Healthcare

RESEARCH JUSTIFICATION

Healthcare across the world is in a state of unprecedented change. COVID-19 stretched and tested every countries healthcare system and in the aftermath of the pandemic opened important discussions on the effectiveness of these networks. Rapid increases in digital technologies, including Artificial Intelligence, have kickstarted a rethinking of how healthcare systems can be run. The traditional model of large, centralised hospitals is becoming increasingly outdated, with remote and digital solutions allowing for varied healthcare systems, providing a more equitable access to healthcare.

Overview of Different Global Healthcare Systems

Healthcare in the United Kingdom

The United Kingdom’s healthcare works predominantly through the government funded National Health Service (NHS), which provides care for the vast majority of the population. However, funding cuts and staff shortages have spread the system almost to breaking point. The system in turn has been bogged down with ‘rationing’ resources, leading to long waiting times. Staff retention, especially in remote areas, remains a major challenge, with remote hospitals struggling to recruit and retain healthcare professionals.

The UK

Healthcare in Portugal

Portuguese healthcare uses a mixed healthcare model combining public and private provision. Most care is covered by the state-run service, yet recent surveys showed 48.7% of people struggle to find specialist care and 30.2% of people wait over three months to receive treatment. Occupational insurance schemes cover around 1.5 million people, allowing access privates services, while 25% of the Portuguese population pays for private health insurance, significantly improving treatment speed – making private coverage increasingly essential.

Portugal

Healthcare in Sweden

Sweden operates a decentralised state-run healthcare system, with 21 regional councils responsible for running hospitals. Due to the country’s remote geography, Sweden has developed a robust telemedicine network, with most consultations take place by phone or online, ensuring that people across the country can access healthcare. Small charges are implemented to cover supplementary costs.

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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

Contemporary hospitals often turn their back on the cities they serve, frequently located on greenfield sites at the urban periphery. This is contradictory, as hospitals can serve as builders of community identity by creating spaces for fundraising, charity and volunteering. A hospital is the backbone of a functioning society and should be treated as a core part of the urban fabric.

An example of a more 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.)

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Le Corbusiers Venice Hospital Plan

Trauma Informed Care

The concept of Trauma Informed Care was first formally introduced by Maxine Harris and Roger Fallot in 2001. It aims to provide healthcare “in ways that reduce barriers and prevent further harm or re-traumatisation for those who have experienced psychological trauma or adversity at any stage in their lives” (Trauma-informed practice: toolkit, NHS, 2021).

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.

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.

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).

6 Principles of a Trauma Infromed Care

Birth of the Clinic

Foucault was a philosopher and historian associated with the Structuralist and post-structuralist movement. An extremely influential thinker, his writing 'The Birth of the clinic' finds the subjective in things we think to be true.

The power of normalisation in cultural and medical discourse is exposed by Foucault's analysis. The philosopher questions dominant narratives considered to be normal and shows that the methods of observation and data gathering are biased in themselves. So too is the relationship of language to things and man to himself. A sick person becomes an object of study as soon as they enter a hospital, though they have the illusion of free will they must give up their autonomy to be cured. Surveillance, normalisation and examination are tools used to produce docile useful subjects. Foucault calls these 'docile bodies' which applies not only to a patient but to any body that is trained, disciplined, and made obedient to function efficiently within a system.

In a world more connected now than ever before, it has become increasingly more difficult to identify a single source of power. (Michel Foucault, Birth of the Clinic, 1963)

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

Michael Foucalt, Birth of the Clinic, 1963

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 be closer to God at the end of life, to the mega-hospitals of today, which host lifesaving technology. Amid all these changes, one theme remains visible: the importance of spaces designed for human needs, revealed through both successes and failures of their design.

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

However, with the arrival of complex medical technologies, many of these human centred 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, whose scale and efficiency driven design often 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.

This evolution highlights the sensitivity required in designing healthcare spaces and reinforces an important conclusion: “the hospital must be defined for humanity” (The Architecture of Health, 2021).

Michigan University Hospital (Lusan Chen, The Michigan Daile, 2023)

Michigan Univeristy Hospital, Interior (Kate Wells, WNMU, 2021)

Butaro District Hospital, Rwanda (Arch Daily, accessed 2025)

Butaro District Hospital, interior (Arch Daily, accessed 2025)

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).

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 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.

Conceptual Section of Marine Hospital, E. Todd Wheeler, 1971.

The Future of The Hospital, Buro Happald, 2022.

“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

Telemedicine

With internet access becoming increasingly widespread, it is now easier to remotely speak to a medical professional. Telemedicine, conducted through online chat systems, allows patients with less serious ailments to seek help without overloading physical clinics. This is especially beneficial in remote rural areas where access to care may be more limited or too far away.

Ninewells Transatlantic Surgery

In November 2025 Ninewells hospital in Dundee, Scotland performed the first ever transatlantic surgery. The Sentante machine uses wires that can be controlled remotely to perform surgeries. The surgeon performed a thrombectomy procedure from a hospital in Jacksonville, Florida while the cadaver was in Dundee over 4,000 miles away, with only a 120-millisecond lag (equivalent to the blink of an eye). The machine only required 20 minutes of training prior to the surgery. This technology is crucial to increasing access to stroke treatment surgery across the country even when specialists are sparsely located. (Graham Fraser, BBC News, 2025)

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Doctor using the Sentante Machine

Wearables

New small scale wearable technologies have revolutionised the way patients are monitored. Traditional post-surgery care would require patients to be hooked up to endless machinery. New technology, in the form of wristbands or plaster style strips, provides constant monitoring of key vitals. This can then be combined with machine learning (ML) and advanced data analytics to notify doctors should any issues arise. These new technologies will allow for less invasive patient monitoring, reducing patient stress levels and in turn aiding recovery. Patients will be able to leave hospital sooner, while still being monitored, freeing up hospital space and staff to treat more urgent cases. (Kemppainen, Wearable Electronic Solutions, 2021.)

In an interview, Tim Zijlstra, a member of the NHS North of Scotland AI Implementation Group, explained that 'the most significant impact AI integration in healthcare will come from wearables technologies, as they enable earlier detection and monitoring of potential health issues'. (Tim Zijlstra, Interview hosted by Ryan Smith, 2025)

Wearbable Monitering Patches

Fujifilm X-Ray

The Portable X-ray Uni FDR Xair is a lightweight system for taking X-ray scans that can run on battery power. Making it ideal for work in disaster zones, with the ability to take up to 100 scans on one charge even without electricity. In hospitals themselves the small size means less built infrastructure is required to conduct scans. When working with children there are fun and colourful covers that can be placed over the machine to make the process less threatening. (Fujifilm, 2025)

Fujifilm X-Ray

Timber Safe Coatings in Hospitals

Studies suggest that patients exposed to natural materials, such as timber, are more relaxed and in turn recover faster. Therefore, in modern hospital design it is beneficial to incorporate wooden elements into the building. However, timber in clinical environments faces issues with meeting hygiene standards. Recent research has found that a coating timber with a solvent-free linseed oil coating which includes nano zinc oxide can increase woods antimicrobial features, self-healing and overall durability. This makes the material suitable for clinical environments such as ward rooms or in theory even operating theatres, aiding patients’ mental wellbeing and overall recovery. (Kilpelainen, Wood for Health, 2021.)