Hospitals are among the most important buildings in people's lives. They are where many of our most profound experiences take place, from the births of children to the deaths of parents to personal struggles with illness or injury. They are the buildings with which we may become most intimately connected, other than our own homes.

Historically, hospital design trends appear to parallel cultural attitudes toward sickness and death. In today's youth- and health-oriented U.S. society, where many people seem to believe they will never grow old or become ill, this type of thinking is coincident with the rise of spa-like or five-star hospital design.

Banner Page Hospital, Page, Arizona

Banner Page Hospital, Page, Arizona

But should a hospital look like a spa? People go to high-end hotels to escape their problems; they go to hospitals to face their problems. As architects, should we question whether our designs deny the real purpose of hospitals—and perhaps even subvert that purpose? In hospital design, we have the opportunity to define an environment that is unique among building types, where extraordinary expertise and technologies serve people at their most vulnerable. Rather than borrow wholesale from other industries, we need to develop a new design vocabulary to meet the very specific needs of the healthcare environment.

To begin creating this new vocabulary, healthcare architects and designers can draw inspiration from other places where serious things happen. Churches, for example, impart a sense of dignity through controlled lighting and a simple palette of materials. Courthouses show similar restraint. Using these types of buildings as models, rather than looking so closely to the hospitality field, architects and designers can create buildings that honor the role hospitals play in our communities and our lives. Such buildings can be beautiful and inspire the sense of hope necessary to healthcare, without compromising the requirements of a medical setting.

Designers and healthcare clients share a baseline understanding that building architecture impacts patient care. Healing environments are undeniably important to patients, their families, and hospital staff. The public's perception of a facility as first-rate is created, in large part, by the quality of the built environment. These are among the many good reasons new ideas have supplanted the institutional hospital design of the past. However, this type of building demonstrated a seriousness of purpose that today's designers would do well to remember.

Above all, healthcare architects and interior designers must keep the healing mission of the hospital at the heart of any design decision. That means professionals in these fields—perhaps even more than other architects and designers—must have a thorough understanding of how the building will be used. This will ensure the finished design fully supports patient care.

In an effort to incorporate hospitality features into hospitals, some designers use inappropriate materials that cannot withstand the intensive cleanability and durability requirements of a healthcare environment. Some water features have raised infection control concerns. Situations like this can be avoided by considering health issues first in every aspect of a hospital design.

Beyond making sure hospitals meet patients' medical needs, architects and designers must also carefully address the complex emotional needs of hospitalized people and those who care for them.

While comfort is an essential component of hospital design, an overly lush atmosphere throughout the building may trivialize the experience of patients and their families, or give the impression the hospital is more concerned with appearance than patient care. Surroundings that seem geared toward pleasure or ease may cause a disconnect for patients between their environment and their condition. On the other hand, creating opulent lobbies while shortchanging backstage and clinical spaces creates just the opposite problem—an environment where patients and staff feel devalued.

Integrity in the use of materials can help bolster the integrity of the institution. Recreating the home environment in a hospital is impractical, and patients know they aren't at a resort. There is no need to pretend otherwise. Certain materials, like wood-look vinyl floors that don't look nearly enough like wood, may not provide the most dignified setting in which to administer care. Other materials that cannot be thoroughly cleaned or sterilized, or have the perception of being less hygienic, are also less suitable to the healthcare environment. Materials can be durable and cleanable while providing a sense of warmth and respect for patients.

Medical equipment does not always need to be cleverly hidden. Several years ago there was a popular movement to hide all equipment from view, but we have learned that it can be comforting to patients to see this technology and know that it is available to assist in their care. Designers should consider the patient population in determining how to handle medical equipment in various areas of the hospital.

SmithGroup, a national architecture, engineering, planning, and interiors firm that specializes in healthcare design, is working to express this new vocabulary in projects currently underway with Banner Health, one of the largest nonprofit healthcare systems in the country. In designing the health system's Ironwood Medical Center, under construction in Queen Creek, Arizona, and the new emergency room at Page Hospital, which recently opened in Page, Arizona, SmithGroup strove for a clear understanding of operational issues to develop strategies that are clinically appropriate, as well as patient-centered.

In the Page Hospital emergency department, for example, the bed in each private patient bay is turned perpendicular to the doorway (figure 1). Patient dignity was an important concern to Page administrators and physicians. Glass doors on the face of the treatment bays enable caregivers to monitor patients as necessary, while the bed orientation lends a measure of privacy. It also allows patients to enjoy the view through the glass exterior wall (figure 2). Room for family members is also provided in the design, away from the door where they will not interfere with caregivers' movement.

Treatment rooms in the Banner Page ED allow views to private gardens and protect patient privacy

Screen walls are carefully placed to allow patients to see outside without compromising privacy

Flat-screen televisions were installed in the treatment bays, as well. In a rural community like Page, where the emergency department also provides urgent care and a patient may remain in a treatment bay for some time, the televisions help to relieve tedium and provide a positive distraction.

At Ironwood, the design focus is not a literal application of hospitality concepts; all elements of the design are purposefully chosen to support patient care, rather than stylistic demands. The interiors are meant to do more than suggest a first-class hotel. They are intended to encourage a connection to nature, which has been shown to improve the healing process. Colors in the design are inspired by the four seasons, with brighter spring and summer colors being applied in livelier spaces, like the cafeteria, and the more subdued shades of autumn and winter in places that need a level of spirituality and comfort, like waiting areas and patient rooms.

Hospitals are singular buildings. Their designs should celebrate this fact, not shy away from it. Serious things happen in hospitals and we must create environments that acknowledge the weight of the events occurring in these buildings. We've all heard Louis Sullivan's famous phrase, “form follows function.” This is especially true of a hospital, where the form must respond to the critical functions that occur within. HD

Mark Patterson, AIA, ACHA, LEED AP, leads the Phoenix, Arizona, healthcare studio of SmithGroup, a national healthcare architecture, engineering, interiors, and planning firm. He can be reached at Anne Bilsbarrow, AIA, LEED AP, is an associate and architect in the health studio at SmithGroup's Phoenix office and can be reached at
Courtesy of SmithGroup

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Healthcare Design 2009 February;9(2):26-31