HOSPITAL PLANNING

Hospital Planning & Design:

Getting it Right
T Mohammed Younus, BE, MS
(UK), MBA
Managing Director,
Cedara Healthcare Pvt. Ltd.

Architect Yusuf Aidroos, B.Arch
(USA), AIA.
Sr. Healthcare Architect,
Cedara Healthcare Pvt. Ltd.
7
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.................................................................................................. A true successful project is
one where goals are identified early on and where inter dependencies of all building systems are
coordinated concurrently from the Planning and Programming phase. This applies more crucially to
Hospitals than other type of buildings, because not only it pertains to occupants well-being, but also,
HOSPITALS are the most complex and most regulated of all building types. Each of the wide ranging
and constantly evolving functions of a Hospital including complicated mechanical, electrical, and
communications systems, requires specialized knowledge and expertise. No one person can reasonably
have complete knowledge, which is why specialized consultants play an important role in Hospital
Planning and Design. The Designer also has to be an advocate for the patients, visitors, support staff,
volunteers, and suppliers who do not generally have direct input into the design. Good Hospital design
integrates functional requirements with the human needs and safety aspects of its varied users. A
decision on Hospital building must be based on multiple factors besides cost, such as safety for patients,
hygiene, building health, environmental protection, sound isolation, energy saving, durability and
utilization rate, choice of construction material, margin for contingencies like floods, fire, earthquakes etc,
among others.

The basic form of a Hospital is, ideally, based on its functions: Bed-related inpatient, outpatient-related,
Diagnostic and Treatment, Administrative, infrastructure Service (Sterilization, Laundry, Information
systems, Water, food, supply), Research and Teaching functions, where Physical relationships between
these functions determine the configuration of the Hospital. The physical configuration of a Hospital and
its transportation and logistics systems are inextricably intertwined. The transportation systems are
influenced by the building configuration, and the configuration is also influenced by site restraints and
opportunities, climate, surrounding facilities, budget, and available technology. New alternatives are
generated by new medical needs and new technology. In a large Hospital, the form of the typical nursing
unit, since it may be repeated many times, is a principal element of the overall
configuration.

The physical design and infrastructure of a Hospital is an essential component of its Infection Control
measure. Thus, this must be a prerequisite to take these into consideration from the initial conception and
planning stages of the building. Hospitals should have adequate supply of Isolation and Negative-
pressure rooms in wards, Emergency department and ICUs. By controlling and ensuring adequate
sanitization of the environment of the host, Hospital authorities can reduce the incidence of Hospital
Acquired Infections (HAI). Likewise there areas such as the Operation rooms require positive pressure
and controlled air quality. Sick baby units, NICU etc have special temperature and humidity control
requirements.

Architecture:
A Hospital may be a single building or a campus. Some Hospitals are affiliated with Universities for
Medical Research and the training of medical personnel. Modern Hospital buildings are designed to
minimize the effort of medical personnel and the possibility of contamination while maximizing the
efficiency of the whole system. Hospital design directly impacts patient health. If designed well, it can give
the patient a much better healing experience. Travel time for personnel within the Hospital and the
transportation of patients between units is facilitated and minimized. Hospital designs should establish
design that takes patients psychological needs into account, such as providing more air and ensuring
adequate ventilation and natural light, inspiring views, relaxing gardens or courtyards, lots of art, pleasant
color schemes, and way finding, to ease a patients hospital stay. These ideas harkens back to the late
18th century, when the concept of providing fresh air and access to the healing powers of nature were
first employed by Hospital Architects in improving their buildings. It is no secret that hospital patients are
influenced by their surroundings. Providing Private rooms reduces medication error, incidence of falls and
the reduced noise helps sleep which is critical for patient recovery not to mention respect of patients
privacy. The environment of a Hospital contributes to the therapy of the patients, and so the Architects
and Designers around the world are working to greatly change Hospitals by humanizing their design.
Hospital Consultancy firms offer a useful blend of strategic thinking, practicality and creativity for,
Healthcare entities seeking to cut costs, maximize staff efficiency, and increase in Patient satisfaction.

