Healthcare

Fig. MA.H.01; Healthcare

RESEARCH JUSTIFICATION

Healthcare across the world is undergoing significant change due to post-COVID reassesment and the accelerating development of digital technologies.

This research aims to explore different theorys behind the development of healthcare facilities, and the impact new technologies have on them.

To determine how healthcare is changing and what systems should be used in the future?

Overview of Global Healthcare Systems

Fig. MA.H.02; Effectiveness of Global Healthcare Systems (Health at a Glance 2023, OECD, 2023)

Funding:

General Taxation | Social Insurance | Private Insurance

Providers:

Public | Mostly Public | Mostly Private | Private

Structure:

Centralised | Hybrid | Decentralised

Private Sector Role:

Dominant | Complementary | Minimal

Current Stress Level:

Low | Moderate | High | Severe

(The Structure of the NHS, Step into Health, accessed 2025)

Fig. MA.H.03; United Kingdom

Funding:

General Taxation | Social Insurance | Private Insurance

Providers:

Public | Mostly Public | Mostly Private | Private

Structure:

Centralised | Hybrid | Decentralised

Private Sector Role:

Dominant | Complementary | Minimal

Current Stress Level:

Low | Moderate | High | Severe

(Properstar. “Healthcare in Portugal: System, Costs, and How to Access It.” Properstar, November 23, 2018)

Fig. MA.H.04; Portugal

Funding:

General Taxation | Social Insurance | Private Insurance

Providers:

Public | Mostly Public | Mixed | Mostly Private | Private

Structure:

Centralised | Hybrid | Decentralised

Private Sector Role:

Dominant | Complementary | Minimal

Current Stress Level:

Low | Moderate | High | Severe

(ExpoMedics, "How Healthcare in Sweden Works", 2021)

Fig. MA.H.06; Sweden

“Truly functional design - satisfying immediate operational needs, catering for the emotional needs of patients and staff, making good connections with the locality, anticipating future change - must be the basis of excellent architecture.”

-Sunand Prasad "Changing Hospital Architecture"

Overview of Architectural Healthcare Theory

Hospitals Relationships with Cities

Fig. MA.H.08; Current healthcare setting on the urban periphery compared to a socially integrated version imagined by Sunand Prasas.

Contemporary hospitals often turn their back on the cities they serve, frequently located on greenfield sites on the urban periphery.

However, Sunand Prasas argues that hospitals can be the backbone of communities and should be integrated within its core urban fabric. Healthcare buildings can serve as builders of community identity, by creating spaces for volunteering, which has positive social benefits and health benefits too (Dr Alison Clement, Interview hosted by Ryan Smith, Angus HSCP Clinical Director, 2025).

An example of an integrated approach can be seen in Le Corbusier’s unbuilt hospital plan for Venice from the early 1960’s. The design envisioned a continuation of the city, organised around a series of small courtyards reflective of the Venetian vernacular. The proposal would have fitted seamlessly into the existing urban fabric, creating a hospital that fully integrates with the community it serves (Sunand Prasad, Changing Hospital Architecture, 2008).

Macro_Healthcare_Hospital Relationshop with City Image.png

Fig. MA.H.09; Le Corbusiers Venice Hospital Plan (Entire Landscapes, accessed 2025)

Trauma Informed Care

The concept of Trauma Informed Care was first formally introduced by Maxine Harris and Roger Fallot in 2001. A significant proportion of people have experienced ‘trauma’ at some point in their lives, whether linked to healthcare itself, or to other physically or mentally scarring events. Since the COVID-19 pandemic, the number of people affected by trauma has increased, with the impact felt most in deprived areas.

Trauma Informed Care aims to provide a healthcare that “reduces barriers and prevents further harm or re-traumatisation for those who have experienced psychological trauma or adversity at any stage”

- Trauma-informed practice: toolkit, NHS, 2021

When designing healthcare services that reflect the principles of Trauma Informed Care, it is important to start from the assumption that anyone may have experienced trauma. Services and environments should be structured in ways that promote safety and choice, reducing the likelihood of re-traumatisation. This can include designing spaces that offer different options in how they navigate and interact with the building, recognising that each person’s circumstances and triggers and unique.

Fig. MA.H.15; 6 Principles of a Trauma Informed Care (Graeme Stuart, 2024)

This approach has been proven to enhance healthcare accessibility in ‘hard-to-reach’ groups, including people who are deprived, anxious or otherwise marginalised. Therefore, making healthcare more accessible, not simply relocating services but by redesigning how people experience them. (Trauma-informed practice: toolkit, NHS, 2021).

