“The building looks very wide. How do people in this middle area have daylight?” I heard comments like this a few times when sharing examples of U.S. hospitals with colleagues in Sweden.  

The Swedish culture places a high value on daylight, fresh air, and access to nature, and as a result these elements are naturally reflected in most designs. To achieve this, Scandinavian hospitals are likely to have courtyards, skylights, and/or relatively narrow floor plates (compared to U.S. hospitals). It’s common for operating rooms to have exterior windows and for ICU patient rooms to have operable windows.

Traditionally, Sweden has been viewed as a leader in sustainable design, and this is often reflected holistically in healthcare facilities, as well.

For example, many Swedish healthcare facilities for the last several decades have been designed with principles of generality and flexibility, in order for a building to change over time to serve new purposes. One design strategy utilizes “hot floors” of intensive functions such as surgery or imaging, while all other floors are general purpose and able to accommodate nearly any function.

At the same time, many trends in Sweden mirror what’s happening in the U.S. and in other countries, such as the standard use of single-bed patient rooms in new construction, larger ORs and the introduction of hybrid ORs, research used in the design process, BIM implementation, prefabrication, and so on.

While design trends like these seem to gain ground globally each year, design trends across Scandinavian countries often have even more in common, due to cultural likenesses and the same design firms working across those countries.

As a method to spur innovation and idea generation, design competitions are popular. For example, the 250,000-square-foot emergency and infectious disease unit at Skåne University Hospital in Malmö, featured in a 2013 HERD journal article, was a project awarded as the result of an international design competition in 2006. More recent competitions include the 2013 specialty building at Örebro University Hospital, the 2012 Majelden Nursing Home in Linköping, and the 2010 Södersjukhuset (hospital) near Stockholm. 

That’s a decent number of competitions for a country of 9 million people.

It’s extremely interesting to interpret global design trends and research literature, and adapt relevant components in a culturally appropriate way. Isn’t that what we are called to do in any project? I have come to believe that truly successful design is culturally responsive, whether the culture of a specific nursing unit or the culture of an entire country. 

Read Mike Apple's first blog in this two-part series: "Cultural Context: Learning From Healthcare Design in Sweden."