading that control among the different stakeholders
and allowing more people to have a say in their environment is at the heart of an inclusive process:
this has TECHNICAL IMPLICATIONS as these levels may then also relate to the degree of
technical skill needed for the different components of a building – thus having an inclusive process
with many different levels of skill accommodated for

25. By understanding the environment in terms of “different levels of control” one is able to
design buildings in such a way were the architect might have complete control at one
level of the building while allowing for more fluid and variated responses at other levels:
HAMDI REFFERES TO THIS AS A CONTRAST BETWEEN EMERGENCE AND
PLANNING:
“places that happen and happen to work – places that are designed and don’t”
Open Building is about with different components of the built environment and clearly
separating between them.
•Some components have a longer life span than others
•If change is required in the short life component – the long life component must not be
compromised in the process

26. This is how old cities are ordered
•there are permanent aspects of the city that give it
character and permanence
•while the second level fabric may undergo constant
change and adaptation
Thus achieving relevance and rendering these
cities sustainable – as some OB practitioners
would say – this is the quality that makes cities
and buildings lovable

27. Most cities have developed, spread
Tunis medina out, declined, renewed in parts,
refocused their sense of place and
have become multi-nucleated.
In all of this, the city is an example of
a fine-grained “living fabric.”
No single party—private or
public—controls the whole.
Only a few owners (universities,
medical centers, large corporate
organizations, and governmental units
being the most prominent)
are large-scale.
Even in these cases, internal
control is hierarchically structured.
•HABRAKEN

28. INO Hospital, Bern, Switzerland