Birth of the Clinic

Foucault was a philosopher and historian associated with structuralist and post-structuralist thought. In The Birth of the Clinic, he examines the subjectivity within ideas that are often assumed to be objective or true.

Through his analysis, Foucault exposes the power of normalisation within cultural and medical discourse. He questions dominant narratives that are treated as normal and demonstrates how methods of observation and data collection are themselves biased.

"The first task of the doctor is therefore political: the struggle against disease must begin with a war against bad governement"

- Michael Foucaly, Birth of the Clinic, 1963

Foucalt also examines the relationship between language and objects, and between individuals and their own sense of self. A patient becomes an object of study upon entering a hospital and, despite the appearance of free will, must surrender a degree of autonomy in order to recieve treatment. Surveillance and examination are used to produce compliant and efficient subjects. Foucault describes these as 'docile bodies', a concept that applies not only to paitents but to any body that is trained and disciplined to support the functioning of a system.

In an increasingly interconnected world, it has become more difficuly to identify a single source of power (Michel Foucault, Birth of the Clinic, 1963).

Fig. MA.H.16; The Birth of the Clinic, Michel Foucault

Human Centred Design

Throughout history, the architecture of healthcare has transformed drastically, from early services delivered in religious buildings, to the mega-hospitals of today, which host lifesaving technology. Amid all these changes, one theme remains visible: the importance of human needs, revealed through both the successes and failures of their design.

One of the earliest and most influential examples of human-centred design comes from a 19th century nurse, Florence Nightingale. In Notes on Nursing, she proposed principles such as natural ventilation and daylight, arguing that environmental impacts plays a critical role in healing. Her ideas shaped hospital design for generations.

“the hospital must be defined for humanity”

- Michael Murphy, The Architecture of Health, 2021

However, with the arrival of complex medical technologies, many of these human principles were overshadowed by a more industrial approach, described as the “factory of healing” (The Architecture of Health, 2021). This shift is evident in numerous Modernist hospitals, such as Albert Khan’s University of Michigan Hospital, its scale and efficiency driven design has made the patient experience more intimidating.

In recent years, there has been a move back towards human-centred healthcare environments that integrate contemporary technology. An example is the Butaro District Hopistal in Rwanda, which incorporates Nightingale’s findings while adapting them for contemporary needs. (The Architecture of Health, 2021).

Fig. MA.H.10; Michigan University Hospital (Lusan Chen, The Michigan Daile, 2023)

Fig. MA.H.11; Michigan Univeristy Hospital, Interior (Kate Wells, WNMU, 2021)

Fig. MA.H.12; Butaro District Hospital, Rwanda (Arch Daily, accessed 2025)

Fig. MA.H.14; Butaro District Hospital, interior (Arch Daily, accessed 2025)

Fig. MA.H.13; Butaro District Hospital, ventilation diagram (Arch Daily, accessed 2025)

Utopian Thinking

Throughout history, the development of new healthcare typologies has been supported by utopian thinking, critiquing current systems and proposing speculative futures. E. Todd Wheeler, an American architect, proposed several radical hospital designs that challenged traditional ideas of healthcare architecture. One of these was an underwater hospital that could expand as needed, acknowledging that hospitals must adapt and grow while responding to emerging environmental and social pressures (Mansfield and Mass Design Group, The Architecture of Health, 2021).

Fig. MA.H.17; Conceptual Section of Marine Hospital, E. Todd Wheeler, 1971 (Mansfield and Mass Design Group, The Architecture of Health, 2021)

Fig. MA.H.18; The Future of The Hospital, Buro Happald, 2022. (Buro Happold, accessed 2025)

Most recently, driven by the emergence of new technology such as drones and Artificial Intelligence, OMA in collaboration with Buro Happold developed their proposal for the Hospital of the Future. They explored principles similar to Wheelers, noting that hospitals become outdated as soon as they are built due to rapid technological developments. Their response was a plug and play model that can adapt to these changes and to population needs (Buro Happold, Hospital of the Future, 2022). This proposal had a big impact on the unit, leaving us with the question, what is the future of healthcare?

This suggests that although utopian ideas may appear radical, they are essential for critiquing current systems. While they may not be realistic to build, they highlight key issues and the potential of new technology.

“The corona crisis has rekindled debate on the subject, once again confirming that, instead of having too few hospitals, we have the wrong ones.”

