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Hospital|WholeBuildingDesignGuide
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Home>DesignGuidance>BuildingTypes>HealthCareFacilities>Hospital

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Hospital

RELATEDRESOURCEPAGES

byRobertF.Carr
NIKATechnologies,Inc.forVAOfficeofConstruction&FacilityManagement(CFM)
RevisedbytheWBDGHealthCareSubcommittee
Lastupdated:04212011

OVERVIEW

AchievingSustainableSiteDesign
throughLowImpactDevelopment
Practices
AestheticChallenges

"Afunctionaldesigncanpromoteskill,economy,conveniences,
andcomfortsanonfunctionaldesigncanimpedeactivitiesofall
types,detractfromqualityofcare,andraisecoststointolerable
levels."...HardyandLammers

WithinThisPage
Overview

AestheticOpportunities

BuildingAttributes
EmergingIssues
RelevantCodesand
Standards

Hospitalsarethemostcomplexofbuildingtypes.Eachhospitalis
MajorResources
comprisedofawiderangeofservicesandfunctionalunits.These
includediagnosticandtreatmentfunctions,suchasclinical
laboratories,imaging,emergencyrooms,andsurgeryhospitalityfunctions,suchasfoodservice
andhousekeepingandthefundamentalinpatientcareorbedrelatedfunction.Thisdiversityis
reflectedinthebreadthandspecificityofregulations,codes,andoversightthatgovernhospital
constructionandoperations.Eachofthewiderangingandconstantlyevolvingfunctionsofa
hospital,includinghighlycomplicatedmechanical,electrical,andtelecommunicationssystems,
requiresspecializedknowledgeandexpertise.Noonepersoncanreasonablyhavecomplete
knowledge,whichiswhyspecializedconsultantsplayanimportantroleinhospitalplanningand
design.Thefunctionalunitswithinthehospitalcanhavecompetingneedsandpriorities.Idealized
scenariosandstronglyheldindividualpreferencesmustbebalancedagainstmandatory
requirements,actualfunctionalneeds(internaltrafficandrelationshiptootherdepartments),and
thefinancialstatusoftheorganization.

AirBarrierSystemsinBuildings
AirDecontamination
VIEWALLRELATED(43)
VIEWRESOURCEPAGEINDEX

Inadditiontothewiderangeofservicesthatmustbe
accommodated,hospitalsmustserveandsupport
manydifferentusersandstakeholders.Ideally,the
designprocessincorporatesdirectinputfromtheowner
andfromkeyhospitalstaffearlyonintheprocess.The
designeralsohastobeanadvocateforthepatients,
visitors,supportstaff,volunteers,andsupplierswhodo
notgenerallyhavedirectinputintothedesign.Good
hospitaldesignintegratesfunctionalrequirementswith
thehumanneedsofitsvariedusers.
Thebasicformofahospitalis,ideally,basedonits
functions:

VAMCBayPines,FL

bedrelatedinpatientfunctions
outpatientrelatedfunctions
diagnosticandtreatmentfunctions
administrativefunctions
servicefunctions(food,supply)
researchandteachingfunctions
Physicalrelationshipsbetweenthesefunctionsdeterminetheconfigurationofthehospital.Certain
relationshipsbetweenthevariousfunctionsarerequiredasinthefollowingflowdiagrams.
Theseflowdiagramsshowthemovementand
communicationofpeople,materials,and
waste.Thusthephysicalconfigurationofa
hospitalanditstransportationandlogistic
systemsareinextricablyintertwined.The
transportationsystemsareinfluencedbythe
buildingconfiguration,andtheconfigurationis
heavilydependentonthetransportation
systems.Thehospitalconfigurationisalso
influencedbysiterestraintsandopportunities,
climate,surroundingfacilities,budget,and
availabletechnology.Newalternativesaregeneratedbynewmedicalneedsandnewtechnology.
Inalargehospital,theformofthetypicalnursingunit,sinceitmayberepeatedmanytimes,isa
principalelementoftheoverallconfiguration.Nursingunitstodaytendtobemorecompactshapes
thantheelongatedrectanglesofthepast.Compactrectangles,modifiedtriangles,orevencircles
havebeenusedinanattempttoshortenthedistancebetweenthenursestationandthepatient's
bed.Thechosensolutionisheavilydependentonprogramissuessuchasorganizationofthe
nursingprogram,numberofbedstoanursingunit,andnumberofbedstoapatientroom.(The
trend,recentlyreinforcedbyHIPAA,istoallprivaterooms.)
BACKTOTOP

BUILDINGATTRIBUTES
Regardlessoftheirlocation,size,orbudget,allhospitalsshouldhavecertaincommonattributes.

