This article is from WeChat public account: Yixi (ID: yixiclub) , author: Hao race, Associate Professor of architecture and urban planning Institute of Beijing University of Civil Engineering and architecture


100 years ago Mr. Wu Liande said, “Beijing, as the first district of goodness, has been noted in the outside world, but hospitals that seek beauty and beauty are not available.” A hundred years later, has the environmental quality of hospital buildings in our country improved?

2020.03.21 Beijing

I am very nervous. I heard that 80,000 viewers are watching the live broadcast. Hello everyone, my name is Hao Xiaosai from Beijing University of Architecture. Because I worked in the design institute for a period of time before designing as a teacher and designed many hospital buildings, I often call myself a “medical architect”.

“What is a good medical building?”, this topic was given to me. In fact, I am very resistant to this problem in my heart, because in the field of medical architecture, we have excellent seniors like Dr. Huang Xizhang and Academician Meng Jianmin. Your technical drawings are completely public.

Compared to them, the work I do is insignificant, so let me stand here and tell you what a good medical building is. I am actually very embarrassed. What I want to explain is that today IHere I just share some of my own thoughts and insights on medical architecture in design research, and communicate with you.

History of hospital buildings

This picture was taken when SARS broke out 17 years ago. My colleagues and I were at the SARS designated hospital in Xiaotangshan. The man in the middle is Dr. Huang Xizhang, chief architect of Xiaotangshan Hospital. After SARS, the drawings of the hospital were collected in the Capital Museum and sealed up as historical events. Unexpectedly, after 17 years, the drawings of this hospital were used again.

Whether it is Xiaotangshan Hospital, Vulcan Mountain or Raytheon Mountain Hospital, the construction of this emergency infectious disease hospital is actually a very traditional method formed by humans in the process of fighting infectious diseases countless times. That is to say, infectious patients are collected and treated in a place away from healthy people, but compared with ancient times, our contemporary medical technology is developed. We can also try our best to provide a zero infection for medical staff through architectural design Safe working environment.

McNeil said in “The Plague and Man” that infectious diseases exist before humans and will coexist with humans forever. In this case, we really need to think about what life will be like in the future and what hospital construction will be like in the future.

Let ’s take a look at the history of our national hospital building. The modern hospital building in our country was passed from the West. When the state gate opened in the late Qing Dynasty and the early Republic of China, with the spread of medical missionary and western learning, there was a A large number of hospital buildings built by foreigners.

▲ Peking Union Medical College Hospital (1919-1921)

▲ Wuchang Tongren Hospital (1916-1918)

Beijing Union Hospital and Wuchang Tongren Hospital are both built by Westerners. This kind of hospital is called the “Nightingale Model”. In the West, the earliest hospitals were affiliated with religious facilities. Such hospitals will be arranged around the needs of religious ceremonies.

How did it change later? In the Crimean War, there were two hospitals, the first field hospital, and the fatality rate of its wounded and sick was as high as 42.7%. After careful design by engineersFor example, the building ’s natural ventilation effect is better, it can provide fresher air, expand the bed spacing and other measures, and the patient ’s lethal rate drops to 3%.

The famous British nurse Nightingale participated in the rescue of the wounded and sick in this war. She wrote a summary of her observations. After that, her views on the hospital’s architectural design were spread, which affected the construction of a group of hospitals. This model of hospital construction was later known as Nightingale hospital . being widely used. The Nightingale hospital responded to the health needs, and the hospital building got rid of the status of religious attachment and developed into an independent building type.

Let ’s look at another example. For the general hospital building, as the hospital continues to operate, its different departments have shrunk or developed. Take the last SARS, for example, we need to establish a hot clinic in SARS, and this time in the new coronary pneumonia period, we also need to build a CT in the hot clinic. After observing this phenomenon in the general hospital, British architect John Weeks proposed the design theory of “machine-to-machine architecture”.

▲ “Machine Change Architecture” (Indeterminate Acrhitecture)

A long and wide main corridor connects the isolated functional departments of the building, and at the same time, there are many loose spaces in the middle that can grow freely.

