Hospitals without walls: healthcare’s future


Before the pandemic, St. Mary’s Hospital was scheduled for a £ 1 billion redevelopment, with construction due to begin in 2027. Northwest London’s main emergency and specialist hospital will still be redeveloped, but it may look quite different now. James Kinross, a surgeon who works at St. Mary’s and is on the redevelopment planning committee, says, “Covid-19 has changed things dramatically,” Before the pandemic, Kinross states, the aim of the committee was to boost the effectiveness of current care pathways; now it is to reconsider those pathways fully.

St. Mary’s is a test case, but the shape of health care is being rethought everywhere, and that has huge repercussions for the way hospitals will look in the future. George Mann, an architect and founder in evidence-based hospital design at College Station’s Texas A&M University, compares the coming transition to that of past commercial airports. The first airports looked like train stations and it took time for individuals to recognize that travel would never be the same. He says, “I don’t think we fully understand that we’re in the middle of a paradigm shift,” Given the eternally tight resources that many health systems face and the predicted economic downturn due to Covid-19, that might sound like hyperbole, but think about the changes that the pandemic has already forced. In 10 days, the Chinese constructed a hospital while medical consultations moved to the Internet in many countries.

Meanwhile, under the sudden, enormous pressure, existing hospitals – including and maybe especially in the wealthy global North – buckled. Images went around the world of 19 Covid patients sitting outside a hospital in Naples in their vehicles, breathing oxygen from bottles. None of this is shocking, says hospital architect Thomas Schinko of Vasconi Architectes in Paris. The richest nations of the world have banished from their hospitals the idea of contagion, where infectious diseases are no longer the greatest killers. “We’ve lost the reflex to protect staff from patients or patients from other patients,” Schinko says.

Outcome? This type of disease is totally unadapted to our health care systems. “The pandemic has accelerated some trends, such as the one towards the ‘hospital without walls’ – the hospital designed as a digitally networked community rather than a demarcated physical space.” Electronic health records (EHRs) are the two pillars of digital health, allowing patient data to be exchanged between different hours.

For example, most doctors’ offices in the U.K. now use electronic health records, but hospitals are still lagging behind. There are real barriers to digital health adoption, says Saira Ghafur, a respiratory doctor and head of digital health policy at the Institute of Global Health Innovation at Imperial College London. These barriers include unequal access to issues of IT and cybersecurity.

The case of a patient who died in a cyber attack on a German hospital in September reminded us that the healthcare stakes are high. Nevertheless, Ghafur said, after Covid, where we witnessed the advantages of home treatment, such challenges seem to be overcome. “Almost overnight, we went from in-person consultations to what we would call digital-first – by phone, text, video call or online,” she says. “That has fundamentally changed the way we care for our patients,”

And we are seeing a ‘salutogenic’ strategy in China and the U.S., which have invested heavily in digitalization, in which health is


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