Hospital Design: What Difference Does It Make?

by Jessica Ryan

Imagine the perfect hospital building. What would it look like? Throughout the years, there have been countless answers to this question. Two versions of the Children’s Hospital of Pittsburgh demonstrate two of the ways someone has thought a hospital should look, the first opened in 1986, and the second in May 2009. By examining the architectural philosophies that influenced the creation of older hospitals and those built more recently,  one can see how the theories driving hospital design have changed over time in an attempt to improve how hospitals fulfill their ultimate function of caring for patients.

First consider the Children’s Hospital of 1986 with its externally simple, industrialized design. It serves as an archetype for the hospitals of the past, which were generally constructed using an approach to architecture known as austere functionalism. According to this theory, a building should be designed with its end purpose in mind (Winter 662). Advocates of austere functionalism therefore believe architects should design hospitals in the way that will best allow the physicians at these hospitals to make sick patients well again. Since it only matters that hospital buildings are designed in ways that help staff serve patients effectively, followers of austere functionalism argue that the visual appeal of hospitals does not matter. Thus, austere functionalism virtually ignores principles related to aesthetics, or “the branch of philosophy dealing with beauty and taste” (WordNet). For this reason, architectural critic Edward Winters argues that, “As such it [austere functionalism] is not an aesthetic theory at all, but rather regards aesthetics as a separate matter, an accidental bonus at best, entirely irrelevant or even a case of false consciousness at worst” (662).

The dominant influence of the International Style of architecture in 1960s hospital construction exemplifies the health care field’s past commitment to austere functionalism. International Style hospitals have a trademark vast size and box structure, and typically use industrial materials, such as concrete and steel, and plain, neutral colors (Verderber 17). Architects working in this style abandoned aesthetic considerations in favor of an ascetic, modern, and streamlined hospital design. According to a 1990 article appearing in the Healthcare Forum Journal, in the hospitals of yesteryear, “external aesthetics and synergy with the neighborhood and environment were sacrificed to grim functionalism and the dictates of the hospital’s labyrinthine professional bureaucracy” (Goldsmith).  Aesthetic concerns were superfluous compared to hospitals’ desire for efficiency and modernity.

Austere functionalism dominated design in an era when physicians generally operated in departmental silos and patients with serious illnesses were often sequestered within hospitals until prepared to go home again (Goldsmith). Therefore, hospital design sought to divide staff according to function and accommodate large numbers of patients who were placed in a sterile environment until their ailments were overcome. Hospitals were modeled after factories and office buildings rather than residential buildings (Verderber 18). This style of design helped hospitals focus on specialization of labor and the production of outputs, which were healthy patients.

In particular, architects designed hospitals with emerging medical technology in mind. 1960s critic Richard Miller made the following remarks regarding the hospitals of his time: “Today it [the hospital] is an intricate complex laid out to facilitate . . . technique equipped with elaborate mechanical, communication, and monitoring networks, linked to laboratories and other rooms for anesthesia, recovery, and intensive care . . . Little wonder that architecture often gets short shrift, and that hospitals can be among the ungainliest, if not the ugliest, of large buildings today” (Verderber 17). Unfortunately, a hospital’s technological needs often led architects to spurn architecture created to foster a welcoming, healing environment. The concern for modern technology unintentionally prioritized electronics and machinery over patients (Verderber 22). This critical drawback of austere functionalist design led to the rise of another school of thought, aesthetic functionalism, in health care.

In aesthetic functionalism, the end use of a building is still an architect’s primary concern. However, proponents of this mindset also believe in the importance of beauty. According to Winters, in aesthetic functionalism, “the form of the building is aesthetically conceived as being appropriate to the utility for which the building was designed” (661). Therefore, an aesthetic functionalist design will have visually engaging artistic properties intended to help the hospital heal patients.

The rise of aesthetic functionalism coincides with health care providers placing renewed emphasis on patient-centered care, “care delivered with the patient’s needs and preferences in mind” (K. Davis). Consideration given for artistic merit can enhance providers’ ability to supply patient-centered care by lessening the impersonal feel of hospitalization and returning a human, creative element to the hospital environment.

Recent research regarding hospital design has emphasized reducing the industrial ambience of hospitals, alleviating stress and anxiety, providing assistance with wayfinding (navigation), and developing unique buildings that reflect local communities (Daykin 86). These suggestions depart from the ideals of austere functionalism for an age when more architects build customized hospitals.  These unique hospitals instill pride in local community members who consider their hospitals special landmarks that bring recognition to their neighborhoods.

Residents of Pittsburgh can admire the aforementioned new Children’s Hospital of Pittsburgh of UPMC, which received national acclaim when named America’s Most Beautiful Children’s Hospital and the seventh most beautiful hospital in the nation in 2010 (Children’s Hospital of Pittsburgh of UPMC). Furthermore, hospital staff members and supporters recognize the critical role a patient’s environment can play in healing. When the Children’s Hospital opened in 2009, its president remarked that the new building was “a pediatric hospital unparalleled anywhere in the nation in its technological sophistication and dedication to providing family-centered care” (Children’s Hospital of Pittsburgh of UPMC). The stunning design of the new building enhanced the Children’s Hospital’s capacity to facilitate high-quality and technologically advanced care for patients. This is an example of aesthetic functionalism at its finest.

Architects, designers, and health care providers now recognize that they cannot ignore aesthetics when constructing hospitals. A recent review of literature found that beautifying a hospital environment through visual art and architectural design “reduced stress, reduced risk, improved wayfinding, and enhanced perceptions of healthcare environments” (Davkin 92). An aesthetically pleasing environment is therefore integral, and not periphery, to promoting healing.

Hospitals with aesthetically pleasing environments are created using principles of evidence-based design, defined as the use of research and data to develop blueprints for buildings that will positively impact the health of patients, families, and staff (Sadler 7). Because evidence-based design prioritizes a hospital’s goals of providing healing and wellness, it aligns with functionalist schools of thought. In particular, evidence-based design promotes aesthetic functionalism because it embraces the idea “that patients and staff are generally healthier and happier in environments that honor the inherent human desire for beauty, peace, and inspiration” (Sadler 8). Architects can therefore help patients, their families, and hospital staff find the beauty, peace, and inspiration that lead to healing by designing hospitals according to the principles of aesthetic functionalism.

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Notes:

Daykin, Norma, et al. “Review: The impact of art, design and environment in mental healthcare: a systematic review of the literature.” The Journal of the Royal Society for the Promotion of Health  128.2  (2008) :   85-94. Print.

Goldsmith, Jeff C. and Richard Miller. “Restoring the Human Scale.” Healthcare Forum Journal  (November/December 1990) : 22-27. Print.

K. Davis, C. Schoen, and K. Stremikis, Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care System Compares Internationally 2010 Update, The Commonwealth Fund, June 2010.

Sadler, Blair, and Annette Ridenour. Transforming the Healthcare Experience Through the Arts. San Diego: Aesthetics, Inc., 2009. Print.

Verderber, Stephen and David J. Fine. Healthcare Architecture in an Era of Radical Transformation. New Haven: Yale University Press, 2000. Print.

Winters, Edward, “Architecture.” The Routledge Companion to Aesthetics, ed. Gaut and Lopes. London: Routledge, 2005.