The Hospital of the Future Will Be Grown, Not Built

Hospitals are hard. They are complicated, expensive buildings that are always being reinvented and rebuilt as ideas and technologies change. Sometimes great buildings, like Chicago's Prentice Women's Hospital by Bernard Goldberg or Toronto's Riverdale Hospital by Howard Chapman, are lost because some hospital bureaucrat says, "It doesn't meet our current needs." Then they build the new one and, 20 years later, go through the same exercise again. Maybe we have been doing this wrong.

Architect Eric Corey Freed has been designing, writing, teaching, making people think, and doing the best PowerPoint in the business; I believe I have seen half a dozen of them from Greenbuild to Passivhaus conferences and always learned and laughed. I was surprised when he became the director of sustainability for CannonDesign, a major firm doing institutional work in healthcare and education—it seems like such a slow-moving, bureaucratic world, not fun. And Freed is fun.

Then I was invited to a Zoom presentation of his work with CannonDesign on reinventing the hospital and, in fact, reinventing how we think about buildings: what they are made of and who they are for. It is all serious stuff, but still brilliantly presented and challenging.

Freed has been looking at where architecture has been going over the last few decades and sees trends toward "bio-engineered" buildings. And when you look at energy or carbon, we are way past energy efficiency and net zero—we are heading toward carbon negative design and the idea of nature-based, symbiotic design. We are going to grow buildings, not build them.

Freed notes architects think about architectural metrics, like air quality or carbon emissions, while their clients are thinking about money. In the health care setting, there are doctors who care about patients and have their own metrics. Freed believes this is wrong.

"What if we were to design the facility so it improved patient outcomes? The more time you spend in it, the better you feel truly a healthy building," said Freed. "If we're designing an office, what if we designed it to boost collaboration or productivity? If we're designing a school, what if we designed it to improve test scores and that became the metric? And then suddenly you've got all three stakeholder groups all speaking the same language."

This is not an entirely new idea. Canadian architect Eberhard Zeidler talked about this in his 1974 book "Healing the Hospital" and, as his obituary noted, he "outlined his people-centered solutions to hospital design and spoke of light-filled atriums and access to nature to aid in healing." Every hospital architect talks about patient-centered design now and builds light-filled atria. Freed goes much further.

Mapping it all out, Freed looked at our biological systems and how architecture affects them. So for a simple example, the muscular system is affected by active design and walkability.

"And we started mapping this on a biological level of are there things that we could do to trigger your endocrine system or your respiratory system, or if you're a cancer patient, you're lymphatic system. And it turns out there are," said Freed. "And so we're working with our clients who are doctors. We've been mapping out where in the patient journey we've been doing this to basically treat them on a very individual level."

From systems, Freed moved on to senses and explained we don't have just five. "It turns out that we have about more than 30, about 32 senses because you have the ability to sense the passage of time," said Freed. "You have the ability to sense pain. You have the ability to sense direction, some better than others. You have prior perception. You can grab your ear lobe without looking at it, right? You know where your body parts are. So what if we were to design to these senses and use them to trigger the response that we want?"

There are more, like signals, that Freed said "is getting weirder," asking questions like, "Could we manipulate their brain chemistry through design?" Examples include designing a reception desk to trigger chemicals that make patients feel calmer or patient rooms to boost immune response. He summarizes it by asking: "Could the building essentially give you a hug?"

Then we get into biology, where Freed talks about switching from construction to "prostruction"—pro and con, positive and negative, get it?—and "building with biology." He has been cataloging natural materials and all the new technologies using everything from mushrooms to lignin and trying to use them in a healthcare setting, which seems a stretch in a world where everything is plastic and stainless and has to be washable with strong disinfectants.

In fact, much of this seemed out there in a tubular sort of way—too extreme for the medical bureaucratic establishment. I had to ask Freed, "What do they say when you present things this way? That's totally unlike how they've seen before. Did they get it, or do they think you're nuts?"

Freed says no, they are getting work because of it. After winning a big job in Chicago, they were at the launch and the client pulled Freed aside, saying: "You know, all the other firms, like they just didn't get it. And you got it. You really, like, understood what we were visioning. And I said, well, what do you mean? And they said all the other teams were talking about EUI [energy use intensity] and energy modeling, and that that that to us was like standard, you know, table stakes is what they called it, but it wasn't anything special. You're the ones that came in and talked about enhancing the patient experience through sustainability."

As I noted, hospitals are hard. Here, Freed is showing a different vision of how to build them and what their future might be.

But what I most admire about Freed is the way he communicates these ideas. Even though he admits some of them may seem weird, you come away convinced that his building is going to give you a hug and send you on your way as a healthier, happier person.

I asked him how he was adjusting to being part of a big firm after a career in his own little one, and he tells Treehugger, "Apparently, my personality is good at a big firm because I like people and I have lots of friends, and now I have 1,200 best friends is how I see it."

I can see why; what a marvelous communicator.