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Special issue: the best papers of SIBRAGEC 2025 • Ambiente Construído 25 • 2025 • https://doi.org/10.1590/s1678-86212025000100925 linkcopy

Open-access Space planning in the conceptual stage of healthcare built environment intervention projetcts

Planejamento de áreas na etapa conceitual de projetos de intervenção no ambiente construído da saúde

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    Abstract

    The increasing demand for healthcare services requires adaptations in built environments to improve service efficiency and meet user needs. In the context of hospital projects, the conceptual phase of building interventions plays a crucial role by defining strategic guidelines for space planning and for the modelling of requirements. This study proposes guidelines to integrate space planning with requirements management, enhancing decision-making in the conceptual design stage of hospitals. The research followed the Design Science Research (DSR) methodological approach, and it is based on an empirical study conducted in a large hospital, resulting in the development of a requirements management (RM) framework, a taxonomy of requirements, and two digital tools: a requirements repository and a dashboard for comparative spatial analysis. The results show that integrating RM with space planning from the early stages contributes to improved clarity, traceability, and value generation. The main scientific contribution lies in the proposal of a requirements management model that links functional, strategic, and structural requirements to the physical planning of the environment.

    Keywords
    Healthcare built environment; Conceptual phase; Intervention project; Requirements modeling; Space planning

    Resumo

    A crescente demanda por serviços de saúde exige adaptações nos ambientes construídos para aumentar a eficiência dos serviços e atender às necessidades dos usuários. No contexto dos projetos hospitalares, a etapa conceitual de intervenções em edificações desempenha um papel crucial, pois define diretrizes estratégicas para o planejamento dos espaços e para a modelagem de requisitos. Este estudo propõe um modelo para integrar o planejamento dos espaços à gestão de requisitos dos usuários, aprimorando a tomada de decisão na etapa de projeto conceitual de hospitais. A pesquisa seguiu a abordagem metodológica da Design Science Research, sendo baseada em um estudo empírico em um hospital de grande porte, resultando no desenvolvimento de um roteiro para a gestão de requisitos, uma taxonomia de requisitos e duas ferramentas digitais: um repositório de requisitos e um dashboard de análise comparativa de espaços. Os resultados demonstram que a integração entre a gestão de requisitos e o planejamento dos espaços desde as fases mais iniciais contribui para maior clareza, rastreabilidade e geração de valor. A principal contribuição científica reside na proposta de um modelo de gestão de requisitos que articula requisitos funcionais, estratégicos e estruturais ao planejamento físico do ambiente.

    Palavras-chave
    Ambiente construído de saúde; Fase conceitual; Projeto de intervenção; Modelagem de requisitos; Planejamento de áreas

    Introduction

    Population aging and lifestyle changes have driven a growing demand for healthcare services (Hicks et al., 2015). This increase requires new care configurations and suitable spaces to support the implementation of new activities (Caixeta; Fabricio, 2013). Additionally, the incorporation of emerging technologies may impact healthcare processes and demand changes in the built environment (Soliman-Junior et al., 2018). In parallel, the application of the Lean Production philosophy to the construction sector and healthcare services (Lean Healthcare – LH) have emphasized the creation of patient-centered physical environments, while improving services and reducing waste (Hicks et al., 2015). Therefore, the design of healthcare spaces plays a crucial role in the efficiency of services, directly influencing value generation both in service delivery and patient recovery (Hicks et al., 2015). Moreover, by aligning physical spaces with user needs and operational strategies, a more integrated delivery of value is promoted, considering the built environment as an integral part of the production system (Sacks et al., 2009). Thus, proper requirements management from the early design stages is essential to avoid waste, improve workflow, and ensure outcomes that meet stakeholder expectations.

    The healthcare built environment can be regarded as a complex system, with multiple users, functions, technical demands, and a large number regulations (Soliman-Junior et al., 2018). In this context, fragmented communication among teams and the diversity of needs make the structuring and shared understanding of requirements a critical challenge for project success (Marchant, 2016; Hofmann; Lämmermann; Urbach, 2024). Therefore, there is a demand for improving Requirements Management (RM) practices, with the aim of delivering projects that fulfill the needs of different stakeholders (Kim et al., 2015). The initial stages of design development are considered the most complex and important for requirements management, as they involve a large volume of information and a high degree of uncertainty (Tzortzopoulos et al., 2006). The functional complexity of hospital buildings demands that this phase be meticulously planned to improve efficiency and generate suitable spaces (Bayraktar Sari; Jabi, 2024). Requirements capture at this stage is often ineffective, as it tends to prioritize predefined solutions over in-depth analysis of user needs (Pennanen; Whelton; Ballard, 2004), while making limited use of digital solutions (Jallow et al., 2010; Kim et al., 2015). This traditional model of designing often compromise value generation by prematurely translating client needs into specific product attributes (Tzortzopoulos et al., 2006).

    Furthermore, intervention projects in healthcare facilities pose additional challenges due to the need to adapt the existing built environment without disrupting operations. This makes user participation in the requirements gathering process essential (Caixeta; Fabrício, 2013). Moreover, integration with the planning of hospital spaces plays a key role in the conceptual phase of intervention projects, as it can guide decisions on flows, layout, and infrastructure, so that the identified requirements are effectively considered.