Christine Nickl-Weller & Hans Nickl

New Developments

Ninewells Transatlantic Surgery

In November 2025, Ninewells Hospital in Dundee performed the first transatlantic surgery. The Sentante machine uses remotely controlled wires to carry out surgical procedures. In this case, a surgeon based in Jacksonville, Florida performed a thrombectomy while the cadaver was in Dundee over 4,000 miles away, with only a 120-millisecond delay. The system required only 20 minutes of training prior to the procedure (Graham Fraser, BBC News, 2025).

This technology has the potential to improve access to stroke treatment and other operations across the country, particularly in areas where specialist surgeons are limited.

Macro_Healthcare_Transatlantic Surgery.png

Fig. MA.H.21; Doctor using the Sentante Machine, developed in Ninewells (Sentante, BBC News, 2025)

Wearables

New small scale wearable technologies have changed how patients are monitored. Traditional post-surgery care often required patients to be connected to extensive equipment, whereas newer technologies such as wristbands or adhesive patches allow continuous monitoring of key vitals. This data can be combined with machine learning and analytics to alert clinicians is issues arise.

'The most significant impact of AI integration within healthcare will come from wearable technologies, as they enable earlier detection and monitoring of potential health issues'

- Tim Zijlstra, NHS North of Scotland AI Implementation Group, 2025

These technologies enable less intrusive monitoring, which can reduce patient stress and support recovery. Patients may be discharged earlier while remaining under observation, freeing hospital space and staff to focus on more urgent cases (Kemppainen, Wearable Electronic Solutions, 2021).

Fig. MA.H.21; Wearable Monitoring Patches (VTT Technical Research Centre, 2024)

Fujifilm X-Ray

Fujifilm’s portable Xray machine is a lightweight system that can operate on battery power, making it suitable for use in disaster zones. It can perform up to 100 scans on a single charge (Fujifilm, 2025).

This technology has implications for the design of healthcare buildings, as it reduces spatial requirements. Traditional X-ray machines are typically housed in isolated rooms lined with led. Portable systems allow for a more flexible use of space and provide a less intimidating experience for patients. Playful covers are also available to help reduce stress in already tense situations (Fujifilm, 2025).

Fig. MA.H.22; Fujifilm X-Ray (Fujifilm, accessed 2025)

Timber Safe Coatings in Hospitals

In modern hospital design, incorporating wooden elements can support patient recovery. However, untreated timber in clinical environments does not meet hygiene standards, due to its absorption of microorganisms.

Recent research shows that coating timber with a solvent-free linseed oil solution containing nano zinc oxide can improve its antimicrobial properties and durability. This treatment makes timber suitable for clinical settings while supporting patients mental wellbeing and overall recovery (Kilpelainen, Wood for Health, 2021).

Fig. MA.H.23; Timber Coatings

Telemedicine

In the past decade, due to an increased access to the internet, telemedicine has emerged as a vital component for the delivery of healthcare. As patients can speak to medical professionals remotely through their phone, computer or other online platforms, reducing the reliance on physical clinics. This in turn, helps to ease the pressure on healthcare facilities, as patients in non-urgent cases, don’t need to be seen face-to-face.

In rural and remote areas where distance and workforce shortages restrict access to healthcare, telemedicine can be vital. Rather than centralising all services into larger hospitals, this method allows healthcare systems to operate as decentralised networks, connecting patients with healthcare professionals across larger areas.

During the COVID-19 pandemic the full potential of telemedicine was realised. Before the Pandemic, it was treated as a supplementary service, until it became an essential mode of healthcare delivery, due to travel restrictions and social distancing guidance (NHS England, accessed 2025) (Julia Shaver, The State of Telehealth Before and After the COVID-19 Pandemic, 2022).

Fig. MA.H.18; The Future of The Hospital, Buro Happald, 2022. (Buro Happold, accessed 2025)

Fig. MA.H.19; Telemedicine

Fig. MA.H.20; Telemedicine in Sweden, doctor in central hospital connected with patient and nurse in rural location

A range of international healthcare models highlight the benefits of utilising telemedicine. In the UK, due to the NHS’s development of virtual wards, patients with conditions such as chronic respiratory disease can be monitored in their own homes using apps and connected devices under hospital supervision. This template lowers emergency admissions by transferring sections of inpatient care into domestic settings.

In Sweden, nurses in rural hospitals are virtually connected to doctors located in central buildings to provide care in remote area, without the need for permanent on-site doctors (NHS England, accessed 2025).

At an even larger scale, Saudi Arabia has developed the Seha Virtual Hospital which operates as a fully networked virtual institution, that delivers specialist care across 170 smaller hospitals without relying on a single centralised building (Saudi Arabia Ministry of Health, 2024).

These examples demonstrate how telemedicine enables healthcare systems to function as distributed networks.