1,720,996 research outputs found
Architetture resilienti per la sanità territoriale. Linee guida per la progettazione: un nuovo modello di Ospedale di Comunità
No full textL'emergenza pandemica del 2020 ha generato un dibattito nazionale sul ruolo della sanità territoriale, evidenziando la necessità di programmare il riassetto della rete di prossimità per prevedere risposte più efficaci alle crisi future.
Tale riorganizzazione, resa possibile dall'erogazione dei finanziamenti europei del Recovery Fund e dal piano degli investimenti contenuto nel PNRR, rappresenta un'occasione imperdibile: nella presente ricerca gli Ospedali di Comunità vengono analizzati e identificati come potenziale strumento di supporto alla rete, per migliorare la risposta del sistema sanitario in situazione emergenziale. Si indagano quindi strategie di resilienza mediante la messa a punto di un nuovo modello di Ospedale di Comunità costituito da schemi metaprogettuali e strumenti operativi per facilitare le fasi preliminari della progettazione, nonché da un sistema di valutazione dell'adattabilità degli edifici esistenti a essere rifunzionalizzati come strutture sanitarie intermedie di prossimità. Il volume si propone dunque sotto forma di linee guida per la progettazione di Ospedali di Comunità innovativi e resilienti.The experience of the Covid-19 pandemic has sparked a general debate about the Italian territorial healthcare system, highlighting the need to rearrange it in order to provide a more efficient response to unexpected future crises. These adjustments represent a great opportunity as they are now feasible thanks to the considerable financial support provided by the community funds and organised through the National Recovery and Resilience Plan. This research analyses and identifies Community Hospitals as potential tools to support the healthcare network, improving the system emergency response: therefore, it investigates resilience design strategies through the definition of a new model for Community Hospitals, comprising meta-design schemes and operative tools to support preliminary design, as well as an original evaluation tool to assess the adaptability of existing buildings to be transformed into proximity intermediate healthcare facilities. This work is conveyed through design guidelines for innovative and resilient Community Hospitals
Planning and design of territorial healthcare facilities in rural areas: opportunities, advantages and recommendations
No full textIn most countries, the majority of healthcare facilities and hospitals are located in urban areas, causing limited access to essential medical services and treatments in rural regions. This situation is further exacerbated by the fact that rural areas are often characterised by isolation, poor infrastructure, and a lack of basic amenities. Often, the primary care system has been underdeveloped and does not provide adequate geographical coverage. This issue has far-reaching consequences on the health and well-being of the rural population and needs to be addressed by developing a comprehensive and sustainable strategy to foster the expansion of healthcare facilities in rural regions, as well as for the underlying challenges related to urban development and infrastructure, which impact on the access to healthcare services, in order to face the future demographic, epidemiologic, economic, and social developments.
Nowadays, the advantages of an extensive and comprehensive primary care system are well-established and the role of primary care in prevention, treatment and management are delineated and endorsed in different strategic national documents.
The opportunity of providing rural areas with territorial healthcare facilities is discussed, with a possible comparison with other practicable solutions (e.g. introduction of mobile health clinics, etc.). Several domains are analysed, starting from the contributing factors to the development of primary care facilities, the design of primary care centres, including healthcare typologies, new construction or renovation, accessibility and recognisability of the facilities, as well as urban regeneration strategies and the implications of the location in rural contexts at the architectural level. This paper addresses Albania and the Municipality of Finiq to exemplify the implementation of the proposed strategy. An illustration of the possible dimensioning and configuration, as well as recommendations for the design of local health services in the Finiq Municipality are proposed as a starting point for the discussion on the potential future scenarios of healthcare services in Albania.
The results of this contribution are potential recommendations for the future planning and design of territorial healthcare facilities in remote areas
Advancing the Design of Local Care Facilities: Development of Support Tools for Community Hospital Design across Building Process Phases
No full textLa tesi riguarda la progettazione degli Ospedali di Comunità (OdC) nel contesto della riorganizzazione del Servizio Sanitario Nazionale italiano. Dal 2022, con il Piano Nazionale di Ripresa e Resilienza (PNRR) e la riforma sanitaria (D.M. 77/2022), gli OdC hanno assunto un ruolo centrale tra i servizi per l’assistenza territoriale. Nei prossimi anni, il potenziamento dell’offerta assistenziale locale vedrà la realizzazione di un OdC da 20 posti letto ogni 100.000 abitanti, sia attraverso nuova costruzione che ristrutturazione di edifici esistenti.
