Imagine a hospital where you go for a good meal; a place you visit to hear lectures, musical performances or hold a reception; a place in which the community gathers to discuss issues that will affect the shape, character and form of the area around them. Imagine a place in which the community congregates for painting, sculpture or dance classes; an environment in which you regularly attend for spiritual services or local little league and house league sporting events.
Many public institutions and private organizations are diversifying the services they already offer to an ever demanding, sophisticated and finicky population. With an unprecedented diversity and distinctiveness of culture in our communities, both urban and suburban, paired together with an unlimited access to information and choice in all that we do, we now expect, or demand, more from all services that we obtain. This now includes health care.
As a result, we need to fundamentally rethink and re-mix the programs that are found in hospitals so as to permit them to embrace a much wider set of activities. We are already seeing the introduction of other related programmes that are piggybacking on the existing infrastructure. These now regularly include such services as wellness recreation centres, day-care centres, alternative medicine centres, general and specialised retail, food courts, pharmacies, offices, community facilities, libraries and long term care homes, being added to the traditional functions changing what we think of as a hospital. This now needs to be investigated and pushed forward from both a patient focused and an economic standpoint. Clearly we are in a time of change both provincially, federally and for that matter globally. But what should the hospital of the future look like and what other services or functions should be offered?
Imagine a hospital that blends and respects the natural landscape. The future hospital’s buildings should express themselves such that we are able to understand what they mean to the larger community; where the scale of built and open spaces are balanced to human proportions and are harmonious in scale with the existing buildings around them.
Imagine a hospital which both embraces the views that the site has to offer, along with creating more intimate enclosed spaces that offer the feeling of both security, comfort and community spirit. The future hospital should be built of materials that offer texture, warmth and a sense of place, going beyond the dictum of form follows function in the visual language of architecture. The buildings should be designed in a responsive way specific to the site’s environmental conditions such as sun, shadow, and light, wind, snow, rain and storm water management. And imagine a hospital where the patients, family and staff, who will live with what is built, help guide the hand in its creation.
The hospital’s role is changing in the community. While in-patients are spending shorter periods of time in the hospital, out patient’s stay for relatively longer periods, such as dialysis patients who spend a large portion of their day on a regular schedule. The longer stays of complex continuing care and rehabilitation patients in this health community and the residents of the long-term care facility who often call this community their home need to be thought of in regards to the larger hospital design. The design challenge at hand is to personalize, humanize and demystify the environment away from the mega-hospital model to a mixed-use neighbourhood design model. Variation, inspiration and individual interaction, are the elements of our daily lives, and are significant in the creation of a mixed-use caring community in support of the people who use it. We must use the opportunity of building hospitals and diverse programmes so as to create a closely woven community.
The centre of the mixed-use community should be a community common anchored by a village meeting hall, which is occupied by the administration programmes. Fronting the common should also be a multi-purpose education centre that serves as the towns library, cinema and performance hall. Edging the common should be the residential components such as the various inpatient beds serving distinct groups as distinct neighbourhoods. These areas may include maternal child, rehabilitation, med-surgical, palliative, complex continuing care and possibly long-term care which would read as a cluster of individual buildings based on the shopkeeper living over the store model, with the common or treatment areas on the ground plane.
The street level spaces should be linked together around the common by a veranda that can open and close depending on the seasons as opposed to the traditionally sealed envelope of most hospitals. Beyond the veranda, the horizontal and vertical passage routes should be modulated to control areas ranging from more public to more private areas based on functional needs of the people who use the buildings. By assessing the design plan as individual houses, they can be designed and built based on their individual needs. The construction and timetable complexities are part of a larger community while using larger clear span structural solutions that will maximize future flexibility beyond their present use such as the historic structures we are so fond of that continue to be recycled to numerous and diverse uses over time.
Within the buildings, main streets should be created with storefronts and waiting areas as a way of creating a community of health care on a pedestrian scale. Similar to a community, beyond the main streets, secondary streets and neighbourhoods can be represented by circulation corridors and departmental areas all interspersed with courtyards and daylight. The connection to the outside comes not only in daylight, but also views to nature and a natural area, which is an important element in both the healing process and the retention of staff.
The auditorium needs to be able to function as education and conference centre, a meeting hall, a cinema, a spiritual or performance venue for the various people and groups with in both the health care village and beyond in the larger community which it serves. The education meeting hall should be able to open to the exterior common to allow summertime performances for residents, visitors and staff alike.
To create the richness and complexity of life in the new health community, we should carefully assess the mixing and blending of various healing and recreational components, thereby linking them together by the common veranda and community common to transform individual, diverse functions into a rich and active urbane environment. Instead of single use buildings focused on the narrow model of health care of the past, the health care village should evolve into the new model of a the community centre. It should offer a larger influence over health, education, the arts, recreation, retail and governance, becoming a magnet for the community.
This new health care village model must, through its physical form, enhance the hospital’s vision of creating a fully integrated community of care. This community of care brings together health professionals, visitors, patients and residents alike to provide care, growth through education, health promotion and research so as to meet the needs of the population in which it resides and serves.
It is the hospital of the past that is responsible for giving health care a bad name. The word hospital singularly sums up in our minds what we don’t want in terms of health care design; repetitive, large, clinical, and off the shelf designs that appear to have been dropped onto their site. The old adage that form follows function seems clearly thin in meaning if the programmatic relationships are the only measure of success.
The use of the hospital as only a place to serve the sick must now change. We must now see the hospital not as a singular institution but as a larger multi-use community not normally aligned with the hospitals of the past: a mixed-use health care neighbourhood responding to our heightened sense of design and overlying expectation of service by those who want our business.