The rising number of outpatient services being performed in hospitals has imposed unreasonable demands on the flexibility of our inpatient infrastructure.
Ongoing technological developments, changing economics, regulatory constraints and consumerism will continue to be the primary forces for this shift in the way hospitals do business.
While aging hospitals function reasonably well as the inpatient facilities they originally were intended to be, their ability to adapt to meet current needs is limited as well as costly to accomplish.
Architectural forms for hospitals, like many other building types, were generated under the premise that "Form follows function." Traditionally, hospitals had been designed as dedicated inpatient facilities. Their design was sound as long as the buildings' function didn't change.
However, the dramatic shift to outpatient services has left many inpatient facilities struggling to survive. Excess inpatient beds are being shut down, and providers who can't afford replacement facilities are scrambling to find creative ways to redesign vacant inpatient units to satisfy other needs based on changes in business patterns.
Typically, it's at this point that hospitals discover the limitations of adapting an aging building to a different use. Problems can arise anywhere, from the lack of adequate and convenient parking to the need to help visitors find their way through a maze of corridors and from restrictive ceiling heights to heating, ventilation and air conditioning systems that are operating on borrowed time.
While hospitals may be great inpatient facilities, they often make lousy outpatient facilities. The designers of successful inpatient hospitals had a narrow focus and never thought that their buildings would have floors of empty beds.
Rectifying this myopic viewpoint is proving to be very costly. While many new hospital master plans are including "exit strategies" that suggest ways to adapt structures to uses other than traditional inpatient care, those master plans that had been built around keeping the existing hospital at the core of redevelopment and expansion are being bogged down because they're too costly to implement or will disrupt ongoing operations.
It's no longer financially feasible to design hospitals under the premise that form follows function.
In the design of residences, churches, museums and schools, architects more safely can hold to that premise because the functions of these buildings have remained substantially the same over time. For example, modern churches are often literal interpretations of the constructs used for such great cathedrals as Notre Dame, only with a modern glass skin. The museum spaces of the Louvre also still function as originally intended, even though a new lobby and an "American mall" have been added. And modern schools are essentially several one-room schoolhouses made larger and attached together.
However, healthcare facilities that have been designed for a specific purpose-specifically, inpatient care-run into trouble if healthcare delivery seeks to limit the use of inpatient care because of its cost. Unlike other building types, hospitals have faced continual alterations in their use because of changes in healthcare delivery.
The feverish search for a new metaphor for the design of healthcare facilities has resulted in some curious assertions. Some argue we'll eventually shop for healthcare services in the same way we shop for athletic shoes; therefore, when we become ill, we'll visit a shopping mall, albeit a medical mall rather than a retail mall.
Others counter that hospitals should be more like hotels. After all, "hospital" is the root of "hospitality." However, if this were true, more people would choose a hospital the same way they choose a resort, and more hospitals would have to be located on beaches.
The extensions of these concepts may seem unreasonable at first glance, but future healthcare facilities should be all of these things and more.
Healthcare facility design will evolve from the design of places where sick people go to be made well to places where well people go to stay healthy. A current example is the growing interest in complementary medicine, which seeks to use external factors to enhance what patients experience through their senses and thus assist the healing process through the patients' own mind-body connection.
However, this transition will be gradual, and while we understand the general direction in which the industry is heading, we aren't able to build tomorrow's healthcare facility today.
What we can build today-with some careful planning, thought and vision-is a facility that meets today's needs and can become the healthcare facility of tomorrow.
In searching for a new fundamental design premise to follow for the design of healthcare facilities, it's crucial to consider how a building should be designed if its function constantly changes over time. Buildings should be designed for a purpose in the short term and, at the same time, designed for change in the long term. We must accept that hospitals need to be retooled periodically, just as an auto assembly line in a car factory must be revamped to accommodate new models and new manufacturing processes.
The goal of the design of new healthcare facilities should be to permit maximum flexibility for evolution and change with minimum inconvenience and cost. Healthcare facilities should be thought of as a chassis for development with adequate infrastructure capacity to provide the ability to support any component that may be plugged into it.
We should avoid the current preoccupation with designing dedicated inpatient facilities and acknowledge the fact that the healthcare facility of the future will support a continuum of care in a variety of settings that will continue to change.
The term "open architecture" is very much in vogue. However, it's used more to refer to the design of information systems than the design of buildings. But healthcare facilities designed with an open architecture are exactly what we need.
Perhaps the new premise for the design of healthcare facilities should be "form follows flexibility." Maybe then, future healthcare facilities will be able to more readily adapt to the continual change in the healthcare environment.