“Innovation is not about a small number of people spending a large amount of money” – Designing the Hospital of the Future

We recently attended the ‘Designing the Hospital of the Future’ conference to discover the technological, architectural, and social intricacies in future hospital build and design. 

The event discussed and explored the physical, virtual, spiritual and social aspects within future healthcare spaces.

The conference also explored the themes of this year’s Wolfson Economics Prize and incorporated panel discussions from members of the government’s hospital building programme, front-line clinicians, patient advocates, and experts in the built environment.

The Wolfson Economics Prize 2021

To begin, Lord Wolfson of Aspley Guise presented the ideas behind the prize. The prize asks for entrants to answer the question of ‘how would you design and plan new hospitals to radically improve patient experiences, clinical outcomes, staff wellbeing and integration with wider health and social care?’ 

Lord Wolfson opened: “Innovation is not about a small number of people spending a large amount of money. We have a chance to redefine what a hospital is all about.”

Lord Kakkar, Professor of Surgery at UCL followed to present from his position of Chair of Judges.

Lord Kakkar outlined the sentiment which was projected throughout the conference of the weaknesses in the healthcare system that were exposed during the COVID-19 pandemic, although focused on the positives of future innovation opportunity.  

“We have seen through the pandemic the huge pressure which has been placed upon the hospital system. There are a huge number of challenges, but also opportunity.

“We are looking for really imaginative and innovative ideas to which we can give exposure to; it is a great opportunity.

“Ultimately, the purpose is to stimulate imaginative innovative thinking; eventually this will stimulate a broader conversation about the nature of the hospital and how it can have a profound effect on patients and management, as well as the community.”

The biggest hospital build programme in a generation?

Baroness Camilla Cavendish of Little Venice hosted a three-part discussion on: ‘the future hospital build programme’, ‘who is the hospital for?’, and finishing with ‘should hospitals be beautiful?’ 

The Baroness reflected on the legacy of hospitals using her own personal experience of being born in the same hospital as her daughter. Despite decades of time passing between these two events, the hospital in question has not implemented any visible innovative change. 

Craig McWilliam, Capacity Delivery Director at NHS England and NHS Improvement, and Natalie Forrest, Senior Responsible Officer of the New Hospital Programme led the audience through the Future Hospital Build programme.  

Natalie: “We are speaking about the biggest hospital build programme in a generation and we want to change the way healthcare is delivered. We want to build new facilities which are designed with new medicine and a new workforce in mind.”

Craig then presented a timeline of hospital buildings in context, showing the 1950s Nuffield investigation on the functions and design of hospitals, to the 1960s hospital plan ‘best buy’ hospitals, to the 1970s nucleus approach, through to the present-day build model.

“The Health Infrastructure Plan (HIP) was launched in 2019 in order to facilitate the political commitment to have built 40 new hospitals by 2030. We want to create an ecosystem which hones and learns over time, making the NHS a master of its own destiny in the future.

“We want to look beyond physical infrastructure, we need to be able to think about sustainability, technology, and how staff and patients interact with systems.”

The conference was thus far projecting a positivity and optimism about future healthcare, and an excitement around the technological systems that we as patients could be interacting with in 10 years’ time. 

Undoubtedly, there are to be many challenges over the course of the build programme, which Natalie and Craig then discussed.

Natalie described ‘flexible space’, when the hospital building can adapt quickly based on the change in care pathways. The pressures over the past year have been described as arising from not thinking about the different ways of utilising the space available. 

“COVID-19 has shone a spotlight on where we need to focus our attention. Flexibility means ensuring that in 20 years’ time, we can challenge the hospital build.

“Value for money is about the whole lifetime of the building, asking what we can do to make sure the building is sustainable, and easily maintainable in the future.

“We don’t have good examples in healthcare as to what sustainability means.” Natalie also challenged the audience to come up with ways to define sustainability in healthcare. 

The hospitals intending to be replaced in the build programme were built in the 1800s and 1900s and some would argue that the aesthetic of the hospital is just as important as the care it gives in terms of structural design, as well as the spiritual benefits that well thought out architecture can provide.

Craig said: “Hospitals have not been built with single rooms but rather large walls, which has been an issue during the pandemic.”

As most in healthcare have agreed, isolation for those with COVID-19 has been an issue in hospitals with open ward designs, and the question of what build method for future hospital wards was then discussed.

Natalie stated that she was involved in the London Nightingale build and described the approach around ‘repeatable design’, which allowed the Nightingales to be built rapidly. This approach has allowed optimism around the build time of new innovative hospitals – particularly in reaching the goal of 40 hospitals by 2030.

Who is the hospital for?                    

Bami Ademipekum, Charity Ambassador for Maggie’s and Director of Inspired to Soar, Dr John Dean, Clinical Director for Quality Improvement and Patient Safety at the Royal College of Physicians, and Imelda Redmond CBE, National Director of Healthwatch England discussed the design of hospitals to best serve patients, practitioners, and the public.

Bami presented first and talked of the importance of hospital design in healing patients spiritually as well as physically.  