In this way, when the hospital building is added, the adjacent functional departments can be arranged nearby instead of seeing the pins. Otherwise, it will accumulate over many years, and the same functional department may be distributed in two buildings that are far apart, which will cause a lot of trouble for medical staff and patients to communicate with each other.

In John Weeks’ view, the complete rational form is the demand of architecture, not the demand of hospitals. So this hospital building, this design work of John Weeks, looks inconspicuous in the architectural design pile, and has no elevation, but it has become an influential generation of architectural works because it responds to the essential needs of the hospital ’s “growth and development” A landmark work.

▲ Northwick Park Hospital, London, 1966-70

Whether it is Nightingale-style hospital or John Weeks’ “machine-to-machine architecture”, we can see that the creative ways and methods of this type of hospital architecture solve the common problems faced by many hospitals, which affects A community of hospital buildings.

Teaching to contemporary hospitals

So what is the situation in contemporary hospitals? Whether I communicate with my colleagues in life or in hospital research, I hear most of the complaints about the hospital.

This is a photo I took at Beijing Children’s Hospital. I often take my daughter there to see a doctor. First of all, we feel that people are crowded.

▲ Beijing Children ’s Hospital

Wait until it is no longer squeezed, and then run off his leg in the hospital, when he is tired, he has no place to stay.

In addition, there is a large amount of pathological information in the hospital, and it is not said whether this pathological information will cause psychological discomfort. First of all, it overwhelms a lot of useful information, such as how to go in the department, how to do the process, This information is overwhelmed by massive pathological slice information.

For this reason, many contemporary hospitals have also made many efforts.

This hospital replaced the posters with light boxes and electronic displays, so this kind of light box display can really helpIs it easier for patients to find a doctor in the hospital?

Some hospitals have also set up intelligent robots in the entrance hall to replace the services of manual doctors. Then can these intelligent robots really help patients solve the difficulties of finding directions in the hospital and the complicated route of treatment?

One hundred years ago, Mr. Wu Liande said, “Beijing is the first district of goodwill, but it is not the only hospital that seeks a beautiful hospital.” A hundred years later, has the environmental quality of hospital buildings in our country improved?

Introduce here, Mr. Wu Liande was a character like Academician Zhong Nanshan when the outbreak of rat plague in Northeast China in 1911 was the hero of the anti-epidemic at that time. He introduced Western medical concepts to China, effectively controlled the Northeast plague, and at the same time used the incident to make Western public health concepts popular.

▲ Wu Liande, public health scientist, 1879-1960

The building quality of the hospital is not high, if it is usually just to make people feel bad about medical treatment, when the outbreak occurs, this medical experience also hides another risk.

In the recent outbreak of new coronary pneumonia, many online news will publish the medical trajectory of the diagnosed patient. An example of these medical trajectories is an empirical test of a broken leg in the hospital.

We take this patient as an example, this is a patient in Tianjin, and he alone led to the isolation of 973 people. His medical behavior in the Tianjin hospital was like this: he spent two and a half hours in the hospital and spent time in eleven spaces.

▲ Trajectory of a patient in Wuqing District People ’s Hospital of Tianjin

One of the points to note is that he strayed into the X-ray room while filming. We know that new coronary pneumonia needs to be filmed, but for ordinary people, whether it is X-ray or CT, it is filming. Hospitals often place X-rays in radiology departments and CTs in imaging departments.

Our medical architects are very familiar with this operation. It is out of the need of hospital management, but for ordinary people, they do n’t understand, so they say that the patient wants to go to the CT room, but it becomes X-ray Increased risk of infection.

This hospital’s treatment process is like this, it seems to be relatively simple.

▲ Flowchart of Medical Treatment in Tianjin Wuqing District People ’s Hospital

But in fact it omits the fifth step, which means that the patient has seen the doctor. After the doctor ’s diagnosis, whether the doctor wants to draw blood, do a B-mode ultrasound, or take a CT film, the doctor wants to bill the patient of.

