Toronto UIA 2013 1

Hospital Planning and Building Standards AIA, NHS, DIN

INTERNATIONAL HEALTHCARE BUILDING STANDARDS &

CODES LATEST ON HARMONIZATION OF CODES AND
ACCREDITATION

HENNING LENSCH, RRP International Hospital Planners Pte Ltd

Munich-Germany-Singapore

September 2013
 Agenda 2

1. Comparison of AIA, NHS and DIN

2. Case Study 1: planned in accordance with AIA, not acceptable for NHS?
3. Case Study 2: Third Party Review and standards please re-design?
4. Accreditation and Planning Standards JCI instead of AIA/NHS/DIN
5. HAAD Abu Dhabi standards, based on Australia hospital standards
6. Outlook and recommendation what to follow?
7. Question and Answers

RRP
 Agenda 3

1. Comparison between AIA, NHS and German DIN

RRP
 4

AUS SICHT DES KRANKENHAUSES

What is the standard OT seize?

RRP International projects, state of the art?

Example 5

1. Standards for hospital operation theatres

AIA: 55 60 m2

NHS: 55 m2

Australasian: 42 52 m2

Canadian: 48 55 60 m2

Germany: different standards

 6

AUS SICHT DES KRANKENHAUSES

What is the minimum clear door

opening in patient rooms?

RRP International projects, state of the art?

Example 7

1. Standards for clear opening in patient room doors

AIA: 1.12 m clear opening

Recommendation for clear opening more than 1.22 m

NHS: 1.30 m structural opening

Recommendation for opening of minimum 1.50 m

Germany: 1.10 m clear opening

In the average around 1.25 m

Standard for Safety Standards for All? 8

INPATIENTS OUTPATIENTS
Standard for Workflow and Schedule of Accommodation?

The Architects Perspective

Clinical Path Ways and Workflow
Economy
Meets
Humanity
10
 STANDARDS FOR 11

Imaging
REHAB Home for the Elderly

Home for dementia

Outpatient Department Core-Hospital

Nurse-school

Hotel

Public Health Office

Daycare Operation Phyiotherapy
Centre Lifestyle and Spa

Hospice Health-Park
Private Hospital
Special. Clinics

RRP
STANDARDS NHS, DIN, NHS and Australasian HFG 12
 Agenda 13

AIA, NHS and German regulations

Source: Dr. Ing. Monika Schill-Fendl, Planungsmethodik

Germany different requirements 14

1. National insurance regulations, protection of staff

Germany different requirements 15

1. National insurance regulations, protection of staff

 Working Draft - Last Modified 4/3/2010 12:54:41 PM
Design Concept Staff area
 Working Draft - Last Modified 4/3/2010 12:54:41 PM
Design Concept staff change
TRACKER
 DIN 18

DIN 13080

RRP
 German DIN 19

1. Syn-energy for the new hospital

RRP
 Using the German DIN for schedules of accommodation 20

RRP
Actual location, United Arab Emirates
Mix of Rehabilitation, Outpatient Center and Hotel

250 beds
Rehabilitation
Ideal distribution of ward area according to Business Planning:
Clinic
V VIP # Rooms # Beds
VIP
10 10
Single 20 20
Double 60 60
Clinic Standard (double) 60 120
TOTAL
20 40

170 250

All relevant medical specialties and diagnostic equipment

Outpatient Center
separated workflow and VIP suites for Medical Check Ups
with Diagnostic

Boarding House/ Room categories according to Rehab Clinic

Accommodation use guest rooms as overflow for rehab patients

6
Main sections
Healing Architecture

24
 Using the German DIN for schedules of accommodation 25

RRP
 NHS example OT 26

RRP
 NHS layout examples here OT 27

RRP
 NHS layout examples here OT 28

RRP
 AIA 29

AIA structure

RRP
 AIA example 30

RRP
 Agenda 31

AIA for Cath lab

RRP
 Agenda 32

2. Case Study 1: planned in accordance with AIA, not acceptable for NHS?

RRP
 Agenda 35

Comparison AIA and NHS

Main difference between US and UK NHS design principles for Cath Lab:

In the US (AIA), a dirty utility room is not required to be adjacent to the cath
lab room

In the US (AIA), rooms for preparation and anaesthesia could be shared and
do not have to be adjacent to the cath lab procedure room

In the UK (NHS), the cath lab shall have the following adjacent rooms:
Anaesthesia, preparation, store room, scrub and gowning and control room.

