A hospital under reconstruction cannot stop admitting patients. That single condition governs the master plan and then reappears, in a different form, inside every building on it.
In the master plan it is a question of sequence: new buildings have to stand on land that is already vacant or can be cleared without taking a working department out of service, and the order of demolition and construction has to leave the hospital whole at the end of every phase. The plan is as much a programme in time as a drawing in space.
Inside the buildings the same constraint becomes a question of movement. An outpatient tower is judged by how far a patient walks and how long they wait. A diagnostic building has to let inpatients, outpatients and emergency admissions reach the same equipment without crossing each other. An emergency department is a problem of ordering rather than area, reception, triage, resuscitation, treatment, in the sequence a patient actually passes through.
Read together, the four commissions are one continuous piece of reasoning about circulation, carried from a site plan down to the position of a nursing station. That continuity is what a single appointment buys, and it is difficult to reproduce across four separate consultants.