Especially in the situation where the contemporary doctor-patient relationship is so tense, in order to avoid diagnostic errors and avoid unnecessary disputes, there are more items for billing examinations. This part of the examination is actually the patients running in the hospital The main reason for the broken leg.

What do medical architects do? In the medical architect’s drawings, the design of the patient’s consultation route is a standard drawing. I randomly found a copy here for everyone to see. In this drawing, the medical architect draws the process of the patient entering the hospital from the hospital, registering, and then going upstairs, after asking the consultation desk, and seeing the doctor in the consultation room. Only such a step was drawn.

The students and I tracked the patients while we were investigating in the hospital. We tried to draw the route of the patients running back and forth in the hospital after seeing the doctor. Later, we found that the distance of these patients from various examinations, from one department to another department, from one building to another building, this flow line is really too complicated, it is difficult to express in this way .

Let ’s take a look at the layout of the entire hospital. The layout of hospitals in our country can be referred to as a three-division layout, that is, there are clinics, medical skills and inpatients. Among them, the outpatient and hospital are placed on both sides, and the medical skills are placed in the middle.

This form of layout has laid roots at the beginning of the formation of the hospital. After the development of medical technology, doctors gathered in the hospital to diagnose and treat patients. They can share the hospital ’s high-precision and sophisticated equipment, reduce the cost of treating patients, and treat more The patient, that is to say the doctor does not move, the patient moves. Some doctors are in charge of diagnosis in outpatient clinics, some are in charge of blood drawing and inspection reports in medical technology departments, and some are in charge of inpatient departments.Rounds, and patients transport themselves on this industrial assembly line.

Under the premise that the core goal of the hospital is management efficiency, no matter how much work the architect does, it cannot solve the problem of multiple round trips for patients in the hospital. So what contemporary architects can do is to arrange some departments nearby, such as the adjacent layout of the B-ultrasound department of the obstetrics and gynecology department of the outpatient department and the medical technology section, the operation department of the medical technology department and the ICU adjacent layout of the inpatient department Wait, but this layout still cannot solve the problem of multiple round trips.

When I first became an architect 20 years ago, the architectural layout model we used was the trisection. Twenty years have passed. In recent years, I have served as a judge for the “China Hospital Construction Award”. After reading many hospital building designs, I find that today’s architects are more and more skillfully using this three-division layout. Too.

▲ A 2600-bed hospital in Nantong, Jiangsu Province, 390,000 square meters (Gresham Smith)

If the core goal of the hospital is still management efficiency, this three-division layout has not changed. Although some hospitals adopt the method of inter-hospital or MDT multi-outpatient center, it is still a trisection in nature.

In addition to running a broken leg, the hospitals in our country have a problem of crowding people. This is the feeling that many people have. Inside the hospital, the halls, wards, and passages are overcrowded everywhere. When we were investigating in the hospital, the doctor was miserable and asked us, The viaduct has design bearing value. Isn’t it in the hospital? Why are people everywhere?

▲ Statistics of outpatients in Beijing hospitals (partial) (2016.12)

Of course, hospital buildings also have design values, but in actual use, the actual outpatient volume often exceeds the designed outpatient volume. When I was researching in Tongren Hospital two days ago, the relevant person in charge of the Infrastructure Department of Tongren Hospital told us that the design amount of their outpatient service was 3,000, but in fact they were 10,000 at the peak.

Why does this happen? Because In our country, the graded diagnosis and treatment system is not perfect enough , no matter it is a serious illness, patients tend to go to a big hospital. According to a survey conducted by health institutions, 80% of patients in large-scale top three hospitals can solve their problems in small medical institutions in the community, and only 20% of patients with intractable diseases, they really need to use large Services of the top three hospitals.

Another factor is that our country is a human society, which means that if someone is sick, family and friends must accompany them, otherwise it will be too ruthless. So a sociologist summed up this phenomenon as: When a person becomes ill, the whole family is hospitalized.

In addition to the characteristics of human society, there is actually a very real problem in our country, that is, shortage of nurses .