“Once you enter a hospital you are immediately stripped of your dignity.”

Bami explained the issue that patients often face in feeling vulnerable and undignified due to the traditional hospital environment requiring the wearing of gowns and large daunting corridors.

Bami’s presentation was an interesting juxtaposition from the technological and physical aspects of hospital design and build. The idea that the aesthetic of the hospital’s physical appearance can aid in the healing and wellbeing of patients was both refreshing and fascinating. 

“Every life deserves a certain amount of dignity – no matter how damaged the soul is that is carrying it. We should shift the power dynamic through design, through intentional architecture and its power to serve and heal.

“You would be amazed at what a difference the interior design makes; you walk in and you feel special and don’t feel a nuisance.”

The theme of the humanist aspect of hospital build and design continued into Dr John Dean’s presentation: 

“I think what makes a hospital is the people; where clinical teams come together to provide care, to learn, and to interact.

“Within the hospital design, communities need space to interact with each other. The word ‘hospital’ constrains our thinking.”

Imelda balanced the discussion talking about the importance of amalgamating multiple key aspects of hospital design, which we perhaps currently do not have in the majority of hospitals in the UK.  

“There are three dimensions to building hospitals – technology, people, and the physical environment.

“We have now discovered we just need flat surfaces and not loads of desks; we need to think quite differently to hospital design.

“There is a whole lot of things we can do within the hospital environment to serve the community.”

This raised an important question in just how permeable can you make a hospital where people feel they can almost just ‘drop in’ like in other community settings. 

On this, Dr John said: “People don’t have to connect physically inside the hospital when we can connect them with technology. The colour and the lighting of a hospital makes a difference and makes hospitals welcoming, physical spaces.”

All three presenters agreed that in-patient spaces need radical redesign where clinical teams can come together to discuss care without distraction. 

Should hospitals be beautiful?

Professor Richard Cork, author of The Healing Presence of Art: A History of Western Art in Hospitals, discussed the question touched upon by previous presenters of ‘should hospitals be beautiful?’

We previously heard two differing opinions over the course of the conference between Natalie and Bami: Natalie stating that she believes the beauty of a hospital lies in its ability to effectively provide care, whereas Bami countered that opinion talking about the importance of the hospital aesthetic in assisting the patient healing process.  

Professor Cork’s presentation furthered Bami’s ideas and experiences, as he gave an in-depth analysis from his art critic background of how European hospitals enhance the patient healing process through ‘terracotta walls’ and ‘natural green spaces’.

“Artists working in hospitals should never settle for anodyne (bland or dull) art.

“The naturally cold clinical character [of hospitals] cannot be countered by inferior art forms.”

Professor Cork recounted his experiences when his wife received radiotherapy. Although his wife’s treatment was successful, the clinical aesthetic in his opinion was a negative effect on her healing.

“Hospitals should do much more to look after the whole person and not just their physical element.”

Ask the judges

The final hour was a six-person panel Q&A chaired by Lord Kakkar in discussing how to design the hospitals of the future and what the audience perceived as current and previous design issues.

On the panel alongside Lord Kakker: Dame Laura Lee, CEO of Maggie’s; Nigel Wilson, CEO of Legal & General; Dr Brian Donley, CEO of Cleveland Clinic London; Dame Elaine Inglesby-Burke, Former Chief Nurse at Northern Care Alliance; and Robert A.M. Stern, Founding Partner at Robert A.M. Stern Architects.

The first question from the audience: 

“How will the design and operation of hospitals be changed? Are we building stables when we should be building garages?”

Elaine: “I think we heard from speakers this afternoon around ‘should we be redefining what a hospital is’. Tech was emerging slowly until the pandemic, where now that technology will allow the redefining of the hospital at a more rapid pace to meet the needs of staff and patients alike. The last 12 months have taught us that we can do many things remotely.”

Nigel: “We have had tech inside the hospitals but the hospitals themselves are antiquated: stable vs garage is a good analogy. Integration is key to solving the healthcare issue and not just the hospitalization issue. Patients need to spend a minimum amount of time in the hospital and a maximum amount of time in an environment that is familiar.”

The second question from the audience:

“What should hospitals be? Should we opt for a flexible configuration?”

Laura: “Our hospitals can be multiple things; symbols and beacons within the community but also provide technical excellence and emotional and social care. With the right talent we can achieve what we want to achieve. We have an opportunity to be centralised and decentralised.”

Robert: “Architects have been confronted by this question for years. A flexible structure that will evolve over time is a lucid dream. What I’m suggesting is the role of the visitor is not paid much attention and the presence of a family member is a major part of the healing process. Community programmes also play an important role such as going to the gym or leisure centre. Trying to out-guess the future is a futile game.”

Bryan: “An important concept is that ‘health care is not one word but two. As we think of hospitals as anchor institutions; anchors to the entire community. I agree with Robert in how important visitors are in the healing process. The balance of the art and science of medicine: art is empathy and a major focus has to be design of hospitals enhance empathy – we’ve struggled with this for 2,400 years. Empathy is the core of what health and care is about.”