Old St. Agnes Hospital
Colored Photograph, Built 1906, FMG Design
The May 2025 Art In Medicine topic is about Hospital Architecture and Design.
Lucinda Bennett, the Medical Librarian at Ascension St Agnes Hospital in Baltimore, MD, publishes a regular series on Art in Medicine and The Health Humanities.
It's only 1-2 pages with gorgeous images, so it won't take you long to read
... and just might enrich your life.
Hospital Architecture & Design
What do you think of when you hear the word ‘hospital’? The place you were born? A medical drama on
television? Perhaps you are afraid of the place and it’s a negative connotation that comes to mind. Does the merit of
design, the history of architecture or the benefits of health come to mind? For this month’s topic we are looking at
the manner in which we build our hospitals, what has changed across time, and how better health outcomes can be
affected by a well designed floorplan. Modern
hospitals have their roots in European Medieval
history. Houses for the sick were attached to
church complexes and often had specific wards for
the poor, lepers, pilgrims and such. Public
hospitals, as we would know them, were funded
by secular governments in addition to wealthy
churches, and into existence after the Renaissance.
“The history of hospital architecture is full of
discussions about windows and their effects on
patient health. In the 19th century, British hospital
reformer Florence Nightingale argued for large
windows. She claimed that well-ventilated hospital
wards would help evacuate any miasma, the “foul
air” thought to cause nosocomial infections. After the advent of the germ theory, the discovery of sunlight’s bactericidal properties led to numerous design experiments with the size, shape and orientation of windows in hospital wards. Architects also took stock of the psychologic benefits of daylight. For instance, in the hospital he planned for Venice in 1963, celebrated Swiss architect Le Corbusier based the ward design on the
patient’s relationship to daylight. He proposed overhead windows for when patients would be confined to bed, and
horizontal windows in the wall for when patients would be mobile.” (Better Design, Better Hospitals)
By the end of the 20th century, and into the 21st, the need for private rooms became tied up in cultural and financial
expectations. More private rooms came into being, with whole pavilions dedicated to such layouts, the ability to
charge for services began to mimic the amenities of a hotel. Good hospital design does not only cover patients and
visitors, however important they are these groups are not the only inhabitants of the building. Staff are present
twenty-four hours a day, seven days per week, and should absolutely be considered in both new construction and
renovation. The American Medical Association even has multiple webpages discussing just this topic, where they
point their concern towards staff well-being and ease of performing their duties.
“Several accounts in the literature describe a lack of space parity: hospitals have well-designed and appointed
spaces for patients and families but not for staff. In particular, a documented decline in staff social spaces signals a
devaluing of health care professionals and denigration of their daily work experience and productivity.
Even after a hospital is constructed, opportunities exist for ongoing performance assessment that can inform
operational changes. For example, locked space for medication storage that serves an ICU may turn out to be
insufficient to bridge resupplies from the central pharmacy, necessitating an expansion of storage near the ICU.
Ascension St Agnes, Photograph 2025, FMG DesignOngoing performance assessment can identify such shortcomings so leadership can guide investment
prioritization.” (How to design and build health care spaces for the best outcomes)
As we move forward in both design trends and the expectations of patients, healthcare workers, stakeholders across
the board, and society at large, we come into the discussion
concerning sustainability. How do we balance the complex
needs of a healthcare setting with the evolving expectation
of green or sustainable building practices? Across the globe,
healthcare professionals have partners with architects to
solve this issue with glowing results.
“The Butaro District Hospital in Rwanda has become a
benchmark for how prioritizing patients’ health can prevent
the spread of infectious disease and send patients home
faster. Working with Paul Farmer’s Partners in Health,
MASS helped design the hospital to mitigate and reduce the
transmission of airborne disease through overall layout,
patient and staff flow, and natural cross-ventilation. The use
of local materials — like volcanic rock from the Virunga mountain chain — and local labor-intensive practices enabled a site-appropriate, sustainable design and stimulated the local economy.” (How the Architecture of Hospitals Affects Health Outcomes) In this same article, a valuable definition is identified early on, the definition of ‘social design’. While the term has been in use for decades, a solid understanding of its meaning and impact was
solidified circa 2006. Social design describes the interconnectedness of relationships, both from the designers
perspective and the end user. In the case of hospital architecture, this would translate into how the healthcare
workers expect to use the space, what patients and their families desire from their experience, and the vision of the
architect all blending into a single design. The needs of today’s community are not the same as their parents’, and
that difference in time is almost negligible in the grand scheme of human society. Time moves quickly and so does
design and the innovations of healthcare. When the very layout of a unit, the greenspace and accessibility of a
hospital could lead to positive or negative outcomes, the time has come to take design and artistry seriously.
“Healthcare institutions face numerous challenges today, from demographic changes to technological innovations.
In this context, architecture has become a critical factor influencing the quality of care, sustainability, and the
entire planning process of healthcare institutions. However, it is crucial to note that while architecture plays a
significant role, it must be integrated with other aspects, such as healthcare policies and technological
advancements, to create a holistic healthcare environment.” (Architectural Evaluation of Healthcare Facilities)
References:
How the Architecture of Hospitals Affects Health Outcomes
Architectural Evaluation of Healthcare Facilities: A Comprehensive Review and Implications for Building Design
How to design and build health care spaces for the best outcomes
Better design, better hospitals
Reprinted with the generous permission of Ms. Bennett.
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