Cranked krankenhaus - hospital design

Architectural Review, The, Oct, 1995 by Peter Blundell Jones

Hospitals are often health machines for anonymous processing of the sick. Here, the architects set out to make a hospital as a series of places, which respects the needs of individuals without impairing medical efficiency.

It is a tribute to the effectiveness of the Gothic Revival in England that the popular idea and image of 'church' is still so bound up with the Gothic, but when we think of 'hospital' it is not nineteenth century examples that come to mind but rather the modernist image epitomised in Aalto's Paimio and Duiker's Zonnestraal. The desire for sunlight and air that reached its ideal fulfilment in tuberculosis sanatoria was driven by the knowledge that the only way to kill the bacillus before the development of antibiotics was exposure to ultra-violet rays. But there was also a powerful symbolic component: the purity of early Modernist forms seemed perfectly to fit the hygienic hospital programme. Not only must germs be eliminated, the place has to be seen to be clean, and although a black surface may be as germ-free as a white one, whiteness makes cleanliness more visible. Also, as Mary Douglas established in her seminal book Purity and Danger, dirt in everyday life is not so much germs as matter out of place, and what is regarded as 'in place' depends on the classification system in force.(1)

The hospital deals with those whose bodies are threatened by alien organisms, and the surgery taking place within it often involves an invasion of the body boundary which in any other context would count as assault. Visible control is needed to reassure, so the hospital is generally, to use another of Douglas's terms, 'high-grid'.(2) That is to say it is organised in a very disciplined way, with everyone in uniform, a well- defined staff hierarchy, and strict ordering of time and space. Faith in the powers of science and technology is reinforced by a show of technical equipment, and the imagery spills over into the normal furniture, reinforcing the daily ritual with its functionalist style and hard materials.

This image belongs more to the '40s and '50s than to the present day. Since then two changes have taken place in quite opposite directions. First, because of its increasingly complex servicing requirements and the labyrinthine bureaucratic procedures developed to produce it, the hospital has been taken over almost more than any other public building type by the kind of quantitative functionalism first advocated by Hannes Meyer.(3) So many are the rules and regulations, so strict the budget, and so forceful the standard design templates imposed at the start, that there is little room for consideration of the whole - some would say little room for architecture. The project is also often so large, the design and construction time so long, that both programme and design personnel change many times. The result is often a huge confusing monster much compromised along the way, never foreseen as a whole by anyone, unloved and unlovable.

The second change is more recent and reflects the theme-park nature of post-modernism. As life-expectancy has improved and medicine has become more sophisticated, the spartan purity of earlier hospitals has given way to images of home and hotel, especially in the growing area of small private clinics, which need to sell themselves by conveying an air of luxury in contrast with the state system. But how far can the pseudo-homeliness go before it critically undermines the necessary sense of reassurance provided by the modernist hospital? State hospitals are still there, and in emergencies they are still the only destination.

Bruck is a small town in Styria on the river Mur, about 30 miles north of Graz. The regional hospital has been there for a century, but the inadequacy of the old buildings in the town centre was felt already in the 1950s. In 1965 a competition was held for a new 500-bed hospital on the suburban site finally occupied by the new hospital, but costs were reckoned to be too high, and instead of building anew, further extensions were made to the old hospital. Pressure on space mounted, and by the mid 1980s had again become untenable, so in 1987 a second competition was launched, and won by Domenig's office. The design was developed and built, and the building has been in use since early 1994.

The image of the new regional hospital is poised provocatively somewhere between the spartan Modernist hospital and the international hotel. It is more the former on the outside, but quite deliberately more the latter within, if not enough to dull the impression of brisk efficiency. It is a relatively large institution with 335 beds and seven operating theatres, for, as with hospitals everywhere, economy of scale requires bringing together expensive diagnostic and life-saving specialist facilities in one place. It has casualty and intensive care departments, a dialysis unit and many other specialist areas. With its own power station, its own shops, and even its own chapel, it has become almost a city in itself, and the beautiful location on a hill at the edge of the town affords it tranquillity, clean air, and good views.