The Impact of Postmodernism on Hospital Design

With large scale changes in technology and society, the narrative of architecture in the twentieth century is that of the birth of Modernism, and the several responses to it. Essentially, the term “modern” emphasizes a focus on the present, but this definition differs from that of the first half of the twentieth century where it came to refer to a particular approach by a group of architects who took a preeminent approach to architecture. Modern architecture sought to reject ornaments and historical precedent and instead embraced minimalism and brought uniformity to the field of architecture. American architect, Louis Henry Sullivan’s famous principle of “form follows function” became the mantra for many Modernist architects like Walter Gropius, Ludwig Mies van der Rohe, and Le Corbusier. It was not until the mid-1960s that the rejection of Modernism’s functional, simple forms and lack of emphasis to history could be seen. This rejection appeared as the new era of Postmodernism which was established on July 15, 1972, at approximately 3:32 PM with the demolition of the Pruitt-Igoe housing development project in St. Louis, Missouri. These residential towers that were intended to solve the ills of poverty as a solution to low-income housing were subject to two decades of turmoil prior to the final destruction of the apartment complex. Architectural theorist, Charles Jencks in his 1977 publication, The Language of Post-Modern Architecture declared the demolition to be the “death of modern architecture”. The modern movement as understood by its pioneers was now over with the initiation of the postmodern era.

Even though, the definition of postmodernism has always been a subject of confusion, many critics believe that postmodernism was nothing but a reaction against modernism. While the modernists focused on simplicity, postmodernism embraced “complex and contradictory layers of meaning”. The development process of this movement can be seen in “Architecture Itself and Other Postmodernist Myths”, an exhibition at the Canadian Centre for Architecture in Montreal by Sylvia Lavin, an architecture professor at Princeton University. The exhibition revolves around the idea of the process of “post modernization” focusing on the conditions that shaped architecture between 1965 and 1990 – from the emergence of technology to the growing power of architectural institutions. Lavin explores postmodernism returning to its humanistic glory after modernism “abstracted the body until it was a machine” in gallery six, Bodies Return, of her exhibition at the Canadian Centre for Architecture. The gallery not only explores the architectural elements of the era, but it also signifies the new concerns that came with it, like health, gender, race, sexuality, and other issues. The presence of such problems was evident in the Prentice Women’s Hospital in Chicago in 1975 by architect Bertrand Goldberg. Goldberg’s connection to the famous modernist art school, Bauhaus, and his commitment to the architecture of the health sector shows his roots to modernism. On the opposite side of the spectrum, his interest in highly specialized forms of medicine and particularly for accommodating the needs of pregnant women, as in the Prentice Women’s Hospital is not typical of the modernist ideology. His design of the hospital was progressive with its centralized plan and its emphasis on making the structure more suitable for its users.

This paper explores the impact of postmodernism on hospital design and how it has reshaped the accommodation of people in hospitals. The essay does not only focus on how families of patients were accommodated in postmodern medical institutions, but it also explores the connection of the postmodern era with social issues which can be seen with the inclusion of the abortion suite system at the Prentice hospital. Essentially it concentrates on the exploration of the progressiveness of the hospital which can be seen from the Prentice Women’s Hospital’s bronze glass panel aluminum window, exhibited at Sylvia Lavin’s exhibition at the Canadian Centre for Architecture in Montreal.

The postmodern era allowed for hospital architecture to be considered a specialty. Architects went from designing hospitals like other large institutions like prisons and schools, where plan and exterior were equally significant, to designing hospitals as they were meant to be, where the organization of the floor plan became the primary focus; enhancing the users’ experience of the building. American architect and industrial designer, Bertrand Goldberg highlights the importance of the floor plan in a variety of his projects like Marina City, Hilliard Homes and especially in the Prentice Women’s Hospital and Maternity Center in downtown Chicago; emphasizing his idea of creating “vertical communities” through careful organization of spaces.

