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Hospitals are not designed for the 21st Century

Thursday 26 June 2003 at The Gallery, 75 Cowcross Street, London (by kind invitation of Alan Baxter & Associates

A lecture by Lawrence Nield of Bligh Voller Nield presented by Architects for Health during Architecture Week 2003

The hospital design industry is in a bind. The present hospital types, produced by our design industry will not meet 21st Century demands. The design industry is transfixed by user requirements and models of care. The industry has failed to investigate the "hospital building type" or indeed look at which is happening in other large "people" buildings. The presentation addressed these issues, moving forward from the talk Lawrence Nield gave to the Nuffield Trust/CABE/RIBA Conference in February. The presentation considered:

• The failure to look beyond user requirements leading to the diagrammatic hospital
• The monotony of modern hospitals... "for past these doors are rooms, and rooms past those, And more rooms yet, each one further off" (Larkin)
• The short service life of present hospitals
• The radical developments in airports and office typologies compared to hospitals
• The impact of new "stakeholder" - computer and information technology
• Dealing with "events" rather than "fixtures"
• The requirement for team working rather than hierarchical organisation and working
• The problems of wall dependency
• The need for furniture/workplace systems - the rise of "aedicular" (small spaces) architecture
• The operating theatre as television studio - the impact of minimally invasive surgery
• New hospital types - towards large span and flexible "warehouses"
• The implications for sites and procurement of a new hospital type

This lecture was based upon a remarkable piece of personal research. It was visionary yet was well grounded in the practicalities of delivery. It focused on the architecture of health buildings. It starts to rework the building type. It brings forward lessons from other building types through an international and longitudinal study of the evolution of the form for hospitals, offices and airports.

The conclusions when set in this context are devastating and hard to refute. Hospitals are sick. The reinvention of the hospital is overdue and here is an impressive start. Open plan theatres are reviewed. Hospital in a hall is proposed and the notion of "loose fit" is reworked. This is perhaps the most significant lecture given on healthcare buildings in the last 10 years. Roger Walters

Lawrence Nield is a Principal of the Sydney-based architectural practice Bligh Voller Nield. He has been designing major public buildings in Australia and Asia including offices, airports, sporting venues and hospitals for over 30 years. In 1996 he headed the team for the masterplanning of the main site of the Sydney Olympic Games. Bligh Voller Nield designed the Olympic Stadium, the Tennis Centre and the Olympic Broadcasting Centre as well as much of the huge temporary works for the Games. Until 1996, he was the Professor of Architecture at the University of Sydney. In 2002 St Vincent's Hospital, one of Sydney's seven major teaching hospitals, which he was the Design Director, was opened. In 1980, he designed the innovative and energy-efficient Mt Druitt Hospital. From 1968 to 1975 he worked in London for Yorke Rosenberg Mardall on St Thomas' Hospital and the John Radcliffe Hospital in Oxford. Lawrence Nield is a graduate of the University of Sydney and the University of Cambridge. He is an Adjunct Professor at the University of Technology Sydney.

Lawrence Nield's PowerPoint slides follow on the next page.

The Lecture featured 86 slides and these are on the following pages:

• Sections 1 & 2
• Sections 3 & 4
• Sections 5 & 6
• Sections 7 & 8
• Section 9
• Section 10
• Sections 11 & 12
• Sections 13 & 14
• Section 15

It is suggested that you start at Section 15 which provides a summary.

Copyright is retained by the author and AfH is grateful for permission to include the material on this site.

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