    This research study proposes a model for space planning integrated with user requirements modeling during the conceptual design phase of hospital projects, aiming to support decision-making at the early project stages. The model comprises a requirements management roadmap and a specific taxonomy for this phase, along with two digital tools: a repository for organizing information and a dashboard for comparative spatial analysis. This study contributes to advancing knowledge by articulating requirements modeling with the planning of physical spaces, addressing gaps in the literature regarding the lack of methods that effectively integrate functional, strategic, and physical requirements into design (Pegoraro; Saurin; Paula, 2012; Baldauf; Formoso; Tzortzopoulos, 2021). Additionally, it expands the application of Lean principles to hospital construction, considering value generation not only centered on the patient or isolated processes but at the interface between both, mediated by the built environment (Sacks et al., 2009; Hicks et al., 2015).

    Literature review

    Product development process

    The Product Development Process (PDP) is defined by Ulrich and Eppinger (1995) as a sequence of activities aimed at conceiving, designing, and commercializing a product. Its main characteristics include multiple sources of information throughout the product life cycle (Rosenfeld et al., 2006), dynamic and uncertain nature (Ulrich; Eppinger, 1995), early-stage decision-making under uncertainty (Rosenfeld et al., 2006), time pressure (Ulrich; Eppinger, 1995) and budget constraints. Regarding the early stages of the PDP, the literature often refers to them as fuzzy, due to the high degree of uncertainty and limited availability of information. Nevertheless, it is at this stage that the greatest opportunities for impactful design improvements arise (Tzortzopoulos et al., 2006). There is no clear consensus in the literature on how to define these initial phases, and different terms are commonly used, such as:

    1. front-end design: begins with the identification of market opportunities and requires intensive cross-functional coordination (Ulrich; Eppinger, 1995);

    2. planning (phase zero): considers market, technology, design, and financial resources, including building surveys in intervention projects (Ulrich; Eppinger, 1995; Caixeta; Fabrício, 2013);

    3. project definition: establishes feasibility and initial client requirements, enabling iterative refinement (Whelton; Ballard; Tommmelein; 2002); and

    4. concept development: an iterative process involving the identification of needs, generation and testing of concepts, ensuring alignment between business vision, requirements, and budget (Ulrich et al., 2008; RIBA, 2020).

    PDP has been extensively studied in various industrial sectors. However, the management of PDP in the construction industry raises discussions on how to address complexity, uncertainty, and the intense multidisciplinary collaboration inherent in construction projects (Koskela, 2000). Tzortzopoulos et al. (2006) and Baldauf, Formoso and Tzortzopoulos (2021) emphasize the importance of understanding PDP in construction as a chain of interdependent decisions, where early understanding of client requirements and technical constraints can lead to significant gains in terms of value generation and waste reduction. Hence, emphasis on the early design stages — especially the conceptual stage — is essential for improving decision-making aligned with a strategic vision.

    In relation to space planning at the PSP conceptual stage, Pennanen, Whelton and Ballard (2004) proposed a cyclical model, which can be associated with the "Analysis, Synthesis, and Evaluation" iterative cycle of the design process (Lawson, 2005), structured into three states:

    1. disturbance: influenced by divergent stakeholder values and changes in the organizational or business environment;

    2. control: definition of strategic and operational visions; and

    3. outcomes: structuring of needs and their impact on space use.

    For the purposes of this study, the term conceptual stage is adopted, given its theoretical and practical consolidation. It encompasses the identification of client needs, concept generation and testing, project planning, and complementary activities such as benchmarking and prototyping (Ulrich; Eppinger, 1995). This stage is thus defined as a set of early activities in a project, aimed at proposing and defining a design concept aligned with the business's strategic vision, based on an initial identification of client requirements.

    Although considered the first phase of the PDP, it is preceded by preparatory activities (prior to the PDP itself), such as:

    1. strategic product planning; and

    2. preliminary project planning (Rosenfeld et al., 2006).

    It should also precede subsequent PDP stages, such as:

    1. spatial coordination (RIBA, 2020); and

    2. detail design (Rosenfeld et al., 2006).

    The conceptual stage can thus be understood as a component of the front-end, without encompassing it entirely.

    In terms of its specific activities, the conceptual stage should be developed through an iterative process involving multiple stakeholders across three main tasks:

    1. identifying client needs;

    2. generating, selecting, and testing concepts (Whelton; Ballard; Tommelein, 2002; Ulrich et al., 2008) through an initial product conception; and

    3. spatial planning (Pennanen; Whelton; Ballard, 2004).

    Requirements management in healthcare projects

    Requirements

    There are various definitions of client requirements in the literature. Kamara, Anumba e Evbuomwan (2002) define them as client needs and expectations. Young (2004) refers to requirements as attributes that add value to the system, while Kiviniemi (2005) relates them to information about spatial properties. Pegoraro et al.(2012), in turn, describe them as statements defining essential project features.

    Requirements often originate from clients, designers, or regulatory bodies (Marchant, 2016) and can be categorized at different hierarchical levels (Kiviniemi, 2005). They may be operational or strategic (Pennanen; Whelton; Ballard, 2004) and vary in their level of abstraction (Gutman, 1982).

    In this study, requirements are understood as statements or constraints regarding the desired characteristics of a product or service (Baldauf; Formoso; Tzortzopoulos, 2021). They may arise from various sources — organizations, end users, project teams, standards, regulations, and others (Kamara; Anumba; Evbuomwan, 2002; Sengonzi; Demian; Emmitt, 2009; Kim et al., 2015; Baldauf; Formoso; Tzortzopoulos, 2021) — and appear in multiple levels of abstraction (Gutman, 1982) and formats (text, images, spreadsheets, meeting records, direct observations, etc) ( Baldauf; Formoso; Tzortzopoulos, 2021).

