Healthcare infrastructure globally is under immense pressure due to the growing demand for quality healthcare services. Over the past few decades, as the population continues to soar, the burden on healthcare systems has begun to pile up. This has compelled healthcare planners and policymakers to future-proof the healthcare infrastructure whilst ensuring sustainability and resilience in the healthcare systems. We have also witnessed rapid urbanisation and the emergence of new construction materials and technologies. While green buildings and energy-efficient technologies promise to reduce carbon footprint and create a healthier built environment, we are beginning to see the irony of what building so-called ‘sustainable’ infrastructure entails, practically. On the other side of the spectrum, the pandemic brought forth the functional inadequacies of healthcare infrastructure across the globe and imposed an urgency to ramp up and build high-quality infrastructure swiftly.

Today, as we find ourselves amidst a health and climate crisis, the question arises – to build or not to build?  To make this decision, it is essential to recognise the several challenges faced by the healthcare infrastructure in meeting the demands of the growing population. Some of the key challenges are:

Current state of healthcare infrastructure: The world's population is projected to reach 9.7 billion by 2050, so existing healthcare infrastructure is incapable of accommodating the growing population.

Many healthcare facilities were built decades ago, and they lack the modern amenities, technologies, and proper infrastructure to house the advanced equipments to respond to the demand. The scarcity of improved healthcare infrastructure leads to a rise in the cost of healthcare. Healthcare planners need to curate a frugal yet effective model of care delivery as the cost of healthcare is surging acutely.

Stressed doctors and caregivers: Personnel shortages and burn-out is one of the most pressing concerns among healthcare providers today. Strategies to promote conducive spaces and strategies that minimise stress and enhance efficiency for caregivers must be adopted while designing healthcare facilities.

Tech-disruption: Careful identification of appropriate technology amidst an exceeding volatile tech disruption whilst ensuring seamless user experience, ease of operation, high efficiency and data security becomes an important consideration.

Limited resources: Many countries have limited resources to invest in healthcare infrastructure, making it challenging to upgrade facilities to meet the growing demand for healthcare services.

Climate change: Climate change is a global challenge that impacts healthcare infrastructure. Extreme weather events, such as floods and hurricanes, can damage healthcare facilities, disrupt supply chains, and affect the delivery of healthcare services. Planners need to consider these factors to prepare buildings for such emergencies.

Recognising the interconnectedness between the planet and our health, it has become critical for us to explore long-term, sustainable building solutions. As a result, architects are now focused on designing medical facilities that are both sustainable as well as pandemic and future-proof.

Sustainability and healthcare

Lately, adaptively repurposing and reusing existing structures has been a successful endeavor for several industrial and commercial projects, significantly cutting down construction costs and time. Making its way into the healthcare industry, ‘adaptive reuse,’ although deemed a skeptical concept initially, is gradually gaining meaningful acceptance. A hospital’s design specificities often pose a challenge to effectively repurposing an existing structure for efficiency and safety. However, with careful consideration and meticulous planning, this approach offers financial, environmental, and communal benefits. While an adaptive repurposed hospital can provide high operational efficiency, a few fundamental design decisions can offer adequate resilience and flexibility during times like the COVID-19 pandemic.

Building sustainable and resilient hospitals requires a comprehensive approach that considers the needs of the community, the environment, and the healthcare workforce. A sustainable design for resilient hospitals should be capable of responding to extreme weather events and pandemics. The design must incorporate backup generators, water filtration systems, and ventilation systems to ensure that hospitals remain operational during emergencies. Hospital planners must integrate suitable modern technologies such as artificial intelligence and digitisation of services along with sustainable practices like solar energy provisions, energy efficiency, repurposing of structures, waste reduction and water-saving techniques to reduce operating costs and improve community health.

Pandemic-proof design

Principally, for a hospital to be resilient against any unprecedented adversity, it must focus on three crucial aspects of healthcare planning – triaging, segregating and surging capacity. Triaging and segregation require a carefully planned Emergency Department, which immediately screens and secludes infectious patients within the facility, thus minimising the risk for caregivers and uninfected patients. Segregation refers to the physical separation of spaces and the mechanical isolation of air conditioning systems. This separation could be slightly challenging in areas where the segregated zones do not have separate air handlers – causing return air from the infected zones to recirculate into other hospital areas.