In questo contesto, il raggiungimento e l’efficacia degli obiettivi della riforma dipendono dalla qualificazione della programmazione, della progettazione e della realizzazione di tali interventi, nonché del processo edilizio. La ricerca mira a superare la mancanza di linee guida per la progettazione degli OdC, proponendo una raccolta di strumenti di supporto alla progettazione (DST) volti a guidare le pubbliche amministrazioni (PA) e i progettisti coinvolti negli interventi di OdC. Questo Toolkit ha lo scopo di agevolare le stazioni appaltanti nell’esprimere le esigenze del progetto e i progettisti nel soddisfare tali requisiti, e di consentire ai Responsabili Unici di Progetto di monitorare le prestazioni dell’edificio durante l’intero processo. Il Toolkit propone una serie di parametri di prestazione edilizia organizzati per domini e criteri, al fine di garantire che la qualità, l’efficienza e l’efficacia della progettazione contribuiscano alle esigenze funzionali e organizzative della committenza, al benessere degli utenti e delle comunità locali, impattando positivamente sull’ambiente urbano e preservando gli ecosistemi naturali.
La ricerca è strutturata in 4 Work Packages: i) studio delle riforme sanitarie nazionali e internazionali e implicazioni sulla progettazione; ii) definizione di OdC e di cosa comporta la progettazione di queste strutture nell’attuale contesto italiano; iii) sviluppo di parametri di prestazione dell’edificio associati agli OdC; iv) proposta del Toolkit e sviluppo di DST specifici per le diverse fasi del processo edilizio italiano. La ricerca ha seguito un approccio multimetodo prevalentemente qualitativo: i metodi di raccolta dei dati includono desk research, revisione della letteratura e casi studio, tre serie di interviste semi-strutturate a esperti in Italia e in Svezia, visite di studio, analisi dei Documenti di Indirizzo alla Progettazione (DIP) e participant observations, al fine di consentire la triangolazione dei risultati ottenuti.
La ricerca mira anche a discutere criticamente come queste linee guida e strumenti possano essere applicati nella pratica, fornendo un framework per l’uso e l’implementazione di tali strumenti nel processo edilizio in Italia.
I risultati della ricerca riguardano la proposta di un Toolkit di supporto alla progettazione degli OdC in Italia e lo sviluppo dei “format” per i DST relativi alla preparazione dei DIP e alla Post-Occupancy Evaluation, al fine di superare le principali problematiche riscontrate nel preservare la qualità del progetto durante il processo edilizio e per valutare l’efficacia della progettazione una volta che gli edifici sono in uso. I diversi DST utilizzano una serie di metodi scelti per la loro rilevanza e facilità d’uso in ogni fase del processo in cui lo strumento viene adottato.
Il Toolkit è concepito per essere ulteriormente sviluppato e applicato dalle PA con vari gradi di flessibilità, adattandolo ai sistemi sanitari regionali, alle esigenze del progetto o ai requisiti procedurali. La ricerca si conclude con la proposta di un approccio metodologico per l’identificazione a livello regionale di Key Performance Indicators e di target da associare ai parametri di prestazione degli OdC proposti nel framework, tali da fornire ai DST ulteriori misure quantitative della qualità della progettazione degli OdC, in base alle esigenze regionali.The thesis focuses on the topic of Community Hospital (CH) design in the context of the reorganisation of the Italian national health service. Since 2022, with the issuance of the Piano Nazionale di Ripresa e Resilienza (PNRR) and the health reform (D.M. 77/2022), CHs have assumed a central role among local care services. In the coming years, efforts will focus on strengthening primary care and achieving a more equitable distribution of intermediate care services by establishing one 20-bed CH per 100.000 inhabitants across Italy, both through new construction and renovation of existing buildings.