Designed in 1971, Prentice was a brutalist design that presented a nine-story concrete quatrefoil tower with oval windows; one of which is exhibited at the CCA. The architecture of the hospital framed an experience-focused space, and thereby provided an interactive and open environment for patients and their families. The centralized tower was used as a maternity center, with nursing stations placed near the core and patient rooms pushed back into the corners of the “four leaf clover plan” ; focusing on the accommodation of people within hospitals as confirmed by him in a 1992 interview, “what I believe I have tried to translate into its many forms is the tendency of people to relate to each other.” Essentially, the Prentice Women’s Hospital was a maternity center with pragmatic purposes. The tower was cantilevered over a five-story glazed rectangular structure, detaching it from being viewed as a pure brutalist building. At first glance, there are several elements of Prentice that scream the word “Modernism” especially with Goldberg’s connection to Bauhaus and his description of the superstructure as being influenced by its function. However, the influence of the form on the function is what sets Prentice apart from other modernist buildings and classifies it as a postmodern hospital. With no clear definition of postmodern buildings, certain elements of the Prentice hospital that can be considered postmodern should be addressed. Fundamentally, postmodernism aims to make a structure more suitable for its use; “having a bigger meaning to it”. This can be seen in Goldberg’s design of the four-leaf clover plan that was built around socialist principles, splitting the tower into four areas, fostering a sense of community between the patients. Architectural historian and university professor, Annmarie Adams in her book, Medicine by Design: The Architect and the Modern Hospital, confirms that “postmodern hospitals are built around patient-centered care”. This shows that the postmodern hospital designs allowed for a better patient experience. The inclusion of curved forms, decorative elements, bright colors and features often borrowed from earlier periods are all characteristics of a postmodernist structure, some of which are seen in the Prentice Women’s Hospital. It often tends to break large buildings into several forms, sometimes representing different functions of those parts of the building. This can be seen in the placement of the tower containing rooms for patient care, placed atop a rectangular podium containing the hospital’s various other functions. Goldberg’s desire to express a more organic way of architecture through his floor plan breaks away from the grid formations that were favored in modern architecture. Essentially, through the use of interlocking roman arches under the brutalist tower and a combination of architectural influences such as brutalism and the Metabolist movement by Japanese architects such as Kenzo Tange and Fumihiko Maki, the Prentice hospital can be classified as a postmodern structure; contrary to modern hospital design that had started realizing the need for flexible space and the adaptability to shifting demands of medical technology.

Known as “complex, high-tech body shops”, modern hospitals focused on disease even though they were constantly neglecting their patient’s emotional and spiritual needs. “The horrific moments of patients suffering were hidden behind facades of steel and frosted glass”, says American historian, Guenter B. Risse in “Humanizing Hospital Space”. Such medical institutions were deemed intimidating, stressful, and impersonal by many patients due to poorly illuminated spaces, noise, and the absence of windows; contributing to the patient’s problem of sensory deprivation, compounding patient suffering and thus making the hospital inhospitable. A San Diego Children’s hospital official declared that “design is now an essential strategic element for our future”. The issues with the experience of patients is evident in modernist structures, however, postmodernism is a response that provides solutions to all such problems, reshaping the accommodation of people in hospitals. The Prentice Women’s Hospital provides great emphasis on “humanism”, regarded as a “fashionable postmodern code word” by Risse. It focuses on meeting human needs, one of the main ideas that postmodernism brought to the door of hospital design. McGill University’s Health Centre advocates that “the built environment is a tool in the healing process that can compliment and enhance the skills, expertise, caring dimension and high-tech support of caregivers”. Goldberg and other postmodernist architects called for a shift away from the idea of designing a “super-hospital” and moved towards creating smaller residential-like rooms that were spacious, painted light colors, furnished with tables and chairs, included telephones and natural lighting, creating a more comfortable environment for not only patients, but their families as well. It was during this time that patients were starting to be considered more like “valuable guests” in a community. The floor plan of the Prentice hospital essentially divided patient wards into four communities, creating a domestic environment for the patients as they interact with their neighbors. Guenter B. Risse further states that “sufferers become partners in their care” and that this sense of community improves patient satisfaction. Another hospital space that is situated within this community is the centralized nursing zone. As hospitalized people require human contact in order to catalyze the healing process, postmodern plans like that of Prentice allowed for frequent communication with patients and their caregivers. One of the most extraordinary features of the hospital, according to Prentice’s promotional pamphlet, would be the inclusion of “Family-Centered Maternity Care”. Inspired by the idea that the entire family should participate in childbirth, as opposed to mothers working alone with doctors and nurses, this new idea meant that fathers were allowed to be present during labor and delivery. This certainly added to the patient experience, in contrast to earlier hospitals where fathers were segregated in waiting rooms during the birth process and babies were held in glass-walled nurseries until it was time for them to be taken home. In “Designing for ‘the little convalescents’”, professor Annemarie Adams says, “the postmodern hospital marks a curious return to the earlier attitude that children’s health is a family affair”. Similarly, the Prentice Women’s Hospital categorizes the birth process as a “family affair”. McGill University’s Health Centre states that patient and family are central to participation in the healing process. Risse supports this statement, classifying patients as “carents” and family members as “carers”. Prentice’s centralizing plan was designed to allow for comfort through the creation of a home-like environment that would decrease patient stress and encourage family participation. It is without a doubt that a “humanized” approach and the quality of the hospital space were considered significant with the arrival of postmodernism. In 1984, a study declared that placement of patients within the sight of nature was extremely beneficial for them. The Prentice hospital’s oval shaped window not only symbolized contact with life but also added to the quality of patient-care by improving the lighting inside the structure. The study further states that windows “register diurnal and seasonal changes that are essential for preventing sensory deprivation and insure the proper functioning of biorhythms”. The inclusion of windows within the wards was a step towards a more user-friendly patient experience. The Prentice Women’s Hospital took a more humane approach to women’s health care and is considered an important milestone in the development of twentieth century medicine. During the 1970s, American life was undergoing seismic changes, as was American medicine. Changing attitudes towards women’s roles in society, family planning, and doctor-patient relationships were all played out in Prentice’s program. Revolving around the same idea of having a “humanized” environment, the inclusion of an abortion suite connected with a psychological center was present in the Prentice hospital as Goldberg believed that abortion was both a physical and psychological event. This was about the same time as the legalization of abortion rights and the inclusion of women into the architecture profession, with women being about 50% of the student population in many significant schools. Postmodernism brought healthcare facilities inside a community and signaled that hospitals are not just spaces of high stress and trauma but are also places for building relationships. With the passage of time, however, postmodernist hospital designs tended to move towards consumerism.

