A sustainable built environment for healthcare: generative mechanisms for future-proofing

Construction projects are planned from a set of deterministic objectives and constraints that dictates what designers must accomplish. In the case of healthcare facilities, where the policy environment is characterized by change on several fronts, fixed requirements could constrain their evolvability and sustainability. Future-proofing is a response to uncertainty whereby a physical structure is designed to respond to future changes in requirements, change of use, strategic perspectives, business drivers, new policies and changing climate. The paper investigates the causal powers that explain how and why future-proofing decisions achieve a sustainable outcome. A critical realist lens is adopted to develop a configurational perspective of future-proofing design evolution. Critical Realism's open systems ontology of social reality can account for the fact that outcomes are not predictable and can better explain the nature of causation in complex social interactions such as construction projects. A case study research design was conducted comprising in-depth interviews with healthcare construction professionals in a UK setting. The study contributes to the sustainability literature by offering four generative mechanisms of future-proofing decision making and how they contingently lead - or fail to lead - to future-proof outcomes. Two change mechanisms and two problem mechanisms are presented, together with their configuration under the right conditions and context to lead to design decisions for construction projects capable of adapting to a range of possible futures.