Technology: The Future Role of Architects in Healthcare Delivery Systems Design

Architecture, as a service to human societies, could be defined as the provision of fit environments
for human activities. The word “fit” may be defined in the most generous terms imaginable, but it
still does not necessarily imply the erection of buildings. Environments may be made fit for human
beings by any number of means. A disease ridden swamp may be rendered fit by inoculating all those
who visit in against infection, a natural amphitheater may be rendered fit for drama by installing
lights and a public address system, a snowy landscape may be fit by means of a ski-suit,gloves, boots
and a balaclava. Architecture, indeed, began with the first furs worn by our earliest ancestors, or
with the discovery of fire – it shows a narrowly professional frame of mind to refer its
beginnings solely to the cave or primitive hut.

The service that architects (healthcare designers included) propose to perform for society can
often be accomplished without calling in an architect, and the increasing range of technological
alternatives to bricks and mortar may as yet set a term to the custom-sanctioned monopoly of
architects as environment purveyors to the human race (more so centralized healthcare delivery
environments). These alternatives, whose justification is measurable performance rather than
some cultural sanction, extend, however beyond the provision of technological services, and
include analytical techniques as well, so that it is possible to define “hospital” without reference to
a patient room or an X-ray machine, but simply as an integration of a complex of intrapersonal
relationships and technical services. To do so would, in fact, be to depart so far from the
operational lore of the society we inhabit as to provoke alarm and discomfort even among the
engineers, scientists and doctors who, within their specialities, regularly employ these techniques.
Nevertheless, a moment’s reflection on such phrases as ‘TV Theater’, ‘Radio Concert Hall’ or
‘Virtual University’ will show how far technological advance has made nonsense of concepts that
were hitherto building-bound, and yet have gained popular social and cultural acceptance.

Under the impact of these intellectual and technical upheavals the solid reliance of architects, as a
profession, must eventually give way. Yet the Functionalist slogan “a house is a machine for living
in’ gives nothing away because it presupposes a house. Far more seditious to the established
attitude of healthcare architects is the proposition that, far from ambulances being substandard
hospitals, a hospital is, for many functions, a substandard ambulance. The profession tends to
dismiss the potential impact of scientific and technological alternatives to the art of building. There
is an ever-increasing tendency among 21st century service providers of any kind to take the service
to the customer, as opposed to the customer coming to the service. Technology is enabling this
paradigm shift, and healthcare facility designers could do worse than take note. Bob Dylan sang
about it, nasally prophetic: “…The times they are a changin’…”

Human environments currently under consideration in urban India are constructed environments,
static, more or less permanent and designed to operate without the consumption of too much
mechanical energy. These last two proviso’s are both rather relative since no discussion of the
present state of architecture in urban India could ignore the transitory, pulsing nature of the
shantytowns of the poor and at the other extreme modern healthcare facilities, embodying hightech
grandeur, which, operating as they are in extreme climates, can only be kept fit for human
activities at the cost of pouring vast quantities of mechanical energy into them in the form of
airconditioning and artificial light.

If we consider automobiles as the manifestation of a complex and agitated culture-within-a-culture
producing discrete objects which are themselves environments for human activities, we could
obtain a standard of comparison for the activities of the architectural profession. They may ruefully
compare the scale of the constructional work produced by the automobile culture with that
entrusted to architects; they may enviously admire the apparently close communion that exists
between users and producers, the direct way in which designers and stylists seem to be able to
apprehend the needs of motorists and satisfy them, but they surely need not draw lessons from
the work of stylists about the possibility of tailoring aesthetics to fit the aspirations or the social
status of the clients. Urban Indian architects are only too aware of this possibility, and indeed make
it a certainty at every given opportunity.

However, there is no ambition to imitate automobile form in contemporary architectural design. The
operational lore of architects seems not to include the idea of expendability. On the other hand the
forms of the more permanent products of technology are liable to imitation – to cite a notorious
example, the development of cooling towers for power stations have been paralleled by a series of
pseudo-cooling towers, an example being Le Corbusier’s Parliament House for Chandigarh, and
the development of modern petro-chemical complexes vis-à-vis Richard Rogers and Renzo
Piano’s Pompidou Center in Paris.