    Requirements modeling and space planning

    Requirements modeling is an expression originally used in software engineering, being essential in the PDP to structure, analyze, and trace requirements, supporting effective decision-making (Sommerville, 2011; Nuseibeh; Easterbrook, 2000). In construction, however, it still faces challenges such as fragmented information (Liu et al., 2013) and asynchronous availability in relation to decision-making moments, often leading to value loss.

    Several studies have emphasized the importance of requirements modeling in construction. Jallow et al. (2017) pointed out that the absence of systematic processes and appropriate tools for managing requirements leads to information loss and recurring errors, particularly in complex projects, such as healthcare environments. According to those authors, effective modeling must ensure traceability, dynamic updating, and integration of information from the earliest phases. Kim et al. (2015) further highlighted that the greatest challenge lies in the constant evolution of requirements, demanding methods capable of capturing, tracking, and updating them effectively. Additionally, Sengonzi, Demian and Emmitt (2009) noted that a major challenge is connecting stakeholder requirements to design solutions, while managing ongoing organizational and operational changes.

    Elkahmisy; Mansour; Kamel (2025) proposed integrated project evaluation methods combining spatial analysis (e.g., Space Syntax) and virtual reality simulations, demonstrating potential for improving operational efficiency in complex hospital facilities by providing relevant data before construction. However, despite its relevance, that study does not integrate space planning into requirements management. Conversely, Pennanen, Whelton and Ballard (2004) proposed an approach that links space planning with the organization’s overall strategy. They also suggested a visual device for modeling stakeholder-perceived value in relation to organizational strategies, alongside spatial requirements modeling, with the goal of supporting decision-making, managing complexity, and adding value to the early project stages.

    Pegoraro, Saurin and Paula (2012) emphasized the direct relationship between PDP stages and requirements modeling, proposing its organization into four main stages: identification, analysis and prioritization, specification, and validation. This sequential logic is fundamental to ensure that requirements are captured, analyzed, and validated in a structured way throughout project development. Complementarily, Baldauf, Formoso and Tzortzopoulos (2021) stressed that this process should not be interpreted as linear but as cyclical and continuous, as requirements are constantly evolving. Therefore, modeling must be flexible, allowing frequent revisions and updates, along during PDP phases. Different activities are involved in requirements modelling ( Pegoraro; Saurin; Paula, 2012):

    1. requirements identification: gathering and organizing client demands;

    2. analysis and prioritization: assessing relevance and resolving requirement conflicts;

    3. specification: linking requirements to design solutions; and

    4. validation: testing project compliance with established requirements.

    Moreover, it is important to recognize that the modeling approach affects the phenomena that can be represented, potentially restricting what can be observed (Nuseibeh; Easterbrook, 2000). Furthermore, the introduction of digital innovations in complex projects, such as interventions in healthcare built environments, is directly tied to uncertainty — particularly in early strategic stages (Albrecht; Müller; Rüttger, 2025). As such, flexible tools for requirements management and modeling are needed to support better responses to emerging situations. In other words, rather than focusing on isolated processes, it is necessary to visualize the network of interacting processes and their impacts in the production system — especially during the conceptual stage, when numerous (and often conflicting) expectations compete for limited resources.

    Therefore, in this study, requirements modeling is understood as a continuous process across PDP stages, during which new requirements emerge and must be identified, processed, controlled, and made continuously available to decision-makers (Baldauf; Formoso; Tzortzopoulos, 2021). This demands multiple cycles of problem analysis and understanding, followed by synthesis and evaluation of proposed solutions — as the development of a solution often generates the need for further analyses (LAWSON, 2005).

    Accordingly, the literature reveals a convergence around the need to integrate requirements modeling with space planning as a fundamental practice, particularly in the early phases of the Product Development Process (PDP). However, there remains a gap in terms of available methods, tools, and practices that ensure clear visualization, continuous traceability, and effective requirements management throughout the entire project cycle (Sengonzi; Demian; Emmitt, 2009; Kim et al., 2015; Jallow et al., 2017; Liu et al., 2020; Baldauf; Formoso; Tzortzopoulos, 2021). This gap becomes even more critical in intervention projects, in which physical and heritage constraints must be reconciled with diverse functional and operational expectations.

    Research method

    Research strategy and delineation

    Design Science Research (DSR) was the methodological approach adopted in this investigation. DSR seeks to develop solution concepts—referred to as artifacts—that address classes of real-world problems while generating prescriptive theoretical knowledge (Lukka, 2003). Considering the context of intervention projects in existing hospital environments, the artifact developed was a model for hospital space planning integrated with requirements modeling during the conceptual design phase. This model includes a requirements management (RM) framework, a taxonomy of requirements, and two digital tools: a requirements repository and a comparative spatial analysis dashboard.

    The research design follows an iterative six-step process: problem identification, understanding the topic, solution development, implementation, evaluation, and analysis of theoretical contributions (Lukka, 2003). The study was structured into three main phases: understanding, development, and reflection. The literature review was conducted continuously throughout the entire research process.

    The understanding phase involved a literature review and context analysis, initiated through the Empirical Study (ES), which enabled the understanding of the real problem faced by the Healthcare Institution (HI), revealing existing weaknesses and highlighting urgent research opportunities. During the development phase, the proposed model was designed, based on evidence collected in the ES. With the support of Building Information Modeling (BIM), two digital tools were devised, tested, and refined to support requirements modeling in hospital space planning during the conceptual design stage. This phase unfolded through iterative cycles of learning and refinement, involving active engagement with stakeholders. The final phase, reflection and evaluation, involved presenting the developed model and tools in meetings with HI representatives, researchers, and academic advisors. These discussions allowed for incremental adjustments and helped consolidate both the practical and theoretical contributions of the research. The empirical study, therefore, was essential not only for the initial definition of the research problem but also for the development, application, and continuous refinement of the framework and tools proposed.

