Sunday, January 21, 2007

An excellent question

Thanks to all who posted comments on my inaugural post. I've received a VIQ (very important question) from The Wandering Author, which has pre-empted my earlier-decided post of today. I'll quote her below:

"MileHighPixie, I'll give you the benefit of the doubt, and assume you don't design the sort of dismal maze every hospital I've ever visited has "boasted". But I'd be interested in a post on why so many of them turn out so horribly, if they pay people with so much training to design them.I've never, thank God, been a patient in one, but as a visitor, and in some cases a visitor who had to spend a lot of time in one hospital and another, I have only noticed three design constants. First, it seems to be a requirement that the building be dismal and depressing. Second, it seems to be a requirement that it confuse anyone without a GPS receiver and a computerised map of the place. Third, they all seem to be designed to make anyone who spends much time there you have any idea why all hospitals turn out that way?"

Excellent question, WA. There are many reasons for the structure you see when you wander their halls. Let's see if I can hit the primary factors in an abbreviated fashion:

Reason #1: Many hospitals are victims of their time period when it comes to design.
Think of a house designed in 1973--avacado green kitchen appliances, orange and brown shag carpeting, wood paneling. Looks really hot now, doesn't it? Well, only if you're filming a low-budget porn. The same happens to a hospital. I wager most of them in operation today were first built between 1920 and 1960 (depending also on the country in which they're located). Design elements and layouts that were edgy or thought of as best-healing practices fifty years ago now look dated.

Likewise, any hospital built in 1950 in the United States will likely use a lot of "bathroom" type materials, such as heavily-painted concrete block (hereafter on this blog referred to as CMU), ceramic tile, and terazzo or a similar hard flooring, all colored some enthralling shade of white. Feels sterile...overly sterile, doesn't it? Let's remember that in 1950, it had been less that 100 years since Joseph Lister discovered and explained the role of germs in disease and the importance of cleanliness and antiseptic practices. White was and to a great degree still is universally thought of as the color of cleanliness, and super-hard, nonporous surfaces were considered to be the easiest to clean. While the bit about nonporous surfaces is true, the flooring and wallcovering industries have come a long way since 1950. There are now new types of flooring that are resilient, easy to clean and sterilize, and come in as many colors as there are crayons in a box. Glass tiles have joined ceramic tiles on walls of bathrooms, epoxy paints are mildew- and mold-resistant and match any color in the rainbow, and solid surface materials (like the brand name Corian) are not only easy to clean but also look like granite and marble. Newer hospitals definitely look more appealing; more on this later.

Reason #2: Many hospitals are victims of their own success.
Hospitals used to be designed to be used about fifty years, but in reality they get used for 100+ years. Master planning and site planning were historically pushed by the wayside while old-school designers thought, "Well, they'll just move and build a new, bigger building." Wrong, Scooter Bob. Rising real estate prices and convenience of present location usually lead hospitals to stay where they are and expand in place: build the new surgery wing into the old parking lot, buy a few residences nearby and build a new parking deck there, and then expand the imaging department to include the new MRI they want. When older hospitals are expanded without a thoughtful master plan, what you end up with is the confusing mass of buildings tacked on and onto each other of which Wandering Author writes. In the past 6.5 years, I've yet to design a hospital without showing dashed lines around the edges showing them how to expand in the future, or without purposefully building in a "shelled" room (just walls and a concrete floor) into which they can expand later.

Reason #3: When most hospitals in existence were built, there were no Baby Boomers.
The Baby Boomers catch a lot of hell these days for ruining the environment, raising spoiled children and grandchildren, and hosing the economy, but they've done a lot for the healthcare field. Boomers are savvier consumers than their parents, who, being raised during the Depression, are just glad to have anything. In terms of heath care. where Depression-era Americans were glad to have a Band-Aid and some aspirin, Boomers insist on getting second opinions and using technology to ensure a more precise diagnosis. Likewise, they insist on nicer places in which to heal, and this philosophy of hospital-as-resort permeates the facility. Modern-day operating rooms are often wired with stereo systems to play relaxing music until the patient goes under, then it cranks the tunes that the operating staff likes. (I guess knee replacements are more successful with BTO in the background; after all, the doctor is taking care of business.) Labor, delivery, and recovery (LDR) suites of old had a curtain around the door for privacy as their only amenity. Every LDR I've done since 2000 has internet outlets, cable TV, and a jetted tub in the patient bathroom, so when Mom goes to soak after delivering her bundle of joy, it feels like a thousand happy post-partum fairies are farting in the tub with her and relaxing her aching back and...stuff.

There are other reasons beyond this, among them that much research has actually been done in the past 30-40 years about how environment heals and helps those in it. The most recent healthcare codes and guidelines require, with only a few exceptions for small rural hospitals, that there be only one patient per patient room because research has shown that having privacy and room for a patient's family helps them heal faster. This sort of design would have been considered indulgent and a waste of square footage fifty years ago. It doesn't just help the patient, however; the hospital stands to make more money by not tying up a patient room for four days with a minor procedure patient.

I can go on and on about this, and I probably will at a later date. Healthcare design is an art and a science, and I have zero problem bragging about what I do.

Note: Portions of this post were provided by my husband and fellow healthcare architect, Mile High Guy.


faded said...

There is a wonderful Monty Python skit about architects. It makes fun of the whole question of style and appearance in the architecture biz.

It starts with the customer looking to design an apartment block. The skit covers the interview and design development process. At the end of the skit the architect winds up designing an automated slaughter house to kill the tenants. The customer protests that this is not what was wanted. The architect calls the customer an unelightned fool and is upset that the customer does not understand the brilliance of the design.

Miss Kitty said...

That certainly clears things up, MHP. Maybe more hospitals will be well-designed now that folks are actually paying attention to them.

The Wandering Author said...

MHP, thanks, at least I understand some of the reasons now. It may not make it easier to bear if I find myself spending far too much time in hospitals again, but at least I won't be tormented trying to figure out why things are the way they are.

I must admit, the most modern hospital I've seen that isn't crowded in a city was also the least uncomfortable to spend time in. On the other hand, in large cities, I think the lack of original planning / land squeeze issues prevent even modern additions from working out well. At least in the example I've endured.

It's interesting to consider your explanation, and think over all the hospitals I've seen, to see which points apply. You made a lot more sense out of it than I could, trying to figure it out on my own.

It looks as if your blog will be as interesting as your sister's, even if you don't do chicken posts...

Mile High Pixie said...

Faded: I've seen that skit, and it makes me howl with laughter and recognition. While now and then as an architect, I find myself having to save a client from themselves, I quite often see my fellow professionals not really listening to a client or walking though their existing spaces to understand what they really need. I feel their pain. And for some reason, I can't get the post you sent me about being a fallen-away architect to post. Go figure. I also empathize with you there. Early on in my career while working for the boss from hell, I considered leaving the profession. Once I started getting the work I liked, I wasn't se ready to leave. Instead, I drink.

Miss Kitty: You know it, fool.

Wandering Author: ..."least uncomfortable..." LOL! Indeed, Norman Cousins referred to hospitals in 1978 as no place to be if one were seriously ill. They're slowly getting better, if I do say so myself. And fear not: though I have no chickens in my high-rise apartment, I do have two sweet, furry cats and an equally sweet and furry husband who provide a great deal of amusement.