”A functional design can promote skill, economy, conveniences, and comforts; a non-functional design can impede activities of all types, detract from quality of care, and raise costs to intolerable levels.” (…Hardy and Lammers)
Evolution of Hospitals:
Hospitals in earlier times served quite different purposes from those of today. They were founded to shelter older adults, the dying and to protect and treat the inhabitants of a community from contagious diseases. There is a paradigm shift in the role of Hospitals in present day scenario. The approach of Hospitals has been more broadened crossing the limits of Curative Health to Health care including education, research and training.
Technological advancement both in diagnostic as well as therapeutic areas, changing economic landscape, patient preferences are few other factors which have led to change in size, shape and function of the Hospitals.
Role of Planning in modern Hospitals
Hospital Planning has evolved as an imperative tool for bringing in overall efficiencies in a Healthcare facility. Good Hospital design integrates functional requirements with the human needs and safety aspects of its varied users. Following are few attributes of a functionally planned Healthcare facility:
- Need based Development of Hospital
- Controlled Circulation
- Minimized cross infection
- Patient and Attendant friendly experience
- Improved staff satisfaction
- Environmentally responsible building
- Future proofing
Need based Development of Hospital:
It is imperative to understand the healthcare needs of a place before establishing a Hospital. A detailed market research forms the basis on which the Hospital can be planned. Medical program is developed following the market assessment which entails the Specialty mix, Diagnostic facilities, Support services and Bed mix in the Hospital. The Medical Program also gives an indication of the utilization trend of services and facilities in the proposed Healthcare facility thereby determining the level of infrastructure required.
A hospital is a complex system of interrelated functions requiring constant movement of people and goods. Much of this circulation should be controlled thereby minimizing crisscrossing of various traffic movements (staff, patients, attendant & visitors) across the facility. This requires optimal functional adjacencies of various departments within the Hospital. These adjacencies should be based on a detailed functional program which describes the hospital’s intended operations from the standpoint of patients, staff, and supplies.
Minimized cross infection
Efficient Hospital Planning also ensures that the Hospitals are designed to incorporate infection control strategies to minimize the risk of infection transmission. This requires zoning of critical areas like Surgical suite, ICUs, Catheterization Laboratory, CSSD, etc. Zoning helps in ensuring an infection free environment by separating the sterile areas from the general public access areas.
One of the other important requirements is to segregate critical areas like OT, ICU from general traffic and avoidance of air movement from areas like laboratories and infectious diseases wards towards critical areas. Provisioning of isolation rooms in ICUs & wards, dirty utility spaces, ante rooms before entering critical areas, adequate wash basins are few other planning principles to keep in mind to ensure infection control.
Patient and Attendant friendly experience
Hospital patients are often fearful and confused and these feelings may impede recovery. If a Hospital is designed well, it can give the patient a much better healing experience. Every effort should be made to make the hospital stay as comfortable, and stress-free as possible. Design of Hospitals should take patient’s psychological needs into account, such as ensuring adequate ventilation and natural light, inspiring views, relaxing gardens or courtyards, lots of art, pleasant colour schemes, and “way finding”, to ease a patient’s hospital stay.
Nowadays, provision for accommodating attendants in adjunct to their ailing near ones is being promoted which is believed to improve the treatment outcome of the patients. This also reduces the attendant’s anxiety level and provides them with a comfortable hospital experience.
Improved staff satisfaction
Hospital is a 24 hours functional unit where staff needs to be dedicatedly working round the clock towards patient care. It is very imperative to consider the comfort level of the staff and provide them with the required functional spaces within the Hospital. Staff lounges, rest rooms for resident doctors, counseling rooms, dining area, adequate number of toilets, change rooms, etc. are non-negotiable space considerations while planning a staff friendly Hospital. Effective Hospital planning promotes staff efficiency by minimizing distance of necessary travel between frequently used spaces
Environmentally responsible building
According to the World Health Organization, close to one fourth of the diseases experienced by the world’s population can be attributed to environmental exposures. The healthcare industry is one of the largest consumers of energy. Hospital waste and energy consumption affect the health of the environment and, consequently, the health of each human being within the environment. While hospitals have the responsibility to treat the sick within their walls, they are also responsible to promote the health of clients, staff, and the environment. The duty of maintaining an environmentally friendly hospital is shared among numerous stakeholders within the organization. Following are some considerations one should make while planning a green Hospital:
- Protect trees and topsoil during site work.
- Prioritize parks, green-ways, and bike-ways throughout the new hospital area.
- Consider (re)use of existing buildings, including structure, shell, etc. (in case of renovation or up-gradation projects)
- Orient building to take advantage of solar energy for heating and day lighting and to encourage natural ventilation and passive cooling
- Consider collecting storm water run-off for other purposes (irrigation) on the site.
- Ensure adequate space for storage of hazardous waste (e.g., biomedical, chemical, radioactive, etc.)
- Use high-performance windows (double-glazed, argon, etc.)
Healthy environments can result in better patient outcomes, a healthier staff and allow the facility to promote itself as a positive, healthy contributor to its community.
Future proofing through Modular Construction
Since medical needs and modes of treatment will continue to change, hospitals should follow modular concepts of space planning and layout. The use of
modular construction is directly influenced by the client’s requirements for speed of construction, addition of new departments, least disturbance to existing facilities, quality, and added benefits of economy of scale as well as single point procurement.
Planning has to be open-ended, with well-planned directions for future expansion; for instance positioning “soft spaces” such as administrative departments, adjacent to “hard spaces” such as clinical laboratories.
Appreciation of Hospital Planning elements has started taking precedence in modern day Hospitals. The country is in a state of Healthcare transition where both Government and Private players are intensively investing in the sector. There is also an immediate need to up-grade old public sector Hospitals which have been growing sporadically over the years. It has created greater inefficiencies in the healthcare facilities thereby compromising patient care aspects. Here, Hospital Consultants have a big role to play in developing efficient and responsible healthcare facilities. Hospital Planners/Administrators need to work in sync with Architects with inputs from the promoters to establish facilities which are in line with the promoters’ vision, local needs and comfort & security concern of patients, staff and other stakeholders.