    This research study received approval from the Research Ethics Committee (REC), ensuring ethical compliance under protocol number 4.611.917 for the REC and 42321121.7.0000.5347 for the Certificate of Presentation for Ethical Review.

    Empirical study

    Description of the Healthcare Institution (HI)

    The Empirical Study (ES) was conducted in a large Hospital Complex (HC), in collaboration with the Healthcare Institution (HI). The choice of this context was motivated by a shared interest between the engineering team at the HI and the academic institution conducting this investigation, as well as the growing demand within the HI for modernization projects. Within this setting, the Outpatient Unit of Hospital 5 was selected as the focus of the investigation, as it represents one of the largest and most complex renovation projects currently under development by the HI, and is still in the conceptual phase of the PDP.

    The HI comprises multiple general and specialized hospitals, in addition to various healthcare services. Its mission is to provide high-quality care to all social groups while also promoting education and research, being recognized as a reference institution in the healthcare field. The HC itself consists of nine (9) hospitals that cater to different specialties. Hospital 5 has ten (10) service or administrative areas, including the Outpatient Unit, which features the largest clinical care area in the entire complex, with 120 consultation rooms and 16 medical specialties. Services are offered to patients from the public healthcare system (SUS), as well as private insurance and self-paying patients, the latter two grouped under the acronym INS (private/insurance patients).

    Regarding the stakeholders involved in the Outpatient Unit project, they can be categorized into six main groups (Table 1).

    Activities performed

    The activities carried out during the Empirical Study are described below in chronological order (Table 2) although they were not developed linearly due to the highly iterative nature of the research process:

    1. understanding the context and identifying the real-world problem;

    2. area analysis and zoning: development of the Visual Device (VD) supported by BIM;

    3. data collection related to user requirements; and

    4. development and evaluation of digital tools: Tool 1 (T1) – Repository of area information and requirements; and Tool 2 (T2) – Area analysis and weighting using a Dashboard.

    Visual tools and devices were developed to structure and analyze both the requirements and the existing spaces. Over time, these tools also became useful to support decision-making and were progressively refined through evaluation cycles involving the HI teams:

    • (e) Tool 1: Information Repository (Areas and Requirements): Tool 1 (T1) was developed to organize information regarding outpatient areas and their associated requirements, enabling continuous evaluation by stakeholders. As traditional requirements management software is often too complex for diverse user profiles, a more accessible digital spreadsheet was adopted. Three semi-structured interviews helped to understand the functions of different specialties, spatial flows, and operational demands. Following the initial draft, remote meetings with the engineering team and hospital management led to several refinements, totaling over three hours of collaborative discussions; and

    • (f) Tool 2: Area Analysis and Weighting (Dashboard): The need for comparative analysis of existing spaces led to the T2 development, also using a digital spreadsheet. The tool was presented in remote meetings and enhanced through feedback from engineers, managers, and healthcare specialists, becoming a strategic support resource for informed decision-making.

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    Table 1
    Stakeholder categories for the Outpatient Unit Project
    Thumbnail
    Table 2
    List of activities carried out in the three stages
    Sources of evidence

    The Empirical Study (ES) involved strong engagement with the HI teams and employed multiple sources of evidence to ensure the reliability of the results (Table 3). Considering stakeholder engagement activities, this study involved approximately 30 hours of data collection: 20 hours of participant observation in meetings, 4 hours of direct observation in walkthroughs, and 6 hours of semi-structured interviews. Semi-structured interviews played a key role in data collection, allowing for in-depth exploration of relevant topics through a flexible script. This format facilitated the collection of detailed insights into practices, perceptions, and challenges faced by different actors within the hospital context (Harrel; Bradley, 2009; Ornstein, 2016). Interviewees included professionals from various roles, enabling the capture of multiple perspectives related to space planning and renovation. Direct observation was carried out through site visits, during which visual information and detailed field notes were recorded (e.g., walkthroughs). Participant observation involved the researcher’s active engagement in meetings and activities with stakeholders, contributing to a more contextualized and dynamic understanding of the study object (Yin, 2003). Document analysis served to complement and validate information obtained through other sources, providing stable and accessible records for continuous review (Yin, 2003).

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    Table 3
    Sources of evidence used in the ES

    Data analysis involved several complementary techniques: handwritten notes in notebooks and centralized documents; analysis of floor plans and printed diagrams, enhanced with manual color-coding to highlight different zones and flows; and photographic records (when permitted and with user identities protected) to support visual documentation of spaces and their usage dynamics.

    Data triangulation was performed to enhance the validity, credibility, and reliability of research findings. The development of digital tools enabled the integration of information extracted from BIM software and structured data tables, facilitating the identification of patterns and logic in the organization of hospital spaces and requirements. Successive rounds of tool evaluation and refinement not only contributed to validate the collected data but also revealed new, emerging information throughout the process—contributing to a more detailed and comprehensive understanding of the context under study.

