The cure for hospitals? Maybe it’s urbanism

Joanna Lombard, a professor of architecture at the University of Miami, has worked with students and others on how to apply New Urbanism’s principles to medical districts in Miami and Memphis, and now she is providing ideas for the Bon Secours Richmond Health System, which operates four hospitals in metropolitan Richmond, Virginia.
    Hospitals as currently conceived are bad for many people, perhaps their employees most of all. “They get a 30-minute lunch break; they can hardly leave their stations,” Lombard says. “So they stay in a break room or go to a parking lot. And then they go back to a pressure-cooker job.” That’s hardly a recipe for happy workers.
    Lombard preaches an alternative vision: lay out hospitals and other health care facilities so that those who work in them can quickly go out the door and down an interesting street where cafes and other amenities await them. “Just the act of walking down a street is a recharge,” she says. What’s good for the staff would also be good for the families and friends who come to visit people in the hospital. They, too, would find a pleasant urban environment rather than the confusing, anti-pedestrian setting that makes most medical institutions feel harsh and intimidating.
    Inside and outside the hospital, the circulation system could be made clearer. For the past few decades, hospitals have grown into ungainly masses, buildings jammed together in ways that are incoherent on the exterior and hard for patients and visitors to comprehend on the interior. Conventional architects, she says, “take the bubble diagram and put a skin on it.”
    “Hospitals spend huge amounts of money on wayfinding,” Lombard observes. “It would be better to put money into good site planning; the buildings could calm down a little bit. You could save money.” Her outlook implies that the hospital precinct as a whole would be designed to be a pleasing urban or village environment. “It could really be a beautiful place,” she says. “Workers could live in a loft nearby. There could be movies and restaurants” within walking distance. “Life could be good.”
    Peter Bernard, CEO of the Bon Secours Richmond Health System, and Dougal Hewitt, senior vice president for mission services, have become intrigued with this new approach, which they see as in tune with spirituality and healing — important to a hospital system affiliated with a Catholic order. For the St. Francis Medical Center, which Bon Secours opened on a 75-acre site in suburban Midlothian in September 2005, they regarded the grounds and the entry sequence as crucial design features of the complex. A 70-foot campanile, homage to Assisi, the Italian hill town associated with St. Francis, was built where it anchors a piazza-like motor court at the entrance. “There are nature trails — pedestrian getaways so that people can be contemplative,” Bernard said. The hospital complex is expected to grow to 100 acres, Bernard said, and this requires “a strategic, well-thought-out effort of how the buildings should be positioned.”
    The buildings are less regular and less capable of enclosing outdoor spaces than New Urbanism generally prescribes. But the project is young, and Lombard says the public-access side of the hospital complex could evolve into part of a town. “Baby boomers want to get off the traffic-jammed roads to get their needs met by walking from one place to another,” Bernard says. That, he says, has the potential to bring about better-designed health care institutions.