Elegant penthouse VIP rooms and gourmet menus put Mount

Elizabeth Novena Hospital in Singapore in the running to be the

most luxurious hospital built anywhere in the world. Even the

standard private rooms in the new 333-bed hospital have beds canted

towards the windows so patients can easily enjoy the healing powers

of natural sunlight. Ambient lighting is designed to dim automatically,

reflecting circadian rhythm and promoting sleep.

The drive to create a “stressless healing environment” could become so

successful that administrators may have difficulty getting well-insured

patients to leave. This is a trivial concern, however, compared with the

headache suffered by hospital designers elsewhere in the world. In

much of Europe and North America, the challenge is to emulate this

standard of care cost-effectively and for populations ten or 15 times

larger than Singapore’s 5.3m inhabitants.

We already know that factors such as lighting,1 heating, ventilation,

room size, hospital layout, location and access, not to mention

infection control, are all crucial to recovery.

The significance of hospital design to the patients and families using

the hospital has also been recognised: the architect’s initial designs for

the Alberta Children’s Hospital in Calgary, Canada were redrawn by an

“advisory group” of teenagers. The colourful outcome (pictured) was

inspired by toy building blocks.

In the longer term, we also know that the advent of day surgery,

telemedicine and remote medical consultations conducted via the

Internet means that we will need fewer traditional hospitals. Yet the

exact shape of hospital requirements in 20 years’ time—let alone 50

years’ time— is hard to predict.

GROWING PAINSThe Future Hospital Commission set up by the Royal College of

Physicians in London recently commented that hospital stays have

shortened, and that chronic conditions, such as diabetes, heart disease

and intractable pain, can be managed remotely, so patients do not have

to come to hospital. The number of patients, however, has soared by

37% in the past decade. The ageing of the population means that the

UK has a higher number of people with multiple problems, while more

are simply too frail to care for themselves at home, unaided.

The commission has produced a list of 50 recommendations, including

the provision of weekend diagnostic and laboratory services to speed

patient throughput. The National Health Service (NHS) is unlikely to

be able to fund these initiatives. Meanwhile, dozens of new high-tech

facilities have been built in the UK using investment from the private

finance initiative (PFI)—the biggest being the £545m University

Hospitals Birmingham NHS Foundation Trust—but these have caused

controversy because of the constraints imposed by the high cost of

long-term mortgage repayments to non-government lenders.

This controversy has contributed to an effective moratorium on new

hospital building in the UK, according to Paul Whittlestone, the global

lead in healthcare strategy at IBI Nightingale, a specialist architecture

firm overseeing two of the largest live hospital developments in Europe

(in Glasgow, Scotland) and in North America (in Montreal, Canada).

The issues with privately funded hospitals need to be separated from

the end result—the hospital, says Mr Whittlestone. The time it takes to

approve and finance hospitals means that too many are being built to

solve problems from two or three years ago, when the process was started.

Others in the field are concerned that medical culture is often

surprisingly resistant to change, which can mean healthcare innovation

is frequently blocked. Rosalyn Cama of The Center for Health Design in

Connecticut, US, has been involved in hundreds of hospital projects in

DESIGNED FOR LIFEFuture-proofing hospital design

S P O N S O R E D B Y :

her 37-year career. “People working in hospitals need to ask themselves

why they’re actually doing lots of the things they do,” says Ms Cama.

“For example, the provision of some services in end-of-life care doesn’t

change the outcome, it just prolongs it.”

HEALTH BYPASSA UK academic body called the Health and Care Infrastructure Research

and Innovation Centre (HaCIRIC) has been set up to find ways to

optimise hospital development.2 According to its director, David Gray,

emeritus professor of construction management at Reading University,

two main theories of hospital design are now emerging.

The first involves a “cheap and cheerful” office block to be used for

patient accommodation and administrative space. Such buildings,

incorporating simple innovations such as natural air flow and window

views for bedridden patients, would be erected alongside costlier

buildings to house the sophisticated requirements of operating

theatres, imaging equipment and laboratories.

The second involves turning hospitals into compartmentalised health

factories. Everything else is sacrificed to make each process—from

joint replacements and hernia repairs to hysterectomies—as efficient

and rapid as possible, reducing recovery times and length of stay.

“You have to design the service, then build around it,” says Mr Gray.

“The problem is that even in the seven or eight years HaCIRIC has been

running, it has been difficult to keep pace with changes like the drive

to manage chronic conditions in people’s homes.”

As many healthcare systems go from crisis to crisis, leaving them

insufficient time to develop a longer-term strategic view of future needs,

the current challenge for hospital designers is to create buildings that

can adapt to future healthcare needs. In Mr Whittlestone’s view, this

requires identifying areas of expansion, such as diagnostic imaging,

then building flexibility into the surrounding interior and exterior

architecture.

Designing generic hospital rooms means that they can be easily

adapted to changing technologies. The departments earmarked for

expansion can be afforded space to extend outwards. This can be

achieved by surrounding them with so-called “soft space”—such as

staff rooms—which can be easily repurposed and moved elsewhere, or

by locating them where extensions can be built outwards.

Looking ahead, the process to build the next generation of new hospitals

in the UK—when it begins—will benefit from better thinking about the

future of healthcare, says Mr Whittlestone. Yet it will still require hard

political decision-making to invest for the future of hospital care rather

than the present—or even the past. Simply replacing old hospitals

with new ones may win public support in the short term, but it is not

sustainable.

1 Esther I Bernhofer, Patricia A Higgins, Barbara J Daly, Christopher J Burant and Thomas R Hornick, “Hospital lighting and its association with

sleep, mood, and pain in medical inpatients”, Journal of Advanced Nursing, November 4th 2013.2 “How should we create 21st century healthcare infrastructure to deliver best value?”, HaCIRIC, September 2011