How will COVID-19 influence Hospital Design?

By Sharjeel Yunus

What will be the 'new-normals' in hospital architectural and structural design?

“Make no mistake, they are connected. These disease outbreaks coming one after another. And they are not simply happening to us; they represent the unintended results of things we are doing.” writes David Quammen in Spillover, a book about the origins of human epidemics and pandemics. In the same book he mentions “By the cold Darwinian logic of natural selection, evolution codifies happenstance into strategy.”Nearly 6 months into this pandemic, it’s time to address this “strategy”. This is where hospital design comes in.

It is said that “healing in hospitals starts with its architects”, and “the walls of hospitals have heard more prayers than the walls of a church”. In a modern world where often hospitals lack the flexibility to accommodate any surge in patient visit numbers, this is both helpful and bleak. Establishing a more modular approach seems to be gaining a lot of importance. But plug-and-play setups fit the bill for a curative healthcare approach, not a preventive one. And the coronavirus has flowed through most of the gaping holes in our system and structures.

Designing for Pandemic Preparedness

First off, the pandemic has created a need for establishing a ‘pandemic protocol’ in India along with industry experts. Ms. Sanchali Harsa, Owner, Kumar and Swamy Architects, says “Large urban centers should have spaces to meet pandemic healthcare needs. Building 4 large spaces across the different ends of the city, wherein a live-in healthcare community utilizes on-site testing centers, isolation wards, ICUs, OT facilities will provide an umbrella of safety for the common population.”

The during-COVID world has left patients fearful of entering hospitals. Low footfalls have resulted in increased online consultations. A bulk of primary consultations and referrals have moved to the virtual space, including pre-hospitalization and post-hospitalization procedures. Even condition management programs can be tweaked to work in the home ecosystem with an increased reliance on smart wearables and condition tracking.

Dr. Vivek Desai, Founder, HOSMAC India, says “Consultations in the future might move to a telecommunication platform, but this is only in terms of out-patients and ambulatory care is concerned. But surgical procedures cannot be done at home. Similarly, anything urgent or critical will always continue to happen at a hospital level.” In the same breath, he adds, “At a larger level, the nature of what is happening is transient. A few years from now things will go back to the way they were earlier. Only in the rarest of possibilities where we live in a world where these breakouts are more frequent, does changing the system apply. Beyond 2-3 years, things should go back to normal”

That said, there are a few things that everyone acknowledges are here to stay. IAQ will be treated with utmost importance, and hospital-dedicated social distancing norms and sanitization standards will be a norm. “Length of stay at hospitals may reduce, but this is not a guarantee. However, OPD models will create an impact where various telecommunications platform will reduce the footfall coming into the hospitals,” adds Dr. Desai.

Hospital Building in Post-COVID Era

The pandemic has put the focus on creating facilities that meet the need of those who actually use them. This means infants and elders will be more actively considered while building the post-COVID hospital. “The one thing we miss one a very large scale is having special geriatric facilities. This could be its own section as the pandemic has really shown how marginalized and vulnerable the elderly population is” says Sanchali.

Another thing to keep in mind is that most ‘pandemic diseases’ are respiratory in nature. Factoring this in, Sanchali says “we should look at creating a wing dedicated to any respiratory tract infections which offer a separate ingress and egress from the rest of the main hospital.”

Apart from these, controlling the number of entry points and enhancing them to perform basic functions like screening, providing PPEs, collecting patient information, and identifying highly infectious patients would go a long way. In terms of furniture, replacing fixtures with carts allows for better sanitization and care, while ensuring only the required objects are in the room. There’s also a need to plan emergency zones and pandemic spaces that can handle an influx in patients. In addition to these, compartmentalizing spaces, and creating hot zones are among the leading recommendations made by experts worldwide.

The Cost Factor

Importantly, no one predicts the overall size of hospitals will change even though many consultations and visits may move out. This is because of the super-specialty nature of the facilities and social distancing norms coming into play. However, this may create an unintended effect on the cost of treatment at a hospital.

“As the area required per bed will go up, there will be fewer beds on the floor, across all the wards and treatment areas. This will create an incremental cost, the burden of which may fall on the patients” says Dr. Desai.

Accommodating Smart Technology

Besides direct structural changes, there will be a number of small design tweaks made on the interiors. Door knobs being replaced by foot pedal openers, regularly place sanitization points, contactless switches and fixtures, and an increased focus on sunlight and natural air are all recommendations being made in the professional architecture world towards long-term hospital design. There will also be a focus on smart technologies and innovations, with robots (particularly in nursing and administration), sensor and camera technology, and big data all contributing to the equation in their own way.

All this only means an increased focus on architects and hospital makers, and the trends they adopt today to define the pandemic of tomorrow. There is a certain reality and gravitas to the statement - “Infectious diseases are an active problem of the future, and we are not equipped to handle it”. This should only focus our efforts on adopting recommended changes and planning for a more responsible, safer path ahead. And it all begins with hospitals.