Like medical care has evolved from the blood vessel to germ theory, the medical spaces in which patients live have also transformed. Today, architects and designers are trying to find ways to make hospitals more comfortable in the hope that relaxing spaces will lead to better recovery. But building for healing involves as much empathy as it does synthesizing cold, hard data.
“Part of the best care can be to keep people calm, to give them space to be alone – things that may seem junk, but are really important,” says 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 pavilion plan, which contained wards: large rooms with long rows of beds, large windows, plenty of natural light, and plenty of cross-ventilation. These designs were based on the theory that humid indoor spaces spread disease. However, wards offered almost no privacy to patients and required plenty of space, something that became difficult to find in increasingly dense cities. They also meant a lot of time for nurses who had to trudge up and down the hallways.
Over the next century, the focus shifted to natural light in favor of prioritizing sterile spaces that would limit the spread of bacteria and accommodate a growing array of medical devices. After World War I, the new norm was to gather patients’ rooms around a nursing station. These designs were easier for nurses who no longer needed to walk in long corridors, and they were cheaper to heat and build. However, they retained some of the stimulants found in older treatment facilities, such as sanatoriums where patients convalesced for long periods; both mimicked smart hotels with ornate lobbies and good food, measures to convince middle-class people that “they felt better in hospitals than at home when they were seriously ill,” Adams wrote in a 2016 article on hospital architecture for Canadian Medical Association Journal. This design, she argued, was intended to give people faith in the institution: “a tool for persuasion, rather than healing.”
In the late 1940s and 1950s, hospitals transformed again, and this time they became office-like buildings with no frills or many features that would enhance the experience of being there. “It was really designed to be operational and efficient,” said Jessie Reich, director of Patient Experience and Magnetic Programs for the University of Pennsylvania Hospital. Many of these rooms had no windows at all, she points out.
By the middle of the 20th century, the hospital had become somewhat the opposite of what Florence Nightingale had imagined, and many of these buildings, or those modeled after them, are still in use today. “The typical hospital is designed as a machine to provide care, but not as a place for healing,” says Sean Scensor, a principal at Safdie Architects, a company that recently designed a hospital in Cartagena, Colombia. “I think what’s missing is empathy for people as human beings.”
Although Nightingale had largely operated on anecdotal evidence that light and ventilation were important, she was right – but it took over a century for scientists to gather the quantitative data to back her up. For example, a crucial study from 1984 was published in Science followed patients after gallbladder surgery. The 25 patients whose rooms had a view of greenery had shorter hospital stays and took fewer painkillers than the 23 patients whose windows faced a brick wall.