This picture shows the ratio of nurses and midwives per 1,000 population in our country compared to other countries in the world. Our country is much less than developed countries in the West and Asia.

▲ Number of nurses, midwives, doctors and beds per 1,000 population in China and other countries in the world

(Data source: World Bank official website; China Statistical Yearbook)

In this shortage of nurses, 50 people are hospitalized. At least 50 family members and caregivers are required to complete some care work in the hospital, complete the work of sending samples and taking care of their errands. In this case, although 80% of patients do not need to come to this large top three hospitals, the large top three hospitals are still expanding on the basis of more patients.

When I worked 20 years ago, an 800-bed hospital was a large hospital. Until now, a 3,000-bed hospital was considered a large-scale hospital.

Now the hospital construction in our country has entered the era of large hospitals. This era of large hospitals was criticized by Western countries in the 1980s. At that time, critics determined that this was a mistake in the industrial era, and China ’s current large hospital construction has repeatedly More than killing, the bigger the bigger the bigger.

This is a Xiangya No. 5 courtyard, which started construction in 2016, with 520,000 square meters. The designer of this hospital explained to us that they are the fifth hospital of Xiangya, so they put two “5” characters and used these two “5” characters to make the form of the building.

▲ The 5th Xiangya Hospital, 520,000 square meters, 5 billion total investment, 2500 beds

Some hospitals have a lot of convenience measures. For example, Tiantan Hospital uses a convenience shuttle bus. This is very similar to the airport. The airport is also a large public building with a large flow of people and a long walking route.

▲ Convenient shuttle bus for Beijing Tiantan Hospital

An architect also proposed such an idea, whether they could make trolleys for transporting rails in hospitals, which would also reduce the chance of infection. This is not feasible in our country, because people crowd, this kind of hanging rail car will only be jammed on the traveling route like a traffic jam.

▲ hanging rail transport trolley

When I was investigating the problem of hospital construction, more than 50% of patients told me that they thought that the problem of the hospital was that the route was too long, as was the case with large hospitals and old hospitals, and with small hospitals because of the process Too complicated, or easy to get lost in a strange space, can not find the place you want to go, will also cause the growth of medical treatment routes, unbearable.

I asked them, what do you think of a good hospital? Nearly 400 people gave such an answer to hope that the hospital’s function is efficient.

The patient drove to the hospital for an hour and waited for 40 minutes. The doctor told him 5 minutes, of which maybe two minutes were saying, you take this list downstairs and turn to the right to go for examination, after Where to go to take a picture, come to see me after getting the report result, I will prescribe medicine for you. Western research proves that in fact, on the issue of hospital guidance, a large number of professionals are wasted a lot of professional time every year. This is a problem that should be solved in architectural design.

Good wayfinding design

A team in the United States has done six years of research, and their perspectives are very different. They went down from the perspective of God based on management efficiency just now, down to the perspective of people. Starting from home, how to get to the hospitalHow to find this building, how to find the consultation desk after arriving at this building, and finally to the doctor’s office, walked through it completely, struck all the questions. Then study how to solve these problems through architectural design.

They not only wrote this result into a book, but also opened a design company based on it, to analyze this kind of path finding problem in the hospital, and put forward an improved design plan. The company opened very well. In their research, it was found that the pathfinding design does not simply equal the identification system.

Because this research was done earlier, it was done in the 1980s, so in order to understand the contemporary problems, I took the graduate students to go to the hospital for a look, to see if our current pathfinding design is still There are problems like the 1980s.

We went there and found that many hospitals in Beijing are equipped with navigation apps. Can the navigation apps solve the problem of difficult pathfinding? We found that no. Whether it is a navigation app or manual guidance, if this space does not allow you to describe it clearly, the effect of any tool you change is the same.

When we were in the Temple of Heaven Hospital, we used its navigation app to randomly order a department. This app told us that we should turn right 50 meters ahead-we were blinded inside, and we do n’t know how far we go. Meters, and there are so many in front, how should I turn? So this is a problem that cannot be solved by navigation alone.

