Care in Place: A Paradigm Shift of the Local Hospital

Abstract

Public buildings habitually reveal valuable interrelationships in culture and place and how society treats its citizens, as Winston Churchill once remarked: “We shape our buildings; thereafter they shape us.” Likewise in the fi eld of healthcare, medical architecture ought to refl ect development of care, relative to medico-technological innovation, shape-shifting insights in psychiatry, and attitudes held by the city and its inhabitants. And where would be more appropriate to witness these key developments, than on the grounds of the local hospital? Such a thought seems peculiar, for the hospital is a curious and fascinating architectural assignment, but often because of its lack of capacity to mirror the demands and desires of the city. There is no greater irony or absurdity in architecture than a civic building purposefully erected as an icon of health and care, that has a general disposition to create unliveable, uncaring spaces; moreover, it tends to be a place avoided by the majority at best and patronized with an air of reluctance, let alone be compared to other conventional public buildings in terms of the architectural delight elicited. This thesis has been inspired by the growing conviction of the need to look for fundamentally fresh approaches to hospital typology, driven by the idea of returning the hospital to society as a milieu of care and good health. Doing so would not only herald the reinstatement of a caring stance, but an architecturally moving and empowering place to redeem the delight of its visitors. Approaching from the evolution of care, and the values of the city, the thesis examines key generalisations made about the architecture of hospitals which has largely incapacitated its ability to provide a perceivably caring setting within contemporary contexts. A suggestion of trends hospital design could adopt to complement adjacent societal trends in relation to healthcare is made, which culminates in a postulation of approaches to re-evaluate what a healthy, caring place should be like, by attaching symbolic meaning and local sense of place. A design-proposal, implementing the fi ndings of the thesis’s for a large community hospital in the suburbs of Auckland, New Zealand, is presented as a test-bed for architectural speculation for a future generation of hospital design that delivers care and exuberance on all levels. This thesis takes a generic-specifi c approach and is in no way prescriptive, but rather it balances a grounded approach inherently imperative in the rationale of healthcare systems with an inventive, optimistic attitude. An extensive range of both architectural and interdisciplinary literature is therefore drawn from global best practices – particularly in Western Europe and Scandinavia where the practice of contextual design is superior – to general design aspects that embody the image of care and general wellbeing.