The contribution of postmodernism on hospital designs is far from just the physical accommodation of people. It introduced intense competition of patients and more demanding consumerism which became the engines driving further changes in hospital architecture. Hospitalized individuals were identified as valuable “marketing targets” and the main goal was “customer security”. The hospital design itself along with its staff created positive experiences for patients in order to develop “brand loyalty”. Architects were encouraged to design high quality and “caring” environments in order to dispense good “customer service”. With Prentice’s centralized nursing station and the creation of a community, there were a “50,000 moments of truth” when a hospital employee had contact with a patient. Such recurring contacts shaped the institutions reputation for quality, performance, and service. Essentially, postmodernism changed the way hospitals accommodated people, not physically but in a way that viewed them as consumers rather than patients. It was only a passage of time, that hospitals started to look more like malls with the inclusion of restaurants, cafes, and other consumer-focused stores. Postmodern architecture had not only reshaped the accommodation of patients, but it had also changed people into consumers.

In conclusion, the Prentice Women’s Hospital served as an early model of a postmodern structure. Through characteristics such as its revolutionary floor plan, its centralized nursing stations, its emphasis on patient-centered care, its creation of a home-like environment, and its emphasis on consumer culture, the Prentice Women’s Hospital embodied the basics of a postmodern hospital. For the thirty-nine years of its existence, Prentice had improved the utilization of space, the quality of hospital care and had reshaped the accommodation of people in hospitals, with it’s groundbreaking architecture and its focus on postmodernist ideas. Looking back to the introduction of postmodern hospitals, one can compare Prentice to present-day health care architecture such as the Memorial Sloan Kettering Cancer Center in New York City opened in 2016. Similar to Prentice’s focus on patient experience, the cancer center incorporates figure-eight walking paths that are intended to improve patient experience along with the inclusion of centralized waiting spaces for their families. Other structures have highlighted the significance of natural light during the healing process. Upon further analysis, health care facilities designed nowadays incorporate the very same characteristics as those outlined in this paper in order to accommodate its users. Essentially, Prentice provided a glimpse into the future, showing how certain elements would enhance health care architecture in our postmodern society. Now the question of whether medical institutions will continue to incorporate postmodern ideas in the future arises. What are hospitals classified as nowadays? Are they postmodern, modern, a combination of both, or something entirely different that we have failed to attach a term to? The quality of medical care nowadays and the entire hospital experience itself, owes much to postmodernism.