Hospital of the Future

"Hospitals in drastic, drastic need of innovation" says Reinier de Graaf

Dutch architecture studio OMA has produced a film exploring hospital design as part of its research into its first hospital buildings. Partner at the studio Reinier de Graaf tells Dezeen how he envisions the hospital of the future.

OMA has been commissioned to build hospitals in France and Qatar, despite having no experience in designing medical buildings. This demonstrates that hospital design needs to be rethought, according to De Graaf.

"We were selected precisely because we had never done a hospital," De Graaf told Dezeen. "Therefore, we were unburdened by a lot of baggage."

"They're apparently willing to take the risk to take on a firm that is inexperienced in the sector, I think this is an indication of how much the sector itself feels that it's stuck," he continued.

"The thinking about hospitals is in drastic, drastic need of innovation."

Coronavirus "hasn't changed healthcare"

As part of its design process for the hospital projects, both of which are currently strictly confidential, OMA created a short film on the Hospital of the Future to outline its thinking on hospital design.

Although OMA began designing the projects before the current pandemic, De Graaf believes that the coronavirus has exposed issues with current healthcare provision and architecture.

Reinier de Graaf on the hospital of the future
Top: an image from OMA's Hospital of the Future film. Above: Reinier de Graaf

"In many ways, the whole Covid crisis has accelerated a number of notions that we had about the hospital from the get-go, in a way and it's made them more pertinent," he said.

"Clearly Covid has changed a lot of things, but it hasn't changed healthcare, ironically. I think what it has done is expose a number of flaws, which were latent in healthcare and simply bought into the forefront."

Hospitals obsolete as soon as they are complete

One of the main findings from the studio's research into health facilities is that hospital buildings are lasting less and less time before they become obsolete. According to OMA, this means that hospitals have to be designed to be constantly evolving.

"The more recently a hospital is constructed, the quicker it gets demolished," said De Graaf.

"So one of the things we thought about early on was taking the trend to the extreme. And say the most extreme consequence of this trend is that essentially they are obsolete when they're finished."

"The moment the building is complete, at that very moment, it's obsolete, so it can only ever be obsolete, it's practically obsolete while you're drawing it," he continued.

"This means that we probably need to think about the hospital, not in terms of a finite product, but in terms of a process. And not of a building, but in terms of an organism."

In the future "hospitals will be everywhere"

According to the architect, developments in technology may eventually result in the hospital ceasing to exist as a building, with healthcare being integrated into the city instead.

"Many ideal city concepts are based on disease and based on hygiene to the point that you can see a lot of the utopian urban concepts as giant hospitals, you know, where the hospital is, everywhere," De Graaf explained.

"I think we are encountering a situation, particularly in cities, where the hospital will be everywhere, once again."

Speaking about its current project in Qatar, however, De Graaf explained that its upcoming hospital will still exist in a physical form.

"All I can say is that the appearance will be an extremely interesting mix between tradition and future, between the primordial and the futuristic," he said.

"It almost aims to be a fully autonomous complex. It will look like it could be built on Mars. Nevertheless, it will look remarkably familiar in Islamic culture."

De Graaf also points to 3D printing and mass robotisation as two areas that the studio is looking to incorporate into its hospital designs.

"I think what the healthcare crisis will do is make what until recently was long term future-gazing become a lot more pertinent and imminent," he said.

Read the full interview with De Graaf on the Hospital of the Future below:


Tom Ravenscroft: How did the film come about?

Reinier de Graaf: It is a product of a long interest in healthcare as an architectural subject. In spring 2019 we were asked to develop a number of hospitals – one in France and we got involved in a very large healthcare project in Qatar.

We asked our clients why us, as we've never done a hospital. And we know that hospitals in particular, like prisons, are the domain of architects who specialise in them.

But apparently, we got the reply that we were selected precisely because we had never done a hospital. And that therefore, we were unburdened by a lot of baggage. Apparently, the hospital concept as it was routinely being done was running into certain problems.

We, particularly in the context of Qatar, got a very long research phase before we actually had to enter a design phase. And what we did, I think, in the summer of 2020, we made an initial video, which we put on our website, where we mainly asked questions about the hospital of the future.