In fact, this study gave a series of proposals. It suggested that we should start with elements such as site design, architectural design, logo design, guide map design, etc. to make a systematic solution. Because there are some elements involved in the architectural design profession here, which is very special, I will not go into it. I will only take a few easy-to-understand examples from it and talk about the importance of this wayfinding design.

First of all, let ’s take a look at the corresponding problem between the guide map and the actual space. If the upward direction of the guide map is consistent with the direction of the patient who is using the map, this map will be easily affected.The author understands that otherwise, it will be a mess, then this map will have no effect.

▲ The guiding direction is consistent with the patient ’s direction of travel

At the same time, this guide must also be valid. I took a lot of pictures in many hospitals, and I randomly found two to show you. There are a lot of invalid information here. For example, in the instruction map of the Temple of Heaven, all the icons are circular and there is no difference in size, so it is difficult for you to quickly find your location.

▲ Invalid guide map: information is complicated

The location in this guide is not clearly marked. Then it marks out a lot of useless room information for you, but when you are looking for a way, what do these spaces look like and what is the corridor between them? These are useless to you.

For comparison, I will show you the correct map. It should indicate the route you want to move forward, and then mark the area name. As for when you get there, there is a nurse station and a registration desk, and then you will find the room you want to go to during the first and second waiting, so the specific room on this picture does not need to be identified.

▲ Effective guide map: concise route

Not only the map, but the space should also be some echoes with the map. In this case, this corridor has no features, it is of equal width, but in order to indicate its location, the designer put a very bright lamp here, and also marked the star lamp on the map. Location, the patient can easily find the location of the corresponding map where he is in such a space.

▲ Space nodes correspond to map information

In this hospital, it made a lot of such nodes to mark, in addition to the star space, there is a tree-shaped space, it put a huge tree in a public space, and also painted the pattern of this tree in On this map, you can easily find where you want to go.

In addition to the methods just mentioned, there is also the practice of using skylights and lights to highlight the information desk. This is a German hospital. In this picture, the doctor’s desk is easy to find.

In this hall, the patients most want to know is where the elevator is, so in a white atmosphere in the background, they painted the location of the elevator in very bright colors, it is easy to find, without asking Anyone can find the functional area they use.

This is a photo I took in the United Kingdom. The United Kingdom posted huge X-ray pictures of daily necessities in the corridors of the radiology department. Words, so that patients can easily understand.

This is also a hospital in the United Kingdom. He wrote the number of the office with a large number beside the office, which is taller than people and can be seen far away.

Our country is also using this logo to solve the problem of finding a way for everyone. This is an illustration of Beijing Tiantan Hospital.

However, the environment of a large number of hospitals still lacks self-clarity. This is very common. The natural light of smallpox, including this environmental color, does not tell us what is used in this environment.

There are also inpatient halls made of this kind of hotel. Some patients were surprised and took pictures, but the information was also self-evident. When I was doing research, some patients in economically underdeveloped areas told me that they felt very uncomfortable in this hotel-like space, and felt that they had to pay a high cost to see good illness.

In addition to the problems that need to be solved in the design just mentioned, there are some cases where the design is done well, but the management and use process has caused “difficult to find the way.” Let’s take a look at the phenomenon of correct design misuse.

We know that the medical main street is a large traffic corridor for a large number of people to pass through. In the western medical main street, it is unobstructed and very transparent, from the entrance.To all departments is such a very large large corridor.

In our country, this is the interior rendering of Peking Union Medical College Hospital. At the time of design, it also gave it an unobstructed large corridor. This is the entrance space. There is nothing in front. There are many waiting seats on the side of the large corridor.

▲ interior renderings of Peking Union Medical College Hospital (AREP, France)

When it was completed, the waiting seats were not made. I made one, one, and a shadow wall. There were shadow walls at the entrances and exits at both ends of this medical main street. Some patients took photos there. Very blocking the route of travel.

This kind of shadow wall practice is not an example in our country. When I visited a large hospital in the south, there was a shadow wall. It was not a half-wall type, it was from the ground.All the way up to the ceiling, a strong wall was built.