This sincere flattery of technology is one facet of the almost fetishistic regard afforded to certain
classes of engineers, nowadays the desire to incorporate engineering forms into architectural
design is overwhelming, more recently the work done by mathematicians in the field of fractals and
forms taken from the biological sciences provide rich imagery for architects. The pop culture and
the visual media also serve as powerful influences on architectural form. Fragments of history
juxtaposed with each other and anything else the designer might find at hand have also had their
effect on the built form of our cities, especially Mumbai.

Prefabricated systems’ building is accepted as “architecture”, however there is a division of mind
here between architects and engineers. The operational lore of the architectural profession in India
has assimilated prefabrication as a technique applied to fairly small repetitive components to be
assembled on site. Such an arrangement still leaves the determination of functional volumes
securely in the hands of architects, and the physical creation of those volumes securely in the
hands of traditional-type site labor.

But prefabrication, for most of the creative minds in the plastics industry, means something quite
different. It means the fabrication of components large enough to be effective determinants of
functional volumes. These designs call for the off-site fabrication of complete functional volumes
such as bathrooms and kitchens, a procedure that both has structural advantages and makes it
possible to complete most of the fabricating work under controlled conditions. The result is a
structure put together from large, modular units with universal joints. Such structures are widely
used today to provide critical healthcare in disaster management programs. The medical
profession in India is also familiar with vaccination and ophthalmic surgery camps, but no effort
has been made to provide for these camps “temporary hospitals”, the surgery is often done under
substandard conditions and the cases of blindness that result make headlines in the tabloids, to be
read and immediately forgotten on the way home from work.

However, such ideas have hardly touched the general body of architecture at all as yet. Much of
the painstaking and valuable research that can be shown has been undertaken in conditions that
presuppose the existence of rectangular, permanent and static buildings. The fruits of such work
often wear a characteristic air of grid-like simplicity, which, it should be noted, derives more from
the mental disposition of the men involved than from the findings of the research programs.
Architects, including healthcare architects, don’t spend much of their time reading research data; in
fact they don’t spend much of their time reading anything at all (tabloids en route homewards?).
Via market and motivation research, and the long accumulation of sociological data, considerable
scientific data on the behavior of people in various environments already exists, and when
designers can overcome their long-standing distrust of sociologists they may well find that a great
deal of very suggestive research is already at their disposal.

The youngsters today might have some good words of advice for the architectural profession in
India today, especially those designing healthcare facilities. They might say: “Get with the scene,
dudes…” There are a whole lot of exciting things happening in the world outside, technical and
scientific developments, information on which is easily available in todays connected, wired world.
We healthcare architects need to open our minds to this plethora of information to improve the way
we approach the design of our projects. A lot of it is couched in very technical language, anathema
to us ‘creative’ thinkers. As was hinted at in the beginning paragraphs of this article, we need to
transcend the traditional limitations of our professional training to embrace a more holistic view of
what we are trying to do and be more creative in finding solutions by going to the roots of the
problems we are dealing with.

Easier said than done, no doubt. However, in our firm of hospital planners and management
consultants, we have evolved a specialized and multi-disciplinary approach to the broad spectrum
of issues that confront healthcare facility designers today, right to the extent of letting our staff
develop their fields of interest in keeping with their temperament, transcending education and initial
job descriptions. Science, engineering and aesthetic sensibilities co-exist with a social conscience
and business management skills in an environment that brings forth the best in all of us.

Healthcare architectural firms have to undergo a metamorphosis into holistic healthcare
consultancy firms, they have to realize that there is more to healthcare facility design than the skills
and knowledge of healthcare architects can competently deal with. We need the help of a variety
of professionals as equally respected members of the design team; the architect has to surrender
his/her demigod status in the design team and has to accept that there are people out there who
can and must shoulder an equal part of the burden.

Let me leave you with this quotation from Chuang-Tzu, a Chinese philosopher:
“A man who knows he is a fool is not a great fool.”