At its most basic level, healthcare buildings are places where people go to restore and/or maintain their health. Patients visit ambulatory care facilities for doctor visits or medical examinations, hospitals for more serious interventions, and rehabilitation or long-term care facilities for the road to recovery. At this basic level, the relationship is mostly transactions and the premises that comprise those transactions tend to be unique in themselves.
As designers, it is often our intention to design and build healthcare facilities that do more than their functions; However, most projects fail to emerge as vital community centers. To truly elevate and create our healthcare buildings within our communities, it’s time to start thinking of them as ‘fourth places’. Closely related to the concept of ‘third places’, or spaces between home and work where we may spend time communicating with other individuals (for example, in a library or coffee shop), fourth places support gathering but also a sense of inclusion where strangers of all backgrounds and viewpoints are present. They can come together for informal social interactions in public or semi-public spaces.
As a visual person, I used to see the ideal healthcare system as a pivot model, with the hospital being the hub and the amplifiers being all the mobile buildings and services that emerged from the hospital into the community. Over the past few years, that image in my mind has morphed into more of a complex spider web covering society, with relationships between buildings amplified through increased communications and services. As the lines between healthcare, education, retail and hospitality blur more and more, the types of buildings that provide services that improve public health are expanding. The web that you weave all together is considerably more complex but also noticeably stronger due to its many levels of connectivity.
This blackout occurs because building types may serve multiple functions with a common goal of improving and contributing to the health of the community. For example, hospitals can become destinations for more than medical reasons if public parks are incorporated into their design. Gyms can be linked to hospitals, not only as places for exercise and socializing but for rehabilitation, while hospital restaurants may provide a gathering place for nutrition and education. In this fourth-tier approach to design, the lines that previously characterized these types of settings begin to disappear thanks to connectivity and a common purpose.
We’ve already seen this happen in other sectors, such as grocery stores selling clothing and household items, farmers markets set up in transit centers, and airports with stores that rival retail centers. This obfuscation of individual jobs is happening at a faster and faster pace in our societies. Although health care is traditional and slow to change – and the idea of hospitals serving the needs of society in a variety of ways is not new – it is still not the norm. As we begin to think about designing the next generation of healthcare facilities to serve our communities for at least the next 50 years, it is time to ensure that they do.