​Hospital Planning & Design : Getting it Right

Explore how hospitals address patient well-being, safety, and efficient functionality through architecture and design

​Hospital Planning & Design

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 occupant’s 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.

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 patient’s 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 patient’s 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. Architect’s 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 Architect’s obligation is to assure consistency throughout the project and at every level of detail.

There are a plethora of aspects that demand an Architect’s 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​

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​T Muhammed Younus
BE, MS (UK), MBA, Managing Director, Cedara Healthcare Pvt. Ltd. | + posts
Yusuf Aidroos
B. Arch, (USA), AIA, Sr. Healthcare Architect, Cedara Healthcare Pvt. Ltd. | + posts