I was accompanying a Dutch architect to visit a hospital in Shenzhen. He did n’t understand it. He said that a good passageway is convenient for people. Why is there such a big wall? The architect who accompanied us to visit at that time, he participated in the entire design process, he said that southerners are more feng shui, so to do such a wall block.

Hospital safety

Also, you are in the hospital, the map is understood, and you can hear clearly wherever you go, but after that, the road is blocked and the door is closed. Why is this? This has happened in the projects I do, and I called it “three doors designed, two closed”.

After the operation of this hospital, I went back and found that the doors of the inpatient department and the emergency room were all blocked, leaving only one outpatient door, which they called the main door.

I designed the three doors at the time to think that there are many visitors in the inpatient department. They are healthy people. They must be distinguished from the outflow of outpatient and emergency departments. The possibility of the patient, so it must be separated. But in actual use, they were all sealed up, leaving only the outpatient clinic for all people to flow in and out.

I am very strange, so I asked the director of the hospital why these two doors are blocked? The dean told me that we have moreTo open a door, you need to hire a few more security guards. I will calculate an account for you. How about the 24-hour shift? After the calculation, I have to pay 600,000 more a year, so I have to close the door.

Like other buildings, hospitals also face the need for public security management, and unlike other public places, hospitals all over the world face a problem of conflict caused by doctor-patient disputes. However, in the task book of architectural design of our national hospital, the needs of public security management are absent.

In order to facilitate public security management, the hospital locks the door and blocks the passage, so no matter how efficient and convenient the hospital building designed by the architect is, it is not easy to use.

In 2012, there were police in 50 hospitals in Beijing. In the Lilac Garden, thousands of doctors have put forward thousands of opinions on the prevention of violence in medical places, and more than ten of them are about the hospital building design, so we have to consider that the hospital not only has the safety of natural attributes span class = “text-remarks” label = “Remarks”> (Safety) refers to the need for anti-skid, electrical safety, and cross-infection prevention. It also has social safety (Security) needs.

In western countries, like the United Kingdom, in the 1990s, they conducted extensive research on how to prevent crime through architectural design. Based on the research results, they formed such a design guide-“Anti-crime Design: Strategic Methods of Hospital Planning and Design. In addition to this guide, the British Sheriffs Association has also published a guide to the safe design of hospitals.

▲ “Crime Prevention Design: A Strategic Approach to Hospital Planning and Design”, United Kingdom, 1992

What about the United States? The United States released the “Guide to the Safety Design of Medical Buildings” in 2012, and made a revised version in 2016. At present in the United Kingdom, Canada, the United States and other countries, the police will intervene in the early stage of urban planning and architectural design. Architects must not only report the blueprint to the fire department, but also to the police department. Suggestions.

▲ “Safety Design Guidelines for Medical Buildings”, United States, 2012

In this new coronary pneumonia epidemic survey of existing hospital buildings, we also found this. For example, the use of a two-zone, two-channel design in an outpatient clinic is conducive to safety. Let’s take a look, it not only reduces the risk of cross-infection, but also helps doctors protect themselves in extreme situations.

If the doctor is suffering from conflicts and disputes, the doctor can run back to his own area from the exclusive channel behind, which can be safer. This is also a recent survey, which is also reflected by many medical workers. The reason why this design is better.

Party A

There are some places where our architects have n’t considered the design. In other cases, the architect is very professional, but this professional design may not be adopted by the owner, and the builder may not choose your professional advice. For example, when I was designing in a hospital, Party A asked me to make blue glass, but blue glass actually interferes with the doctor’s diagnosis.

During the diagnosis, the doctor needs to see if there are allergic reactions, what is the situation on the body, how is the skin color, and how about the lip color, so the colorless transparent glass is convenient for the doctor to make a correct diagnosis, so this hospital Of course unreasonably asked me to refuse.

Another request from some hospitals is that when you plan and design, the door of the hospital cannot open to the west. It thinks it is unlucky to return to the west. Some hospitals have put forward more excessive requirements. It feels that the outpatient department is too short. It is necessary to move the tall and beautiful inpatient department to the front of the hospital. When entering the hospital, go to the inpatient department and then to the outpatient department. This process It is completely screwed.

