Hospitals are a matrix of specific parts that all need to be joined in a way that works, design expert Ken Schwarz tells Hélène Hofman.
Successfully incorporating a range of health services such as ambulatory care and outpatient facilities into Irish hospitals is more important than bed numbers, a leading international expert in hospital design has said.
Ken Schwarz, who has been involved in the planning and design of healthcare facilities in North America and Britain for the past 35 years, was speaking to the HSE's estate management team in Dublin last week.
"The hospital is becoming the last resort for patients, and technology is constantly moving to reduce bed numbers. The aim now is to treat people at home if you can, or through other services. Hospitals are really the last resort," says Schwarz, whose award-winning projects include Brigham and Woman's Hospital in Boston, University of California Medical Centre and the Royal Alexandra Hospital in Edmonton, Canada.
"We're moving in the direction of more outpatient care, more ambulatory services rather than inpatient care. Some people measure how big a hospital is by the square metres per bed, but that's going up like crazy because there are fewer beds and more of everything else. That's really what we need to develop," says Schwarz.
Schwarz's team was also behind the redesigning of the Norfolk and Norwich University Hospital in the UK at an undeveloped site in 1992, which subsequently won the NHS's award for Best Designed Hospital. The project was one of the largest to be funded by the British government's Private Finance Initiative (PFI), which provides financial support to the health sector through public-private partnerships.
Schwarz has since become involved in similar PFI projects for university hospitals in Manchester, Newcastle and London.
He says many hospitals, including Irish hospitals, have in the past failed to create buildings that make the most of medical technology and are efficient.
"The main thing is to look at the whole plan and develop the individual projects in that broader plan. Adding a wing without thinking is probably where the mistakes are made," he says. "A lot of buildings that were built in Victorian times are terrific and can be useful for modern clinical stuff. They can be used for offices for example and can be part of the picture."
Schwarz estimates only a quarter of hospital space has to be designed with high-tech treatments in mind while most of the remaining area can be used with more flexibility.
"There are some spaces that have special requirements but in many cases they don't. Hospitals are made up of different departments which all have different requirements. Inpatients and outpatients are all attached to a central core of high-tech stuff but most areas in a hospital are just normal," he says.
"They are rooms where doctors meet patients or cafeterias for example. There is a tendency to put things in the same envelopes but this is something that should be avoided. Hospitals are a matrix of specific parts that all need to be joined in a way that works," he explains.
An integral part of Schwarz's designs is the inclusion of atriums which create light and allow patients and visitors find their way around campuses more easily.
"The ability to find your way around a big place is extremely important. The problem is this labyrinth of corridors you often find in an older hospital, and no one knows where things are except for a little sign," he says.
"That is the benefit of the atrium design of which a glass roof and circulation galleries are a typical feature. Suddenly when you walk in you see all the points you want to go to," he says.
Schwarz says that good design, including the use of light, is also likely to improve patient outcomes. "Light is important in any place where human beings are. No one likes to be in a dark basement. Very often hospitals have not done that [include light] well so it's definitely important and I think you could say it's almost more important in a hospital . . . There are a lot of studies that say that it does [help patient outcomes], whether these are true scientific studies I don't know, but I don't think you could argue with the idea that if you're in a nice space - light-filled, furniture that's comfortable, space for your family - you're likely to do better than if you're in a place that doesn't have these things.
"At that level alone there's a very good case for having a good environment," he says.
"There is no reason you can't have a positive and pleasant building even though that's not always found in hospitals. That's partly because of money, but also because of aspirations. But it is possible and important," he says.