The History and Evolution of Hospital Design Strategies

When improving our healthcare system, focus is currently put on physical improvement in space like improved hygiene, innovative devices, improved energy performance, improved ergonomics, ... An often overlooked key parameter is the focus on cognitive experiences of people (e.g. the psychic state of the patient, quality of live/work of staff, welcoming of the family). More research in design and a supportive design strategy is needed to understand the user perspectives within healthcare services to guide architects in their design process. This is where Design for All (EU), Universal Design (USA), or Inclusive Design (UK, AU) comes in. It is a design strategy which no longer considers the disabilities of the users but instead focuses on enabling and disabling conditions of the environment. However, the domain lacks design methods and parameters to link user experiences with the design principles.
This study hypothesizes that many architectural design strategies for healthcare environments have a medical objective but neglect a Design for All-strategy with attention for abilities, emotions and experiences.
A literature review is undertaken, and international hospitals are analysed by means of case study reviews and plan annotations. By exploring the historical evolution of hospital design, the paper attempts to identify the determinants which have shaped previous hospital design strategies. The evolution of hospital design is structured into different time frames which mark distinct directions in hospital design. Within each time frame, the role of the hospital as an institution, the design strategies, and the theory which supported design strategies are analysed. Design develops from needs, and the changing needs mark the evolution of the hospital facility. This reshaping of the hospital design may provide opportunities for generating new design conceptualizations.
Consequently, insights may inspire the design community from a medical problem-solving design strategy towards a more socio-cultural design strategy.