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Why architects are just what the doctors should have ordered

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Some years ago my Dad (arb Registration No. 034189D) suffered the excruciating pain of a kidney stone. Before the advent of modern surgery there would have been no treatment. Those who 'passed' the stone lived to tell the tale - those who didn't could well die.

More recently, treatment involved invasive surgery: open-up, remove kidney, dissect the organ, locate and cut out stone, patch up patient. If all went well, four to six weeks of hospitalisation. Complications such as septicaemia would frequently double that, and sometimes cost patients' lives.

Dad was lucky. The clever French (early manufacturers of low-frequency sound weapons which destroy human organs) had turned their attentions to the development of sonic treatment for kidney stones. It works like this: two sound beams of different frequency are directed at the stone from opposing angles causing it to disintegrate before it passes out of the body naturally.

No invasive surgery, no anaesthetic, no hospitalisation, no risk of infection and all very cheap for the taxpayer - or health-insurance provider.

Indeed, the patient can even watch the 'operation' on screen and it's all so fast! Poor Dad, who had been heavily sedated whilst awaiting the treatment, arrived at hospital on a stretcher. Barely an hour later he walked out pain free, and fit as a fiddle.

So why this story? Well, it follows on from last week's column on developments in garage design through which I pointed out that new techniques in management and corporate imaging constantly challenge traditional architectural responses.

And it is here that architects need to be at the 'cutting edge' in terms of working closely with their clients to anticipate and facilitate such progress.

Of course our society instinctively resists change. But in an area where new techniques challenge even the principles of invasive surgery for an ever widening range of ailments, and where new equipment is ever more compact and mobile, it must make sense to constantly review the facilities from which treatment is given. Indeed, the concept of taking equipment and treatment to patients, rather than the reverse, is the extreme of such reviews. As Cedric would say, 'Do they need a vehicle or a building?'

I once led a team on a project to Alma Ata in Kazakhstan. Commissioned to review the healthcare estate of that region, we had managers, accountants and epidemiologists with us. What was the condition of the hospitals? Were they in the right place? How effective, if at all, was the primary healthcare system? These were the questions.

The issue that perplexed us most was the Kazaks' insistence that they were some 2300 bed spaces short, despite having a much higher ratio of hospital beds to population than here. We found that, with the exception of tuberculosis (which we removed from the equation), ailments per head of population and epidemiological trends were similar to the uk. They didn't look after patients better - yet their average hospital stay was 23 days to our four.

Further investigation revealed that a lack of pre-hospitalisation diagnosis, and delayed treatment of those hospitalised, placed unnecessary demand on bed spaces (some patients were hospitalised for as long as nine days before receiving their first examination!)

Conclusion: putting money into more buildings would be wasted. They didn't need extra beds; they had too many. They needed better management, more diagnostic equipment, and more doctors.

And the point of all this? Architects must remain closely involved in brief development, as it is this that informs design objectives and outcome. It simply isn't acceptable for others, be they project managers, administrators, contractors or the ever-hungry qs, to take this territory. Their ambitions are frequently incompatible with design research, and their experience all too often denies them any effective role in the creative processes that are intrinsic to brief formulation.

Controversial - of course, but a truth that must be acknowledged in the interest of the client, the user and indeed of architecture.

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