Matt Morgan wrote previously about the impact that poor hospital design has on staff, patients, and healthcare. It is a timely debate and hit home for me as I am both a physician and an architect. When I was a resident doctor, a large part of my hesitation in pursuing advanced training as a doctor was due to what I considered intolerable hospital settings. Even though clinicians are now included in the design process, there remains a fundamental gap between the aims of hospital design and the final user experience. This can have an impact on the overall delivery of care.
Consultation rooms are laid out in a way that does not take into account the space and layout that a physician needs to examine a patient on the appropriate side. Sinks are placed in a way that discourages hand washing. There is a lack of spaces for confidential discussions between clinicians, or spaces for staff to rest after emotionally difficult moments. A design process should be developed whereby clinicians have input into the design of clinical spaces alongside architects and designers, and have an opportunity to discuss the complexity of clinical systems and services.
Architects have been asking how to design hospitals so that they are a tool for healing, but we are not asking it in the right forum with the involvement of clinicians. In medicine, as in architecture, it seems that our ambition for total well-being has become fractured, which may in part be due to the sub-specialisation of medical science, and also due to the rise of complex chronic illness and the need for multiple different types of buildings for delivering care.
The professions of hospital architecture and medical practice have progressed alongside each other, but have rarely converged, and any convergence is relatively recent. The tuberculosis sanatoriums built in the nineteenth century illustrate how the design of a hospital environment was considered part of a patient’s treatment. The buildings were designed to give patients access to gardens and nature to help their recovery and prevent the spread of disease.
Since the advent of critical care technologies and advanced pharmaceutical treatments, hospital design has moved into a more industrial machine-like period designed to provide all levels of life-sustaining care. Architects are challenged to maintain a sense of humanity and overcome the technical apparatus through design. Designers now try to maintain a tranquil and healing environment in spaces that are filled with technology, and make clinical spaces appear more “human.” While medical science can often disguise mortality with technology, we are now revisiting the sanatorium model to de-medicalize architecture. New healthcare centers feature access to nature and healing gardens for patients, families, and staff, in addition to artwork, views, and access to daylight throughout the designs. It is time to shift our thinking and develop healthcare architecture that is focused on prevention, rehabilitation, and independent living.
Architecture is progressively adopting the model of evidence and scientific methodology within hospital design. Increasingly, clinicians are asking not only for the architect’s perspective, but to develop a skill-set and knowledge-base, allowing them to help shape the future of healthcare design. There are now more opportunities for cross-disciplinary collaboration.
The architect Louis Kahn said “Once challenged, the architect will find completely new shapes and means to produce the hospital, but he cannot know what the doctor knows.”  One way we hope to challenge this notion and create an enduring connection between clinical practice and design is through the recent formation of Clinicians for Design, an international group with a vision to enhance health outcomes through innovations in the design of healthcare spaces, technologies, care delivery systems, and policies.  By developing unique platforms to apply clinical insights and experience to the design of settings and systems, teams can be brought together in order to challenge the stated norms.
Matt Morgan’s account of hospital design reminded me that architects, like doctors, take an oath, to serve and protect the public good and aim to design for a more beautiful world. If we are irresponsible, architecture becomes potentially harmful. I have seen poor design cause distress to patients, families, and staff in healthcare settings. Nevertheless, good design has the potential to promote healing and improve care delivery as well as cost savings.
Diana Anderson, Dochitect, and Fellow in the Human Experience Lab at Perkins+Will, an international architecture and design firm. She is on twitter:
Competing interests: none declared.
- Twombley, R. (ed.) (1964). Medicine in the Year 2000. Louis Kahn: Essential Texts. New York, NY: WW Northon & Co. p.184
- Anderson DC, Edelstein EA. www.cliniciansfordesign.com (accessed 3 Nov 2017).