Surging capacity requires additional beds and carefully factoring for the 4 S’s - staff, stuff, structure, and systems. Therefore, resilient healthcare design constitutes facilities that are employed with the requisite infrastructure and planning with flexibility to escalate their bed numbers while ensuring optimal areas for additional staff and medical paraphernalia. The design impact of such provisions for resilience is based on the factors like ease of expansion for healthcare operators or managers, ensures preparedness in advance which is also cost-efficient and enhances the quality of care even in times of an unprecedented adversity and does not affect the project costs at large, hence is a cost-effective approach to future-proofing hospitals.

Future-Proofing Global Healthcare Infrastructure

Most of the healthcare design notions are still based more on experience, intuition, and hypothesis and lesser on research evidence. The concept of data collection, post-occupancy evaluation and evidence-based design (EBD) is highly concentrated in the West. There is hence a need for more local data collection, analysis and research which could help curate high-potency ‘Glocal’ responses.

Future-proofing healthcare infrastructure requires a long-term vision and investment in modern technologies, sustainable practices, and resilient infrastructure. Hospitals should broaden the healthcare horizon beyond buildings to institute a healthier, more resilient population with better endurance against infections, ailments, or future pandemics.

Achieving this will involve re-orientating the healthcare system to incorporate the following factors:

1. Investment in workforce development: Healthcare facilities must invest in their workforce to ensure they have the skills and knowledge to deliver quality healthcare services. Workforce development programs can improve healthcare outcomes and reduce costs by improving the efficiency and effectiveness of healthcare services.
2. Collaborate with communities: Healthcare planners must collaborate with communities to understand their needs and develop impactful solutions. Community engagement can reduce costs by identifying the gaps in the system and enable more thoughtful solutions that address them. During the design and planning phase of a healthcare ecosystem, designers, developers, policymakers and other stakeholders must consider two fundamental principles – preventive health and wellness and equity in care delivery. Hospitals must focus on community integration and cultural penetration to effectuate communal health and wellness. Healthcare providers, policy-makers and designers should come together to design collaborative spaces and programs that will encourage interaction and educate the community about health and wellness, such as maintaining healthy diets, self-monitoring etc.
3. Technology integration: Technology has revolutionised healthcare delivery, and we must embrace new technologies to improve the quality and efficiency of healthcare services. Technologies such as telemedicine, artificial intelligence, electronic health records, and IoHT, etc., incite healthcare to move out of the physical bounds of a hospital building and step into homes through smart technology. The future of healthcare, like most other industries, is digital.

Healthcare futurists and researchers are now focused on orienting the healthcare system towards a physically disintegrated and digitally seamless care delivery model. The future of healthcare will collaborate with IoT, make the best use of rapidly changing technology, and manifest into an efficient model that is less susceptible to untimely collapse, claim researchers. Employing tools such as Big Data and Artificial Intelligence will allow healthcare professionals and designers to comprehend patterns out of patients' existing profiles and use them to create dynamic, iterative design layouts for reconfigurable hospitals. With the help of technology and the growing acceptance of digital interactions, patients’ health will soon be monitored by smart infrastructure remotely by doctors and nurses.

Significant strides in research and development of these schemes are underway, and the future looks promising. The involvement of tech giants is already underway, paving the way for huge investments in research and development in this space.

With a commitment to improving the healthcare scenario, with architects working in partnership with doctors, researchers and tech giants, an evolved healthcare ecosystem awaits us all.

This article was authored by Ravideep Singh, as part of the 'Expert Talk' series. Singh is the Associate Director at Creative Designer Architects (CDA), an interdisciplinary architectural practice that is an established design leader in healthcare, institutional and commercial projects. Built Environment's ‘Expert Talk’ series carries knowledge pieces every week by industry professionals who give their take on the key trends, observations, issues, and challenges in the built industry. The opinions in these articles are the author's own and do not reflect that of the publication. This is a standard disclaimer.