I’m giving one of the opening speeches at the European Congress on Healthcare Planning and Design. We often hear that the hospital is doomed as healthcare moves into the community. Yet, rather like Mark Twain, reports of its death seem greatly exaggerated. Our two books on hospital design have attracted far more interest than we could ever have imagined, with a seemingly endless list of requests to speak at conferences and write papers in scientific and professional journals. I made a three points. First, many existing hospitals are essentially dysfunctional, designed and built with little thought for what they have to do. The long period between conception and birth, coupled with the pace of change in health care, means that many are obsolete by the time they open. Second, we need to understand why and how hospitals are changing, taking account of changing patterns of disease and emerging therapeutic options, many of which have blurred the boundary between hospital and community. Third, hospital design must respond to the needs of those who are in them, both patients and staff. We often forget that it is the staff who spend most time in hospitals and, while we constantly urge them to find new ways of working, in multi-professional teams that communicate with one another effectively, we create buildings that do little to facilitate this process.
These factors have three important implications for the hospital. The first is the importance of adaptability. The hospital has changed throughout its existence and will continue to change but many of those changes cannot be predicted so we should make change as easy as possible. This affects how we pay for hospitals, such as avoiding failed experiments like the UK Private Finance Initiative that locks hospitals into contractual straightjackets, and how we build them, ensuring that we can change the configuration of the buildings without knocking them down. There are some excellent examples of good practice, such as the variable acuity beds pioneered in Indianapolis, where which the patient stays in the same bed while modules are added or removed to take account of his or her changing needs. The second is design. Hospitals involve a lot of people on the move, from one department to another. In this respect they are like an airport. Yet in an airport the flow is in one direction. In hospitals they move in different directions, they loop back on each other, many have disabilities and some are confused. We recognise that the flow is erratic, and we even create places to store patients to stop them getting lost (waiting areas and wards). The challenge is to find ways to design hospitals that make these flows as easy as possible, something that a number of innovative designs (described in our book of case studies) are doing. The third issue is capacity. It would be nice if the demand for hospital care was entirely predictable but it is not. The hospital must have the ability to accommodate peaks, troughs, and surges. It is clear that there is an audience for these messages. Let’s just hope that they can turn them into reality.