LUCIANO MONZA – ARCHITECT AND PARTNER, ARQUISALUD INFRASTRUCTURE


A look at the evolution of healthcare provision


Worldwide, the hospital has for centuries been the dominant type of healthcare facility. A significant part of the development and strengthening of the hospital infrastructure occurred from the end of the 19th until the mid 20th century, while at the same time it became the dominant force in healthcare provision. In this analysis, health centres and clinics are considered within the same category as hospitals because they have similar characteristics, but are of different sizes and complexities.


Hospitals were introduced to provide care and shelter for widows, orphans, pilgrims, the poor and terminally ill people who were waiting to die. This is the origin of the term ‘hospitality’. Rich and powerful people were cared for and died in their own homes.


Originally hospitals had few beds for inpatients as there were few medical treatments. The hospital was a ‘passive’ building. However, towards the 18th century hospitals started to become therapeutic institutions. During the 19th century and the first half of the 20th century, diagnosis and treatment technologies were developed and incorporated into hospital services. This resulted in the hospital becoming an active building in which treatments were provided and patients were cured. Technological innovations allowed for


the development of a larger number and variety of diagnostic services and treatments, but the hospital maintained a characteristic element; patient admission, also known as hospitalisation. The outpatient visit was only introduced during the 19th century. Worldwide, the hospital has for


centuries been the dominant type of healthcare facility. A significant part of the


development and strengthening of the hospital infrastructure occurred from the end of the 19th until the mid 20th century, while at the same time it became the dominant force in healthcare provision. In this analysis, health centres and clinics are considered within the same category as hospitals because they have similar characteristics, but are of different sizes and complexities.


Healthcare provision During the second half of the 20th century and accelerating towards the end of that century and the beginning of the 21st century, a series of changes resulted in the emergence of an increasing number of new types of facility in our cities. The hospital was no longer the predominant healthcare provider. We therefore consider healthcare facilities a consequence and/or a result of the care model or rather the result of various models of healthcare, actions and policies. Their characteristics are the result of


providing physical and tangible responses to the needs of other non-architectural disciplines. However, the existing capacity has an important rigidity in terms of its geographical location and accessibility, its arrangement and organisation and its


Luciano Monza


Luciano Monza is a partner at ArquiSalud. He is an architect specialising in healthcare facility planning and a PHD student at the University of Buenos Aires. He is also a graduate of the Program of Social Sciences and Health (CEDES-FLACSO) and


former president and vice president of the Asociación Argentina de Arquitectura e Ingeniería Hospitalaria (AADAIH). He is a postgraduate teacher in Argentina, Brazil and Spain and a


conference lecturer in Argentina, Brazil, Chile, Colombia, Cuba, El Salvador, Peru, Uruguay and Norway. He was president of the 23rd International Federation of Hospital Engineering (IFHE) World Congress 2014.


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The corridor of an ambulatory centre.


scale and dimensions, together with a significant ‘inertia’ (long planning, design and construction procedures and lifespan). Because of this, the physical resource also gives direction to the healthcare model and health actions. It is important to consider the


relationship between needs (use) and the building rather than the relationship between morphological characteristics and the building, as currently defined in architecture. The transformations that occurred during the second half of the 20th century and the beginning of the 21st century can be grouped into the following categories: l changes in the health/disease/ healthcare paradigm that positioned healthcare above the treatment of disease and care


l technological developments that modified healthcare patterns


IFHE DIGEST 2019


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