Hospitals

Hospitals - The growth in population, the enhanced human life expectancy, the more efficient and more sophisti- cated healing technologies, all resulted in consider- ably broadening the demand for health care facili- ties, such as hospitals and others (James and Tatton-Brown, 1986, Jolly, 1988, Marberry, 1995, Wagenaar, 1999, Krankenhäuser, 2000, Wörner, 2001). Throughout the first half of the twentieth century very many hospitals were designed and constructed, many of them in the form of clustered pavilions for different branches of healing. Then in the second half of the century large multi-storey hospital complexes began to appear. Whilst these belonged to the most expensive and most volumi- nous investments in public life, they usually retained a degree of self-containment and did not associate themselves with the ongoing renewal of the central downtown areas. Hospitals retain some independence, which is a distinctly specific fea- ture, in contradistinction to the development of museums, libraries, hotels, town halls and office buildings.

During the 1960s and the 1970s requirements for hospital investments grew significantly, not only in absolute terms but also when expressed as a ratio per bed. Even increased wealth was unable to sat- isfy the increasing demands. This conflict became the starting point for rationalizing demands.

This included a revision of the number of nights spent on average by a patient in the hospital which in turn also reduced the total number of beds needed and, as a consequence, lowered health care costs. The three basic zones of a hospital – the nursing, the clinical and the support zones – all underwent changes, creating a pressure to increase the areas in each of the three zones and, together with this, the investment and running costs. The rapid changes in medical technology and in the rela- tive occurrence of various maladies pushed those responsible for preparing the briefs for hospital designs to ask for more flexibility to enable hospital managers to rearrange the hospitals according to changing requirements. Various actions attempted with varying measures of success to put a brake on this pressure for higher investments. The demand for more large and expensive hospitals was slightly alleviated by constructing smaller, less expensive district hospitals and by establishing alternative means for convalescent patients outside the expen- sive central hospitals. The struggle for more in all sectors of health care facilities was marginally reduced by various measures aimed at economies. In any case a marked development has been to reduce the average number of night stays in hospi- tals by patients, which to some extent has been achieved by replacing full hospital stays by day-care periods. The result of the above and other changes was a noticeably more flexible network of health care facilities and a restriction on rising health care expenditures. Let us quantify the above changes by quoting some tentative data:

• Prior to the First World War hospitals had a gross area of approximately 20 square metres per bed; this grew during the interwar period to 40 and, by the end of the twentieth century had reached 75–80 square metres, but in most countries was kept to 20–45 square metres.

• Earlier the average duration of a hospital stay was 15–20 days; by now this has been cut back to 8–10 days.

Sundsvall Hospital, Sweden. A total of 19 operating suites, arranged in six banks served by a single corridor system.

• The total floor area of operating theatres grew during the twentieth century from 60 to about 300 square metres and they contained more expensive equipment. In large hospitals com- plex units of operating theatres are established with at least three theatres per unit. Operating sections are set up in an interdisciplinary way so as to enable management to switch over from one medical field to another, including the com- bination of septic and aseptic processes. Indi- vidual operating units may share common auxil- iary premises.

• Large open wards have been broken up into smaller rooms though each is better equipped.

• Wards with two beds have become the most common, although there are some deviations from this solution. Twelve square metres per bed in two-bed wards and 8 square metres per bed in multi-bed rooms have become widely applied.

• The equipment of patient rooms comprises shower, toilet, telephone and television connec- tion.

These guidelines are intended to highlight trends but in actual practice there are substantial devia- tions in different countries.

Despite applying certain cost reductions, hospitals became more up-to-date, but obsolescence set in more quickly, which again called for greater flexibil- ity in design and management. Precautions to pre- vent infections in hospitals have, in the meantime, become a matter of urgency, both in the nursing zone and even more in the clinical zone. In operat- ing theatres a supply of ultra-clean air, for example clean air blown down from the ceiling over the operating area, has provided only a partial solution.

For architects designing hospitals, the increased size, sophistication and cost of hospitals brought with it the need to become intricately acquainted with modern medical technologies, hospital equip- ment, materials and structures best adapted to hospitals and different health requirements.

Share :