Hospitals on the time axis: trends in the real world and implications for architectural education

Hospitals are never finished, and in the best cases they retain value and coherence for decades while they adjust in response to the dynamics of the healthcare field. In the worst cases, the facility is demolished, incapable of accommodating cycles of change. These are well known but poorly documented realities. Today, it is not unusual for one architect to design a hospital and another to design the interior fit-out, either initially or years later. Some clients ask for "shell space" to be fitted out later by another firm. Architects educated to define function first and to maintain unified control find this unsettling, believing that only if one party controls everything can high-quality architecture result. This is not the case, as diverse buildings, cities, and neighborhoods show, but the belief dies hard. In fact, the educational paradigm in schools of architecture largely maintains the old myths.This article describes this reality and poses questions about habit and method that are now at odds with reality. Finally, the paper suggests a way to handle new realities in the education of the next generation of architects.