In this context, the effectiveness of the reform and the achievement of positive outcomes are influenced by the qualification of the planning, design and construction of such public interventions, as well as of the building process by which these activities are carried out. This research aims to address the scientific literature gap regarding the lack of design guidelines for CHs by proposing a collection of design support tools (DSTs) to guide public administrations and design teams involved in CH projects towards achieving high-quality environments. This Toolkit is intended to facilitate contracting authorities in expressing the project’s needs and design teams in addressing these requirements, and to enable project managers to monitor building performance along the building process. The Toolkit proposes CH building performance metrics arranged by building performance domains and criteria, to ensure that the quality, efficiency and effectiveness of the design contribute to the healthcare functional and organisational needs and evolving demands, to the wellbeing of end-users and local communities, while positively impacting the urban environment and protecting natural ecosystems.
The research is structured into 4 Work Packages, regarding: i) the study of the national and international context of the latest healthcare reforms and the implications on healthcare design; ii) the definition of what are CHs and what designing these facilities entails in the present Italian context; iii) the development of building performance metrics associated with CH design; iv) the proposal of the Design Support Toolkit and the development of DSTs formats specific to the Italian building process phases. This research followed a predominantly qualitative multi-method approach: data collection methods included desk research, literature review and case studies and three sets of semi-structured interviews with experts in Italy and Sweden, site visits, project documentation analysis and participant observation, enabling triangulation of findings.
This research also aims to critically discuss how this Toolkit can be applied in practice, providing a framework for the use and implementation of DSTs in the Italian building process.
The results of this research concern the proposal of a Design Support Toolkit intended to guide the development of CH projects in Italy and the development of DST formats for the CH Design Guidance Document Annex and CH Post-Occupancy Evaluation Tool, to address the primary challenges and obstacles faced in preserving and ensuring project quality along the building process and evaluating the effectiveness of the design once the buildings are in use. The DSTs utilise a range of techniques chosen for their relevance and ease of use at each process phase where the tool is adopted.
The Toolkit is conceived to be further developed and applied by public administrations with varying degrees of flexibility, tailoring it to regional health systems, needs of the project or procedural requirements. The research concludes with the proposal of a methodological approach to the regional identification of Key Performance Indicators and targets to be associated with the proposed CH building performance metrics, to provide DSTs with specific quantitative measures of CH design quality based on regional needs
Understanding Healthcare Design Transformations. Insights from the Swedish Experience [Elektronisk resurs]
No full textIn Europe, most countries are facing common healthcare challenges that lead to a need for innovation, effectiveness and efficiency in the healthcare systems. This is often addressed through actions and intentions including enhanced primary and integrated care. However, these developments seem to be progressing slowly and non-uniformly, nor is there knowledge exchange, and the full implications of these changes on healthcare design are still unfolding. The research presented investigates what are the current trends in healthcare systems and the effects on design transformations, focusing on the Swedish experience. In Sweden, a reform known as "Nära Vård" [Close Care], aims to "reconstruct" the core of the healthcare service around primary care. It strives to bring care "closer" to people and communities concerning access to both care and the facilities where it is delivered. The objective of this paper is to understand what can be learnt from the Swedish experience; the research presented aims at investigating the effects of the Close Care reform on primary care facilities design. The study was conducted from April to July 2023, and it consisted of: i) desk research and literature review; ii) data collection through 12 interviews with experts; iii) data analysis through qualitative content analysis; iv) study visits to local care facilities. From the interviews, 10 factors for change and 9 challenges emerged. Moreover, it appears that the organisational structure of the Swedish healthcare system caters for regional and individual projects' interpretations of how to bring care "closer" to the patients; this variation allows for a broader understanding of the advantages and drawbacks of each organisational model and design, and it reinforces the idea that there is no "one-size-fits-all" for close care. This diversity points to a need for a project evaluation program of the ongoing experiences, aimed at assessing the performance and effectiveness of each approach
