Three Ideas for the Hospital of the Future

A hospital visit usually begins with a sensory overload. Uncontrolled noise, harsh lighting, and depressing art prints go hand in hand with greasy food and stressed staff. It is the backdrop of a system geared toward efficiency, yet it often forgets people as sensory beings. To this day, the hospital is often seen as a mere “repair shop”: the body is treated, stabilized, and discharged again – but what recovery needs beyond that is often considered a side issue.

The hospital system, however, stands at a turning point. The new Hospital Care Improvement Act (KHVVG) and the associated Transformation Fund of 50 billion euros are meant to bring about changes by 2035. The aim is a fundamental restructuring: away from the case-based reimbursement logic that creates economic pressure to treat as many cases as possible, toward higher quality standards and financing that rewards maintaining necessary services. This should enable better treatment quality, less economic pressure, and more reliable care – including in rural areas.

So far, the reality is often governed by cost-cutting. For healthy food, comfortable environments, or decelerated workflows, money is lacking – and so is staff: By 2035, according to the Institute for Employment Research and Vocational Studies, up to 1.8 million jobs in the health sector could be unfilled. Critics warn in relation to the KHVVG about hospital closures and a further tightening of regional inequalities. More than ever, the question arises: Is health understood as an industrial service or as a social common good?

A look at three areas where solutions for a more effective stay are emerging.

Acoustics of Healing

In the entrance area of the Asklepios Clinic Harburg, phones ring, elevators hum, and sliding doors squeak. Stress hormones have a home game here. Then seven people enter the hall with sound rods, and clear upper tones settle over the exhausted nerves like a blanket.

The action is part of the scientific project “Healing Soundscapes live,” developed at the Hamburg Ligeti Center in collaboration with the Medical School Hamburg. “Sound is a direct access to the emotional level,” says researcher and music therapist Jan Sonntag.

His goal is to lower the clinical space a little. For many people, “alarm fatigue” can arise—a state of exhaustion caused by an overwhelming number of low-priority warning signals. In fact, the noise level in modern clinics is often permanently above 70 decibels. That is comparable to a busy street. The consequence is a massive release of cortisol, a stress hormone that has been shown to delay wound healing and weaken the immune system.

Ongoing investigations at the University Medical Center Hamburg-Eppendorf (UKE) show that targeted sound environments, so-called Healing Soundscapes, can reverse this effect: “Overtones and organic sound progressions are stress-reducing and increase well-being,” explains Sonntag. At the University Medical Center Hamburg, this approach has already been implemented in the central emergency department and is to be integrated into an operating room in the future to stabilize the surgical team’s concentration over hours. “Hospitals must become places that promote healing rather than hinder it,” says Sonntag—and emphasizes: “Healing Soundscapes are a comparatively inexpensive means of promoting patient well-being.”

Colors, Light, and Forms

From what we hear to what we see: harsh light, endless corridors, spaces without orientation that subtly trigger stress upon entering. Hospitals are often designed as though one should leave as quickly as possible. But for patients and staff, they are a home for a time – sometimes for weeks or even years. “I haven’t found a place in clinics where I could truly recharge,” says Miriam Burger, educator and artist. From this experience, she began systematically researching the effects of clinical spaces at the Medical School Hamburg.

At the center of her work is the question of how colors, light, shapes, smells, and materials affect people who are sick, exhausted, or highly sensitive. “Illness changes perception. Stimuli come unfiltered. Disorientation in space itself becomes a form of stress. Heart rate rises measurably,” says Burger.

She works with concepts from environmental therapy. Symmetrical shapes are calming, blue can demonstrably reduce stress, and warm light soothes. Her vision for the clinic of the future is: less glaring white, more warm tones, views of greenery, clearly structured spaces, and textile materials to calm acoustics. “Spaces can provide safety, and safety is a prerequisite for healing to begin,” says Burger.

That such effects are more than subjective perception is shown by a large study at Helios University Hospital Wuppertal. After a pure color and light adjustment in intensive care units, the usage of acute antipsychotics for delirium fell by an average of 30 percent. The evaluation of nursing measures also rose among patients by 28 percent and among staff the satisfaction with work by 12 percent. “Those were minimal interventions. No new technology, no new medicine,” emphasizes Burger. “Only color, light, and atmosphere.”

Meal as Medicine

Hardly anything shapes everyday hospital life as much, and yet it is valued so little as food. “Nutrition is not a service but part of the therapy,” says Matthias Pirlich, internist, nutritionist, and vice president of the German Society for Nutritional Medicine (DGEM). The reality in many institutions, however, is sobering: “On average, nearly €6 per day per person is spent on hospital meals. Taste and nutritional value are often sacrificed.”

Particularly problematic is that many patients arrive at the hospital already weakened. “Around 20 to 30 percent of those admitted are malnourished, usually as a result of their illness,” Pirlich explains. The medical consequences are substantial: longer stays, more complications, higher mortality. “With malnutrition, the duration of treatment lengthens by 40 percent or more. The complication rate is two- to threefold higher.” Even after discharge, this carries over: the rate of unplanned readmissions rises markedly.

That nutrition is nonetheless often treated as a marginal topic is, from Pirlich’s perspective, less because of a lack of knowledge than because of missing structures. “The problem is not solved in the kitchen alone.” What matters are qualified professionals. A systematic screening for malnutrition on admission would be easy to implement—but has not yet been established nationwide.

Studies also show: Even if better nutrition costs more at first, it saves money in the end. Surveys suggest that through consistent screening and treatment of malnutrition in German hospitals, several billions of euros net could be saved per year. For the Clinic of the Future, Pirlich therefore calls for a cultural shift: flexible meal times, reserve meals for late admissions, healthy snacks at night for both patients and staff. “High-quality meal provisioning should be standard and not a nuisance necessity.” Food, understood this way, would be not merely sustenance but daily medicine.