Same as medical care has evolved from bloodletting to germ theory, and the medical spaces in which patients live have transformed. Today, architects and designers are trying to find ways to make hospitals more comfortable, hoping that relaxing spaces will lead to a better recovery. But building for healing involves just as much empathy as synthesizing cold, solid data.
“Part of the best concern could be keeping people calm, giving them space to be alone – things that may seem frivolous but really important,” said Annmarie Adams, a professor at McGill University who studies the history of hospital architecture.
In the 19th century, the famous nurse Florence Nightingale popularized the plan of the pavilion, which contained wards: large rooms with long rows of beds, large windows, lots of natural light and plenty of cross ventilation. These designs are based on the theory that wet enclosures spread disease. But wards offered almost no privacy for patients and required a lot of space, something that became difficult to find in increasingly dense cities. They also meant a lot of walking for the nurses, who had to walk up and down the aisles.
Over the next century, that focus on natural light faded in favor of giving priority to sterile spaces that would limit the spread of germs and receive a growing raft of medical equipment. After World War I, the new norm was to group patient rooms around a nurse station. These designs were easier for nurses, who no longer had to walk long corridors, and were cheaper to heat and build. But they kept some of the pitfalls of older residential treatment facilities, such as sanatoriums where patients would recover for a long time; both mimicked posh hotels with ornate lobbies and fine food, measures aimed at convincing middle-class people that “they are better off in hospitals than at home when they are seriously ill,” Adams wrote in a 2016 article on hospital architecture. Canadian Medical Association Journal. This design, she argued, was supposed to give people faith in the institution: “a tool for persuasion, not for healing.”
In the late 1940s and 1950s, hospitals were transformed again, this time into office buildings without decorations or many features aimed at enhancing the living experience. “It’s really designed to be operational and efficient,” said Jessie Reich, director of the Patient and Magnet Experience Program at the University of Pennsylvania Hospital. Many of these rooms did not have windows, she said.
By the mid-20th century, the hospital had become something contrary to what Florence Nightingale had envisioned, and many of these buildings, or those modeled on them, are still in use today. “A typical hospital is designed as a care machine, but not as a treatment site,” said Sean Scensor, director of Safdie Architects, a company that recently designed a hospital in Cartagena, Colombia. “I think what is missing is empathy for people as human beings.”
Although Nightingale mostly worked on anecdotal evidence that light and ventilation were important, she was right – but it took scientists more than a century to gather quantitative data to support it. For example, a key study from 1984 published in Science followed patients after gallbladder surgery. 25 patients whose rooms had a view of the greenery had a shorter hospital stay and took fewer painkillers than 23 patients whose windows faced a brick wall.