Words by Katie Puckett
So what do we know so far about the future of healthcare? Hospitals need to be bigger, and to cope with surges of sudden high demand. In the longer term, they will probably shrink, but offer more specialist care for the sickest patients. They need to be more human, but also smarter, more automated, connected and highly serviced. They will host technologies that haven’t been invented and treat diseases that have yet to be diagnosed. They will have to do this against a backdrop of pandemics, climate change, extreme weather, and shortages of water, power and resources.
“Uncertainty is the only certainty there is, and knowing how to live with insecurity is the only security”John Allen Paulos, Temple University
Beyond that, all bets are off. The buildings we are designing today may not be ready for a decade, and have to stand in some form for a century or more. So they must be robust and, above all, flexible. The problem is that it’s hard to predict exactly what kinds of space will be needed, says Simon Kydd at WSP. “Technology is developing rapidly, and everything you read about is within touching distance. Will we need lots of bunkers for radioactive treatment, or laboratories that take our blood, engineer it and put it back? We have to design to buildings that are at the forefront, but future-proof for as long as possible.”
We know this is important because we are living with the consequences of inflexible design. As in many developed countries, Sweden’s healthcare estate comprises many buildings from the 1960s and 70s. “They are not up to the standards for the healthcare of the future, so providers have a lot of space that they can’t use,” says WSP’s Gunnar Linder. “It’s too narrow and the span from the floor to the ceiling is too low. Today the equipment is so integrated into the building that you need to build in a different way. MRI scanners, for instance, are getting more powerful and that means they are bigger and heavier, so you have to have a really strong foundation. And they also need a lot of space, which requires a broad span between the piles.”
Main article: the future of healthcare
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Adapting these older buildings to meet modern healthcare standards usually requires compromise. Converting the space to other uses such as offices is an option, but there’s a limit to how much office space a hospital needs. Selling it off to pay for new development is another — but there are not many types of building that can be comfortably collocated with a working hospital.
There’s no sure way to tell what kind of technology today’s hospitals may have to accommodate over their long lifespans, but there are ways to make them more adaptable. “When we’re building something, we need to look at what that space could become in the future,” says Suzanne MacCormick, director of global healthcare business growth at WSP. “You’re almost doing a double design, which does have a cost implication upfront. But in our analysis we’ve found that, in almost every case, it breaks even at the first change.” Buildings designed on a grid layout and made from component parts precision engineered off site, and with an up-to date digital twin, could be reconfigured far more easily, for example. MacCormick suggests that one possible use for a redundant outpatient department would be as assisted living space for older people, as it would have good access to care. “They would have instant access to therapists and healthcare. But we also need to make sure that the space can be equally well accessed from a separate route, not just through the hospital.”
Healthcare is already becoming a component of more mixed-use developments, says Jason Schroer at HKS. “You might have a clinic, but also retail, hotel, places to live. We are seeing a trend for blending these together. Hospitals have been designed to be very inward-focused, but this is requiring us to think about them in a different way. In some cases, health buildings are becoming anchors to development.”
In 2019, there were at least 396 natural disasters, affecting over 95 million people and costing nearly US$130 billion
Pandemics, earthquakes and other disasters
Hospitals need to be resilient, in every sense of the word. In the event of a pandemic, sections of a hospital need to be sealed off to prevent cross-contamination, but until then, they need to function normally. “We need to set the space up in a smart way so that it’s there if there’s a major incident, but it’s not wasted at other times,” says Suzanne MacCormick at WSP. For the redevelopment of Kwong Wah Hospital in Hong Kong, for example, there is a 140-bed isolation facility designed to be negatively pressured — a ventilation technique that allows air to enter but not to escape — and 100 beds that are convertible from normal to isolation mode.
As the global population grows, exposure to natural disasters is increasing too. Many of the world’s major cities are located in areas prone to flooding, storms and earthquakes, and urban development worsens their impact by degrading natural barriers. Climate change is also increasing the frequency of extreme events. Healthcare buildings need to withstand disasters themselves, as well as being able to care for those affected. “Resiliency is more and more part of the design solutions that we’re working on with clients, particularly those in coastal areas,” says Jason Schroer at HKS. “You can’t completely proof every building against every disaster, but there are certain measures you can take to mitigate risk.” Patients and their carers have to be able to shelter in place, for example, so to protect against rising sea level, critical areas or infrastructure might be elevated. HKS also designed a hospital in Joplin, Missouri, to replace one that had been destroyed by a tornado. “We hardened the core and within that we provided infrastructure such as medical gases, so that they could bring patients in from perimeter rooms.”
This article appeared in The Possible issue 06, as part of a longer feature on the future of healthcare
Notes  CRED, Disaster Year in Review 2019