Recent attempts to ‘reinvent’ the hospital are not as innovative as their architects would like you to believe In December 2024, Renzo Piano Building Workshop (RPBW) unveiled plans for Jawaher Boston Medical District in Sharjah in the UAE – a series of rectangular pavilions under a canopy of photovoltaic cells described by Piano as ‘a new model for the hospital of the future’. Three years earlier, in 2021, OMA and Buro Happold presented their designs for the Al Daayan Health District in Qatar. In an article published on e‑flux in January, partner at OMA Reinier de Graaf and colleague Alex Retegan showcased the firm’s ambitious goal to create ‘a new hospital typology to better suit local culture, climate and resources’.  The future is here. Pepper the robot, launched in 2014, is able to detect human emotions and has been used in care homes around the world Credit: DPA Picture Alliance / Alamy These supposedly futuristic hospitals share some features. They are both horizontal, rather than reaching upwards. This in itself is not so original: the courtyard typology adopted by Al Daayan Health District is a common one for hospitals in the region, as De Graaf and Retegan acknowledge, and Piano’s new hospital in Sharjah recalls the tradition from more than a century ago of situating hospitals on the edges of cities, surrounded by fresh air. This horizontality is a reaction against the postwar tower hospital, widely criticised for its monotony, sterility, lack of human scale and dependence on lifts. De Graaf and Retegan point to Bertrand Goldberg’s Prentice Women’s Hospital – a tower hospital opened in 1975 in Chicago and demolished in 2014 – as an illustration of inflexibility: ‘precisely its iconicity prevented it from being adapted to the changing needs of healthcare. The clearly defined tower, where patient rooms were located, was impossible to reconfigure according to new standards.’ Unmentioned by the architects are modernist tower hospitals which continue to function well and are much loved by their communities. The France‑USA Memorial Hospital in Saint‑Lô, France, designed by Paul Nelson and inaugurated in 1956, is still in use today. The hospital has a claustra facade – an aluminium frame with movable parts – as well as a sophisticated colour system indicating functional zones and a spectacular mural at the hospital’s entrance, both by artist Fernand Léger. The Al Daayan Health District claims to be expandable – this is also not a new idea. The big pavilion‑plan hospitals of the 19th century, built across the British empire, Europe and the US, could grow by adding more dormitory‑style Nightingale wards. These long, narrow, open spaces for patients featured windows between hospital beds, ensuring that each patient would be flushed with fresh air. The architects of pavilion‑plan hospitals – such as St Thomas’s Hospital in London, the Hôpital Lariboisière in Paris, and Johns Hopkins Hospital in Baltimore – planned expandable spines and included elevated bridges to which more wards could be added. Mega‑hospitals of the 1970s, too, included plans for growth and flexibility. These massive, modular hospitals were sometimes pre‑engineered for additional floors, or expandable laterally because their deep footprints included lightwells. In the 1972 McMaster Health Sciences Centre in Hamilton, Canada, architect Eberhard Zeidler positioned technical services on secondary floors that formed a superstructure in order to minimise the need for and disruption caused by renovations.  Both the Al Daayan Health District and Jawaher Boston Medical District (as well as a host of others around the world) are designed to operate like cities, independently of their local environments. But again, hospital‑as‑city is not a completely new idea. Tuberculosis sanatoria for a hundred or so patients often included farms for growing food, and services like theatres and libraries. Staff members sometimes lived on site. Many 19th and 20th‑century psychiatric hospitals were nearly self‑sufficient, functioning almost like monasteries on the edges of cities; the Buffalo State Hospital, designed by Henry Hobson Richardson in 1870 with a landscape plan by Frederick Law Olmsted, included an extensive farm. The 1.3 million square metre Al Daayan Health District in Qatar, was designed by OMA and Buro Happold to be expandable Credit: OMA / © HMC Similarly, St Thomas’s in London, designed by Henry Currey and opened in 1871, could theoretically be endlessly extended Credit: RIBA Collections Hospitals today are not all alike. In contrast, the city can also successfully infiltrate the hospital, rather than the hospital function as an autonomous city. For example, Christ & Gantenbein’s Zürich University Hospital, set to open in 2028, will be situated in the centre of a busy campus and will be highly porous, rather than self‑sufficient. I heard the architects describe how students might use the building for daily circulation, unrelated to healthcare, and that the surgeries might be visible from the street.  Perhaps the most obviously ultra‑modern feature of the Al Daayan complex is that it ‘welcomes the robot’, but the implication that robots are in some way futuristic is not accurate. As architectural historian David Theodore has shown, postwar hospitals planned by Gordon Friesen, such as the University Medical Center of Cologne, Germany, featured computer‑controlled conveyor systems for delivery of supplies as early as 1973. Robots were used in hospitals for surgery in the 1980s, and the robots in St Olav’s University Hospital in Norway, which opened in 2005, have accents and built‑in clumsiness. Even in the 19th century, massive Victorian mental health facilities, like the Hôpital St Jean de Dieu in Montreal, had forms of mechanisation like electric trains that delivered food to patients.  ‘Today’s medical knowledge is better than yesterday’s – in architecture, this is not always the case’ In an interview from 2021, OMA’s Hans Larsson points to Amazon as a model for hospital organisation. The context was OMA’s film on the future hospital, produced for the 2021 Venice Biennale, which asserted that: ‘The hospital of the future will take your order – like a logistics centre sorting and sending.’ Larsson explained how Amazon uses an algorithm to arrange goods according to climate: ‘What if a hospital network had the same algorithmic approach, locating their medical goods where they are most needed?’ I have also heard nurses ask why hospitals cannot be more like Walmart, pointing in particular to the US‑based retailer’s tradition of locating things in the same place in every store. These suggestions resonate with the era of the ‘patient‑consumer’, which saw a shift in healthcare where patients make more informed decisions about their health. But for both retail giants, prioritising algorithms has come at an architectural cost, representing a placelessness that runs counter to our current appetite for custom‑designed, context‑driven, culturally sensitive design. Such claims of reinventing the hospital are mostly framed in selective perspectives on the architectural history of the building type. Jacques Herzog, co‑founder of Herzog & de Meuron who have designed numerous hospitals, claims that architects have been excluded from healthcare design: ‘Healthcare is a totally neglected field. Architects were rarely allowed to get involved, and if they did, they were unable to turn the hospital into a worthwhile, liveable place.’ This is historically inaccurate. Healthcare is one of the earliest specialisations among architects. For example, most of the pavilion‑plan hospitals built in 19th‑century England were designed by specialised firms such as Henry Saxon Snell, Alfred Waterhouse, H Percy Adams, Henry Currey and William Milburn Jr. The OMA co‑authors hold specialised architects in contempt: ‘Since [the time of Le Corbusier], hospital design has been relegated to the expertise of a handful of specialised firms that are happy to go about business as usual, and which coincidentally or not, often also have expertise in prisons.’ According to De Graaf and Retegan, the wrong architects have designed hospitals. ‘There used to be a time when architects such as Otto Wagner, Tony Garnier, Louis Kahn and Le Corbusier would take on a commission to design a hospital. The latter’s unbuilt Venice Hospital (1965) is probably the last attempt by an avant‑gardist to construct a hospital,’ they claim. Le Corbusier’s design for a hospital for Venice was famously windowless. Automation in hospitals is not new. A tramway traversed the corridors of the Hôpital St Jean de Dieu in Montreal, built in 1873, to bring supplies to patients Credit: Old Time Trains / Wikimedia Innovations in hospital design continued in the 20th century – the France‑USA Memorial Hospital in Saint‑Lô, France, from 1956, is an example of the postwar tower hospital typology. It features spherical operating rooms that are still in use today Credit: Région Normandie ‑ Inventaire général / Corbierre Pascal The OMA co‑authors point to the demolition of hospitals as proof of failure. The e‑flux piece opens with a grid of 20 photos of modern hospitals being demolished, overlaid with the hospital’s age. A caption suggests that the more recent the hospital, the more likely it is to be demolished. The ages range in date from 21 to 103 years. Goldberg’s Prentice Women’s Hospital is included, as are several demolished hospitals from Canada, where I live: the Calgary General, the Montreal Children’s Hospital and Saint John General Hospital. Each was demolished for a different reason: the Calgary General Hospital was demolished in 1998 to reduce the number of hospital beds in the city due to budget cuts; in 2015, the Montreal Children’s Hospital moved to a new site to merge with an adult‑care hospital (its former site is now a condo development); and the 1930 Saint John General Hospital was demolished because it was in disrepair.  The McMaster Health Sciences Centre in Canada, was built in 1972 with flexibility in mind. Services can easily be rearranged within generous service spaces between floors and in vertical shafts. It was described by the World Hospital Congress as ‘obsolescence-proof’ Credit: Tom Bochsler Jawaher Boston Medical District in the UAE has been described by its architects Renzo Piano Building Workshop as ‘a new model for the hospital of the future’ Credit: Renzo Piano Building Workshop A compelling alternative is to avoid demolition and to renovate and extend existing hospitals. Upcycling buildings is often better for the environment and acknowledges the deep meaningfulness of hospitals as neighbourhood and civic institutions. St Bartholomew’s Hospital in London, founded in 1123, is still on its original site. But this idea is held in low regard by starchitects such as Jacques Herzog, who describes ‘some of the medically best‑appointed clinics in the world’ as ‘ugly monsters made even uglier by proliferating extensions’. In the healthcare sector, it is presumed that today’s medical knowledge is necessarily better than what was thought yesterday. In architecture, this is not always the case. Historical ideas continue to be relevant in hospitals designed for an uncertain future. As physician Lord Stephen Taylor proclaimed in the British Medical Journal in 1960: ‘Inevitably and always, most hospitals of the future will be hospitals of the past.’ 2025-04-29 Kristina Rapacki Share AR April 2025Buy Now