That was a very, very short video. We thought more, I started to think about the subject, we have a team of people in the office who work across the different projects that we have on the topic. I wrote a number of articles.

So we've been very active, the project was continuing, then Matadero, the arts Spanish organisation asked us to participate in an exhibition about the hospital of the future, which basically got a lot of traction.

We are working on hospitals as we speak, they're confidential projects, but mainly our thinking about it. And whatever we broadcast about, it gets a lot of traction, a lot of people ask us about it. And that organisation asked us about it, the Venice Biennale asked us to do something on the subject, but clearly, for Covid reasons to be postponed, postponed and postponed.

Then with Matadero, we had the first idea that we would do something virtual. And we would make a film, which is very much of this time, you know, you can go anywhere, you don't need to breathe and other people's faces, you don't need to inhale you, you just make a video. So that's, that's what we did.

Tom Ravenscroft: How have recent events impacted your thinking?

Reinier de Graaf: I think in many ways, the whole Covid crisis has accelerated a number of notions that we had about the hospital from the get-go, in a way and it's made them more pertinent.

In our view, it's not that Covid has changed everything. Well, clearly, it has changed a lot of things, but it hasn't changed healthcare. Ironically, I think what it has done, it has exposed a number of flaws, which were latent in healthcare and simply bought into the forefront.

Tom Ravenscroft: Like what?

Reinier de Graaf: One of the things we found in our research is that the more recently a hospital is constructed, the quicker it gets demolished.

So the evolution of the technology and the evolution of medical science seems to result in an ever-quicker expiry date of the typology and of the design. Up to the point that you have some recent hospitals, which, you know, didn't even live for a quarter of a century. And were then demolished.

Tom Ravenscroft: Did you compare that timeline to other building typologies? Isn't this broadly true for all buildings?

Reinier de Graaf: It's part of a general trend. I mean, it's also part of clearly of a housing trend, but it is a more radical example of the trend. It's almost an extreme example, you have, essentially of hospitals and you have airports.

Airports are too big to demolish, so they're in a permanent state of conversion. And in a permanent state of expansion.

So one of the things we thought about early on was taking the trend to the extreme. And say the most extreme consequence of this trend is that essentially they are obsolete when they're finished.

The moment the completion date of the building at that very moment, it's obsolete, so it can only ever be obsolete, it's practically obsolete while you're drawing it, which means that we probably need to think about the hospital, not in terms of a finite product, but in terms of a process. And not of a building, but in terms of an organism.

So we began to look at that we began in Qatar, we're really very advanced in looking at 3D printing prefabrication and 3D printing. As you may know, also in surgery, 3D printing is a very prominent thing. Organs are 3D printed. So there's an interesting overlap between medical technology and construction technology there.

So we're taking that very far to the point that you would have factories on site. You have industrial, complex enough to produce offspring, you practically eliminate the contractor from the equation.

I mean, that is an interesting thing. And, of course, another thing you see that in the course of the 20th century, we saw the trend that generally acute diseases became chronic diseases, we got to live a lot longer, not necessarily healthier, but acute diseases became chronic diseases.

And with that, you essentially have the whole evolution of the healthcare sector go privatised, it entered a kind of comfort zone where there was ever fewer staff, ever greater efficiency possible, etc.

Because I mean, it's been 100 years since the Spanish flu. And Covid, of course, what it does, is that it makes a lot of chronic diseases, all of a sudden, acute again.

Many people are basically alright, with Covid, but as soon as there's already something wrong with you, it can become acute, in an instance when you contract that virus.

And that means that we are in a way thrown back in time, with a certain amount of urgency. Hospitals sort of pop up in an instant, we saw the Chinese hospital that got there in 10 days. We see stadiums be converted, we see ships converted into hospitals.

It also highlights a problem in architecture anyway, that as a discipline with an ethos of permanence, it is facing a condition of life, which is ever less pertinent.

So the friction between architectural ambitions and that of your ability plays out in the extreme in healthcare. So that's also why we were so enthusiastic to dive into it, because healthcare is a sector where we're certain crisis of architecture becomes very manifest.

