Design and Health World Health Design

Book Review: Changing Hospital Architecture

Changing Hospital Architecture
Edited by Sunand Prasad
RIBA Publishing     
Code: 55094      
Price £45.00

There are plenty of thin-lipped critics who chastise architects for being unable to produce hospital designs as fashionably smart as today’s offices and airports, but who fail to realise that the sheer complexity of the problem and extent of political interference has made good design hard to attain.

The arrival of Changing Hospital Architecture, with its presumed emphasis on changing for the better, is timely. It contains individual essays from a wide variety of contributors, all of whom are alive to the difficulty of making progress in the face of the political opportunism and short-term thinking, which have plagued the situation for so long.

The book starts with an excellent piece by Sunand Prasad who combines his considerable intellect with hard-won experience as a healthcare architect to produce a well-argued essay, so readable it could almost be regarded as a stand-alone critique. He states clearly the purpose of the book which “is intended to be a tool. Its aim is to help improve the quality of design by pointing to potential exemplars, presenting key issues and occasionally signalling caution. This book is not intended to be a world survey.” He goes on to stress: “If this book is a tool, it is intended for the hands of change agents.” But we have to ask ourselves, who are they and how do we ensure that those with sufficient political power to implement the book’s recommendations will ever read it?

Derek Stow, who has had longer in the game than most, follows with a chronological review of hospital design since World War 2. He observes: “A striking aspect of the story is the lack of continuity of purpose, as governments came and went, initiating this and abolishing that. This frustrated the efforts of health planners and architects”. He rightly gives credit to practices like Powell & Moya who overcame many of the problems, political and bureaucratic, which stood in the way. Stowe also draws attention to the grotesque waste incurred by newish buildings being abandoned in the wake of yet another new initiative from the centre, soberly concluding that “ultimately, as in the past, the architecture of
hospitals, their location, content and built form will be determined by the wealth, culture and ethics of the society that commissions them.”

One of the book’s strengths is that it includes contributions from outside the hospital design mainstream. The first is by John Worthington, best known as a founding partner of DEGW, whose spatial analysis for the commercial office world has transformed the way large organisations provide a civilised and efficient working environment. He reminds us of the critical importance of a thorough brief; the essential role of post-occupancy appraisal; and the need to plan for infinite flexibility. All of these are well-known clarion calls but still too often given short thrift.

The second ‘outsider’ is Michael Davis who, in many ways, is more of an insider than most, having devoted much of his time to examining how new hospitals are financed. His succinct chapter is a model of clarity. He understands the design/cost interface better than most and is equally forthcoming about the disruptive effects of sudden change.

Global perspective
Susan Francis’ thoughtful contribution broadens the scope to include several schemes in mainland Europe. These provide a good comparison. However, in describing the highly creative work of Alberts and van Huut at Zwolle in the Netherlands, it would have been even more illuminating had she alluded to the dominating influence of the social philosopher Rudolf Steiner which suffuses all their work and has marked ‘healing design’ potential.

American and Australian contributions follow by Douglas Olson and Lawrence Nield respectively. The former describes the particular demographic challenges of the US and is chillingly observant about the power of political lobbyists representing the ‘managed healthcare industry’, and the resulting stranglehold on progress towards a fairer system. Nield gives a thorough account of the early days of Australian hospital design when it was heavily influenced by UK practice and describes how local influences, both organisational and architectural, have now yielded a more authentic expression.

The only distraction from this excellent book is the concluding postscript, which is poorly written. To repeat the word ‘paradigm’ on one half page no less than 11 times is a disincentive to read any further.
The whole book deserves to have a conclusion written by an authoritative third party who, above all else, should give a lead on how the pertinent and constructive suggestions in this timely volume can be implemented at a sufficiently high level in Government to really make things happen: otherwise we will be left spitting into the wind.

John Wells-Thorpe is an architect and former NHS trust chair

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