Adaptive customization: New design opportunities in orthopedics, driven by the merging of imaging and surgery

The architectural response for an out-patient orthopedic surgery and rehabilitation facility that merges the fields of imaging and surgery needs to be an architecture of changing needs. Orthopedic patients are a diverse population with varied and changing medical treatment needs. The practice of orthopedic medicine is rapidly changing in response to these needs and ongoing advances in medical technology. One of the most significant changes under way today is the merging of surgical and imaging modalities. Settings for the delivery of orthopedic medicine must be able to better accommodate these changing needs by becoming more easily adaptable while being highly customized at any given point in time.; The architecture of this setting should promote a more efficient, effective and dynamic patient care experience achieved through the use of adaptive customization. Adaptive customization, a form of mass customization, increases the modularity and adaptability of a given product and while providing a greater level of customization to each end user. The design of healthcare settings in general, and settings for the practice of orthopedic surgery in particular, would benefit from an improved approach to adaptability. This thesis will attempt to demonstrate that it is possible, through the design of healthcare settings that employ principles of adaptive customization, to create a more adaptable environment that can meet the specific needs of many different users and technologies over time.; The design process for this thesis began with a conventional literature review and discussions with experts at leading architectural firms, and multiple site visits to major medical facilities across the country. These interviews and site visits were made possible through an AIA Academy of Architecture for Health Arthur N. Tuttle, Jr. Graduate Fellowship. Interviews were conducted with professionals, ranging from the head of anesthesiology at Massachusetts's General Hospital, to residents in the surgical field at UCLA Medical Center. Shadowing health professionals through operating rooms and observing procedures was an invaluable experience and helped inform this work. Lectures and conferences on related health and architectural topics contributed to the development of a design process and principles centered on the notion of adaptive customization.; Applying adaptive customization to architecture requires developing a prescribed set of design principles. They have been defined to apply at multiple levels of scale and to be applicable as the building changes over time. The building should be conceived as a dynamic physical interface between the contextual or external environment and the programmatic or internal spaces as both conditions change. In order to allow for flexible growth and change over time, co-location of all mechanical, electrical and plumbing utilities is desirable. The co-location of these utilities should also become a distinct design element. The facility should accommodate and celebrate multiple modes of mobility so people with varied disabilities and abilities can freely navigate the building and not feel intimidated or segregated. Adaptive customization must provide a level of user adaptability. The building must be able to be adapted by the facility managers to achieve their desired needs. The building should also accommodate active program elements that are the functional areas of the building and re-active elements that serve the active, functional areas.; An ideal site and setting for testing the implementation of adaptive customization is one that is in a state of change. The proposed thesis project is located as part of the new University of California - San Francisco campus in the Mission Bay redevelopment area of San Francisco. UCSF has stated a need for orthopedic services as part of the new campus. Because the Mission Bay area and the new UCSF campus will be an area of intense development, the site is and will be in a...