Hospital design challenges: now and into the future

Who can predict the nature of the health service which is housed inside a hospital in 20, 30, 40 years from now?

Health service delivery plans would do well to accurately forecast 15 years into the future. With the inevitable changes to demographics, technology and political policy, a hospital’s legacy tends to become a driver of what health services can be accommodated there as time progresses. This can steer the building’s potential away from the ideal: being an ongoing accommodation for the best possible health service. The problem is only becoming more intense with the accelerating rate of change anticipated in the health field.

There is a tendency to design hospital facilities on a ‘problem-based-functional-solution’ methodology. That is, an immediate need is identified, a brief is developed and a design response is provided. Say, for instance, there is an identified need for an emergency service to be expanded. A location and definition is given to the project and a design is commissioned to respond to that need. Another example might be that there is a modernisation of beds in a hospital with more single-bed rooms to reflect best practice. Again, logistics are identified, a brief is presented and a design is commissioned to respond to that need.

This problem-based-solution approach can easily slip into individual considerations which address the immediate needs only. Over time, these individual solutions aggregate into the many hospitals as we know them (constrained places not known for their quality environments). In order to remain true to the essential objectives of a hospital, the best practice of procurement should, instead, endeavour to incorporate these following processes to avoid the designs merely responding to incremental problems:

• Question delivery options to health services as they change and grow.
• Strategise an overview, free from departmental silos. Work to a well-considered masterplan.
• Think beyond functional solutions to particular problems; define a brief including those things important to the staff, patients, hospital and the overall system.
• Define the issues in the brief to designers: the room-by-room schedule is not a brief but is merely one solution. It is preconceived and not always the best design.
• Test designers’ drivers and credentials to lead the process, prior to the commission.
• Include an opportunity to further reflect and review the brief as design options emerge; design is a heuristic process and will present new benefits in solutions if the process encourages this.
• Include reporting to demonstrate how a design solution will fit into the future (even assuming that the current focus will one day be redundant).
• Evaluate through peer experts, not through persons who qualify by previous participation (experience reflects on past systems; expertise can also vision best practices).
• Measure success against clinical outcomes, efficiency (including value), satisfaction, wellbeing and the ability to address the future.

As can be seen in these points, a successful hospital design relies on an integrated vision and process across the whole procurement team. This is the challenge, to produce overall hospitals which serve the essential purpose of the health service.

Harm Hollander is a Project Principal with Conrad Gargett with extensive experience in the areas of Health and Defence. A Fellow of the AIA, Harm has lectured in Construction/Technology, Professional Studies and Design at both the University of Queensland and Queensland University of Technology. Harm has developed comprehensive skills in leading large projects and working meticulously through brief, design and delivery challenges. In the health sector, Harm’s industry-leading knowledge in both strategic and practical health requirements has seen him lead the health planning on major projects such as the Princess Alexandra Hospital Redevelopment and the Lady Cilento Children’s Hospital, as well as speaking engagements at a number of conferences. As a Doctor of Creative Industries candidate, Harm remains the student in seeking further improvement in collaborations towards better design outcomes.

Image caption: Lady Cilento Children's Hospital, Qld. Demonstrating intuitive wayfinding with a non-clinical image.