Renzo Piano talks about a moment that, once you hear it, is hard to forget. When he and his colleagues designed a children’s hospice in Bologna, they created a small motorized skylight that each child could open or close with a remote control by creating an opening in the roof directly above each child’s bed. Not for airflow. Not to comply with regulations. Thus, a dying child could decide whether or not to look up at the sky. Small enough to be written off as sentimentality, that detail may be the most accurate representation of what good hospital design can be and how far most American hospitals are still from realizing it.
A growing movement among architects, planners, and healthcare administrators opposing decades of clinical, efficiency-first hospital design was recently highlighted by Forbes. Even though the politics surrounding healthcare construction budgets are often complex, the argument itself is not. Hospitals constructed in the 20th century became both medically remarkable and devoid of humanity. The experience of being a patient—frightened, confused, and dependent—stopped being important to the people in charge of the blueprints somewhere between the pressure to pack more beds per floor and the advancements in surgical technology.
Through his work on Maggie’s Centers, a network of small buildings created especially for newly diagnosed cancer patients, Lord Norman Foster, another Pritzker laureate, has been presenting a version of this argument for years. The idea is almost purposefully modest: a serene, homey area close to a hospital where people can sit, reflect, and find solace. According to Foster, he learned that human comfort and functional efficiency don’t have to be mutually exclusive by drawing on his experience designing airports, which are places where a lot of nervous people travel. Before approving another design proposal, hospital administrators might need to spend more time in airports.
The historical record does not lessen the urgency of the present; rather, it increases it. The phrase “humanizing” hospitals dates at least to 1958, when the French Ministry of Health formally designated it as a policy goal, according to a study published in the National Institutes of Health. By the 1980s, it was considered common sense in British medical journals. However, the majority of American hospitals still have fluorescent lighting, hard floors, no visible greenery, and an overwhelming feeling that the building was designed more for staff mobility than for patient recovery. There is a clear disconnect between the discourse and the actual situation.
This isn’t about aesthetics, as the Forbes article and Piano and Foster both seem to feel strongly. There is growing, if still incomplete, evidence that patients heal more quickly in rooms with views of trees and natural light. that workers who work in settings that prioritize their well-being are less likely to burn out. that a hospital’s physical layout either supports or contradicts the clinical work that takes place there. After years of researching healthcare settings, the architecture firm NBBJ has documented specific design modifications that significantly lower caregiver stress. These arguments are no longer theoretical.
It’s difficult to ignore the fact that the most striking examples of compassionate hospital design typically originate from Europe or from specialized, frequently privately funded projects. It is truly challenging to mainstream this strategy throughout the American healthcare system given its disjointed funding, regional disparities, and massive infrastructure already in place. It is important not to discount that uncertainty. Retrofitting a 600-bed urban medical center in Cleveland is not the same as redesigning a children’s hospice in Bologna.
However, something appears to be changing. Budget committees find it more difficult to ignore the increasing volume of the conversation, the mounting evidence, and the credibility that architects of Piano and Foster’s caliber are giving it. It remains to be seen if that translates into actual buildings rather than renderings.