Post-Project Evaluation: A Perspective on Effective and Sustainable Healthcare Design
No full textEuropean countries are facing healthcare challenges demanding significant improvements in the efficiency and effectiveness of healthcare delivery. Consequently, primary care is being strengthened by developing new facilities. As the design of healthcare facilities inevitably entails a delicate balance between various needs and requirements (functional, spatial, environmental, etc.), alongside economic constraints, it is important to determine which elements should be prioritised in the design of new primary care facilities. For this reason, building performance evaluation (BPE) has become a critical aspect of the design, construction and operation of buildings. BPE tools may provide a rational basis to guide designers and local public authorities in decision-making and in prioritising design objectives to optimise primary care facility design as well as to verify design quality in post-occupancy phases. The aim of this chapter is to analyse validated evaluation tools for healthcare-built environments to provide a comprehensive understanding of their main characteristics (target audience, aspects investigated, application phases, data collection methods, expected outcomes and impacts), thereby developing a guideline framework to streamline the adaptation or development of tools specifically tailored to primary care facilities
Dal progetto al prototipo: soluzioni per l’ottimizzazione delle prestazioni dei componenti edilizi attraverso la verifica in cantiere. Il caso degli infissi
No full textDa sempre, in edilizia, la traduzione del progetto in effettiva realizzazione implica la necessità di passare attraverso una moltitudine di soggetti che operano in maniera eterogenea. A causa di ciò, spesso, l’intenzione progettuale rischia di non trovare esito in fase di esecuzione.
Per quanto la normativa regolamenti gli aspetti principali relativi a progettazione, produzione e montaggio dei componenti edilizi, come nel caso della UNI 11673 in materia di infissi, la corrispondenza tra prestazioni attese e loro raggiungimento dipende in realtà da una molteplicità di fattori, tra i quali la discrezionalità dei soggetti operanti, la complessità dei processi costruttivi e le insidie tipiche dei cantieri edili. Tutte queste incognite influiscono sulla realizzazione del sistema edilizio nel suo complesso, tramutando il paradigma della progettazione in quello che si potrebbe definire un prototipo costruito: ogni cantiere è soggetto a condizioni diverse, determinate dalla specificità del contesto di applicazione, e ciò fa sì che ogni dettaglio costruito debba essere testato in opera di volta in volta. Tuttavia, le tempistiche del cantiere non consentono la realizzazione di test in fase preliminare rispetto al completamento dell’opera; la verifica deve pertanto configurarsi come un processo trasversale alle diverse fasi. Attraverso l’esecuzione di prove, necessarie all’ottimizzazione del prototipo, sarà dunque possibile prevedere interventi riparatori non codificati dalla normativa, nel tentativo di avvicinarsi quanto più possibile alla performance prevista.
Il presente contributo pertanto, analizza il caso degli infissi, indagando il ruolo della normativa come strumento di codifica di obiettivi prestazionali, il cui conseguimento passa attraverso soluzioni alternative, frutto dell’ottimizzazione del risultato grazie al costante processo di verifica sul campo.As it has always been in the building industry, translating design into construction entails a plurality of professionals that operate according to different perspectives. As a result, the design goals often strive to find resolution in the construction phase. Despite several regulations regarding design, manufacture and assembly of building components, as is the case with UNI 11673 about window design, the correlation between the expected performance and their achievement depends on a variety of factors, among which the subjectivity of the operators and the difficulties and obstacles associated with construction processes. These variables influence the features of the overall system, transforming the design patterns into what could be defined as a built “prototype”: every construction site is affected by different site-specific conditions that require the prototype to be tested in each of them. However, the building process and span does not allow for any preliminary verification before completion of the whole system. Therefore, the testing phase follows the process from its early design phase to its fulfillment. The evaluation practice is not only intended to assess the quality of the results, but also to optimise the prototype through reparatory and non-codified interventions, attempting to attain the expected building performance as closely as possible. Through the example of window design, this article aims at investigating the role of regulations as a potential tool to codify performance goals to be achieved through alternative solutions, as a result of the prototype field testing and optimisation process
Il "gradiente di permeabilità" nell'involucro edilizio. Una risorsa per l'intervento sul costruito esistente
No full textL’intervento sull’esistente, tema oggi più che mai attuale, presuppone una serie di considerazioni spaziali, funzionali e prestazionali spesso piuttosto complesse, che vanno a sommarsi alla molteplicità delle prescrizioni normative che regolano tali azioni.
