How to design a better hospital? Start with the light

Equally medical care has evolved from bloodletting to germ theory, the medical spaces in which patients live have also changed. Today, architects and designers are trying to find ways to make hospitals more comfortable, in the hope that the relaxation spaces will lead to better recovery. But building for healing involves as much empathy as synthesizing cold, hard data.

“Maybe part of the best care is keeping people calm, giving them space to be alone, things that may seem trivial but are really important,” says Annmarie Adams, a McGill professor who studies the history of hospital architecture.

In the 19th century, famous nurse Florence Nightingale popularized the pavilion plan, which featured rooms: large rooms with long rows of beds, large windows, lots of natural light, and lots of cross ventilation. These designs were based on the theory that damp indoor spaces spread disease. But the services offered almost no privacy to patients and required a lot of space, which became difficult to find in increasingly dense cities. It also meant a lot of walking for the nurses, who had to pace the aisles.

Over the next century, the emphasis on natural light faded in favor of a priority on sterile spaces that would limit the spread of germs and could accommodate a growing raft of medical equipment. After World War I, the new norm was to group patient rooms around a nursing station. These designs were easier for nurses, who no longer had to walk long hallways, and they were cheaper to heat and build. But they have retained some of the attributes of older style residential treatment facilities, such as sanatoriums where patients recuperate for long periods of time; both imitated luxury hotels with ornate lobbies and fine cuisine, measures meant to convince middle-class people that “they were better off in the hospital than at home when they were seriously ill.” Adams wrote in a 2016 article on hospital architecture for the Journal of the Canadian Medical Association. This conception, she argued, was intended to give people faith in the institution: “a tool of persuasion, rather than of healing.”

In the late 1940s and 1950s, hospitals transformed again, this time becoming office-like buildings with no frills or many features meant to enhance the experience of being there. “It was really designed to be operational and efficient,” says Jessie Reich, director of patient experience and magnet programs for the University of Pennsylvania Hospital. Many of these rooms had no windows, she points out.

By the mid-20th century, the hospital had become somewhat of the opposite of what Florence Nightingale envisioned, and many of these buildings, or those inspired by them, are still in use today. “The typical hospital is designed as a machine for delivering care, but not as a place of healing,” says 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 operated largely on the basis of anecdotal evidence that light and ventilation were important, she was right, but it took more than a century for scientists to put together the quantitative data to back it up. For example, a 1984 pivotal study Posted in Science follow-up of patients after gallbladder surgery. The 25 patients whose rooms overlooked the greenery had shorter hospital stays and took fewer pain relievers than the 23 patients whose windows faced a brick wall.


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