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Changing Hospital Architecture.

Edited by Sunand Prasad. London: RIBA Publishing. 2008. [pounds sterling]45

The title Changing Hospital Architecture could be construed as a call to arms or the study of an evolving building type (or ideally both). This book was long in the making (indeed Sunand Prasad was not its commissioning editor) and in that time there have been many developments. The book is a collection of eight essays which deal with the history and the current design of hospitals in the UK, Europe. USA and Australia. The four set in the UK deal with the post-war history of hospital design and commissioning, the architecture of the current hospital programme, the financing of this public and private investment and finally the application of current workplace design to healthcare. By far the best is the introductory essay by Derek Slow on the evolution of the NHS and hospital design. These are complemented by comparative studies of current work in the US. Europe and Australia.

Unfortunately, the book is less than the sum of its parts--the essays are written by practising architects and a financier, who were commissioned, it would appear, without a clear brief or guiding thesis. As a consequence the completed work does not have a unifying narrative to bind the chapters together and does not provide rigorous appraisal or design polemic. There is too much detail in the case studies that bulk up many of the chapters and too little explanation and analysis. Design methodologies for changing and improving the architecture of the hospital are not discussed. Since the book was not conceived as a design primer or is illustrated as a picture book, I fear that it will struggle to attract a general readership or serve as a reference work for healthcare architects. It will serve, however, as a historical postscript to the last 15 years of insufficiently considered hospital development. This is doubly disappointing. There is no building type more in need of an intelligent and cogently researched reappraisal than the hospital. Nor could any sector benefit more from a passionately argued case for better design than healthcare architecture.

Each of the essays which deal with the UK is illuminating but (here is significant overlap and repetition in both the case studies and the potted histories and sociology which star! each chapter. The case studies are classified as conforming to one of eight basic design types yet there is no comparative evaluation of these or an attempt to propose new models that might respond to patient expectation and good workplace design. This section would have benefited from a single author who might have integrated an examination of the changing politics and sociology of health with an exploration of the design possibilities of this building type, complemented by international examples and delivered with fervour.

The recent buildings for Moorfields, St Thomas (Evelina} and ACAD have gained public and professional acclaim and taken their place within the architectural mainstream. It would be interesting to examine why they succeeded where others have failed and use their genesis as a model for achieving greater design excellence. JOHN COOPER

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Publication:The Architectural Review
Article Type:Book review
Date:Oct 1, 2008
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