EfficiencyandCostEffectiveness

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Anefficienthospitallayoutshould:
Promotestaffefficiencybyminimizing
distanceofnecessarytravelbetween
frequentlyusedspaces
Alloweasyvisualsupervisionof
patientsbylimitedstaff
Includeallneededspaces,butno
redundantones.Thisrequirescareful
predesignprogramming.
Provideanefficientlogisticssystem,
whichmightincludeelevators,
pneumatictubes,boxconveyors,
manualorautomatedcarts,and
gravityorpneumaticchutes,forthe
efficienthandlingoffoodandclean
suppliesandtheremovalofwaste,
recyclables,andsoiledmaterial
Makeefficientuseofspaceby
locatingsupportspacessothatthey
maybesharedbyadjacentfunctionalareas,andbymakingprudentuseofmultipurpose
spaces
Consolidateoutpatientfunctionsformoreefficientoperationonfirstfloor,ifpossiblefor
directaccessbyoutpatients
Grouporcombinefunctionalareaswithsimilarsystemrequirements
Provideoptimalfunctionaladjacencies,suchaslocatingthesurgicalintensivecareunit
adjacenttotheoperatingsuite.Theseadjacenciesshouldbebasedonadetailedfunctional
programwhichdescribesthehospital'sintendedoperationsfromthestandpointofpatients,
staff,andsupplies.

FlexibilityandExpandability
Sincemedicalneedsandmodesoftreatmentwillcontinueto
change,hospitalsshould:
Followmodularconceptsofspaceplanningandlayout
Usegenericroomsizesandplansasmuchaspossible,rather
thanhighlyspecificones
Beservedbymodular,easilyaccessed,andeasilymodified
mechanicalandelectricalsystems
Wheresizeandprogramallow,bedesignedonamodular
systembasis,suchastheVAHospitalBuildingSystem.This
systemalsouseswalkthroughinterstitialspacebetween
occupiedfloorsformechanical,electrical,andplumbing
distribution.Forlargeprojects,thisprovidescontinuing
adaptabilitytochangingprogramsandneeds,withnofirst
VAMCAlbuquerque,NM
costpremium,ifproperlyplanned,designed,andbid.TheVA
HospitalBuildingSystemalsoallowsverticalexpansion
withoutdisruptionstofloorsbelow.
Beopenended,withwellplanneddirectionsforfutureexpansionforinstancepositioning"soft
spaces"suchasadministrativedepartments,adjacentto"hardspaces"suchasclinical
laboratories.

TherapeuticEnvironment
Hospitalpatientsareoftenfearfulandconfusedandthese
feelingsmayimpederecovery.Everyeffortshouldbemade
tomakethehospitalstayasunthreatening,comfortable,and
stressfreeaspossible.Theinteriordesignerplaysamajor
roleinthisefforttocreateatherapeuticenvironment.A
hospital'sinteriordesignshouldbebasedona
comprehensiveunderstandingofthefacility'smissionand
itspatientprofile.Thecharacteristicsofthepatientprofile
willdeterminethedegreetowhichtheinteriordesign
shouldaddressaging,lossofvisualacuity,otherphysical
andmentaldisabilities,andabusiveness.(SeeVAInterior
DesignManual.)Someimportantaspectsofcreatinga
therapeuticinteriorare:
Usingfamiliarandculturallyrelevantmaterials
whereverconsistentwithsanitationandotherfunctional
needs
Usingcheerfulandvariedcolorsandtextures,keepinginmindthatsomecolorsare
inappropriateandcaninterferewithproviderassessmentsofpatients'pallorandskintones,
disorientolderorimpairedpatients,oragitatepatientsandstaff,particularlysomepsychiatric
patients.
Admittingamplenaturallightwhereverfeasibleandusingcolorcorrectedlightingininterior
spaceswhichcloselyapproximatesnaturaldaylight
Providingviewsoftheoutdoorsfromeverypatientbed,andelsewherewhereverpossible
photomuralsofnaturescenesarehelpfulwhereoutdoorviewsarenotavailable
Designinga"wayfinding"processintoeveryproject.Patients,visitors,andstaffallneedto
knowwheretheyare,whattheirdestinationis,andhowtogetthereandreturn.Apatient's
senseofcompetenceisencouragedbymakingspaceseasytofind,identify,andusewithout
askingforhelp.Buildingelements,color,texture,andpatternshouldallgivecues,aswellas
artworkandsignage.(Asanexample,seeVASignageDesignGuide.)
ForanindepthviewseeWBDGTherapeuticEnvironments.

