When I started my career in the 1980s, the healthcare design industry was on the cusp of dynamic change and the beginning of a “golden age.” At the time, there were very few firms that identified as healthcare practices.
For the most part, architects “looked down their noses” on the building type. None of my college design studios discussed health or well-being, and never hospitals.
But while much has changed since, it hasn’t all been for the better.
Evolution of healthcare design
Forty years ago, healthcare design conferences and magazines didn’t exist. Access to information pre-internet wasn’t shared between architects. There was limited discussion or proposed measurement of how facilities could contribute to patient experience, operational improvement, or clinical outcomes.
Idiosyncrasy and customization of hospital departments were often driven by the whims of powerful physicians. Evidence-based design, or as I consider it, “research-informed design,” wasn’t a concept yet. Post-occupancy evaluations happened but weren’t usually shared. And, of course, we didn’t have the graphic tools to document as thoroughly or visualize our designs as freely as we do now.
For all the limitations, there were many positives that don’t exist today. Rather than mimicking precedent facilities, and with fewer healthcare guidelines in place, we developed customized planning solutions through a process of listening and responding to clinicians. The time and pace allowed to complete work was much slower, allowing for more thoughtfulness and exploration.
Staffing for both firms and our healthcare clients was more robust and time less constrained. Project teams had much more access to front-line clinicians and could spend hours with large teams learning and questioning how they worked. Construction budgets weren’t of greatest concern. Design fees were higher, and less time was spent on marketing and competition for projects.
Prior to the massive consolidation of healthcare systems, we could establish personal relationships with a singular hospital and team, often with a long tenure for both the architect and administrators. Hospital leadership treated their staff as family and their hospital as their home.
Though some leaders could be provincial, the best entertained exploration of new ideas and approaches and didn’t need to answer to a larger bureaucratic decision-making process. For better or worse, architects could explore new planning and design approaches without proof of prior efficacy.
As much as the field has matured from a whimsical teenager to a rational adult, I propose that many healthcare designers (and our clients) have lost much of our creativity in the process. Many established planning architypes, such as surgical sterile cores or combined birthing facilities as LDRPs, would be slow to develop today when so much is based on precedent and prior “research.”
My challenge to both healthcare designers and client leadership is to understand research and precedent but to “push the envelope” and try untested planning, design, and construction concepts to solve the most pressing problems.
Budget shouldn’t be an excuse but rather a challenge. American healthcare architects can learn from our more adventurous global counterparts or from other industries. For instance, we can discover much about the incorporation of natural light and ventilation from our European counterparts. Additionally, home-based care could open a whole new field of health-based residential design.
We need to educate our clients on the benefit of time (and fee) to understand their goals and issues, so we can develop new, innovative solutions together. The fast track “big room” charrette has its place but cannot replace time to think and re-think during the design process, which often creates better solutions.
Future outlook on healthcare design
Our design tools are far more sophisticated, but our thinking may not be following suit. The more the healthcare industry understands how our creativity can support them with issues such as staff retention, technology integration, and campus obsolescence, the less architects will be seen as a commodity.
My wish is that healthcare design will attract the best and the brightest not because buildings are formulaic, but because they can apply their talents to create the most innovative solutions for the health and well-being of others. Who knows what the next 40 years will bring?