The story of the parametric hospital started by chance, in response to two questions that arose during the development of a research project we were conducting in collaboration with Makiber SA, a Spanish company belonging to ACS group, which believed in the idea and defended it, together with us, when facing the administration board. 

The project concerned the design of a hospital model that could respond to the needs of efficiency, austerity, flexibility and, above all, the urgency of building quickly that we perceived as crucial in the developing countries in which we were working: those countries had a large deficit of sanitary infrastructures, and there was a need to solve this shortage urgently.

While we were thinking about this idea, two questions emerged: is it possible to design, build and equip a hospital not in three years, as usual, but in less than a year? And if possible, is it really necessary?

We didn’t answer the second question; that came from the analysis of the healthcare reality of the countries we visited. After several visits, we started to obtain first-hand information about the problems and urgencies of those areas, where, in most cases, there isn’t a central hospital, or at least one hospital centre at a reasonable distance. This means that certain mild medical contingences may even become fatal, as the sick person can’t receive specialised or common medical assistance on time. Therefore, the answer to our question seemed obvious: if we have the economic resources, we need to build a hospital, and making it function two years earlier than usual is equivalent to reducing this terrible reality with which some places have to live.

At this point, new questions emerged: how can we build three times faster while, at the same time, maintain all the features of a conventional project – that is, a full custom design tailored for every case, and a high-quality building that endures over time? How is it possible to design quickly if the project has to be tailored for every client? And, what are the functional starting factors?

In a way, the answer was hidden in the question itself. After a long trial and error process, we realised that in order to design made-to-measure hospitals it wasn’t necessary to generate as many models as possible cases. Rather it was important to be able to conceive a single model that could fit them all, based on a combination of parametric rules. The parametric hospital aspires to be like an adjustable spanner: instead of having to use a specific tool tailored to each situation, it has the ability to adapt to any metric.

Therefore, we needed to define a series of rules, metrics and strategies that are common to all health facilities to ensure their proper functioning, regardless of the final particular conditions. We have defined those parameters that guarantee not only the proper functioning of the building but also its customisation from the beginning, as well as its adaptability to future changes.

In order to define, organise and rank the concepts that are used to design the parametric hospital, many factors had to be taken into account. To this end, we’ve strictly selected those parameters that are generic and that should be considered in any hospital: organisation and location of the corridors according to their use, metric of the plot and the spaces, facade modulation, strategies for future extensions, location and hierarchy of the accesses, location of installation galleries, and other rules that allow the start of the initial construction works to begin only with the definition of the generic functional plan by the property. Thus, the parametric model guarantees that every detail contained on the functional plan will fit with the general design, which may already be under construction: this allows us to overlap part of the design process with the construction process.

We can compare the design process of the parametric hospital to a game of chess. With just a board defined by an invariable mesh, six different pieces, and a series of rules that strictly define all their possible combinations, we generate the possibility to play an infinite number of different games.

Instead of a prefabricated modular building system, the parametric hospital is the result of an intellectual process based on an in-depth analysis of the metrics and the parameters that define complex healthcare facilities. This analysis allows us to overlay and optimise all the intellectual and design procedures, in such a way that the hospital becomes fully efficient. Simultaneously, the time needed for conception, construction, equipment and commission of the hospital is reduced significantly, while all the leading provisions required for a high-quality hospital are maintained.

The first parametric hospital was built in El Puyo, a small Ecuadorian village near the Amazon rainforest. El Puyo is traditionally known as an area with a significant deficit of healthcare and sanitary infrastructures. In that context, the local government had the goodwill to search for an urgent solution for, procuring a company that could design and build an efficient hospital at a size of 14,000m² on an extremely short time schedule.

We committed to this project, which became a great opportunity to implement the intellectual process developed along with Makiber. In time, the opportunity became a responsibility: the responsibility to design, build and equip a hospital in less than a year, putting the parametric system to the test. 

From a technical point of view, El Puyo Hospital consists of 21 alternate gable roof pavilions connected by two main corridors: one for the staff and another for patients and visitors. Both corridors are disposed lengthwise, in such a way that allows the 21 pavilions to be categorised into three different access groups: one that only requires access from the public corridor, another that only requires access from the service corridor, and a third that demands access from both corridors. 

This pavilion-type spatial composition allows all hospital rooms to benefit from natural daylight and natural ventilation, thanks to the patios located between each pavilion. This increases energy efficiency with respect to lightning and climate control systems, and ensures the rooms are well suited to their users. 

The building appearance is the result of the geometric structure, intrinsically related to all the functional elements that articulate and define the pavilion’s rectangular mesh. Consequently, we create an interesting roof combination that covers the hospital facilities. The top facades of each pavilion are designed as main facades, without using more formal resources than those needed to comply with the functional requirements.

Thanks to El Puyo Hospital, the parametric hospital model has already been a success, and has been endorsed by many experts. It was described as one of the five best sanitary buildings in the world by Archdaily in 2014, the same year it received an award from the Bienal Iberoamericana de Arquitectura. Most significantly, the Ecuadorian government has recognised it as one of the best working environments in the country.

The success of El Puyo Hospital relies on the fact that it was designed and built in less than one year. Since El Puyo, we’ve built many other parametric hospitals, including facilities in Mantaand Machala (Ecuador), Malabo (Equatorial Guinea), and Menongue (Angola). At present, two more parametric hospitals are under construction: Chuquisaca Hospital and Montero Hospital, both in Bolivia.

The typological model of the parametric hospital is a parameterised hospital design method by PMMT and Makiber. Granted with an official patent in 2015, it’s a consolidated research and innovation model in the healthcare architecture sector. This model continues to evolve, providing a greater degree of versatility; indeed, today the model has no solar size limitation and can use all kinds of materials.

Clear Code Architecture 

Another important aspect of the parametric hospital has is the inclusive design of its spaces. According to World Health Organisation, 15 per cent of the world population suffers from some kind of functional diversity, and more than 25 per cent has some type of limitation in the use of built environment: this represents 40 per cent of the world population. Given this scenario, we felt the need to push forward the obsolete concept of “accessibility” to a new one: the “universal accessibility” approach. To guarantee universal accessibility in our projects requires us to question the current parameters on which conventional architectural design is based.

As a result of this concern, a three-year research project emerged from our R&D department: the result was Clear Code Architecture, a methodology that allows us to ensure universal accessibility in our projects. Clear Code collects and organises, in a detailed, objective and parametric way, all the existing material related to universal accessibility applied to our field of action, architecture, in order to unify all global universal accessibility knowledge and became a tool that can analyse, measure and implement the highest standards of universal accessibility in a built environment.

As of today, the typological model of the parametric hospital has modified some of its variables to ensure that the resulting hospital design complies with the scales that guarantee the building is fit for people, offering them the highest level of autonomy regardless of any type of functional diversity they may have.

Authors

Luis Gotor is project manager at PMMT, an architectural practice based in Barcelona, Spain. Maximià Torruella and Patricio Martínez are partners and directors, also at PMMT.