CleanlinessandSanitation

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Hospitalsmustbeeasytocleanand
maintain.Thisisfacilitatedby:
Appropriate,durablefinishesforeach
functionalspace
Carefuldetailingofsuchfeaturesas
doorframes,casework,andfinish
transitionstoavoiddirtcatchingand
hardtocleancrevicesandjoints
Adequateandappropriatelylocated
housekeepingspaces
Specialmaterials,finishes,and
Crosssectionshowinginterstitialspacewithdeckabovean
occupiedfloor
detailsforspaceswhicharetobe
keptsterile,suchasintegralcove
base.Thenewantimicrobialsurfaces
mightbeconsideredforappropriatelocations.
IncorporatingO&Mpracticesthatstressindoorenvironmentalquality(IEQ)

Accessibility
Allareas,bothinsideandout,should:
ComplywiththeminimumrequirementsoftheAmericanswithDisabilityAct(ADA)and,if
federallyfundedorowned,theGSA'sABAAccessibilityStandards
InadditiontomeetingminimumrequirementsofADAand/orGSA'sABAAccessibility
Standards,bedesignedsoastobeeasytousebythemanypatientswithtemporaryor
permanenthandicaps
Ensuringgradesareflatenoughtoalloweasymovementandsidewalksandcorridorsarewide
enoughfortwowheelchairstopasseasily
Ensuringentranceareasaredesignedtoaccommodatepatientswithsloweradaptationratesto
darkandlightmarkingglasswallsanddoorstomaketheirpresenceobvious

ControlledCirculation
Ahospitalisacomplexsystemofinterrelatedfunctionsrequiringconstantmovementofpeopleand
goods.Muchofthiscirculationshouldbecontrolled.
Outpatientsvisitingdiagnosticandtreatmentareasshouldnottravelthroughinpatient
functionalareasnorencounterseverelyillinpatients
Typicaloutpatientroutesshouldbesimpleandclearlydefined
Visitorsshouldhaveasimpleanddirectroutetoeachpatientnursingunitwithoutpenetrating
otherfunctionalareas
Separatepatientsandvisitorsfromindustrial/logisticalareasorfloors
Outflowoftrash,recyclables,andsoiledmaterialsshouldbeseparatedfrommovementoffood
andcleansupplies,andbothshouldbeseparatedfromroutesofpatientsandvisitors
Transferofcadaverstoandfromthemorgueshouldbeoutofthesightofpatientsandvisitors
Dedicatedserviceelevatorsfordeliveries,foodandbuildingmaintenanceservices

Aesthetics
Aestheticsiscloselyrelatedtocreatingatherapeuticenvironment(homelike,attractive.)Itis
importantinenhancingthehospital'spublicimageandisthusanimportantmarketingtool.Abetter
environmentalsocontributestobetterstaffmoraleandpatientcare.Aestheticconsiderations
include:
Increaseduseofnaturallight,naturalmaterials,andtextures
Useofartwork
Attentiontoproportions,color,scale,anddetail
Bright,open,generouslyscaledpublicspaces
Homelikeandintimatescaleinpatientrooms,dayrooms,consultationrooms,andoffices
Compatibilityofexteriordesignwithitsphysicalsurroundings

SecurityandSafety
Inadditiontothegeneralsafetyconcernsofallbuildings,hospitalshaveseveralparticularsecurity
concerns:
Protectionofhospitalpropertyandassets,includingdrugs
Protectionofpatients,includingincapacitatedpatients,andstaff
Safecontrolofviolentorunstablepatients
Vulnerabilitytodamagefromterrorismbecauseofproximitytohighvulnerabilitytargets,or
becausetheymaybehighlyvisiblepublicbuildingswithanimportantroleinthepublichealth
system.