His reason was that he could see a tall inpatient building in their hospital from a distance on the street. He spent so much money that he could not see anything on the street. In response to this requirement, of course, we are professionally committed and cannot agree.

In fact, the owner has a long history of interference with architectural design. Back a hundred years ago, Mr. Wu Liande felt that there was no good hospital in Beijing, and the construction of hospitals all over the country was built by foreigners, so he proposed to build a Chinese own hospital, and to imitate the latest and best in the United States The hospital was built, so he asked Harry Hussey, an American architect, to make a Victorian hospital. This hospital is the Beijing People’s Hospital.

And Rockefeller Group was building the Union Hospital in the same era. In order to avoid the Chinese people’s repulsion of Westerners, they asked Harry Hirsey to design the hospital in Chinese style, because the form of this building does not affect the internal use, so Harry Hirsey agreed Too. In the same era, the same city, and different owners, the architectural forms they proposed are completely opposite. This is a very interesting case.

In some hospitals, Party A ’s requirements for the appearance of the hospital are beyond what we can bear, and it will affect the medical function.

When we were bidding for this hospital, the hospital leaders asked us to make an ingot-shaped hospital design. I asked him at the time, were there any other requirements? The dean said, if you don’t have it, just make an ingot shape, the more like the better.

If Mr. Wu Liande lamented that the hospital construction in China is not good, and built a Western-style hospital in order to make Chinese hospital medicine as developed as in Europe and America, then for what purpose did this hospital lead him to pursue an ingot shaped hospital ? Is he in an area where the economy is very developed and business thinking is very active?

It ’s not. The environment around it is like this.

Building an economical hospital

Sociologist Professor Li Qiang did a study on the social structure of our country, this is a picture he painted. If the ideal and healthy modern social structure is this type of olive society, there are few rich and poor people, and most of them are middle class. After analyzing, he found meOur country is inverted “D” font.

Later, he did a study using the latest census data, corrected it, and drew a short horizontal line in the middle, which increased the middle class. The long line under the “D” shape is the low-income class of our country, which is dominated by migrant workers, so there are not many rich people and middle class in our country. A large number of migrant workers and low-income class .

▲ Illustration of China ’s population structure (Source: Li Qiang. How far is China from an olive society–a sociological analysis of the development of the middle class [J ]. Exploration and Contention 2016 (08).)

What kind of hospitals does this group like to see? In my research, I found that there is such a Huimin hospital in Beijing. What is Huimin Hospital? It is government subsidies that the top three hospitals come to this hospital to rotate. In the case of the same medical services, this hospital charges only half of the fees of a large top three hospital.

Many migrant workers come to this hospital to see a doctor. The most they see is the obstetrics and gynecology department. why? Because for migrant workers, they can catch a cold and eat a few tens of dollars of medicine. But having a baby is a big deal, often thousands of dollars, which is an unbearable huge sum of money, so they all choose to have children here.

Let ’s take a look at Western countries. In the 1960s, the United Kingdom was studying how to build hospitals economically, from the earliest Best Buy to the last Nucleus hospital.A number of experimental hospitals have been built, and if everyone evaluates the experimental project well, it will be promoted nationwide.

For example, Nucleus Hospital, which has built more than 130 in the UK. In this process, they also did a lot of hospital research, such as how to transfer medical services to the community to reduce the use of hospital buildings, or several hospitals shared some equipment to reduce the invalid expansion of the hospital scale, reduce some Necessary space and so on, through these measures to reduce the scale of hospital construction, the slogan of “Best Buy” is to use the money to build a hospital to build two. Of course, this is the slogan, which was not achieved in the end, but the construction cost of this hospital has been reduced by at least 1/3 compared with ordinary hospitals.

