OBJECTIVE: The goal was to identify practical, cost-effective, design-related strategies for "future-proofing" the buildings of a major Australian health department. BACKGROUND: Many health buildings become obsolete before the end of their effective physical lives, requiring extensive reconfiguration or replacement. This study sought to move beyond the oft-used buzzword flexibility to seek effective strategies to accommodate future change (future-proofing) that could be further explored in Australia and other developed countries. METHODS: A systematic literature review compiled definitions of flexibility and adaptability from a range of sources. Nineteen case studies were identified that illustrated various future-proofing strategies. A matrix was developed to classify different approaches to flexibility and then used to assess the case studies. RESULTS: Analysis was hampered by inconsistent use of terminology and limited availability of quantifiable methods for assessing the long-term success of approaches to future-proofing. Several key strategies were identified, classified, and discussed in terms of their relevance and application. CONCLUSIONS: More rigorous definitions of flexibility, adaptability, and related terms are needed to enable more useful comparisons of the strategies implemented to future-proof health projects. Local conditions often affect both the strategies adopted and the degree to which they can be considered successful. Many of the case studies analyzed in this research were not operational long enough to enable assessment of their claims of being future-proofed. Therefore, review of lifetime facility costs, including the service life periods of major facility components, should be considered, and some older projects should be evaluated in terms of these criteria.
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