A Hospital that incorporates artistic and human scale and the therapeutic features of hospital design is
considered to be a good example. Hospital Architecture must facilitate Technology adoption,
implementation and also contribute to the efficiency and transparency of processes while remaining
scalable and flexible to accommodate future needs. It must provide seamless integration of Clinical
requirements with Building Planning and Designing issues. The real challenge is to Design a building that
will fit the functional processes. The golden Architectural principle of indeterminacy should be followed
which enables a building to grow with order and change with charm. Hospital Architecture must focus on
improving the quality of environment for the consumers and the care givers. All aspects including Interior
Designing, Spaces, Exteriors Landscaping should receive due care. Hospitals must be designed to
support the process that have to take place within the building to treat the patients in an efficient manner.
State of the art technology and human sentiment can be adopted, adapted and implemented to create an
unrivaled Architecture.

Environmental stressors include noise, light, and compromised privacy. Gardens or Landscaping in
Hospitals reduces stress among patients and families. Way-finding problems in hospitals have a
significant impact on patients, visitors and the staff, who can be stressed and disoriented. Architecture
has an effect on patient outcome and staff performance.

Architects specializing in Hospital Design are known as Healthcare Architects. Architects know
understand the demands of patients, relatives, and staff, and come up with a Humanistic Building Design
which is built by humans for humans. Architect should be knowledgeable about operational processes
and departmental activities and needs (Emergency, Diagnosis and Treatment, Nursing Units, Labs,
Pharmacy, ICU, Surgery Services, etc.), familiar with Healing process, medical equipment, Building
codes, Fire regulations etc. They should create in the building good Lighting, Ventilation and create a
pleasant Environment and also co-ordinate with Hospital Consultants, End Users and Hospital
Administrators apart from the other engineering disciplines (Electrical, Mechanical, Civil, Structural etc.).
Critical thinking is required to develop an appropriate solution to the design
problem.
In the Design development phase, an Architect should play the role of facilitator for the various
contributors. In Contract documents, high quality can be achieved by scrutiny, accountability to the initial
program needs by the design team and the client, along with careful co-ordination among the technical
consultants.

Architecture has an effect on patient outcome and staff performance and hence the Hospital Designers
and Administrators main aim is to create a Healing space, which could be defined as a space that
reduces stress, helps health and healing, and improves patient and staff safety. The Patients have
become more quality conscious as well as price sensitive. They expect Clinical, Administrative and
Supportive Services as well as Design of facilities to be contusive to their requirements. Architects
objective should be to create a patient focused, patient centered Architecture by offering an atmosphere
of safety, security, cleanliness and physical comfort.

First and foremost one needs to address the Circulation, that is, in-flow and movement of patients,
visitors, doctors, technicians, nursing staff, both inside and outside of the building. Location of spaces for
different departments and inter-linking is very important; if it is properly designed it can reduce
unnecessary movement and stress on everyone. Architects need to ensure adequate transition space for,
staff, and patients and design the appropriate treatment areas required by the equipment and services.
The Architect should also make an effort to bring nature into the patients surroundings. Enough
importance should be given to acoustics, privacy, safety, hygiene, etc., in addition to services like
ventilation, air conditioning, bio-medical gases, lighting, and sanitation. When Safety is mentioned, it
includes storage and disposal of bio-hazardous and solid waste.

Energy conservation must be planned and implemented, and some of the measures are: use of high
efficiency light sources, Natural light utilization, effective Ventilation, easy Maintainability and Energy
recycling. Architects and Hospital Planners have to keep pace with the advancement in modern Medicine,
Nursing techniques and Community clientele expectation. The best buildings are the result of high
degrees of consistency at all levels of their realization. The Architects obligation is to assure consistency
throughout the project and at every level of detail.

There are a plethora of aspects that demand an Architects attention while designing a Hospital. The role
of a Healthcare Architect should be recognized in health care design. In most cases it is usually left to a
non-specialized Architect without adequate exposure to the functioning of a hospital building. The result is
a design that does not address the apparent and latent needs of functionality. This impacts not only
operational costs but also compromised patient outcomes.

In conclusion hospital administrators and owners planning to either establish and new hospital or extend
or renovate an existing one must seek expertise from hospital consultants and healthcare architects,
clearly articulating their goals and objectives, defining the focus areas and expected function of
the hospital building. These must be validated by a proper feasibility study, proper demand analysis,
facility plan and design brief. This will result in a facility purpose built that facilities the healing process,
reduces stress and is economical for operation and maintenance.

Contact: C/o Medipro, Dhaka, Bangladesh
Email: tanvir@mediprobd.com