▲ Best Buy hospital model in the UK: build two with the money to build a hospital

The construction idea of ​​this kind of economic hospital in the last century has continued till now. This is a contemporary British hospital building. As we can see, it is actually painted only, mainly through design techniques to create a better diagnosis and treatment environment. This is a picture of the appearance of the hospital, it is paint, and the shape is very simple.

▲ Economic Hospital Building (UK)

The same is true in the Netherlands. The appearance is very simple, and the space inside is very touching. This is just using paint, which is a very elegant environment.

▲ Economical Hospital Building (Netherlands)

Hospital digestion

Contemporary western put forward the concept of “hospital digestion”, which is different from the thinking of building cost in the 1960s and reducing the cost of a single building. It puts its eyes on a larger pattern.

We know that one ounce of prevention is better than one pound of treatment, so Western countries have already launched a large number of preventive, or rehabilitation, or community-based prevention and control-type medical facilities. The number of people using the hospital is minimized.

They put forward a slogan that is from large and closed medical cities to small and scattered urban medical institutions , a large number of small medical facilities are built to reduce the number of hospitals from the source of construction Construction.

In this case, fewer people use hospital services, and the focus of hospital services changes from management efficiency to patient-centered. With fewer people, they can concentrate a small number of patients on Diagnosis and treatment of one piece, outpatient examination and hospitalization are on the same floor, all solved in one room.

So their current hospital can fully realize the patient-centric layout, coupled with the designer’s efforts, their new hospital is such a patient-centric, truly people-oriented hospital design.

This picture shows a comparison of cases between our country and the Dutch hospital. The Concord Hospital was built relatively late. In 2012, compared with the Dutch hospital, it adopted a three-division layout, which is one of the excellent hospital building cases using the three-division layout. However, it still failed to adopt a multi-center layout, which seems to be lagging behind, because the hospital’s goal of centering on management efficiency has not changed.

This hospital in the Netherlands is very well done, and it has many commendable points in its design and has won many awards.

The orange part in the middle (right 1) is the main medical street, the large corridor is curved into a “back” shape, and the surrounding gray The part is the diagnosis and treatment room, the patient only shuttles back and forth in the orange part, and enters the gray part if necessary, forming a non-practice layout, which reduces the cross infection rate.

The picture in the middle shows the distribution of this hospital from the first floor to the fifth floor. Why is it painted in different colors? It is meant to meet the needs of the hospital for shrinking and shrinking, and they arranged the different treatment spaces adjacent to each other.

For example, the red color, the red color part is called a hard space. The hard space is equipped with ICU, CT or operating room, which has large-scale diagnosis and treatment equipment, and has high requirements for environmental conditions. It is not easy to move the department, so they need to grow. During the expansion, the green department like the adjacent department was removed. The green part is called soft space, and it is only used to accommodate those warehouses or office houses that are easy to move.

At the same time, in order to facilitate the adjustment of the hospital space, they also made the same height. They made a slightly loose design. For example, some building space needs three and six meters is enough, and some building space needs four and two meters, they will make this space to four meters two storeys, In this way, the upper and lower layers can also be converted.

This hospital is used by more peopleThe less came, so they vacated part of the space and sublet it. In order to facilitate subletting and maximize the real estate benefits, they do not look like a hospital in appearance, and can be transformed into other public facilities with little or no changes.

The following picture is its internal environment. They used a picture to represent a special feature of this department. This hospital is in a port city, so they took a lot of photos of the port in this city, which is convenient for elderly patients to remember and use the space.

A good hospital building is bottom-up. As just said, it requires architects to work hard to solve the problems of medical flow, pathfinding design and safety design, more tolerate the needs of patients, and needs fault tolerance. With frailty. It is also top-down and requires changes in the hospital’s social environment.

When our hospital is truly transformed from management efficiency to serving the needs of patients, I think our society will have better hospital buildings.

By that time, to borrow Dr. Wu Liande’s words, our National Meibei Hospital is available everywhere, and all are set up by the Chinese.

Thank you.

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This article is from WeChat public account: Yixi (ID: yixiclub) author: Hao race, Associate Professor of architecture and urban planning Institute of Beijing University of Civil Engineering and architecture