Tom Ravenscroft: So as you say in your video healthcare as we know it is dead?

Reinier de Graaf: Of course, that is an attention-grabbing statement in the video. But I guess we mean it of sorts. I mean, at least the way we have thought about the hospital so far is running into a dead end.

I mean, the thinking about hospitals is in drastic, drastic need of innovation. I guess it's the sentence in the film as a short way of saying that.

Tom Ravenscroft: So back to first principles, kind of redefining what the hospital is and how it operates within a current?

Reinier de Graaf: Another thing that's very prominent in the video is that of course, you can rewrite the history of architecture and urbanism completely along medical terms.

I mean, many ideal city concepts are also based on disease. And based on hygiene to the point that you can see a lot of the utopian urban concepts as giant hospitals, you know, where the hospital is, everywhere.

I think we are encountering a situation that particularly in cities where the hospital will be everywhere, once again.

What is modern technology? And that's the latter part of the film that tries to speculate on how that could happen in a number of ways.

Tom Ravenscroft: So the buildings disappear, as the technology enables it to be basically everywhere?

Reinier de Graaf: Yeah, in the most extreme form. But of course, like with any prediction it will never fully come through. So I'm sure there will always be hospitals. But they'll be different.

Tom Ravenscroft: So how does this long-term future-gazing impact on your actual designs?

Reinier de Graaf: I'm not sure if it's long term, future-gazing. I think 3D printing, for instance, has been on the cards for a while. And architects have flirted with it, but always in quite a tentative way. It's been applied in small-scale buildings.

I think what the healthcare crisis will do is that what until recently was long term future-gazing may become a lot more pertinent and imminent.

I mean, if our plans work out we would be building such a thing in the near future.

I think the other thing that you also see happening is mass robotisation. In the course of the hospital. It's also an interesting flight forward, we're incredibly scared of mechanical labour, we are incredibly scared of robotisation.

Nevertheless, it's long been a fact of life in many sectors. And it will also be a fact of life in the healthcare sector. And maybe the benefit of that is that there's more people suffering and burnout in the medical field than almost any other field. And maybe the mass robotisation of certain tasks will allow the hospital staff, again to focus on the things that matter.

I think there you will see another acceleration, clearly, robots cannot become sick.

Tom Ravenscroft: That being said, when you build your hospital in Qatar will it broadly look like a hospital?

Reinier de Graaf: I can't say too much of it, but all I can say is that the appearance will be an extremely interesting mix between tradition and future, between the primordial and the futuristic. It almost aims to be a fully autonomous complex, that also reduces the dependency of the whole hospital system on the supply chains, on external factors, etc.

It will look like it could be built on Mars. Nevertheless, it will look remarkably familiar in the Islamic culture.

Tom Ravenscroft: But this is more than just a mental exercise?

Reinier de Graaf: Something like the video emerges in tandem with us being confronted with all of those things. I mean, it's not like we withdraw in a room and then we come up with a kind of visionary strategy; in a way the video is a form of communicating insights that we gain when we're actually doing this and progressive insights where we're actually doing this.

Tom Ravenscroft: Do you think that hospitals in particular, and healthcare has been stuck in a bit of a kind of rut of continuing down the same path?

Reinier de Graaf: I think the fact that people ask us because of our ignorance is very much a symptom of that.

I mean, they're apparently willing to take the risk to take on a firm that is inexperienced in the sector, I think is an indication of how much the sector itself feels that it's stuck.

Tom Ravenscroft: It's kind of amazing that OMA is being asked to design hospitals because it is such a complex building.

Reinier de Graaf: It really puts architecture to the test because the stakes are so high, you know, people die. And in that sense, any architectural frivolity or any kind of frivolous argument very quickly runs into a very hard test.

The nice thing is when you design a hospital as an architect, you have to be incredibly hard on yourself and also have to really scrutinise your own preoccupations and your own idiosyncrasies in a way because things need to happen a certain way. It's really a functional machine.

Tom Ravenscroft: You've got to take the arrogance of the architect out of it?

Reinier de Graaf: Yes. Which is very good therapy for us.