The Covert Life of Hospital Architecture

Edited by Julie Zook and Kerstin Sailer. 2022. UCL Press; London, England.

Available free at:

Every designer, design researcher, and space manager should read The Covert Life of Hospital Architecture, edited by Zook and Sailer.  Why?  First of all, the text is actually readable, not packed with academic mumbo jumbo.  Second, it is an excellent introduction to space syntax research tools.  Third, the powerful insights presented by chapter authors (academics and practitioners) are useful when all sorts of spaces, not just healthcare ones, are being designed and managed.

Zook, in her acknowledgements, lays out the reasons the book was developed: “This is a book of research, but in making it, we wanted to speak with practising architects and designers, the clients and publics with whom they seek solutions, and the students who will in time enter these areas of practice. What I am saying is that making esoteric ideas more accessible is at the centre of this project, and it is for this reason that we are particularly pleased and proud to publish this book open access.”

In Chapter 1 (The Spatial Dimension of Hospital Life), Zook adds more details about the structure of the text she’s edited with Sailer: “Hospital space is experienced by users who are both positioned socially in roles, such as patient, doctor or nurse, and positioned physically in specific locations within a spatial pattern. This book demonstrates ways that the experiential side of hospital architecture systematically and probabilistically affects outcomes. Specifically, this book presents cases where hospital plans are spatially analysed to reveal underlying patterns of paths and visual fields that impact behaviours and outcomes that are important. . . . The authors here are interested in how building spaces organise life activities and how built forms are designed to fortify some activities and relationships and not others. . . . What a building is made for and what it is used for inevitably fail to fully match up. A building’s sanctioned activities are augmented or undermined by informal, emergent ones. . . . Hospitals present a concentrated version of the challenges that prevail more broadly in architectural thought and practice. . . . It is very easy to declare how some architectural approach will work, but very difficult to capture nuanced but generalisable descriptions of how it actually does work. The volume takes on this latter, less glamorous task because it is foundational to developing theories of building function that can offer a stronger and more flexible basis for design decisions.”

Do you design or manage physical environments and want to better understand how the spatial and social conditions in them are (or should be) related?  If you answered “yes,” read The Covert Life of Hospital Architecture.