What exactly is a hospital? We rarely ask ourselves that basic question because most people think it’s that big building over there with the emergency room. But consider all the species that have evolved since the first ambulatory surgery center opened in 1970. Now we have places like the outpatient hospital, the micro-hospital, the digital or virtual hospital, mobile integrated health and the freestanding emergency room, among many other forms. This latter speciation occurred over the last ten to fifteen years.
Medical care inexorably advances, allowing us to do more outside of the classic hospital setting. Driven by technological advances, we now have, for example, outpatient robotically assisted cardiac catheterization, day surgery hip replacements, personalized genetic nano treatments, autonomous service robots, and predictive analytics. And these advances are accelerating at a rate faster than many organizations can implement them.
Three Keystone Hospital Species Are Emerging
From a taxonomic viewpoint, the hospital family or genus has created many new species because of these advances. Three that are emerging can be considered keystone species:
The Intense Acute Care Facility: Characterized by expertise, autonomous efficiency, and information via robotics and artificial intelligence, it will have very short lengths of stay, the minimum number of beds to do the job and a 24/7 working environment.
The Intense Ambulatory Care Facility: This species will have many of the same features as the Intense Acute Care Facility and provide many of the same services, but length of stay will be in measured in hours.
The Virtual Care Facility: Doctors and data scientists will work here coordinating care and doing research. This facility is the receiver and integrator of all wearable, implantable, and mobile data streams of patients. It will manage the mixed-reality environment that will connect the patient’s experience to all aspects of care no matter where it is provided. And it will be the Network Operations Center for the entire system.
These facilities and their functions don’t necessarily have strict borders between them. They will come together in various combinations depending on the market and the system. For purposes of differentiation, though, we can divide them according to whether care is delivered inside the Intense Acute Care Facility or outside of it:
What Will Happen Inside an Intense Acute Care Facility?
Major emergency and disaster response, maternity and neonatology, infectious disease requiring intensive care and/or containment
Care for cancer and other chronic diseases with complex morbidity to stabilize and return a patient home
Advanced procedures that need a high degree of infection control and post-procedural monitoring
Invasive entry and use of intensive technology involving active robotics, ultra-precise placement of devices/implants and/or intensive care due to procedural failure, and the 3D printing of biologics, implants, and custom instruments
Therapeutic treatment that needs containment to ensure nano waste does not go into the general waste stream, and administration of otherwise toxic or high-dose pharmaceuticals
What Will Happen Outside an Intense Acute Care Facility?
Everything else. Here are the major functions that will be managed in the Intense Ambulatory Care Facility, the Virtual Care Center or other purpose-specific places (sub-species):
Urgent, super-urgent, and emergency care
The care of cancer and other chronic diseases that are digitally managed including IV meds and hydration
Incisionless and minimally incisionless procedures
Therapeutics, whether pharmaceutical or nano-tech based, that do not require waste stream containment
The Challenge for Architecture
The challenge for architecture is to merge the mixed reality of the physical and virtual care provided in these keystone species so it is indiscernible to the patient. Digitalization is taking over every aspect of healthcare and the power to heal and stay healthy will be in us and on us. Perhaps, in the long-term, the most intriguing species to emerge will be you, as your own personal hospital. The lessons learned now will go a long way to inform how architecture responds to this greater challenge.
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