The Systems We Deserve: Designing Smart Hospitals for Real Lives
Designing for Movement, Not Stability
Smart hospitals are not a future ambition; they are a design imperative. As the healthcare sector confronts a convergence of challenges, ageing infrastructure, patient demand, digital disruption, and systemic fragmentation, we need to fundamentally rethink how care environments are conceived, constructed, and connected.
In a recent address, Sarah Borg Bonnici, CEO and Co-Director at Aryium, challenged the notion that digital transformation is optional.
"We’re still building healthcare for a world that doesn’t exist anymore," she said. "Smart healthcare isn’t about throwing more tech at the wall. It’s about designing for how people live, which is to say, unpredictably, globally, digitally, and in motion."
This article explores five priorities for designing smart hospitals that are truly responsive to real lives.
1. Clinical Interoperability: A System That Follows the Patient
"Interoperability isn’t an IT project, it’s an estate strategy."
The Goal: Real-time access to labs, imaging, history, and medication, regardless of postcode or provider.
The Reality: Systems remain siloed. Pathology, radiology, and prescribing. Each on a separate server. Even within the same hospital.
The Risk: Errors, duplication, delays, and disjointed care.
The Fix:
Mandated nationwide interoperability standards (FHIR, HL7)
Middleware for legacy system integration
Capital funding linked to integration outcomes
Embedded digital infrastructure in new builds and retrofits
2. Cybersecurity: Patient Safety in the Cloud Age
"A system that can’t protect itself can’t protect its patients."
The Opportunity: Smart systems enable precision care, predictive analytics, and operational efficiency.
The Threat: Every connected device - from infusion pumps to mobile apps - is a potential attack vector.
The Blocker: Cybersecurity is still siloed in IT, not embedded in clinical or operational safety culture.
The Fix:
Zero-trust architecture
Endpoint isolation and routine penetration testing
Capital ringfencing for cyber resilience
Mandatory staff training and routine drills
3. Data-Driven Triage and Flow: From Reactive to Proactive
"Flow isn’t a data issue, it’s a design issue".
The Promise: Real-time dashboards that reduce A&E wait times, optimise elective surgery, and predict bottlenecks.
The Problem: Too many hospitals still rely on whiteboards, Excel sheets, and anecdotal escalation.
The Fix:
Central command centres with live oversight
Predictive analytics platforms
Clinical leadership in platform design
Digital retrofit funding for existing estates
4. Remote Monitoring and Virtual Wards: Extending the Estate
"Virtual care isn’t an experiment, it’s the frontline extension of smart hospitals".
The Advantage: Patients receive hospital-level care at home, freeing up beds and improving outcomes.
The Challenge: Uptake is inconsistent. Devices vary in quality. Integration with EPRs is patchy.
The Fix:
National procurement of validated remote devices
Estate-integrated digital triage hubs
Full interoperability with acute records
Subsidised connectivity and training for patients
5. Infrastructure Equity: Smart Shouldn’t Be a Postcode Lottery
"Equity isn’t just about buildings, it’s about access to digital care."
The Ideal: Digital systems as levellers, supporting care quality everywhere.
The Gap: Most transformation happens in flagship sites. Many hospital buildings predate personal computing.
The Fix:
Digital retrofit programme backed by Treasury
Minimum digital standard for estate investment
National Digital Readiness Index
Public accountability for progress
Building for Real Lives
"…(a) patchwork of experience," said Sarah, reflecting on a childhood spent between health systems, "left me with one very clear conviction: healthcare has to reflect real lives. Lives that move, that age and that crosses borders."
Smart hospitals are not about complexity. They are about responsiveness. We already have the tools - what we need now is leadership.
The ask:
Designers and developers: Build for interoperability, not just occupancy.
Trust boards: Invest in cyber and flow like your outcomes depend on it, because they do.
Policymakers: Make digital equity a national standard, not an aspiration.
Because if we wait for the perfect system, someone else will build it for us!