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Henry Marsh, Phil Gusack Talk at RIBA Feb 2018

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Henry Marsh - "Why are Hospitals so often Horrible?" - speaker for the Phil Gusack Talk at the AfH AGM at RIBA on 22 February 2018

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Henry Marsh, Phil Gusack Talk at RIBA Feb 2018

  1. 1. Why are Hospitals so often Horrible? Henry Marsh
  2. 2. “Neuropreservation”
  3. 3. Medicine as a secular religion • Hope for long life instead of eternal life • Fear dementia instead of the Devil • Exercise cycles and 5 a day fruit and veg instead of prayer • Care assistants instead of angels • Charitable donations to cancer charities instead of to chantries
  4. 4. The Insatiable Appetite for Healthcare • US predicted to spend 20% of GDP on healthcare by 2020. • Rate of increase double that of inflation in recent years • No corresponding improvement in healthcare outcomes. • 26% of Medicare costs incurred in the last year of life
  5. 5. Many reasons why • Who is the client? And is he informed? • Ignorance and misunderstanding • Technological complexity • Ideological faith in technology • Cost and restricted space • Size • Economics. Private v. socialized health care. • Dualism
  6. 6. The Client • Managers? • Clinical staff? • Financiers? • Government? • Patients?
  7. 7. Payette AKU Karachi
  8. 8. Ignorance and misunderstanding • Evidence-based design Roger Ulrich
  9. 9. Immunity and stress Sleep
  10. 10. • Much of modern medicine is palliative – care not cure.
  11. 11. PFI - WONGA £80 billion debt for an initial cost of £11.5 billion
  12. 12. Technologically complex
  13. 13. Economics • Economists – markets and incentives • In the NHS where is the incentive to build a well-designed, sympathetic hospital? • Why is there such a difference between NHS and private hospitals? • Carpets • Curtains • Single rooms (less risk of cross-infection etc)
  14. 14. NORTH WESTERN,CHICAGO. THE HOSPITAL AS HOTEL
  15. 15. SIZE: Dunbar’s Number
  16. 16. • The staff need to feel at home and hence responsible for what goes on in the hospital • Institutional pride. • Good offices and coffee rooms.
  17. 17. Patients as other
  18. 18. What is to be done? ART
  19. 19. BRUGGE HOSPITAL, BELGIUM

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