    Evaluation of the artefact

    The evaluation phase was carried out in parallel with the development of the digital tools. For artifact evaluation, two main constructs were considered: utility and applicability, as proposed by March and Smith (1995). Utility encompassed four criteria: visualization (organization of requirements), availability (facilitated access to information), standardization (uniformity of the process), and automation (reduction of manual work). Applicability included: ease of use (intuitive interface) and transferability of the solution (adaptability to different projects). It is important to note that the framework (or roadmap) for requirements modeling supported by space planning did not undergo the same iterative evaluation cycles as the tools, as it emerged later from the insights generated during their development. Based on the lessons learned from the iterative development, application, and refinement of the digital tools, a structured roadmap was ultimately proposed to support requirements modeling through integrated spatial planning.

    Results

    Practical problem description

    Intervention area

    The Outpatient Unit of Hospital 5 is distributed across three interconnected buildings (Buildings C, D, and R) (Figure 1), spanning three floors (Ground Floor, Basement 1, and Basement 2), with a total area of 8.984 m².

    thumbnail of Figure 1
    Figure 1
    Schematic diagram of the relationship between the buildings and floors of the Outpatien

    Understanding the distribution of spaces and the structural constraints of each building is essential for renovation, contributing for technical feasibility and heritage preservation. The ground floor, with 5,683 m², extends across the three buildings and contains the main access points to the Outpatient Unit, as well as the specialties for SUS, INS, and private care. Building C, the oldest in the complex, features early 19th-century architecture, with thick walls and small openings, in addition to peripheral corridors adjacent to a large central courtyard. These characteristics require special attention for structural interventions. Basement 1, with 2,323 m², is in Buildings D and R and does not extend into Building C due to excavation limitations. This floor houses part of Hospital 5, including the Emergency Department, and has exclusive access for SUS patients. Finally, Basement 2, the smallest floor (335 m²), is restricted to Building D, accessible only by stairs and elevators, and is used primarily for administrative areas.

    Indentified practical problem

    Based on the analysis of different sources of evidence, several potential issues related to the complexity of the conceptual design phase were identified, which may affect both project development and value generation outcomes, including:

    1. highly complex renovation project, with no possibility of interrupting services during construction and no available area for temporary relocation; multiple specialties offering different services and, therefore, demanding different requirements for the built environment;

    2. numerous stakeholders with varying perceptions, information, requirements, and interests, some of which may be conflicting;

    3. fragmented communication, due to the limited number of meetings among team members, with much of the information dispersed across different stakeholders;

    4. limited participation of end users in design meetings, such as representatives from healthcare and administrative teams;

    5. limited understanding by the project teams of the broad scope of services performed (including operations and flows), some of which are specific to each medical specialty;

    6. lack of clarity regarding project’s goals and the HI’s business strategies. In other words, the area needed to be redesigned not only from an aesthetic and functional perspective, but also aligned with the HI’s strategic positioning, which includes addressing user needs, strengthening its role in the healthcare sector, increasing revenue, and maintaining alignment with its core values; and

    7. unclear definition of the area available.

    From this analysis, one of the main challenges in developing this project was the limitation regarding available space and the uncertainty surrounding area removals and additions across all hospitals in the complex, considering the need to align decisions with the business’s strategic guidelines. Therefore, understanding the existing spaces, how these are distributed, and their actual availability for delivering care services emerged as a critical activity during the conceptual phase of the intervention project for the Outpatient Unit.

    This led to the need to:

    1. analyze the areas, flows, and services, as they are directly related;

    2. present, discuss, and make these analyses and data available;

    3. structure the various relevant pieces of information and requirements that emerged from exploring the sources of evidence; and

    4. make this information and requirements centralized, clear, accessible, and reliable for all parties involved.

    Clinic

    To address these needs, visual tools were developed to support the understanding of existing spaces, along with prototypes of digital tools designed to structure and clearly present the areas available and key requirements. Furthermore, as the conceptual phase involved representatives from various areas of the HI, a simple and user-friendly digital solution was adopted. This choice was made because existing requirement management software had complex interfaces, which made them difficult for representatives from different departments of the hospital to use and adopt effectively.

    Space planning and requirements modeling

    Visual device for the analysis of areas with the support of BIM

    The study of the Outpatient Unit areas was based on three main categories:

    1. Room Type, which classifies spaces according to their function (such as consultation rooms and exam rooms) (Figure 2); and

    2. Service Type, which groups medical specialties and administrative areas; and

    3. Type of Care, which differentiates between SUS, INS (insurance/private), and hybrid services.

    In the case of hybrid spaces, healthcare can be delivered concurrently, with shared exam and procedure rooms, or scheduled in separate shifts.

    For the analysis and planning of these spaces, specific properties were created for different zones in the BIM model, allowing for the assignment of standardized information and minimizing errors. Subsequently, the zones were color-coded through graphical overlays, facilitating the visualization of classifications.

    The visual organization in BIM enabled the extraction and analysis of square meter measurements for each zone, resulting in the development of a visual device containing floor plans and analytical spreadsheets. These devices were presented in meetings to support decision-making regarding the occupation and reorganization of spaces, helping to identify issues such as the excessive amount of waiting and circulation areas, which account for nearly half of the total area of the Outpatient Unit.

    The analyses made it possible to understand the current distribution of hybrid specialties, which require separate flows for SUS and INS patients — a requirement defined by the Institution’s strategy. Specialties with simultaneous care for both types of patients, such as Dermatology and Ophthalmology, were positioned centrally to facilitate separate access points, while those with alternating shifts, such as Gynecology, needed to be close to both entrances. The zoning by Type of Care revealed the concentration of INS services in the peripheral areas, hybrid services in the central zone, and SUS services on the opposite side, reinforcing the need to improve the spatial layout.

