Introduction
Hospital design is often reduced to basic aesthetic or functional considerations, such as wide corridors, clear signage, clean areas, and well-equipped operating rooms. However, this simplistic view overlooks crucial aspects.
Hospital design is not merely an architectural activity focused on functionality or decoration; it’s a discipline that, when applied optimally, directly impacts the quality and safety of care, clinical outcomes, staff well-being, and even operational sustainability of the hospital.
The Complexity of Hospital Design
Hospitals are highly complex buildings, with their operation inherently requiring a design capable of continuously adapting to medical, technological, and social changes.
Historically, hospitals built at the turn of the 20th century have shown remarkable durability and adaptability. In contrast, numerous hospitals erected between 1960 and 1980, following rigid models centered around the technology of their time, have had notably short lifespans. According to renowned Dutch architect Reinier de Graaf (OMA, Office for Metropolitan Architecture), many of these buildings became obsolete within 30 or 40 years. For instance, the Prentice Women’s Hospital in Chicago, opened in 1975, closed in 2011 and was demolished in 2013, just 38 years later. On the other hand, hospitals built at the beginning of the 20th century have demonstrated remarkable resistance to the passage of time: the Reid Memorial Hospital (Indiana), opened in 1905, operated clinically until 2008 (103 years), and the Millard Fillmore Gates Circle Hospital (Buffalo), built in 1911, functioned until 2012 (101 years).
This contrast demonstrates that designs with modular spaces, natural ventilation, and flexible structures can surpass generations, while overly technological designs fail to adapt to new medical requirements, leading to costly renovations or premature abandonment.
Evidence-Based Design
Currently, evidence-based design (EBD) is an approach that applies validated scientific criteria to improve specific clinical outcomes. For example, studies have shown that patients with views of natural environments recover faster, require fewer painkillers, and have shorter hospital stays compared to those looking at walls.
- Single rooms vs. shared rooms: Single rooms reduce cross-infection and promote rest and privacy, benefiting both clinical and emotional well-being. Conversely, poorly placed nursing stations and badly designed corridors increase staff movement and response times in emergencies, while well-placed common areas reduce workplace stress and promote collaboration.
- Natural light: Maximizing exposure to natural light through larger windows, better orientation, strategic bed placement, and views of natural environments has been linked to a significant reduction in postoperative stays.
Specialized areas have also substantially benefited from improved hospital design. For instance, in neonatal units, the transition from shared spaces to individual or single-family rooms has shown significant clinical benefits. A recent study reported that this change was associated with a 37% reduction in neonatal sepsis incidence (relative risk of 0.63) and a higher rate of exclusive breastfeeding at discharge. These results underscore that a carefully designed environment not only prevents severe complications but also facilitates practices that strengthen family bonds and contribute to early child development.
Key Architectural Elements for Medical Staff
Architectural decisions should be based on rigorous scientific evidence, just as in medicine.
- Minimizing medical errors through spatial design: How can the physical environment improve patient recovery?
Operational and Financial Relevance
The relevance of the built environment is not only clinical but also operational and financial.
A flexible hospital design allows for future adaptations that extend the lifespan of infrastructure and reduce operational, renovation, and expansion costs.
Moreover, an energy-efficient design, through strategies like natural ventilation, thermal insulation, and smart climate control and lighting systems, can significantly reduce operational costs. Studies show energy savings of up to 20%, while simultaneously improving thermal comfort, which is particularly relevant in hot climates like Mexico’s, where electricity consumption for cooling represents a significant operational expense.
The Impact of COVID-19 Pandemic
The COVID-19 pandemic highlighted the importance of adaptable hospitals. Institutions, like the Hospital Español de Veracruz, that could quickly reconfigure their spaces during the emergency achieved better clinical and operational results. This experience should drive the incorporation of flexibility as a fundamental criterion in future hospital projects.
Impact on Mexican Hospitals
Improving hospital architectural design in Mexico would have a significant impact. For example, if an evidence-based redesign could reduce average hospital stay by just 10%, it would free up approximately 11,000 beds. In practical terms, this would be equivalent to adding the operational capacity of almost eight new regional hospitals without constructing additional infrastructure.
Active Medical Staff and Leadership Involvement
Active participation of medical staff and leadership during the initial design phases is crucial. Plans should undergo practical and clinical evaluations before execution, and the evidence generated during this process should inform future decisions, fostering a hospital culture oriented towards clinical design.
Conclusion
Recognizing that good hospital design directly impacts clinical quality, safety, financial sustainability, and public perception is essential. Hospitals should be designed with the future in mind, with infrastructure capable of growth, transformation, and adaptation to new medical, technological, and social requirements, ensuring their long-term relevance.
