If Sarita Chand is right, health care facilities of the future may place more concern in the supply of bandwidth than blood, and pay more attention to open plan space more than open-heart surgery. Chand, a principal of Bligh Voller Nield architects and one of Australia’s leading health facility designers, says the nature of medicine is changing and, with it, the nature of health care infrastructure.

Such is the rapid and broad nature of that change, and the rise of high-technology in medicine, that the hospital of the future may look nothing like a hospital, and everything like a communications hub.

“The whole nature of the building is changing a lot,” Chand says, stressing that flexibility will be the key to the future design of successful hospitals and medical facilities.

To that end, she says no-one is using pre-stressed forms in the design of buildings these days, and there is less emphasis on hierarchical design.

“We’re talking a lot about open-plan,” Chand says. “The departmental boundaries are blurring. Columns will always get in the way.”

She says specialisation in medicine is a key driver of change in health infrastructure.

The parallel rise in drug and medical technology, along with the increasing focus on home care, are also changing the very nature of medicine, and the types of buildings in which it is practised.

“Drugs are now being formulated for things that used to be treated (with) surgery,” Chand says.

“Acute hospitals have become very acute. In the old days acute hospitals used to have non-acute areas. (Now) it’s become a very serious building, a high-tech building.”

Non-acute care is increasingly dealt with in the wider community, although Chand says that the community is still trying to come to terms with that concept. The end result is that medical centres are getting bigger.

“What people are grappling with is whether to have separate ambulatory care or join it with an acute care hospital,” Chand says.

An increase in ambulatory care and preventive medicine means more treatment at home and in facilities that aren’t hospitals.

“Patients don’t like to be in hospital, they like to be at home,” Chand says.

Specialist equipment and staff are now driving the design of medical facilities, too.
“To have a stand-alone children’s or women’s block is becoming very hard,” Chand says. “You have to centralise and make that work for you. I say, don’t increase the number of consulting rooms, make the rooms work for you.”

Much like office space went through a campus evolution Chand says the need for research and training to be integrated with health care delivery is driving campus planning in health infrastructure.

“Almost every development I do now (is) on a large scale it’s like a campus,” Chand says.

“Research and training is now becoming an integral part of the hospital. It’s becoming more about campus planning. It’s not just one big building.”

In past years property developers have spoken of the potential opportunities in catering for the health needs of our ageing baby boomer population. But Chand believes the issue is more about tackling their future lifestyle and housing needs, rather than concentrating on healthcare facilities.

“They’re healthy because of the kind of health care they’ve had. They’re not ill — it’s just that they’ve stopped working,” Chand says. “The only reason they want to downsize is because they don’t want to mow their gardens anymore. But it’s not because they’re frail.

“They’re not interested in a huge lot of community facilities. I think want all the recreational benefits, but quite differ ent to what our grandmothers wanted.”

Of greater importance than ageing baby boomers to our health infrastructure system is the rapid obsolescence of facilities. Chand says 35 to 40 percent of the cost in a new hospital goes into electrical and communication systems.

“There is robotic surgery. It’s no longer a thing of the future — it’s happening now,” she says.

It’s an interesting point — what will a hospital have to be like to accommodate a patient that is being operated on by a surgeon in a communications room in another country?

“You never know — maybe 50 years from now a hospital is really just going to be a communications centre,” Chand says.

Her advice to the industry is not to hang on to outdated buildings.

“I’ve never found a hospital building that’s of any use after 20 years,” she says. “It is stupid for a hospital to try to use a building that is more than 20 years old, It’s a different world. Do not spend too much money on your structure ... it’s the equipment inside, It will never be efficient after 20 years. Bulldoze it if you can, and start again.

“We’re certainly not thinking about making them last for 50 years. There’s no market in that.”