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Adaptive Healthcare Design for the Future

By Luís Miguel Barros, Associate Director and Architect

Several American articles have recently arisen on the lack of capacity to respond to public health ‘outbreaks’ and ‘disasters’, questioning their own model of healthcare provision and Hospitals.

In this time of global crisis, when we are all suddenly subject to a problem of disastrous proportions regardless of our class, which forces us to distance each other and, in the process, destroys the foundations of the economy as we know it, I cannot help remembering an aspect that has always been present in the numerous hospital programmes we have been doing in recent years.

In the Portuguese public programmes (resulting from the knowledge of the technicians of Hospitals, then DGIES, then ACSS) there has always been a concern to design the Network, Services, Functional Units and Buildings not only for ‘outbreaks’ but also for ‘disasters’, including the Infectiology in such parameters. It was probably a reflection of the problems Portugal encountered until 1974 (but not only…), both in the mainland and colonies.

This concern has been gradually lost over the past years, perhaps because it is difficult to justify the cost of equipped areas that apparently are useless… The financing mechanisms of Hospital projects, PPP assemblies, real estate financial return schemes, etc., do not help in this rigorous and objective analysis: one day it may be necessary and therefore we must be prepared.

The course that has prevailed is to build Hospitals that only contemplate what is now necessary and, through calculations that anticipate ‘a’ future, that are able to grow and accommodate the growth scheduled during the financing amortisation period…

A whole theory about flexibility and modularity has been created which – being essential in a Hospital – cannot handle situations like the ones we are experiencing. They are exceptional, catastrophic.

Did we, the Western Society, think we were free from infectious diseases? Over-confidence? Lack of modesty?

It is unforgivable if we do not use the ability of our health technicians, our ingenuity and technical knowledge, the public and private network itself – recognised internationally as it seems to be emerging…

We cannot forget the lessons – based on a multidisciplinary experience – that we have in Portugal, applying them to Health Buildings in a systematic way, without losing innovation in treatment techniques and new models of Hospital organisation.

Using the new outpatient care paradigm as a way to segment and ‘compartmentalise’ treatments – in case of infectious diseases – is desirable in view of the ‘concentration’ model in huge and monolithic Health Buildings, which facilitate the spread.
Include in such Buildings the ability to address the challenges of disasters and epidemics that, in a global world, become global themselves very quickly.

Maintaining what we know how to do, believing in it and exporting that knowledge, putting it at the disposal of others.

It is our responsibility, Architects, to defend, use and develop these principles, without abandoning them.

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