Approcciarsi al costruito esistente può voler dire sostanzialmente procedere in due modi: demolire totalmente, scegliendo di realizzare un edificio di nuova costruzione in luogo del precedente, o mantenere in funzione, anche solo parzialmente, l’oggetto dell’intervento. Quest’ultima strada, seppur non sempre percorribile, può tuttavia risultare interessante dal punto di vista dell’ottimizzazione delle risorse, qualora si riesca a giungere ad una sintesi equilibrata tra invasività dell’intervento, spese necessarie alla sua realizzazione e miglioramento delle prestazioni globali.
La messa a punto di un approccio progettuale capace di valutare l’opportunità o meno di procedere con un tipo di intervento piuttosto che un altro, a partire dalla valutazione delle istanze critiche connesse ad azioni di questo tipo, sembra dunque oggi necessaria.
Un approccio potenzialmente efficace prevede l’implementazione del sistema di involucro esistente attraverso la giustapposizione di uno o più layer funzionali per rispondere ad esigenze di vario tipo: socio-culturali, strutturali, tipologiche e ambientali, solo per citarne alcune. Attraverso il controllo del “gradiente di permeabilità” dell’involucro sembra dunque possibile mettere a sistema la complessa molteplicità di istanze specifiche, rendendo quest’ultimo elemento generatore e ordinatore del progetto, secondo una strategia declinabile caso per caso e in funzione del contesto specifico.Renovating already existing buildings, as one of today’s priorities, necessarily implies to take specific note in relation to the complexity of spatial, functional and performance considerations, which add up to the usual prescriptions and regulations that guide these design actions.
Approaching the existing means either completely demolishing and rebuilding from scratch a new construction or preserving whatever remained of the building, even just parts of it. The latter solution, although it could sometimes prove to be unfeasible, is interesting in terms of resource optimisation, assuming it would be possible to achieve the right balance between the scale and costs of the actions to take and the potential benefits resulting from the performance improvements.
Therefore, it seems today necessary to develop a design approach that helps evaluating which of the two options is preferable, arising from the specific site condition and considerations required for this kind of actions.
A potentially efficient approach to improve the existing building stock is that of implementing the outer envelope system through a series of new functional layers, each of which plays a role in responding to different needs: social and cultural background, structural issues, quality improvement in terms of climatic solutions and many more. Thanks to the definition of a “permeability gradient” as a variable feature of the building envelope, it seems possible to solve multiple specific needs and requirements, creating therefore a strategy that can be individually referred to each specific site and context of action
Concept programmes to support healthcare design. Analysis and discussion of the Swedish case
Full text linkNell’attuale complessità del processo della progettazione sanitaria e nell’assenza di norme nazionali in materia di organizzazione funzionale e spaziale delle strutture sanitarie, il presente contributo si propone di indagare l’esperienza svedese legata ai Concept Programmes, ossia strumenti di orientamento alle prime fasi della progettazione sviluppati per facilitare il trasferimento sistematico della conoscenza dalla ricerca e dalle best practices nella pratica progettuale. Il contributo propone un confronto con il rapporto tra norma e progetto nel contesto italiano, stimolando un duplice dibattito su: gli strumenti e i metodi necessari per guidare la progettazione delle strutture di prossimità; le modalità di definizione di tali strumenti e metodi.Against the backdrop of the complex healthcare design process and the absence of national regulations on the functional and spatial organisation of healthcare facilities, this paper discusses the Swedish use of non-regulatory Concept Programmes, i.e. orientation tools for the conceptual stages of design conceived to facilitate the systematic transfer of knowledge from research and best practices to the design practice. A comparison is also made with the design approach and the norm in the Italian context, stimulating a two-fold debate on: the tools and methods needed to guide the design of primary care facilities; the process that should lead to the definition of such tools
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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