I welcome this opportunity to say a few things about current "Healthcare Design" that have bothered me for some time. I started working in health care architecture in 1966, after nine years doing several other building types, including three years in the hospitality sector (more about that shortly). Though no longer active, I still receive a few healthcare design magazines each month (I don't subscribe, but they keep coming), which illustrate a terrible disconnect between what healthcare architects are now doing, and what the newspapers regularly and rightly describe as a national crisis in the unsustainably increasing cost of health care in this country. Much has been said about the disproportionate share of the nation's energy consumption attributable to buildings not designed to be energy-efficient, and the responsibility of architects to design sustainable buildings that do not contribute to energy waste, and thus to global warming and climate degradation.
But nothing seems to be said about healthcare design that adds cost with no true benefit for the patient treatment and care that is the only reason for the healthcare building to exist. And because those unnecessary costs are added to the daily rate charged for patient care, they are added to the nation's unsustainable health care costs.
When I started in this field, there were strict limitations on total building costs, enforced by state agencies (at least in New York) that would not have permitted even the suggestion of what I see in the current magazines. Construction cost is only part of the problem; function is another: Large atrium lobbies with elaborate architectural features, hanging light fixtures and sculptures that no housekeeping department can hope to even dust, much less clean, when a surge in hospital-acquired infection demands buildings that can be kept far cleaner than in the past. Elaborate gardens that no one uses, but do photograph well (when was the last time you saw a patient wheeled by a staff person into a hospital garden except in 1930s Hollywood movies?). Patient rooms trimmed out and with family accommodations that rival, along with the atrium lobbies, anything in my earlier experience in hospitality architecture. But patients and family are not there for a holiday; they want to get in and out as quickly as possible (an objective insisted upon by the health insurance industry).
Building exterior features share this abundance (and also photograph well). The list could go on and on, but I think the point is made.
Trade magazine narrative is replete with language about patient comfort, family member satisfaction, and staff amenity that, in my view, is little more than eyewash justification for fulfilling architectural design aspirations. And it surely starts much earlier than the magazines, with convincing by the architects of the clients of the necessity of all these things to maintain a competitive advantage in the business of health care, therefore the clients are equally culpable. And the nation is the poorer for it all.
Certainly much has evolved in medical technology that requires substantial investment in facilities that accommodates its use, and that is where the money should be spent. But not the frills!
Sidney L. Delson, FAIA Emeritus
East Hampton NY
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