It is time for hospitals to change their appearance, organization, logic. The Recovery Fund offers us the opportunity and one of the most appreciated Italian architects in the world offers us his idea. Based on four essential principles: flexibility, functionality, beauty and multiplicity
An article extracted from the number 96 of Wired, dedicated to scientific research efforts in the field of health.
by Mario Cucinella, text collected by Francesco Oggiano
art Rik Oostenbroek
The first time I entered it when I was eight and stayed there for three months. My everyday life was interrupted there, in the corridors of the Gaslini in Genoa: a place that did not belong to me, and that I used to ride in a wheelchair chasing after me for fun with my roommates. Since then, in the hospitals I have entered it hundreds of times, almost always flanked by men and women in suits, to study, dissect and design them. Very easy to understand the period in which each one came up. There are those of the late nineteenth century, such as the Sant’Orsola in Bologna: they were built inside parks, by men convinced that nature was itself an essential element for the care of human beings. There are those of the fifties and sixties: huge monoliths built outside the cities by men convinced that a bit of megalomania would help to get out of the postwar period. Finally, there are those built in the last thirty years, symbolic works of a return to a more human dimension.
During the pandemic, especially the first two types showed their weaknesses, which coincided with what until recently were considered strengths. They were hospitals designed as huge concrete blocks – large corridors with rooms on either side – rather hostile, on average uncomfortable, very ugly, not very functional and unable to adapt to the economic needs. By their nature, some have even proved to be one of the causes of distribution of the virus: by not providing separate access for symptomatic people, they have brought together in one place – the emergency room – ordinary people and infected people. Made to concentrate the solution in the same place, they ended up concentrating the problem as well. Now, thanks to the Recovery Fund, we have ahead one of the biggest challenges of the last decades: rethink our hospitals and imagine new ones. I like to believe that we will do it, above all, respecting four principles.
First, the flexibility. The hospital of the future must be modular, capable of modifying itself. It will have to be able to change the number of rooms, move wards, replace one room with another, expand or reduce the number of beds, transform an operating room into an area for day hospital. All this in a very short time, and with the patients inside.
According to functionality. Enough vertical giants of dozens of floors used as watertight compartments, each dedicated to a specialty. The new hospitals will develop horizontally. Once inside, the patient will find the entire supply chain in front of him, and must be able to reach it comfortably and in a short time. Let’s take the San Raffaele in Milan. Until recently, a red code patient had to travel 60 meters to get to the operating room. During the last intervention, we shortened that path to 34 meters. That’s 26 meters shorter. That is equivalent to 12 seconds of travel. Which, for a person in red code, is equivalent to a life.
Third, beauty: itself, a form of treatment.
The hospital of the future will have to be generous, relaxing, welcoming. In the world there are already some hospitals that rely on the so-called healing architecture. It is healing architecture, which aims to accelerate healing or at least alleviate the suffering of patients through nature. One of the most beautiful things I have ever seen is the atrium of the hospital in Riyadh. A huge complex open to the whole city, with flying trains, reception, shops, reception areas for families, restaurants, bars, lounges for chatting. One of the most beautiful places in the world, where to spend one of the worst moments. The hospital will be a context in which people’s daily lives will not be completely interrupted, but will be able to find some new form. Until now, the patients’ only space has been their room: a dark place, linked to the disease. In the future we will build more and more non-residential environments, in which to experience a piece of everyday life: kitchens, living rooms, areas where you can host visiting loved ones, pedestrian streets with shops, parks.
Last principle, the most important: the hospital of the future will have to reduce itself, and multiply in smaller structures distributed throughout the territory.
It will be he who goes towards the people and not the other way around. The main lesson we will draw from 2020 is the following: we need to spread services more carefully on the territory. In recent years, hospitalization times have plummeted from about five days to one and a half days. The culture of the day hospital meant that not only the people went to the hospital inpatients, but people who need assistance for just three to four hours. Here, these men and women, the elderly and children, do not need traditional hospitals, but smaller and widely distributed structures throughout the city, in which to make use of common outpatient services.
We will increasingly create a hierarchy of places of care, based on the severity and the services offered. If at the highest point of the hierarchy there will be the classic hospital (intended for the most serious cases) in the middle one there will be outpatient clinics and hospitals, which will be immersed in the city and will be very important social points. They will be health houses with more functions: they will have rooms where you can play cards next to the clinics, rooms where you can study music alongside those for the day hospital. Idealism? Far from it. So far we have talked about medical advances solely from a technological point of view. We filled our mouths and conferences with words like robots, telemedicine, artificial intelligence. But we have not yet talked about the social and psychological evolution of the treatment itself.
A lot of older people get sick because they are alone. They face a hostile world. Here, the new hospitals spread in the cities will be the places of treatment and those of encounter. They will be spaces for everyone, also dedicated to free socializing, open to the voluntary contributions of new people, perhaps the elderly, who here will be able to bring their help to other patients through cultural exchanges. Wouldn’t that be a good place to have a bad time?
At the lowest but most important point in the hierarchy of the care system will be our homes. They will be the first pieces of our well-being. Today, too many Italians live in unhealthy homes, inadequate for space, performance and thermal efficiency (in 2003, following an anomalous heat wave, thousands of elderly people died simply because they lived in uninsulated houses). Inside them, we will heal thanks to telemedicine, artificial intelligence and, why not, listening. Many people will be able to talk to their doctor remotely, be controlled digitally, be reassured and no longer need to go to hospital. Because yes, the best hospital will be the one that fewer and fewer people need.