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A resulting from the coronavirus pandemic reasonably well. Nevertheless, the que-
lthough the German hospital landscape was able to cope with the crisis situation
stion is justified as to what can be improved in future to prepare for such circumstan-
ces. How can the rapid and short-term occupancy of infectious intensive-care patients
be optimised? Here, the contribution hospitals could make is particularly interesting
for us. The pandemic has shown that Germany mainly has a structural problem, not
so much an architectural one. Our problem is more one of oversupply than lack of ca-
pacity – an instrument is lacking to reasonably organise inpatient care in the districts
and cities and to avoid redundancies. “Germany currently still lacks population-based
classification systems that can be used to survey medical care requirements in a re-
gionally differentiated manner,” says Professor Dr Reinhard Busse, who researches the
structures of the German health care system at the TU Berlin. Thus, at present, requi-
rements cannot really be planned in a meaningful way. The result is care structures
lacking one important resource in particular, because it is spread over too many hos-
pitals – staff. So, if the bigger problem is not room capacity but staff shortage, then the
first question is not how to build a hospital, but which hospital to build where in order
to use existing resources more sensibly. It could be argued that this is not the archi-
tects’ problem. However, once the tender with an inadequate space programme is pre-
sented, it becomes their problem. The only thing left to do then is to plan within the (5) Zukunftsvision Künstliche Intelligenz: Roboter Paco hilft bei der Visite
narrow framework of the space allocation plan, even if it may be perceived as wrong.
It is therefore important that the expertise of architects and planners is included in the
planning of inpatient care in Germany before the programmes are finalised – i.e., in a
service phase 0. This requires discussions with health insurance funds, operators, in- Healing environment and digitalisation
vestors and politicians. We do this very actively, for example within the Health Care
of the Future Symposium, initiated at TU Berlin. This debate is sometimes an arduous “Light, greenery, retreats, access to the outdoors” is a mantra that cannot be repeated
and lengthy process, but gradually the message “architecture matters”, which also be- often enough. The approach of a “healing environment” is relevant for both staff and
nefits hospital operators, dawns on people. At least most tenders now formulate the patients, especially in case of extended stays. Recently, we completed the rehab of the
demand for a patient- and staff-centred environment. However, implementation and Unfallkrankenhaus Berlin (ukb), which among other things specialises in so-called
providing the corresponding funds are sometimes still difficult. “weaning” of patients from the ventilator. We see that a relaxing atmosphere is emi-
nently important, especially in this highly anxious situation, when patients have to
More scope in the room schedules learn to breathe on their own again, sometimes after several weeks of artificial venti-
lation. (Fig. 1,2) The necessary physical isolation of highly infectious patients is inevi-
With regard to the pandemic, too, we would wish that architecture be given more tably accompanied by social isolation. This is a conflict that cannot be resolved. Digital
scope for the development of intermediate spaces. Room schedules in hospital con- media offer only a makeshift substitute, which cannot replace real interaction with re-
struction are currently too tight. Every square metre is allocated to a specific function, latives. A real improvement, however, could lie in the empowerment of patients and
leaving hardly any space for encounters, relaxation or even for the unforeseeable con- their relatives via digital tools. Patient empowerment means the patient’s control over
tingencies. When the building is completed, it may no longer meet the already all processes related to the clinical pathway – before, during and after hospitalisation
changed requirements for use. Hospitals are evolved structures. They are in a constant – and facilitated communication about it with all healthcare stakeholders. In PRD (pa-
process of change in order to adapt to the given technical, medical and social require- tient-reported data) or PRO (patient-reported outcome) projects, the patient is upgra-
ments. It is therefore illusory to believe that the German healthcare landscape can be ded from a recipient of services to a partner. Mobile, smart devices equipped with sen-
turned upside down overnight. Nevertheless, the discussion about the lessons learned sors enable the patient to collect and forward health data himself. Thus, anamnesis,
from the pandemic for the architecture of hospitals will probably consolidate one or simple diagnoses and therapies can take place from home online independently or
the other idea. Here are some of them, without claiming to be exhaustive. under telemedical supervision.
Flexibility and optimising triage Hospitals of the future – networked systems

Is a hospital able to flexibly adapt to a crisis situation? Only to a certain extent. A first In the hospital of the future, we have arrived in the world of algorithms. All processes
step would be to have reserve space available. Since this is quite illusory in the reality – examination procedures, health data, patient and staff flows, equipment use and ma-
of a hospital, the focus must be on flexible use of the available space. At ward level, terial flows – will be mapped and interconnected in the Internet of Things (IoT). Time-
floor plans are preferable that allow the merging of wards or the flexible allocation of consuming and repetitive tasks will be performed by sensor technology and displayed
patient rooms to one or the other ward. (Fig. 3) At room level, the discussion about ad- in the digital patient record. Automated and partially automated processes will have
aptable patient rooms should be emphasised. Completely uncommon in Germany, an impact on all movements in the building, on logistics, staff, patients and relatives.
“acuity-adaptable patient rooms” – i.e., rooms that can be used for various intensities Robotics has also long since found its way into the operating theatre and will increa-
of care without any constructional effort – have already been tested in the US. What is singly conquer nursing. In future, we will also have to integrate artificial intelligence
missing are reliable evaluations of the economic success of such rooms. Another point into room schedules and space calculations. The question is no longer the technical
is the optimization of the triage. Already today, triage – the separation of infectious pa- feasibility of artificial, self-learning intelligences but how the autonomy of the indivi-
tients from non-infectious patients – takes place at the hospital entrance. This separa- dual can be preserved and whether AI can learn the norms of ethics and aesthetics.
tion must then be consistently pursued. Both the intensive care and operating theatre (Fig. 5) Some architects and physicians may currently feel overwhelmed by the rapid
areas and a nursing area, which can be isolated from other wards in the event of a digital development. Architecture can provide support and security in the virtual
pandemic, must be connected via separate vertical circulation. We have planned this world in an analogous way. About 150 years ago, tuberculosis presented architects
scenario in our competition entry for the Zentralklinikum Georgsheil. (Fig. 4) The prin- with the challenge of creating an optimised building form for the recovery of lung pa-
ciple of infection prevention through separation also includes the principle of one-bed tients, which resulted in pulmonary sanatoriums. We can assume that the coronavirus
rooms, the implementation of which should be pushed forward in Germany. will also leave its mark on the health landscape.

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