Sustainability
Hospitalsarelargepublicbuildingsthathaveasignificantimpactontheenvironmentandeconomy
ofthesurroundingcommunity.Theyareheavyusersofenergyandwaterandproducelarge
amountsofwaste.Becausehospitalsplacesuchdemandsoncommunityresourcestheyare
naturalcandidatesforsustainabledesign.
Section1.2ofVA'sHVACDesignManualisagoodexampleofhealthcarefacilityenergy
conservationstandardsthatmeetEPAct2005(PDF1.3MB,550pgs)andExecutiveOrder13693
requirements.TheEnergyIndependenceandSecurityActof2007(EISA)(PDF740KB,310pgs)
providesadditionalrequirementsforenergyconservation.AlsoseeLEED's(LeadershipinEnergy
andEnvironmentalDesign)USGBCLEEDforHealthcare

RelatedIssues
TheHIPAA(HealthInsurancePortabilityandAccessibilityActof1996)regulationsaddresssecurity
andprivacyof"protectedhealthinformation"(PHI).Theseregulationsputemphasisonacousticand
visualprivacy,andmayaffectlocationandlayoutofworkstationsthathandlemedicalrecordsand
otherpatientinformation,paperandelectronic,aswellaspatientaccommodations."

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BACKTOTOP

EMERGINGISSUES
Amongthemanynewdevelopmentsandtrendsinfluencinghospitaldesignare:
Thedecreasingnumbersofgeneralpractitionersalongwiththeincreaseduseofemergency
facilitiesforprimarycare
Theincreasingintroductionofhighlysophisticateddiagnosticandtreatmenttechnology
Requirementstoremainoperationalduringandafterdisasterssee,forexample,VA's
PhysicalSecurityManuals
Statelawsrequiringearthquakeresistance,bothindesigningnewbuildingsandretrofitting
existingstructures
Preventativecareversussicknesscaredesigninghospitalsasallinclusive"wellnesscenters"
Useofhandheldcomputersandportablediagnosticequipmenttoallowmoremobile,
decentralizedpatientcare,andageneralshifttocomputerizedpatientinformationofallkinds.
Thismightrequirecomputeralcovesanddataportsincorridorsoutsidepatientbedrooms.For
moreinformation,seeWBDGIntegrateTechnologicalTools
Needtobalanceincreasingattentiontobuildingsecuritywithopennesstopatientsandvisitors
Emergenceofpalliativecareasaspecialtyinmanymajormedicalcenters
Agrowinginterestinmoreholistic,patientcenteredtreatmentandenvironmentssuchas
promotedbyPlanetree.Thismightincludeprovidingminimedicallibrariesandcomputer
terminalssopatientscanresearchtheirconditionsandtreatments,andlocatingkitchensand
diningareasoninpatientunitssofamilymemberscanpreparefoodforpatientsandfamiliesto
eattogether.
BACKTOTOP

RELEVANTCODESANDSTANDARDS
Hospitalsareamongthemostregulatedofallbuildingtypes.Likeotherbuildings,theymustfollow
thelocaland/orstategeneralbuildingcodes.However,federalfacilitiesonfederalproperty
generallyneednotcomplywithstateandlocalcodes,butfollowfederalregulations.Tobelicensed
bythestate,designmustcomplywiththeindividualstatelicensingregulations.Manystatesadopt
theFGIGuidelinesforDesignandConstructionofHospitalsandHealthCareFacilities,listedbelow
asaresource,andthusthatvolumeoftenhasregulatorystatus.
StateandlocalbuildingcodesarebasedonthemodelInternationalBuildingCode(IBC).Federal
agenciesareusuallyincompliancewiththeIBCexceptNFPA101(LifeSafetyCode),NFPA70
(NationalElectricCode),andArchitecturalBarriersActAccessibilityGuidelines(ABAAG)orGSA's
ABAAccessibilityStandardstakesprecedence.
SincehospitalstreatpatientswhoarereimbursedunderMedicare,theymustalsomeetfederal
standards,andtobeaccredited,theymustmeetstandardsoftheJointCommissiononthe
AccreditationofHealthcareOrganizations(JCAHO).Generally,thefederalgovernmentandJCAHO
refertotheNationalFireProtectionAssociation(NFPA)modelfirecodes,includingStandardsfor
HealthCareFacilities(NFPA99)andtheLifeSafetyCode(NFPA101).
TheAmericanwithDisabilitiesAct(ADA)appliestoallpublicfacilitiesandgreatlythebuilding
designwithitsgeneralandspecificaccessibilityrequirements.TheArchitecturalBarriersAct
AccessibilityGuidelines(ABAAG)orGSA'sABAAccessibilityStandardsapplytofederaland
federallyfundedfacilities.ThetechnicalrequirementsdonotdiffergreatlyfromtheADA
requirements.SeeWBDGAccessible
RegulationsoftheOccupationalSafetyandHealthAdministration(OSHA)alsoaffectthedesignof
hospitals,particularlyinlaboratoryareas.
Federalagenciesthatbuildandoperatehospitalshavedevelopeddetailedstandardsforthe
programming,design,andconstructionoftheirfacilities.Manyofthesestandardsareapplicableto
thedesignofnongovernmentalfacilitiesaswell.Amongthemare:
DepartmentofVeteransAffairs(VA),OfficeofConstruction&FacilitiesManagementTechnical
InformationLibrarycontainsmanyguidesandstandards,including:
DesignGuidesforplanningmanydifferentdepartmentsandclinics,designmanualsof
technicalrequirements,equipmentlists,masterspecifications,roomfinishes,space
planningcriteria,andstandarddetails.
BACKTOTOP

