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How Big Hospitals are Growing, Changing and Adapting Post-COVID

Michael Grave, COX Associate Director and a leader in our health sector, shares his insights on themes impacting health architecture today. Drawing from overseas trends, particularly from the United States, Michael reveals valuable lessons for Australian facility planning.


[above] Jefferson’s Honickman Center, Philadelphia. Photo taken by Michael Grave. 

Worldwide, large hospital campuses are becoming increasingly complex. To gain insights, we visited several facilities outside our region, asking ourselves: what can we learn, and how do our practices compare in response to this ongoing challenge? Major hospitals are at the intersection of urban density, expansive scientific research, transport, urban amenities, education, and social equity. These complex, interwoven themes must be considered together to achieve the best outcomes, presenting a significant physical planning challenge.

At COX, we are actively engaged in developing intricate regeneration expansion plans, which often necessitate bold and innovative thinking to usher in the next phase of our projects. Over the past year, we have visited several exemplary facilities that address these complexities, including Massachusetts General Brigham in Boston, Jefferson Health’s newly opened Honickman Center in Philadelphia, and SickKids Hospital in Toronto.

[below] Jefferson’s Honickman Center, Philadelphia. The embedded health precinct; in this case a vertical consolidation. At the rear of picture, the Honickman Center for specialised health opened in March 2024 by Stantec (clinical fitout) with Ennead Architects (base building architect). Tour courtesy of Stantec. Photo taken by Michael Grave. 

Each of these facilities offers unique solutions for dense campuses that continue to grow and expand in operational complexity. Even the Texas Medical Center (TMC), a virtual satellite city of Houston and the largest conglomeration of hospitals in the world, is simultaneously expanding and maturing spatially.

The broad lesson we are seeing is that conglomerates of focused clinical centres, no matter how successful, are not enough.

Within all of the many campuses we visited,  traditional boundaries are ‘broken’ – as the hospital ‘engines’ of employment, healthcare, education and research, community, and connection all extend into their neighbourhoods, driving a broader urban renewal. There has never been a more complete prospect of achieving healthcare-centred urbanity, driving renewal and city enrichment.

In our most successful projects, and those we have visited, the brief expands from simply providing direct health functions to developing a more comprehensive city vision, bringing in all of the necessary ingredients to benefit from these core activities.  Our cities are enriched when positive links between healthcare, commerce, education and social life are co-located.

[below] SickKids Hospital in Toronto, Canada. New buildings in the initial stages of the SickKids Project Horizon renewal, Toronto. SickKids was rated NewsWeek  #1 Specialised Hospital in the world in 2022. Site tour courtesy of SickKids with Stantec. Photo taken by Michael Grave.

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