Can Hospitals be Architecture? The Image of a Hospital

     The question ‘can hospitals be architecture?’ has often been posed. One approach to the answer could be to ask how ‘architecture’ is defined.

Merriam-Webster offers:the art or science of building; specif : the art or practice of designing and building structures and esp. habitable ones. Not very helpful. Merriam-Webster thinks hospitals can be architecture, by overly simplifying the issue.

Let us turn to Nicklaus Pevsner, who began the introduction to ‘An Outline of European Architecture’ with these words:

“A bicycle shed is a building; Lincoln Cathedral is a piece of architecture. Nearly everything that encloses space on a scale sufficient for a human being to move in is a building; the term “architecture” applies only to buildings designed with a view to aesthetic appeal.’

It is, however, possible to argue that a well-designed bicycle shed can be “architecture” and a dull and unimaginative cathedral merely a building. Is it architecture when the design was made with ‘a view to aesthetic appeal’, but when the resulting building was generally regarded to be a total failure in this respect? In other words, the description ‘architecture’ should be applied to quality of outcome rather than of intention. This is more in accord with Henry Wotton’s famous statement based on Vitruvius, that ‘In Architecture, as in all other operative arts, the end must direct the operation. The End is to build well. Well building has three conditions, Commodity, Firmness and Delight’. For Wotton, ‘architecture’ and ‘building well’ seem to be synonymous.

The functional and technical complexity of modern hospitals has often led to the neglect of aesthetic quality, thus raising doubts about whether they can, in either Pevsner’s or Wotton’s terms, qualify as architecture.

Both in countries where private hospitals are in competition with each other, and in those where a publicly funded health service has become increasingly aware of a need to make it’s patient’s feel more welcome, there has of late been greater emphasis on environmental quality. This has manifested itself in increased attention to landscaping, finishings and furnishings, and the use of works of art, either as permanent features or as revolving exhibits. But, more fundamentally, it concerns total design of the building.

At a time of pluralism in architectural taste, the response of hospital clients and their architects, internationally, has been varied. Hospitals have traditionally been less influenced by fashionable styles of architecture than have office, domestic and retail buildings. At the same time, there does not seem to be any justification for the application of traditional styles in this building type, despite the need to maintain a human as opposed to a monumental scale. The disparity between interior and exterior would be glaring. Most hospitals are designed in the mainstream of modern architecture, in keeping with whatever is the prevailing aesthetic.

Individual architects who have their signature style are very rarely commissioned to design hospitals. In the West, most hospitals are designed by specialist healthcare design firms or large corporate firms that have a healthcare design division. Some years back I was shown pictures of work done by one such specialist healthcare design firm in the USA by one of its designers, and a layman onlooker asked about the architectural style. I had to bite back “suburban chic”. It would have been arrogant. It was not as if I had designed anything substantially better. Later I had the opportunity to briefly interact with architects from Kaplan, McLaughlin & Diaz, a large architectural firm based in San Francisco, on a hospital project they were designing in Mumbai (Bombay), India. I thought they had done an excellent job technically as well as aesthetically, done wonders on an impossible site meeting the byelaws of an unimaginative municipal authority. So I have seen both extremes of the aesthetic design abilities of these specialist designers from the USA.

(Where KMD failed was in their understanding of the Indian healthcare market, the needs of the patients they were designing for. In the absence of bread, what price cake?)

A healthcare design firm is in no position to have a signature style, unless it is well in the middle of the mainstream. A client does not choose his healthcare architect on the basis of architectural style. In our firm, we have to provide the healthcare component of healthcare architecture as per current best design practice, and tailor the architecture component to suit his taste. It can be quite a challenge, more intellectually stimulating than designing any other type of building, albeit in a design circumstance offering less purely artistic freedom, but offering the designer the opportunity to ‘design’ his way out of a maze of functional, technical and humane concerns.

Healthcare design is all about teamwork.

Signature styles are about prima donnas.

Healthcare design is about almost daily interaction with the client, weekly presentations and constant feedback.

Signature styling is about going into a huddle in a cave for a month and then unveiling a statue with a flourish, bowing in anticipation of the awed applause.

Healthcare design is about working to schedules, working in sequence, ten consultants of different disciplines stepping in perfect time to the architect’s violin.

Signature styling can be about Jim Morrison of the Doors having a bad day.

Healthcare design can also be about rock ‘n roll; it can be about Jimi Hendrix kissing the sky.

Signature styling can also be about Jim Morrison and the Doors on a great day, singing like an angel, screaming guitar.

There are pro’s and con’s to everything. The most well known healthcare facility by a famous architect is a tuberculosis sanatorium in Paimio VIIpuri, in Finland by Alvar Aalto, a modernist. It was designed and built in the early 1930’s. Tuberculosis has long since been eradicated from Finland, but the sanatorium still stands in mute testament to Aalto’s greatness. This is the only thing approaching a healthcare facility that you will find in any compilation of outstanding architecture by an outstanding architect.

There are hundreds of outstanding healthcare facilities all over the world that deliver outstanding healthcare services to the communities or countries they are located in. Many of them, like the Cleveland Clinic in Cleveland, Ohio, USA, attract patients from all over the world. The Cleveland Clinic has a 5 Star Hotel on its campus of over 50 interconnected buildings, where families of overseas patients can stay. This and many other such healthcare facilities and campuses have been designed by specialist healthcare architectural design firms worldwide. If any of these healthcare facilities were to admit a patient diagnosed as having tuberculosis, they would not need to send him to Aalto’s sanatorium to spend his last days breathing the clear mountain air. They would cure the patient of tuberculosis.

Dylan sings about it (albeit nasally), ‘the times they are a-changin’

The question ‘can hospitals be architecture?’ has often been posed. One approach to the answer could be to ask how ‘architecture’ is defined.

If ‘architecture’ embraces ‘healthcare architecture’ in its definition, then a hospital that is “well built” by Wotton’s standards would be more than mere ‘architecture’.

That hospital would be ‘healthcare architecture’.