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    Figure 2
    VD – Ground Floor Room Type

    Beyond supporting spatial planning, the study highlighted the need to structure strategic and functional requirements to better integrate information. This led to the development of a modeling tool that links requirements to their respective areas, enabling a more systematic and accessible approach during the design phase.

    In addition to supporting spatial planning, the study highlighted the need to structure strategic and functional requirements for better information integration. This led to the development of a modeling tool that links requirements to their respective areas, enabling a systematic and accessible approach during the design phase.

    Tool T1: requirements modeling and space planning

    Tool T1 was developed to combine space analysis and planning with requirements modeling, organizing dispersed and sometimes conflicting information. To achieve this, a spreadsheet was structured according to the IS's internal hierarchy, allowing logical navigation and facilitating the insertion and evaluation of new information. Regarding the level of data entered and the associated information, the following hierarchical structure was defined (Figure 3):

    1. Hospital Complex: general data and strategic planning;

    2. Hospitals: specific requirements;

    3. Services: in this case, the Outpatient Unit;

    4. Types of Care: SUS, INS, Hybrid;

    5. Specialties: vocation and sub-units; and

    6. Sources of Requirements: BIM model, regulations, technological advancements, among others. It is important to note that BIM data can be automatically extracted, but updates in the tool must be done manually.

    thumbnail of Figure 3
    Figure 3
    Tool 1 – Logical structure diagram

    Navigation in T1 occurs through hyperlinks in a hierarchical diagram or via internal buttons within the tabs. The hierarchical structure and return buttons facilitate navigation between tabs, allowing for detailed queries without losing connection to the overall context. Figure 4 illustrates this structuring of requirements and area information for the Dermatology tab. Additionally, the tool’s organization is divided into three quadrants:

    1. Quadrant 1: main information (strategic requirements and vocation) (Figure 4);

    2. Quadrant 2: graphical representations, such as floor plans; and

    3. Quadrant 3: data related to graphical information, such as area spreadsheets.

    thumbnail of Figure 4
    Figure 4
    T1 – Dermatology tab interface

    The prototype evaluation of T1 Tool took place in three meetings with different stakeholders, including engineering teams, administration, operations, and the manager of Hospital 5. The tool was considered relevant for the project phase, as it can facilitate access and increase the reliability of information for decision-making.

    Despite the positive perception, management expressed concern regarding the availability of the Health Institution’s strategic requirements, especially those related to financial sustainability. This highlighted the need to clearly identify the Health Institution’s Strategic Requirements in order to allow proper control of access to this information. After evaluation and refinements, the teams showed great interest in deepening their understanding of the existing areas to support the definition of the space intended for the renovation of the Ambulatory.

    Tool T2: dashboard for area weighting

    T2 Tool was designed to present the collected information in a visual and intuitive manner, despite its analytical basis. Thus, unlike T1, which had multiple tabs, T2 was structured as a spreadsheet with a single main tab in the form of a dashboard, facilitating the reading and understanding of the data. Additionally, the other T2 tabs follow the hierarchical structure of the Health Institution and load data extracted from the BIM model, processed, and organized to facilitate the simulation of different future scenarios. The T2 prototype therefore centralizes navigation in its comparative and interactive tab, while the secondary tabs store and process the necessary data for its operation.

    The T2 Dashboard (Figure 5) organizes the information into two sections:

    1. upper half: presents quantitative and qualitative information visually, including the proportion of service areas (SUS, INS, Hybrid, Administrative) and strategies for the future. It also displays three-dimensional diagrams comparing the current floors and the boundaries of future areas.

    2. lower half: focuses exclusively on quantitative data, segmented by specialty and expressed as percentage indicators of the total area, such as:

      • circulation (corridors, stairs, and elevators);

      • waiting/reception (critical areas for the renovation project);

      • service/operation (areas designated for outpatient service);

      • bathrooms (for patients and staff);

      • infrastructure (technical rooms such as CSSD and Biohazard Waste Room, which must not be reduced); and

      • support (meeting rooms and staff rooms).

    Three columns of areas are presented:

    1. current ambulatory areas (left column);

    2. comparison between current and future scenarios (central column); and

    3. future ambulatory areas (right column).

    It is important to note that in the third column (future), the data reflect the total areas of each specialty, generated from scenario simulation. This process occurs in secondary tabs and must be conducted by a specialist due to the complexity of the quantitative information involved.

    T2 Tool was evaluated in meetings and was considered useful for decision-making, especially in the analysis of areas and in balancing reductions and additions of spaces. The data showed that walls occupy about 13% of the total area of the Ambulatory, highlighting the difference between Gross Area (including walls) and Usable Area (intended for use). This distinction was essential for better space distribution. Additionally, T2 revealed an excess of circulation area, indicating the need for improving design. In the simulation of the proposed scenario – with the addition of area on the ground floor and the elimination of Building R and basements – there was an actual 25% reduction in total area, surprising the participants. This finding led management to reconsider the exclusion of Building R and highlighted the need to restructure processes and services in the Ambulatory.

    thumbnail of Figure 5
    Figure 5
    T2 – Main interface and Dashboard

    Taxonomy of requirements relevant to the conceptual phase

    Based on the literature review and the requirements modeling, it was possible to categorize the nature of the requirements relevant for the conceptual design phase of hospitals. Thus, the different types of information related to the requirements were organized into the following groups (Figure 6):

    thumbnail of Figure 6
    Figure 6
    Conceptual phase requirements characterization

    Information processing:

    1. needs: expressed in natural language (Baldauf; Formoso; Tzortzopoulos, 2021);

    2. requirements: needs interpreted and converted into explicit requirements ( Baldauf; Formoso; Tzortzopoulos, 2021);

    3. neutral solution: requirements translated for stakeholder understanding (Kamara; Anumba; Evbuomwan, 2002); and

    4. specific solutions: resulting from the conversion of neutral solutions into design solutions (Jallow et al., 2010).

