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Why are Hospitals so often
Horrible?
Henry Marsh
“Neuropreservation”
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
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
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
The Client
• Managers?
• Clinical staff?
• Financiers?
• Government?
• Patients?
Payette AKU Karachi
Ignorance and
misunderstanding
• Evidence-based design
Roger Ulrich
Immunity and stress
Sleep
• Much of modern medicine is palliative –
care not cure.
PFI - WONGA
£80 billion debt for an initial cost of £11.5 billion
Technologically complex
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)
NORTH WESTERN,CHICAGO.
THE HOSPITAL AS HOTEL
SIZE: Dunbar’s Number
• The staff need to feel at home and hence
responsible for what goes on in the
hospital
• Institutional pride.
• Good offices and coffee rooms.
Patients as other
What is to be done?
ART
BRUGGE HOSPITAL, BELGIUM
AGM Phil Gusack Talk at RIBA Feb 2018
AGM Phil Gusack Talk at RIBA Feb 2018
AGM Phil Gusack Talk at RIBA Feb 2018
AGM Phil Gusack Talk at RIBA Feb 2018
AGM Phil Gusack Talk at RIBA Feb 2018
AGM Phil Gusack Talk at RIBA Feb 2018
AGM Phil Gusack Talk at RIBA Feb 2018
AGM Phil Gusack Talk at RIBA Feb 2018
AGM Phil Gusack Talk at RIBA Feb 2018
AGM Phil Gusack Talk at RIBA Feb 2018
AGM Phil Gusack Talk at RIBA Feb 2018

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AGM Phil Gusack Talk at RIBA Feb 2018