Global pandemics used to be once-in-a-century events. But due to climate change, a more connected world, and the continued rise of zoonotic diseases, most experts say large-scale pandemics are likely to be more common in the future.
That’s bad news for all of us – but especially for conventionally designed hospitals and other healthcare settings, which have struggled mightily under the weight of Covid-19’s relentless and unforgiving waves.
But the good news is that the current public health crisis has forced a rethink of how hospitals are designed, specifically in their ability to handle mass casualty and transmissible disease events. Indeed, Covid-19 has begun changing how hospitals look, feel, and operate arguably more than any event in our lifetimes – which ultimately could result in better and more resilient health care in the future.
“Things that advocates have pursued for decades are now happening,” explains obstetrician Neel Shah in Bloomberg.
But what, exactly, is changing? And what does it mean for hospital architects, designers, and – most importantly – patients?
The pandemic-resilient hospital: Seven principles
Several healthcare priorities have emerged in the pandemic’s wake and the realization of the need to improve infection control. These include designing for physical distancing while avoiding social isolation (which can have its own negative health implications); improving facility flexibility; providing the right connectivity, collaboration, and mobile technologies and tools; and maximizing air quality.
Private firms have been quick to jump on the opportunity. A recent collaboration between engineering and design firm Arum and HKS Architects developed seven principles for pandemic-resilient healthcare design, including:
Hospitals must meet both every day (non-infectious) and pandemic-related healthcare needs in a financially viable way.
Healthcare designs need to accommodate large influxes of patients as smoothly and non-disruptively as possible.
Well-being for healing
Healthcare facilities must include spaces that improve patient and staff well-being, including the provisioning of green spaces and plenty of natural light.
Clean surfaces, clean air
Building materials and healthcare design must actively reduce infectious particles’ transmission while enabling easy cleaning and maintenance.
Isolation and containment
Hospitals must isolate large numbers of infectious patients to keep staff and other patients safe and support ongoing operations.
Designs must minimize transmission risk through people’s safe and efficient movement, both in terms of hallways, shared spaces, and entrances/exits.
The intersection of digital and physical
New hospital spaces must be appealing, innovative, and allow for a seamless transition between the digital and physical realms.
But what do these principles mean in practice? Let’s take a deeper dive into how some hospitals are changing for the better in the face of the pandemic.
Pandemic-ready hospital design in practice
Physically distanced indoor spaces
Hospital design must balance the need for safe socializing with the requirement for controlled separation between staff, visitors, and patients based on severity of illness and possibility of contagion. This includes designing larger open spaces (that can be subdivided or used as triage areas if needed), physically distanced seating in waiting areas, and reimagined intermediate spaces such as outdoor seating areas or corridor alcoves with seating.
A separate emergency entrance for contagious patients to keep them away from the main doors and indoor traffic can also improve pandemic response.
While not a design feature per se, deploying telemedicine and digital solutions more often for patients able to be monitored remotely – a group McKinsey says equates to around a quarter of all outpatient services – can facilitate easier distancing while reducing the immense pressure on physical infrastructure.
HealthTech Magazine says many Covid-19 surges saw large numbers of hospitalized patients in rooms with solid doors and no windows, inhibiting the ability of staff to monitor their progress without entering the room. That’s why Arup and HKS say patient visibility through patient room windows is a must for ensuring efficient and safe monitoring without spreading infection.
Sliding or hinged doors with ample glass are also very useful in this regard. Arum and HKS point to the Orlando Regional Medical Center, whose examination rooms feature three standard walls plus a glass wall to improve visibility and maximize patient separation.
Facility flexibility (aka “pandemic mode”)
We’ve all seen firsthand the physical inflexibility of most contemporary hospitals, many of which had to erect makeshift field hospitals in parking lots to accommodate the influx of Covid-19 patients. That’s why facility flexibility – the ability to shift from normal operations to “pandemic mode” in a heartbeat – is perhaps the most important design change of all.
“Pandemic mode will be a compulsory way of thinking about how the hospital can quickly convert, physically as well as operationally,” says B+H Architects.
That means designing efficiently convertible spaces, such as large open spaces that can easily be subdivided, as we mentioned above. It can mean strategically placed corridor doors allowing quick compartmentalization of larger departments, and offices or other rooms that can be converted into triage or surge areas.
It also means patient rooms that can quickly and safely become isolation rooms through negative pressure, easily accessed personal protective equipment (PPE), well-marked donning and doffing areas, and the ability to monitor patients.
Staying flexible is also about modular design. Many new hospitals and design ideas lean on this new approach of building hospitals from dozens of prefabricated modular buildings that can be scaled up or down (and repurposed) as needed. The Héroe Research Initiative by the USC School of Architecture designed blueprints for an isolation healthcare facility that can be assembled in weeks. The Hong Kong branch of engineering firm WSP designed a similar solution from shipping containers.
“Not only are the containers stackable, but they can also be converted into a variety of configurations for offices, laboratories, and other purposes – all connectable and easily transported by sea or land,” explains MSP’s Thomas Chan. Modular design is also popular with designers of post-Covid assisted living facilities.
Designing for wellness
With the sterile and relatively bland design of many older hospitals, you’d be forgiven if you forgot that wellness and tranquility are essential for healing. While hospital design was trending towards wellness since before Covid-19, the pandemic has only accelerated this design trend prioritizing biophilic design and green space, healing gardens, and plenty of natural daylight. This design approach positively impacts both patients and healthcare workers, allowing for more staff breakout space and a less stressful working environment.
Views of nature and sound control within patient rooms can also help, leading to a calming sense of tranquility that can speed the healing process. The use of non-toxic building materials, as well, such as mold-resistant window operators and hermetically sealed louvers to eliminate the collection of dust and germs, can also help improve healing and reduce the spread of infection.
Pandemic-ready hospitals in action
Rush University Medical Center
Chicago’s Rush University Medical Center was built with pandemics in mind. Designed by Perkins and Will, its emergency patient rooms employ broad glass doors to allow easy patient monitoring without spreading infection. Its lobby includes infrastructure (such as medical gas outlets) to accommodate surge beds quickly.
CHUM in Montreal is another facility designed before Covid-19 but which took pandemic preparedness seriously (the first phase was designed by CannonDesign and NEUF, and the second by Jodoin Lamarre Pratte and MSDL). Its traffic flow design features wide hallways and ensures staff and patient movements are separated from public areas, and it features an isolation unit for respiratory and other illnesses.
Jewish General Hospital
Another example from Montreal includes a recent expansion (by Jodoin Lamarre Pratte) that designed all ICU rooms to have complete isolation and nursing units able to be divided into smaller subunits. The JGH includes isolation rooms throughout the hospital (including the neonatal unit, OR suite, and birthing suite). And its emergency department features room isolation and double access (one entrance for staff and another for patients and visitors).
Vision Control® for the pandemic-ready hospital
Unicel Architectural’s Vision Control advanced glazing technology features a patented, hermetically sealed unit combining louvers within glass. It’s customizable to virtually any shape for interior or exterior applications and provides unprecedented control of vision, light, temperature, and sound, ensuring total privacy and optimal hygiene by combining louvers within glass.
Vision Control is the winner of numerous industry accolades, including a National Symposium on Healthcare Design Architects’ Choice Award, and a Product Innovation Award from Architectural Products Magazine.