Why is it that the criteria we employ in making a professional judgement can diverge so far from the values we use to make decisions in our private domestic life?
For example, when we are choosing a place to live we generally rate comfort, well-being control and independence very highly. In fact we go further than this when taking into consideration children, close relatives and pets. Our concern for their well-being will generally include buffers against noise, air pollution, busy roads and inhospitable hard environments, preferring a balcony with a view or a sunny outlook with garden for recreation and restoration. Proximity to local amenities if available, is a fortunate bonus.
These places we carefully choose for our loved ones are based on values that demonstrate fully our understanding and appreciation of mental and physical well-being.
They are actually good for us too
It’s no different when we go on holiday, for the most part seeking excitement, tranquillity, or aesthetic stimulation, in nature and the built environment.
Why then does all this go out of the window when, as professionals, we set about designing hospitals? Why are we willing to put up with such poorly conceived and delivered outcomes that are supposed to represent the pinnacle of artistic and technological achievement in what we would consider to be an advanced and civilised society? Hospitals should represent the apex of community investment and civic pride and yet, more often than not they are poorly arranged dysfunctional environments that cause more distress than relief, and in some instances, death.
As poor as any industrial environment permitted
We seem prepared to put up with conditions intolerable in our day to day lives, on top of the reasons for being there in the first place. The working environment is considered to be one of the worst of any in terms of occupational health and the support facilities as poor as any industrial environment permitted. The buildings are unnecessarily complicated to find from the moment one arrives and their interiors stressful to navigate.
Many of us are unable to function well when we are sick in such an environment so it is no surprise that the most vulnerable users do even worse.
Is the public sector incapable of making good decisions?
Designers lamely accept the briefs they are given, poorly selected sites that are in the wrong place, are the wrong shape or that are too small. Funding structures that make little sense to the average citizen and a corporate attitude that suggests that the public sector is incapable of making good decisions and that somehow the private sector will deliver the best outcome.
That the most important civic investment is left to a few stakeholders and the market is surprising if not shocking given that health involves so many interested parties. That so little time can be given to the masterplanning of a hospital compared to other major infrastructure projects is also a source of concern. The new St Olav’s Hospital in Trondheim took 15 years in the planning and building of a replacement hospital. This is not too long, if the decision to start the process is made at the right moment with an adequate budget and timeline in place.
In my master planning workshop with Andy Black, Chairman of Durrow, UK, we intend to discuss and address some of the challenges facing those who commission, design and operate new facilities. We will illustrate some alternative, and successful approaches to masterplanning and suggest some directions for travel for the future. The endpoint may be to agree what makes a good hospital and how to start the process of getting there.
Mungo Smith is co-hosting the ‘Masterplanning the 21st century hospital’ workshop at the Planning & Delivering Healthcare Infrastructure conference this November. Book your place by October 23rd to save $100!