Cultural Context: Learning From Healthcare Design In Sweden
How does cultural context affect healthcare planning and design? Having the opportunity to recently spend a couple years in Sweden, I’ve found it interesting and valuable to reflect on the similarities and differences in healthcare planning between there and the U.S.
Similar to many other European countries, most healthcare in Sweden is administered by regional governments; this includes patient care, building construction and operation, and financing/insurance. Less than 10 percent of hospitals in Sweden are privately operated, and funding for both private and public healthcare comes primarily from regional governments.
Healthcare facilities operate within a network of vertically integrated care: from home-based care all the way to large academic medical centers. As one example, when my wife and I were expecting our son, we appreciated how information was transferred from our prenatal check-ups to the hospital where he was born, and then to the clinic where we went for well-baby check-ups.
Healthcare design in Sweden reflects the broader Swedish culture of extensive collaboration, consensus-based decision making, and equality of treatment and access. For example, user-group meetings during programming and design are collaborative and inclusive, and it’s important to achieve consensus among stakeholders as much as possible.
On a couple of occasions, I had the privilege of participating in workshops where clinicians and administrators from around the region gathered for interactive sessions to discuss the future of ICU and OR environments. Rather than focus on a specific project, the goal was to share knowledge and generate ideas that were useful for healthcare facility planning across the entire region.
Cultural values of equality and public health are reflected in the location of healthcare facilities, too. Many buildings are in the center of communities and seen as public resources alongside other services provided in town centers. Access via walking and public transportation is the norm. Where we lived, my wife and I enjoyed a 10-minute walk to the clinic for baby check-ups, and from the clinic we could cross the plaza to the library, pharmacy, or supermarket.
Former colleague Stefan Lundin, healthcare architect at White and part-time doctoral student at Chalmers University, shared several Swedish healthcare trends that reminded me of some we’re also seeing in the U.S.
First, there’s a shift toward healthcare specialization, with fewer but more competent healthcare centers. Facilities are also becoming more integrated by collocating spaces for treatment, care, and research—organized around a case type or body organ, rather than by conventional departments. Finally, similar to the U.S.’s trend toward increased outpatient care, for quite some time Sweden has also seen a reduction in inpatient care and a prioritization of primary care and outpatient services.
The Swedish healthcare planning model is an interesting example of utilizing regional resources to achieve cultural values of public health, equality, and accessibility. At the same time, the system has been able to utilize private design firms to provide optimal design solutions.
Like many countries, Sweden faces the challenges of an aging population, healthcare financial pressures, and finding a balance between public and private healthcare. Let’s keep an eye on how the Swedish healthcare planning model adapts into the future, so we can keep learning from each other in the midst of our similar challenges.
Read Mike Apple's second blog in this two-part series: "Cultural Context: Applying Local Values To Healthcare Design."