Foundations of hospital design: an analysis of the evolution of determinants and strategies of hospital design

This thesis examines the historical evolution of hospital design and attempts to identify the primary determinants which have shaped hospital design strategies. In order to facilitate a systematic study of this subject, a matrix has been constructed to organize historical information. The evolution of hospital design is structured into Five Time frames which mark distinct directions in hospital design. Within each Time Frame, the role of the hospital as an institution, the design strategies which developed for organizing space and activities within the hospital, and the technology and theory which supported design strategies are analyzed. From this historical inspection of the evolution of hospital design, conclusions are set forth as to the emerging directions in hospital design and their implications on architectural practice and as to the generalized implications of the unfolding nature of the hospital design problem on the organization of activities within the city. A major theme in this thesis is the deep relationship of hospital design to the society in which it develops and the dynamic impact of the changing components in precipitating the restructuring of the design problem and stimulating new design strategies. It attempts to identify these mechanisms of change and to encourage a more dynamic fit of solutions to problems as they are perceived and the anticipation of directions and needs. Design develops from needs, and the changing needs and changing approaches to meeting them marks the evolution of the hospital facility. The evolution of the hospital and its design is anchored to a fundamental precept which has formed the foundation of hospital design: the concept that the physical environment should assist in the recovery of the sick and injured. The definition of who is to be served has expanded with the wider definition of illness and health. With the shift from the consideration of the individual as healthy until proven ill, to the concept of the individual assumed ill until proven healthy, the orientation of the hospital and design moves from the specific patient to society. The definition of how the needs of this expanding group could best be met forms the second changing determinant of design. The orientation of design has shifted from the need to control infection which was restricted to serving the hospitalized patient to the need for the effective management of resources which can provide a wider delivery of services to society. The hospital has shifted from a limited-use facility with its design determinants oriented to the specific nature of internal function to a mixed-use complex which generates design determinants from the broad framework of intermixed health care, educational, research, and social service systems. This reshaping of the hospital design problem has provided new opportunities for organizing activities to meet collective needs and is generating design strategies which allow the structuring of a more interdependent society