Co-designing hospitals with staff and patients can radically improve them as workplaces and spaces to provide care

Better hospital design could improve staff productivity and wellbeing, as well as bringing a host of therapeutic benefits, say Emma Boxer, Mark Butler, Anne Lumb, and Kendal Moran

Ask any member of hospital staff about their workplace and they will be able to point to the numerous ways in which the design of the building can be a source of frustration, creating inefficiencies and unnecessary waste.

These flaws encompass everything from minor irritations, such as long walks to catering facilities that mean staff can’t reach them during short breaks, to more serious design flaws, which reduce the speed at which equipment and patients can be moved around the building, reducing quality of care. Would these problems exist if staff and patients were at the heart of planning hospitals? 

We recently shared a platform at an event hosted by Policy Exchange to discuss the themes of this year’s Wolfson Economics Prize on hospital design. During our discussion, it became clear how commonplace these issues are, yet how much we can all contribute to improving how healthcare facilities are designed and built. Hospital staffas well as the public at largeare currently under-represented in the debate on the future hospital, but we should be harnessing the widest range of perspectives to transform our hospitals for good. Co-designing with staff and patients is the best way to make that happen.

Many healthcare facilities have developed in a piecemeal fashion, without a long term building strategy, which has meant the physical estate hasn’t developed in-step with technological and medical advances. The result is a “make do” mindset, with staff left working around design deficiencies (quite literally), when we need to tackle them head on. 

Technology can transform hospitals: tools are already available that can optimise patient flow and transform surgical procedures. Yet the best innovation is unevenly distributed across the NHS, while opportunities to transform models of care are often missed. Take digital health records, which currently just replicate a paper system in a digital format. So often we look for new ways of doing the same thingjust larger, faster, or cheaperwithout questioning whether there’s a better way of working altogether.      

While we should rethink how our hospitals can deliver enhanced services; we also need to rethink their physical layout. A windowless box room that’s also the sister’s office isn’t an appropriate place for a colleague to have their appraisal while others are eating lunch, yet these are the types of interactions staff regularly have to manage in our hospitals, which are overcrowded and outdated. 

Enhanced design can make hospitals look and feel nicer, but can also bring a host of therapeutic benefits too. Ensuring there’s plenty of natural light can help patients recover after a procedure. Creating enough space for staff to relax comfortablyand to catch up on sleepimproves their wellbeing and the care they give their patients. These improvements can help make hospitals an effective, modern workplace but their surroundings and place within local infrastructure need rethinking too, so that they’re connected to the landscape and the urban neighbourhood as public buildings at the heart of communities. 

We also shouldn’t underestimate the importance of ensuring that hospitals are well connected (visually and physically) to the outdoors, increasing the number of green and tranquil spaces and people’s contact with nature. A focus on these outdoor spacessuch as courtyards that most hospitals already havewon’t just make hospitals look nicer, with the bonus of easing stress, there are also a range of associated benefits. A well designed outdoor space supports sustainable building design, helping to manage water run-off; improves biodiversity and air quality; and assists with managing microclimates. 

There’s plenty that can be achieved by taking a multifunctional approach to designing the outdoor NHS estate. The presence of a food market outside one of the hospitals we work in has a calming and cheering effect, but it also incentivises healthy food choicesboth by those who can see the stall from inside, but also those who are just passing by. 

In England, the government has committed to the most significant investment in the NHS estate in two decades. What is needed though is a shift from thinking about hospitals as sites to cure sickness, to places where humans provide care.

New, modern facilities are welcome. But even in the current estate there are a host of small scale improvements that don’t come with enormous price tags, but which could significantly improve staff productivity and wellbeing at work, as well as improving the experience of patients too. To harness the best ideas to transform our health infrastructure, we need to more effectively draw upon all hospital staff—particularly those under-represented in the conversation, including porters and ancillary staff who have insights and practical advice that can improve hospitals for all. Patients and the local community need to be at the heart of that process too. Let’s seize the opportunity and have a conversation about the future hospital.

For more information about this year’s Wolfson Economics Prize, visit

Emma Boxer is lead outpatient pharmacist at Sunderland Royal Hospital and a member of the Early Careers Pharmacist Advisory Group, Royal Pharmaceutical Society.

Competing interests: none declared.

Mark Butler is a consultant general paediatrician at Evelina London Children’s Hospital.

Competing interests: none declared.

Anne Lumb is a greenspace and health adviser at Nature Scotland.

Competing interests: none declared.

Kendal Moran is a registered army nurse in the Surgical High Care Unit at Queen Alexandra Hospital, Portsmouth and the newly registered nurses co-lead at the Royal College of Nursing.

Competing interests: none declared.

All the authors are writing in a personal capacity, and the views expressed in this article are not necessarily representative of the organisations listed.