The pavilion design lasted for a few centuries until it fell out of favor starting in the early 20th century, when major advances in medical science persuaded hospital administrators and architects to concentrate on creating facilities that would reduce infection risk and serve as functionally efficient settings capable of incorporating new medical technology. The strong emphasis on infection reduction, together with the priority given to utilitarian efficiency, shaped the design of hundreds of major hospitals internationally. Function fused with form, creating some highly uninspiring edifices. A prime example may be the works of the famed American architect, Bertrand Goldberg.
Trained at the Bauhaus in Germany and by some of the most prominent architects of the 20th century, he was known for his innovative structural solutions to complex design problems. Little wonder that he was highly sought after by hospital design committees, especially following the construction of his tour de force, Marina City, a multi-building complex that included the largest concrete building in the world at the time, built on the banks of the Chicago River in his hometown, Chicago.9 He adapted some of his prior concepts and applied them to create several near-identical prefabricated concrete slab hospital structures around the country, including the Good Samaritan Hospital in Phoenix, Providence Hospital in Mobile, Ala., Prentice Women’s Hospital in Chicago and my current facility, Brigham and Women’s Hospital (BWH) in Boston—nine in all.
The interesting exterior quadrafoil plan for these hospitals allowed for the construction of identical pod-shaped wards, generally comprising four per patient floor.10 Based on my experience at BWH, whose design was touted for creating a close proximity between every patient room and the nursing station, the floor plan’s redundancy and its homogeneous appearance allowed a certain dreariness to settle in just a few years after its construction.
In addition, Goldberg’s design eschewed two requisite features of most hospitals: the need for a large, welcoming entryway and a sufficient number of elevator banks to ferry patients and staff up and down the floors. Although the former flaw was rectified a decade later with the construction of a lobby entrance worthy of a large bank headquarters, adding new elevators to a 16-story building remains a highly unrealistic proposition. Sometimes, while waiting endlessly for the next elevator, I wonder how many minutes, hours, days, years have been wasted by staff outside the closed elevator doors. Stairs, anyone?
Currently, there’s a healthcare construction boom raging, with close to $100B in projects either underway or recently completed. Although most are building renovations, about 150 new hospitals are being built at a cost of more than $1B for most academic medical centers.11 One may view this expense with disbelief, until considering that this cost falls within the price range of implementing electronic health record systems in some of these same facilities.12