Building resilient hospitals

By tapping into efficient modes of digital systems and addressing current challenges, hospitals in India can successfully future-proof healthcare infrastructure

December 22, 2023 04:39 pm | Updated 04:39 pm IST

Healthcare infrastructure globally is under immense pressure due to the growing demand for quality services. Over the past few decades, with increasing population, the burden on healthcare systems has begun to pile up. According to the World Health Organization (WHO), the global population is expected to reach 9.7 billion by 2050, further exacerbating the strain on healthcare systems. This has impelled planners and policymakers to future-proof infrastructure, while ensuring sustainability and resilience in healthcare systems.

We are also witnessing rapid urbanisation and the emergence of new construction materials and technologies. While green buildings and energy-efficient technologies promise to reduce carbon footprint and create a healthier built environment, we are beginning to see the irony of what building so-called ‘sustainable’ infrastructure entails, practically. On the other hand, the pandemic brought forth functional inadequacies of healthcare infrastructure across the globe and imposed an urgency to build high-quality facilities swiftly.

Today, as we find ourselves amid a health and climate crisis, the question is whether to build or not.

The challenges that come with designing a sustainable and resilient hospital must be addressed to future-proof India’s healthcare infrastructure.

Outdated framework

As per the National Family Health Survey (NFHS-4), the lack of modern facilities in rural areas contributes to a situation where 69% of the population has to travel over 5 km to access healthcare. Many healthcare facilities in India were constructed decades ago and lack modern amenities, making it challenging to accommodate the growing population’s health needs. This can lead to increased costs.

Personnel shortages

Healthcare providers in India are experiencing personnel shortages and burnout. The WHO estimates a global shortage of 18 million healthcare workers by 2030. Designing hospitals with spaces that promote caregiver well-being, reduce stress, and enhance efficiency is essential.

Tech disruption

The healthcare technology market is projected to reach $511 billion by 2025, emphasising the need for efficient technology integration. Selecting and integrating the right technology in the rapidly changing healthcare landscape is crucial. The design must ensure seamless user experiences, ease of operation, high efficiency, and data security.

Limited resources

India, like many other countries, faces limitations in resources for investing in healthcare. Finding cost-effective ways to upgrade facilities is a challenge.

Climate change resilience

Hospitals in India must also consider climate change as a factor in their design. Extreme weather events, such as floods and hurricanes, can disrupt healthcare facilities, making it necessary to prepare for emergencies. By recognising the interconnectedness between the planet and our health, it has become critical for us to explore long-term, sustainable building solutions.

Sustainable choices

Adaptive reuse of existing structures has proved to be a successful endeavour for several industrial and commercial projects, significantly cutting down construction costs and time. Making its way into the healthcare industry, ‘adaptive reuse,’ although deemed a sceptical concept initially, is gradually gaining meaningful acceptance.

According to a report by McKinsey, the global construction industry generates about 40% of the world’s waste annually, highlighting the potential environmental benefits of adaptive reuse.

In India, over 70% of healthcare infrastructure is concentrated in urban areas, leading to significant challenges in rural healthcare access.

A hospital’s design specificities often pose a challenge to effectively repurposing an existing structure for efficiency and safety. However, with careful consideration and meticulous planning, this approach offers financial, environmental, and communal benefits. While an adaptive repurposed hospital can provide high operational efficiency, a few fundamental design decisions can offer adequate resilience and flexibility during times like the COVID-19 pandemic.

With the rapid advancements in technology, remotely managed smart infrastructure is becoming a reality in healthcare. Some current examples include:


This allows doctors to provide remote consultations and monitor patients from a distance, improving access to healthcare services.

Artificial Intelligence (AI)

Largely used for tasks like diagnosis, patient monitoring, and predictive analytics, this enhances the efficiency and quality of services.

Electronic Health Records (EHR)

EHR systems enable seamless access to patient data, reducing paperwork and improving information flow among healthcare providers.

Internet of Healthcare Things (IoHT)

IoHT involves interconnected medical devices and wearables that collect and transmit data, contributing to remote monitoring and early intervention.

Smart infrastructure

Hospitals are increasingly incorporating smart infrastructure elements, such as remote monitoring of patients and equipment, automated environmental controls, and digital systems for managing healthcare operations.

During the design and planning phase of a healthcare ecosystem, several factors like preventive health and wellness, equity in care delivery and technology integration must be considered. Educating communities about maintaining healthy lifestyles and self-monitoring is done along with orienting healthcare planners to identify gaps in the system and develop solutions to address the gaps.

Building sustainable and resilient hospitals requires a comprehensive approach that considers the needs of the community, the environment, and the healthcare workforce. The design must incorporate backup generators, water filtration and ventilation systems to ensure that hospitals remain operational during emergencies. Hospital planners must integrate suitable technologies with sustainable practices such as solar energy provisions, energy efficiency, repurposing of structures, waste reduction, and water-saving techniques to reduce operating costs and improve community health.

Pandemic-proof design

Principally, for a hospital to be resilient against any unprecedented adversity, it must focus on three crucial aspects of healthcare planning — triaging, segregating, and surging capacity. Triaging and segregation require a carefully planned emergency department, which immediately screens and secludes infectious patients within the facility, thus minimising the risk to caregivers and uninfected patients. Segregation refers to the physical separation of spaces and the mechanical isolation of air-conditioning systems. This separation could be slightly challenging in areas where the segregated zones do not have separate air handlers, causing return air from the infected zones to recirculate into other hospital areas.

Surging capacity requires additional beds and carefully factoring for the four Ss — staff, stuff, structure, and systems.

Therefore, resilient healthcare design constitutes facilities that are employed with the requisite infrastructure and planning with flexibility to escalate their bed numbers, while ensuring optimal areas for additional staff and medical paraphernalia.

With a commitment to improving the healthcare scenario, with architects working in partnership with doctors, researchers, and tech giants, an evolved healthcare ecosystem awaits us all.

The writer is Associate Director at Creative Designer Architects.

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