    Source:

    1. corporate;

    2. process-related;

    3. regulatory (Sengonzi; Demian; Emmitt, 2009);

    4. user-based, related to client expectations (Kamara; Anumba; Evbuomwan, 2002);

    5. production; and

    6. maintenance and operation of the built environment (BALDAUF et al., 2021).

    Categories:

    1. strategic: company-client requirements from a long-term perspective (future vision);

    2. functional: operational and regulatory needs of the system's processes (Lethbridge; Laganière, 2005), including user requirements regarding their roles; and

    3. structural, which involves the physical needs of the built environment to carry out activities (Kim et al., 2015), as well as the categorization of requirements into specific design solutions, considering attributes and performance ( Baldauf; Formoso; Tzortzopoulos, 2021).

    The third category is particularly relevant for intervention projects when it is necessary to consider the structural and heritage characteristics of the existing environment —such as wall thickness and size of original openings — and aspects of historical value, including original spatial arrangements, spatial qualities, and materials.

    Protocol for space planning and requirements modeling in the conceptual phase

    From the development of prototypes for the digital tools and the understanding regarding the characterization of the collected requirements, a protocol for space planning and requirements modeling during the conceptual phase of the PDP was proposed, with a focus on intervention projects in the healthcare-built environment. Considering the studies by Baldauf, Formoso and Tzortzopoulos (2021) and Pegoraro, Saurin and Paula (2012) as a point of departure, this protocol was divided into four stages:

    1. identification;

    2. analysis (also includes the structuring phase);

    3. evaluation (also includes the translation and prioritization phases); and

    4. communication (also includes the storage phase).

    The Identification phase consists of understanding the context, identifying stakeholders, and collecting needs through walkthroughs, interviews, data analyses, among others. In the case of the strategic perspective, it is necessary to understand the context from the Institution’s point of view, including business goals; in the functional perspective, the socio-technical context must be understood, including the identification of the main stakeholders, the services, processes, and operations in which these are involved, and regulations, and thus gather data on the functional requirements. In the structural perspective, it is important to understand the existing built environment and its structural and heritage characteristics or constraints – especially in the case of intervention projects – and to model the existing spaces in BIM. In the case of new building projects, it is possible to study references from built environments of other hospital complexes.

    In the Analysis phase, the needs collected from both the strategic and functional perspectives are analyzed and transposed into explicit requirements (at times, a single need may lead to more than one explicit requirement). From the perspective of structural analysis and space planning, these areas must be divided into zones according to a logical organization, preferably with the support of BIM.

    In the Evaluation phase, the previously structured explicit requirements may be translated into neutral solutions for stakeholder understanding. Strategic and functional neutral solutions should be structured with the support of space planning results so that they can be evaluated (and, if necessary, prioritized or combined). Once evaluated neutral solutions can be translated into specific design solutions, which also require evaluation from the structural perspective of the existing built environment.

    The availability of specific solutions to stakeholders must rely on the results of space planning. This final phase is called Communication, and from it, new requirements may emerge, which requires a return to the Identification phase, starting a new cycle of requirements modeling (Figure 7).

    thumbnail of Figure 7
    Figure 7
    Guideline for requirements modeling and space planning in PDP conceptual phase

    Discussion

    This study contributes to the management of hospital intervention projects by integrating requirements modeling with space planning during the conceptual phase. This research study proposes a direct integration between requirements modeling and space planning by incorporating a visual, hierarchical, and spatial logic. The proposed tools not only strengthen the traceability of requirements but also enable their analysis in relation to physical areas, their uses, functions, flows, and operational strategies, representing an advancement over approaches identified in the literature.

    The literature review highlights that this phase of the PDP is essential to identify key requirements and avoid rework (Ulrich; Eppinger, 1995; Tzortzopoulos et al., 2006) and in this regard, the results of this investigation indicate that the proposed model may facilitate decision-making at this stage by structuring and visualizing information clearly. Although this has been suggested in the literature (Sommerville, 2011; Baldauf; Formoso and Tzortzopoulos, 2021) there is a lack of prescriptions on how to structure the relationship between requirements modeling and space planning, especially in hospital intervention projects, which face additional challenges due to the need to adapt to existing structures (Caixeta; Fabrício, 2013). This research expands that concept by applying digital tools that connect requirements to the functionality of hospital spaces, potentially improving the communication of this information to decision-makers.

    Indeed, the participation of different stakeholders is widely recognized as essential for the proper identification of requirements (Pennanen; Whelton; Ballard, 2004), and this research innovates by structuring information by using visual devices and digital tools, that can potentially enhance understanding and collaboration among the different stakeholders. In fact, currently available software does not encompass this type of information display, indicating opportunities for future digital innovations, as well as integration with BIM models.

    Previous studies on requirements modeling, such as those by Pegoraro, Saurin and Paula (2012) and Baldauf, Formoso and Tzortzopoulos (2021), advance significantly in proposing processes and methods to support requirements management in construction, emphasizing aspects like traceability, continuous monitoring, and standardization of information. However, those studies do not explore how these requirements are directly connected to space planning, nor propose visual tools that support decision-making.

