Wednesday, December 17, 2008

And now, a question from a reader

For those of you who missed it in the comments, new (and much appreciated) WAD reader 2H had the following to share and ask:


I had the opportunity of working on the Museum of Art in Puerto Rico which incorporated an old hospital to house the permanent collection. The hospital building was built in the 1890's and had gracious gallerias that connected a series of sunny patient wings with soaring ceilings and generous windows. Classical proportions of the rooms and symmetry made the old hospital almost an ideal museum and very little adaptive work was required. It seemed that the building had been designed as a work of architecture first and the hospital function was someone else's problem as far as the original architects had been concerned. Certainly if you ever wanted to adapt a modern hospital for another use - it would be impossible, just because health care buildings are so specialized now.
Are you ever concerned by this aspect of the architecture that you do? Does the specific nature of the design date the buildings we do today and ensure their obsolescence? Do you think that sustainability should mean that buildings are easily adaptable after they have served their initial function? Would you ever want to see art exhibited in one of your designs?


Good question, 2H.  Let’s see if I can address this briefly and/or coherently.


First, let’s consider the past of medical care and medicine in general. Medicine has taken a long time to develop properly (after all, we only figured out antiseptics and sterile surgical fields 140 years ago) and most of what you see in a modern surgery suite or exam room have been developed in the past 50 to 60 years.  Most imaging technology, such as MRI and CT scanners, has been developed in the 20th century, the exception being your typical x-ray machine, developed in the last half of the 19th century.  To complicate things a little more, the concept of a hospital has only been developed in the past 150 or so years.  Most people were treated at home, or, if you were poor, you just died at home.  With the advent of sterilized treatment areas and tools, anesthesia, and doctors in general having science-based training (as opposed to simply being part shaman part herbalist), it started to make sense to locate medical care in a building in which these conditions could be controlled.  When we began developing lot of the life-saving technology and techniques and treatments, it also made sense to locate them in the same place.  What this means is that, unlike homes, churches, and government buildings, hospitals as a building type don’t have a long history in human civilization.


Without an idea of “what should this ‘hospital’ thing look like?”, architects simply applied their classical training to the buildings, and each subsequent generation followed suit—make it pretty before it’s all that functional. The passing of Truman’s Hill-Burton Act in 1946 provided standards for and improve the physical structure and environment of hospitals, and many hospitals were constructed in the U.S. with these standards in mind—antistatic floors in the operating rooms (ORs) to keep from setting fire to the flammable anesthesia, surfaces that could be cleaned easily, spaces for the staff to clean supplies and to store dirty linens and used needles, and spaces to do all the paperwork now required by the fairly-new entities of Medicare and Medicaid.


But as the population grew, people got sick (or sicker), and technology created new requirements, hospitals realized they needed to expand.  It made the most sense of hospitals, especially the larger ones, to expand in place because patients knew where it was, and also because they had already invested so much money in the building and grounds.  Besides, who wants to buy a huge old hospital?  What would you use it for, really?  But hospitals realized that the original buildings had not been designed with expansion in mind.  No architect in the 1940s had likely imagined what was to come and had not provided for a hospital to expand in any way that made sense.  Hence, many hospitals today are a mess in terms of wayfinding—it’s easy to get lost when walking around an older hospital because it’s been added onto in a hodgepodge kind of way.  And who, really, in the healthcare architecture field could have seen the technology coming?  When I was in undergrad (1994-1998), only a few hospitals had an MRI, and it was usually in a mobile trailer behind their facility.  Nowadays, having an in-place MRI in your imaging suite is de rigueur.  I remember getting email—email!—in 1997 while going to Georgia Tech and thinking I was da shizznit, and now most hospitals need extra space above the ceilings to run network cables and wireless routers.  Technology has changed hospitals that much in ten years, y’all.  And I’m not that old.


So, what this means now is that an healthcare architect worth her salt (and I most certainly am, yo) knows to design a facility with as much “future-proofing” as possible so that a client can get the most out of the building for as absolutely long as possible.  We provide higher floor-to-floor heights so that a client has more room for putting new technology above the ceiling and can actually access that technology to maintain or replace it.  We locate departments and provide even schematic master plans to show a facility where they can add on in the future, and we even design some space into a department so that it could be remodeled in the next ten years to be something else—today’s storage room is tomorrow’s procedure room or 256-slice CT room.  Engineers will oversize the RTUs (roof top units, which handle heating and air conditioning) now so that in the future when the facility adds on, the capacity to heat and cool the addition is there.  (Replacing an RTU is extremely costly and painful, so if you don’t have to do it, you try not to do so.)


As for reusing an old hospital building, it does happen.  Even though the Hill-Burton Act made some facilities a little more practical in terms of room size and materials, a hospital built in 1950 actually can make a pretty decent office building or even facility for a technical school.  I heard from a friend of mine in da biz that when a small hospital here in Colorado built a new facility, they got a free piece of land to build on from their city and county in exchange for their 60+-year-old hospital building. The city and county’s offices were spread out over town, and they wanted to use the old facility as their new office building and headquarters.  Good trade, says I.


I could go on and on about this, but perhaps this is a somewhat clear and somewhat concise explanation.  Any questions?  Class adjourned.


2H said...


Thank you for the thoughtful and informative response to my rambling stream of consciousness inquiries. I guess most of the hospitals I’ve experienced have all been the rabbit warren kind that evolved over decades with no master plan to guide them. I would love to experience the well planned, state of the art buildings that you get to develop. I didn’t know that hospitals are adaptable as offices – and now that you mention it, it does make sense. Some of the more exciting offices I’ve been to have been converted breweries or power stations.

Thanks so much,


Eric said...

It's almost inevitable that most buildings being used for their original intention would someday be used for a different program. Despite future-proofing buildings as best to your ability sometimes the local surroundings get built up to where the building no longer has a place to expand. This happened with the University of Colorado Medical School Campus. They simply ran out of space to expand so the entire campus was moved to a former military base (another place being used for a different program).

With the sustainable battle cry of "reduce, reuse, recycle" it makes sense that to reduce the amount of construction materials to build a new structure you would try to reuse an existing building. The future will most likely involve providing new uses for factories, shopping mall parking lots, and other defunct buildings including old hospitals.

But you can't design something with the intention that in one hundred years a more advanced society is going to use your building for something else. Let the next genius in line figure that one out.