A hospital building is not an end in itself – it must enable strategy

Hospital reform is on the way – as a reorganisation of the healthcare system. For many hospital operators, this represents a structural shift: service groups, partnerships, sites, funding – many aspects are being reorganised. In terms of planning, this means not calculating floor space first, but clarifying the role of the site first. Viktor Lorentz, Managing Director of ATP health and ATP architects engineers in Aachen, has been addressing these issues for years.

Mr Lorentz, when speaking to hospital operators these days, one thing stands out above all else: uncertainty. Do you share that feeling?

Yes – the uncertainty is real. But we must make a distinction: uncertainty does not mean that nothing can be done. What is changing is not just the funding, but the logic behind it: which services are provided where, how hospitals cooperate, and what primary care will truly mean in future. The point is: the reform will take effect over several years. The budget-neutral phase in 2026/27 gives us time. Those who use this time to make well-founded decisions rather than putting them off will navigate the transformation more smoothly.

What exactly does the reform change for building clients – beyond the funding logic?

Above all, the starting point. In the past, a project often began with the space allocation plan: beds, wards, floor space. That remains important – but it is no longer enough.

The key today is to determine at an early stage: what role should the site play in the healthcare system in five to ten years’ time? Only once that is clear will the spatial layout, technology, organisation and investment requirements become truly comprehensible.

Who actually carries out this strategic clarification? It’s not exactly traditional architectural work.

Exactly. Before a single line is drawn, someone is needed to ask the questions before planning begins – and to link them clearly to operations, strategy and construction. For example:

- Which service groups should be covered?
- Which partnerships are realistic?
- What does a decision mean for operations and construction – now and in the future?

This is the level at which our sister company blu-print operates: master planning, operational organisation, strategic building development. If you skip this stage or cut corners, you’ll pay the price later – in the form of redesigns, spaces that don’t fit the bill, and structures that hinder rather than facilitate new care models.

How do you experience this in practice?

At our Aachen site, we often see the early stages of projects. These usually contain good ideas – but they are often not yet linked to all the relevant considerations and fail to take future developments into account. It used to be standard practice to have strategic plans tucked away in a drawer – even for smaller hospitals. Then, over the years, the framework conditions changed so rapidly that many organisations abandoned this approach and opted instead for small-scale, rapid, business-optimised implementation. Strategic planning was ‘out’.

With the hospital reform, the tide is turning again: strategic planning is becoming necessary once more. This also explains why blu-print is currently in such high demand.

What can you do as a planner?

We do not make the strategic decisions – that is the task of the governing bodies and management. But we can sharpen the basis for decision-making.

Our strength lies in structuring complexity and thinking through scenarios: what does setting a course mean in structural terms – in terms of space, technology, costs and scope for development? If this is clear at an early stage, decisions are better – and the project becomes more manageable later on.

Once the strategy is in place – how does that translate into the planning phase?

This is where integrated design really comes into its own. Architecture, engineering, medical technology and operational organisation are developed not in succession, but in tandem. That may sound obvious – but in practice, it often isn’t.

This is particularly relevant in healthcare construction: a building designed today for one service group may need to serve a different one tomorrow. This is only possible if flexibility is factored into the structure, technical management and floor plans from the outset. Retrofitting is expensive – and often barely possible once the building is in operation.

What role does medical technology play in this – and where does ATP health come into the picture?

In healthcare construction, medical technology is not a question of equipment, but of structure. A large piece of equipment or an operating theatre system is not ‘a piece of technology’ that you simply place somewhere. It defines service routing, safety requirements and processes – and has an impact right down to structural engineering and building services.

Our colleagues at ATP health bring this depth to the table: medical technology planning, functional design, space and functional programmes. And what is currently evolving is an even closer integration with ATP’s integrated design approach: working more closely together spatially, sharing a common project logic, thinking together from the outset – rather than laboriously bringing everything together later.

A large part of the transformation does not take place in new builds, but in existing buildings. How are the requirements changing there?

Existing buildings almost always mean: densification whilst operations continue. You have existing structures and technology dating back several decades, and you have to develop them further without interrupting service provision. This requires intensive planning.

And this is precisely where the three levels come together: blu-print first clarifies what the existing building is strategically intended to achieve and which options are realistic. Integral planning translates this into robust spatial and technical structures. ATP health provides the precision that is essential during ongoing operations – because mistakes there are not only costly, but directly impact operations.

What I see time and again is that many people underestimate how deeply one must look into an existing building before one can even begin to plan sensibly. Those who skip this step end up with costly surprises later on.

What advice would you give to clients who have to make decisions now?

That investment decisions today must be assessed differently than in the past. Not just: ‘What does the building cost?’ but: ‘What does it enable strategically?’

A building that can respond flexibly to changing requirements is different from one that is optimised for a single use. A structure that facilitates rather than hinders collaboration has a different value to one that merely reflects the status quo.

Those who grasp this connection early on – and have the right partners to translate it into planning – make better decisions and have more room for manoeuvre when the circumstances change again. And they will.