    Additionally, the research addresses other important gaps in the literature. One of the main contributions is the incorporation of structural requirements into requirements modeling through space planning – an aspect neglected in many existing studies, which focus on functional and strategic requirements (Kim et al., 2015). The study pointed out that structural and heritage characteristics – such as wall thickness, infrastructure limitations, and the need for structural reinforcement – directly impact design decisions and the feasibility of interventions.

    Regarding the nature of modeling cycles, based on the work of Pegoraro, Saurin and Paula (2012), a significant funneling throughout the PDP stages is proposed, as shown in Figure 8. The diagram illustrates that, during the conceptual phase, the level of specificity of certain modeling cycles may vary, even though the PDP is in its early stages. This is intended to reflect its iterative nature and the resulting ability to fluctuate between abstract and specific requirements (Cross, 1994), which sometimes need to be anticipated to support certain decisions in the early stages (for example, specific equipment and their complexity regarding dimensions, basic infrastructure, logistics, and cost). Furthermore, it can be observed that regarding requirement categories, the importance of strategic requirements gradually decreases throughout the PDP stages, while functional requirements have more importance in later stages.

    thumbnail of Figure 8
    Figure 8
    Two-dimensional schematic diagram of the relationship between requirements modeling cycles and PDP steps

    The T1 and T2 tools were evaluated in terms of their usefulness and applicability, highlighting their impact on requirements modeling and space planning for projects in the built healthcare environment.

    In terms of usefulness, T1 supported the structuring and organization of project requirements into categories, facilitating communication among stakeholders. Its use contributed to the standardization of information, reducing inconsistencies, and improving transparency of information to support decision-making. T2, in turn, was essential for simulating different scenarios involving the addition and removal of areas, helping visualize the quantitative impacts of those decisions. One of the most relevant outcomes was the identification of a 25% reduction in the initially planned total area, which led to a reassessment of the project initial strategies. Additionally, the tool indicated that the area allocated to circulation was above the ideal, signaling the need for adjustments in space usage. Regarding applicability, T1 proved to be user-friendly and adaptable to different contexts, though it still requires refinements to improve integration with other systems. T2, despite its importance in spatial analysis, features multiple tabs and requires technical knowledge to produce simulations. To expand its use in new projects, the tool needs further refinement in terms of standardization and automation, which would help increase efficiency and reduce dependence on manual data inputs.

    Finally, although the development of the tools and the proposed protocol in this study was based on the empirical study conducted in a large hospital complex, its directives were grounded in well-established principles from the literature, such as iterative and continuous requirements modeling (Pegoraro; Saurin; Paula, 2012; Baldauf; Formoso; Tzortzopoulos, 2021) and the articulation between space planning and user requirements (Pennanen; Whelton; Ballard, 2004). The resulting model presents a conceptual and operational structure that is flexible to be adapted to other construction contexts that share similar complexity. Specifically, public facility projects—such as schools, social assistance centers, or administrative units—which also involve multiple stakeholders with distinct interests. In such cases, aligning functional requirements with institutional guidelines becomes equally critical to guide the efficient use of space. The model proposed in this study can therefore serve as a reference to support the structuring, analysis, and decision-making process in complex, multi-stakeholder projects, offering visual and logical support to reconcile different levels of requirements throughout the early phases of product development. Although applying it to new contexts may require specific adaptations, the model presents strong potential for transposition, offering a structured foundation to foster value generation.

    Conclusions

    The design process for interventions in the healthcare-built environment stands out as one of the most complex challenges in terms of client requirements management. In the conceptual stage of these projects, there is a need for an initial effort to identify and model requirements, as well as to carry out effective space planning. This effort is further complicated by the need to adapt new demands to existing spaces without interrupting ongoing operations.

    Space planning is a critical activity to support decision-making during the conceptual stage of the Product Development Process (PDP), when many trade-offs between requirements must be addressed. One of the main contributions of the proposed model is the distinction between strategic and functional requirements. It is suggested that this differentiation be adopted to facilitate the understanding of requirements and the analysis of trade-offs between them. This work also proposed a third category, referred to as structural requirements. It is expected that activities and analyses related to structural requirements, such as space planning, will support the evaluation, prioritization, and combination process across all categories of requirements. Finally, translating the requirements originating from each of the two initial categories (strategic and functional) into specific design solutions, evaluated under the third category (structural), can not only align with the institutional strategic needs but also help improve information reliability, reduce uncertainties, and contribute to increasing value generation in the PDP.

    The limitations of this study refer to the application of the digital tools in a single context, constrained by specific strategic conditions and pre-existing spaces. Furthermore, due to delays in starting the intervention project, it was not possible to evaluate the proposed model in greater depth, and no cycles of assessment and refinement were carried out.

    Based on the activities conducted and the results obtained, opportunities for future work have emerged:

    1. to evaluate the proposed model from the perspective of potential decision-makers;

    2. to test the tools and guidelines in different contexts and stages of the design process;

    3. to include the capture of end-user requirements in future refinements of the model;

    4. to apply the proposed digital tools to new hospital building projects to identify their potential and limitations; and

    5. to analyze the relationship between strategic and functional requirements in other stages of the PDP, aiming to improve requirements modeling in terms of content and timing.

    Declaração de Disponibilidade de Dados

    Os dados de pesquisa só estão disponíveis mediante solicitação.

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    Edited by

    • Editores:
      Ariovaldo Denis Granja e Dayana Bastos Costa

    Publication Dates

    • Publication in this collection
      03 Nov 2025
    • Date of issue
      2025

    History

    • Received
      23 Mar 2025
    • Accepted
      23 Aug 2025
    Creative Common - by 4.0
    This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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