MAJORRESOURCES
WBDG
FederalMandate
ExecutiveOrder13693,"PlanningforFederalSustainabilityintheNextDecade"
ProductsandSystems
BuildingEnvelopeDesignGuide

Websites
SeeWBDGHealthCareFacilitiesforgenerichealthcarefacilitieswebsites

Publications
DesignDetailsforHealth:MakingtheMostofDesign'sHealingPotential,2ndEdition by
CynthiaA.LeibrockandDebraHarris.NewYork:JohnWiley&Sons,Inc.,2011.Innovative
designsolutionsinkeyareassuchaslighting,acoustics,color,andfinishes
DesignGuideforImprovingHospitalSafetyinEarthquakes,Floods,andHighWinds:Providing
ProtectiontoPeopleandBuildings.FEMA,2007.
DevelopmentStudyVAHospitalBuildingSystembyBuildingSystemsDevelopmentand
Stone,Marraccini&Patterson.Washington,DC:U.S.GovernmentPrintingOffice,rev.1977.

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EmergencyDepartmentDesign:APracticalGuidetoPlanningfortheFuturebyJohnHuddy
andMichaelT.Rapp.Irving,Texas:ACEP(AmericanCollegeofEmergencyPhysicians)2000.
HealthcareFacilityPlanning:ThinkingStrategicallybyCynthiaHayward,AIA,FAAHC,ACHA.
HealthAdministrationPressandtheAmericanCollegeofHealthcareExecutives,2005.
Hospitals,ThePlanningandDesignProcess,2nded.byOwenB.HardyandLawrenceP.
Lammers.Rockville,Md.:AspenPublishers,1996.
HospitalInteriorArchitecture:CreatingHealingEnvironmentsforSpecialPatientPopulations
byJainMalkin.NewYork:JohnWiley&Sons,Inc.,1992.
HealthcareDesignAquarterlymagazinewithdesignarticlesandpresentationsofrecent
projects
MedicalandDentalSpacePlanning:AComprehensiveGuidetoDesign,Equipment,and
ClinicalProcedures,3rdEdition ,byJainMalkin.NewYork:JohnWiley&Sons,Inc.,2002.
Sound&Vibration:DesignGuidelinesforHealthCareFacilitiesbytheAcousticsResearch
Council.2010.
UFC451001Design:MedicalMilitaryFacilities
SeeWBDGHealthCareFacilitiesforgenerichealthcarefacilitiespublications

Tools
SpaceMedGuideASpacePlanningGuideforHealthcareFacilitiesapopularplanningtool
providingstateoftheartplanningmethodologies,industrybenchmarks,andplanningtips.
BACKTOTOP

NationalInstituteofBuildingSciences|AnAuthoritativeSourceofInnovativeSolutionsfortheBuiltEnvironment
1090VermontAvenue,NW,Suite700|Washington,DC200054950|(202)2897800|Fax(202)2891092
2016NationalInstituteofBuildingSciences.Allrightsreserved.Disclaimer

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