RRP
 Following AIA, but not NHS 36

RRP
 Agenda 37

1. Syn-energy for the new hospital

RRP
 Agenda 38

1. Syn-energy for the new hospital

RRP
 Agenda 39

Main differences between US and UK NHS design principles for OT:

In the UK (NHS), the direct access of the scrub / gowning room, Anaesthetic, Dirty
Utility and Preparation room is mandatory
In the UK (NHS), the room for preparation is only not needed if the preparation could
be done under the ultra-clean canopy in the operation theatre itself
In the US (AIA), the ANAE area is the so called induction room, and this room
could be shared between the OT and also be located not directly adjacent to the OT
In the US (AIA), shared scrub zones can be located outside of the OT, in a more or
less open zone (ventilation system to be designed in a way that a air curtain is more
and less prohibiting water from the scrub to come contaminate other areas)
In the UK (NHS), separated single room recovery spaces are requested. In the US, a
curtain between recovery spaces can be accepted
In the US (AIA), the transfer from the patient bed to the OT stretcher could be done
in the OT. We do not see any clear requirements / procedure in the NHS guidelines.
Here, we can only find the following: increasing number of patients are transferred onto
their beds rather than a trolley. A bed is significantly larger than a trolley.
In the UK (NHS), there are many requirements for the admission lounge, waiting
room, administration office as integral to communication base etc. which are more
and less referring to very specific workflows and procedures. Here, many of these basic
requirements (also for ambulant / outpatient) are not fulfilled and must normally being
discussed with the user.
 NHS layout examples here OT 40

RRP
 AIA for OT 41

AIA extract

RRP
 Agenda 42

3. Case Study 2: Third Party Review and standards please re-design?

RRP
 Working Draft - Last Modified 4/3/2010 12:54:41 PM
AIA Guidelines - Comparison
 Working Draft - Last Modified 4/3/2010 12:54:41 PM
AIA Guidelines - Comparison
Third party review according to AIA 45

1. Is our design wrong?

Third party review according to AIA 46

1. Is our design wrong?

Third party review according to AIA 47

1. Is our design wrong?

Third party review according to AIA 48

1. Is our design wrong?

Third party review according to AIA 50

1. Is our design wrong? It is an ICU renovation project..

Third party review according to AIA 51

1. Is our design wrong?

Third party review according to AIA 52

1. Is our design wrong?

 Agenda 54

4. Accreditation and Planning Standards JCI instead of AIA/NHS/DIN

RRP
 Hospital Standard and JCI, example 55

RRP
Hospital Standard and JCI, example 56
 Agenda 57

5. HAAD Abu Dhabi standards, based on Australia hospital standards

RRP
 HAAD Abu Dhabi 58

Further developments of mainly the Guidelines from Australia

RRP
 HAAD Abu Dhabi 59

Further developments of mainly the Guidelines from Australia

RRP
 HAAD Abu Dhabi 60

Further developments of mainly the Guidelines from Australia

RRP
 HAAD Abu Dhabi 61

Further developments of mainly the Guidelines from Australia

RRP
 HAAD Abu Dhabi 62

Further developments of mainly the Guidelines from Australia

RRP
 Agenda 63

6. Outlook and recommendation what to follow?

RRP
Standards are good, but..

requirements
Customers
There is no standard workplace design!

Workplace design
Designing for Operational Change
Agenda 68

7. Questions and Answers

Toronto UIA 2013 69

Hospital Planning and Building Standards AIA, NHS, DIN

INTERNATIONAL HEALTHCARE BUILDING STANDARDS &

CODES LATEST ON HARMONIZATION OF CODES AND
ACCREDITATION

HENNING LENSCH, RRP International Hospital Planners Pte Ltd

Munich-Germany-Singapore

September 2013