Healthcare Architecture in an Era of Radical Transformation (review)

Stephen Verderber and David J. Fine. Healthcare Architecture in an Era of Radical Transformation. New Haven: Yale University Press, 2000. xii + 404 pp. Ill. $55.00 (0-300-07839-0).

In this well-illustrated, large-format book, architect Stephen Verderber and health-systems management expert David J. Fine chronicle the evolution of health-care facilities since 1965. They focus on this period for three reasons. First, they want to update John Thompson and Grace Golden's The Hospital: A Social and Architectural History (1975), which covers hospital architecture from the ancient world to the 1960s. Second, "[the middle sixties] was the dawn of the rapid growth and impact of Medicaid and Medicare," which opened a new era in governmental support of health care and hospital construction (p. 9). Third, and most importantly, they wish to chronicle the development of postmodernist hospital design, which they trace to the 1960s even though most scholars believe that its impact was in the 1980s. The authors provide a great deal of information and insight into the forces that have shaped the recent hospital and provide a very helpful chronology of hospital styles. Ultimately, however, historians will fault the book for its limited historical context and brevity of interpretation of the substantive issues.

The first chapter introduces the authors' "six waves of health architecture": Ancient, Medieval, Renaissance, Nightingale, Minimalist Megahospital, and Virtual Healthscape. The next three chapters examine the modernist hospital and its crisis, and visionary hospital designs. The following four chapters cover the reinvention of the hospital and the patient room, architectural environments for the aged, and community care clinics. The last chapter summarizes the book's themes and explores possible futures. Although the authors focus primarily on American developments, they use examples from around the world to give their argument an international dimension.

The book's strengths are its range and the authors' efforts to explicitly discuss the modernist/postmodernist divide. First, especially at the current time, changes in hospital design are inseparable from those occurring in other health-care facilities. The chapters on facilities for the aged and community care clinics demonstrate how projects in these spheres are following design paths similar to that of the hospital--in some cases, such as the hospice, even anticipating changes in the hospital. Second, historians of medicine are unlikely to be familiar with the architectural theory surrounding postmodernism, and why postmodernism has had, and is going to continue to have, an influence on the ways that hospitals are designed. Verderber and Fine effectively argue that postmodernism has reshaped the design of the hospital--as well as other facilities such as the hospice, which they view as particularly influential. The material on critical regionalism (pp. 167-78) and on "Postmodern Neoclassicist Clinics" (pp. 302-6) is especially perceptive.

However, the authors do not consistently connect the architectural changes to the broader evolution of medical practice. Each chapter begins with a summary of relevant issues that quickly devolves into a discussion of design styles and individual projects. For instance, chapter 2 opens with a discussion of Hill-Burton hospitals, but quickly fragments into descriptions of design styles. These are not coherently organized into a strong narrative, nor does the opening theme get related back to them. These accounts are often accompanied by very long quotes from the architectural press (see pp. 150-54). In their welcome attempt to cover as much as possible, the authors too often leave the historian with more questions than answers.

Healthcare Architecture contains a wealth of information that should be of interest for many readers. Even given the limitation of the overly generalized descriptions of complex changes in medical history, the book provides a remarkable compilation of projects and trends for those wishing to understand the evolution of health-care design over the last half of the twentieth century.

David C. Sloane
University of Southern California

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