Getting it right: merging medicine and architecture

October 05, 2017
​By: Dr. Diana Anderson, Health Care Physician and Architect

Despite a relationship between medicine and architecture since ancient times, the professions of hospital architecture and medical practice have progressed alongside each other, but have rarely converged. Any convergence we have seen is a relatively recent phenomenon.

The 19th century tuberculosis sanatorium model illustrates the design of an environment intended for treatment. The building itself actually served as a medical instrument. With the advent of pharmaceutical treatments and critical care technology, hospital design moved into a more industrial period of machine-like centers designed to provide all levels of life-sustaining care. These are the hospitals we know today.

As a previous medical student and resident physician, a large part of my hesitation in pursuing advanced clinical training was due to what I considered an intolerable hospital setting. Staff facilities are frequently without windows or art, and I have found myself desperately anticipating the first ray of sunlight after a long shift. Working in environments with constant noise from ventilator and infusion alarms, floor polishers, telephones, pagers and staff discussions creates an ongoing battle to work effectively, or hold private, often life-changing discussions with patients and their families. 

During my initial time working in hospitals I often wondered, “Is anyone asking the clinicians about their opinions on the design and function of their work environments? Don’t they realize the characteristics of the physical environment can enhance or hinder productivity, or reduce the stress associated with our work and the condition of our patients?” 

Fortunately, we are now revisiting that 19th century sanatorium model to de-medicalize architecture. That means architects are faced with the challenge of maintaining a sense of humanity and overcoming the technical apparatus through design, and we’re seeing some of these changes starting to happen.

Take Mount Sinai Hospital in New York, for example. Families and patients should, of course, have access to gardens and green spaces whenever possible, but often clinicians and other staff are placed at the centre of hospital buildings, which means their access to nature is limited. This was the case in the emergency department at Mount Sinai Hospital, which doesn’t have any windows. In order to help patients and staff feel more connected to the outside and potentially less anxious during a stressful ED visit, virtual windows were installed throughout the department.

There is abundant evidence that design has a large influence on health, whether across public health or health care. In fact, in clinical settings, design of the built environment has impact patient care outcomes including length of stay, use of pain medication, clinician efficiency and health care costs. Current research questions are investigating whether the environment can play a role in prevention of inpatient falls and delirium rates, which carry high rates of morbidity and mortality, in addition to costs and levels of care. 

Design also has the potential to reshape professional collaboration. The Salk Institute in San Diego is recognized for its pioneering method of encouraging innovative collaboration. It’s known that 80% of scientific breakthroughs occur in social settings outside the lab environment. The Salk Institute architect Louis Kahn created a design that encourages scientists to walk outside where spontaneous ideas can be generated in open, social spaces. 

Addressing design issues and finding innovative solutions can only occur when there is a dialogue between architects and clinicians about working within clinical spaces. Exchanges with researchers will also enable them to clarify processes contributing to design issues and measurable outcomes.

Designers can walk the halls and talk to clinicians, but it can be challenging to learn the intricacies of a profession and its details of practice. Hybrid professionals can provide integrated solutions that cross disciplines in new ways, bridging this gap. Encouraging architects to experience medicine from a perspective that’s typically hidden, and allowing physicians to realize how design can create a context for participation can allow for a deeper understanding of health care delivery. By applying design-thinking to medicine, I feel strongly that multidisciplinary approaches for solving current health care challenges can be developed.

Through the creation of shared knowledge I truly feel that we can inspire the emergence of a new mode of practice. I will be speaking more about the ways clinicians and architects can find a balance between illness, health, and design at the ‘Process Design to Achieve Transformative Outcomes’ session at HealthAchieve in Toronto on November 7. 

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