Why Is It So Hard to Build a Superhospital?

Unlike a lot of medicine, architecture can combine function and good taste, but the MUHC's new hospital design fails to acknowledge that.

After nearly two decades of waiting, news came in April that the McGill University Health Centre (MUHC) finally broke ground on a proposed new superhospital in Montreal.

Recently the MUHC also released images of the final design. Some journalists have applauded the way the design fits such a large building into the surrounding residential neighbourhoods. Yet the proposal is awful. It’s not just that it looks bad – though it does. Rather, it’s that the design barely acknowledges urban issues of community, public transport, or even parking.

Overall, the MUHC may have missed its best chance to give Montreal cutting-edge hospital design. New buildings should enrich the city, not just fit into it. Just think of the spectacular success of recent libraries in downtown Seattle and Montreal. So we should applaud the MUHC’s desire to provide world-class care. But they still don’t get the importance of world-class architecture. Why is it so hard to build a good superhospital?

Design questions have plagued the MUHC for years. The centre started in 1994 as an administrative merger of five McGill teaching hospitals. In 2001, I started work on a study led by Prof. Annmarie Adams in the McGill University School of Architecture. She wanted to track the design and construction of the proposed building, nicknamed a “superhospital” because it would consolidate the five institutions onto one new site.

The first obstacle quickly became clear: the Quebec government needs to build not one but two new hospitals. The Université de Montréal’s teaching hospitals also went through a merger process and are also planning a new building. Wealthy Paris struggled to merge three hospitals into one superhospital, the 2001 Hôpital Européen Georges-Pompidou. Can Montreal seriously hope to build two?

It may sound odd, but the merger process itself, meant to make the health care system more efficient, is also a problem. Merger mania developed from trends in the U.S., where hospital maintenance organizations (HMOs) bought and merged private hospitals not to improve care but to improve profit.

North American hospitals are not so easily fused. Their staffs have what medical historian Charles Rosenberg calls “inward vision”: doctors and administrators are trained to focus inward on hospital practices and merely to glance outward to the concerns of public health, political decision-making, and the hospital network. It will take years before a new generation, trained to value that outward glance, displaces the fiercely loyal old guard.

It is unfortunate that internationally renowned architect Moshe Safdie left the project in 2007. He makes buildings that make people feel good. Best known for his Habitat 67 housing in Montreal, Safdie’s recent public buildings have been popular successes. Canadians love his National Gallery in Ottawa, Vancouver’s neo-classical library square, and the Pearson airport re-do. But the hospital is in a bind. The MUHC doesn't want to be seen squandering money on architecture rather than patient care. So the building must look inexpensive to show how little money they've spent (even though they're actually spending lots).

What’s worse, the hottest trend in hospital design actually works against recognizing the value of architectural expertise. That trend, known as evidence-based design (EBD), says that architectural decisions should be based on medical research into the therapeutic value of environments. Advocates use scientific methods to show how good views, for example, will lead to shorter hospital stays.

But medical research alone can’t make a good building. As Adams notes, doctors like EBD because it makes architecture seem like medicine. But the two are very different. “Good hospitals are like all good buildings,” she claims. “They are shaped by complex cultural forces rather than only the progress of medicine. Twentieth-century hospitals have looked like office buildings, hotels, and most recently malls, without parallel shifts in medical practice.” Without good architecture, EBD is useless.

Finally, the MUHC campaigned for the superhospital by demonizing the existing buildings as hopelessly out-of-date. Again, they have simply confused what makes good medicine with what makes good architecture. Condemning the buildings as obsolete has both decimated support for their continued use as hospitals and limited possibilities for their re-use as anything else.

If the MUHC could address the hospital’s vital role in cities, they could show how good health care and great architecture can go together. That is, if the MUHC could overcome their inward focus on medical practice to understand the institution’s urban place and culture, they could propose a superhospital that is, well, super.

Why spend over a billion dollars and get something mediocre?