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

1. Why are Hospitals so often
Horrible?
Henry Marsh

12. “Neuropreservation”

13. 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

14. 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

37. 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

38. The Client
• Managers?
• Clinical staff?
• Financiers?
• Government?
• Patients?

39. Payette AKU Karachi

44. Ignorance and
misunderstanding
• Evidence-based design
Roger Ulrich

45. Immunity and stress
Sleep

46. • Much of modern medicine is palliative –
care not cure.

48. PFI - WONGA
£80 billion debt for an initial cost of £11.5 billion

49. Technologically complex

50. 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)

51. NORTH WESTERN,CHICAGO.
THE HOSPITAL AS HOTEL

54. SIZE: Dunbar’s Number

55. • The staff need to feel at home and hence
responsible for what goes on in the
hospital
• Institutional pride.
• Good offices and coffee rooms.

58. Patients as other

59. What is to be done?
ART

60. BRUGGE HOSPITAL, BELGIUM