Comparative Analysis of Hospital Design Typologies

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UNIVERSITY OF NAIROBI
COLLEGE OF ARCHITECTURE AND ENGINEERING
SCHOOL OF THE BUILT ENVIRONMENT
DEPARTMENT OF ARCHITECTURE & BUILDING SCIENCE
THE PLANNING AND DESIGN OF HOSPITALS:

A comparative analysis of the hospital design typologies.
A Research Thesis
Bachelor of Architecture
Submitted by: MAINA HARUN WANYEKI

BO2/0310/2009
2014/2015
TUTOR: DR KAMENJU
The Planning & Design of Hospitals
DECLARATION
This thesis is my original work and to the best of my knowledge has not been presented for a degree in any other institution .
Author: Maina Harun Wanyeki
Signature…………………………………………. Date………………………………
This thesis is submitted in part fulfillment of the examination requirements for the award of the Bachelor of Architecture degree,
Department of Architecture and Building Science, University of Nairobi.
Tutor: Dr. Kamenju Year Co-ordinator: Arch.Musau Kimeu
Signature…………………….. Signature…………………………
Date………………… Date…………………………………
Chairman, Department of Architecture and Building science: Arch Erastus Abonyo
Signature…………………………
Date…………………………………
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ACKNOWLEDGEMENTS
To God almighty, for the gift of good health and mental composure that enabled me to write this thesis with consistency.
……………………………………………………………………………………………………………………………………………………………………………………………………………………….
To my loving Parents, Mr. and Mrs. Maina, Thank you for your continuous devotion to me through prayers, moral and financial support.
To my siblings: Regina Maina, Monica Maina and Hellen Maina, thank you for your moral support throughout the writing of this thesis.
To Dr.Muriithi, thank you for your career guidance and financial support. I would not have joined the field of Architecture were it not for
your career guidance.
To Tabitha Kiarie (department of architecture) thank you for allaying my fears in first year when I joined the department. Your
encouragement has brought me this far.
……………………………………………………………………………………………………………………………………………………………………………………………………………………….
To my tutor, Dr.Kamenju, I am greatful for your valued insight, support and encouragement throughout the writing of this thesis.
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To Arch.Musau (6 Year Co-ordinator), Prof .Rukwaro (Dean, school of the built Environment) and Arch.Samuel Kigondu (JKUAT) thank
you for the initial guidance that helped shape this thesis.
To all lecturers, Department of Architecture and building science: Prof.J.Magutu, Prof.Anyamba, Arch.Abonyo, Arch.Adnan Mwakulomba,
Arch.Liku, Arch Bulli ladu, Arch.Oyaro, Arch.Oyugi, Arch.Allan Otieno, Dr.Kakumu, Arch.Thatthi, Arch.Lorna kiamba, Arch.Kamau Karogi,
Dr.Shihembetsa, Arch.Kigara Kamweru, Des.Kahare Miano, Arch.Norbert Musyoki, Arch.Robert Kariuki, Arch.Yusuf Ebrahim,
Arch.Mahinda, Arch.Ogolla and Linda Nkatha, I owe you for the critiques during the design studios and for broadening my academic
horizon through the theory classes.
……………………………………………………………………………………………………………………………………………………………………………………………………………………….
To Mr.Mundia (Administrator Kenyatta National Hospital), Mr. Githaiga and Mr. Mungai (Kenyatta National Hospital drawings office),
thank you for taking time from your busy schedule to orient me through Kenyatta National Hospital during the fieldwork.
……………………………………………………………………………………………………………………………………………………………………………………………………………………….
Special thanks to my friends Jedidah Gitahi, Mr. Matagaro, Rhoda Kaguo and Patrick Gitonga for their contribution in the data collection
during the fieldwork. I wish to particularly thank Mr.Caleb for undertaking to print this thesis document free of charge.
……………………………………………………………………………………………………………………………………………………………………………………………………………………….
To the B.Arch class of 2014/15, it has been a wonderful experience learning together. Thank you for your positive criticism that helped
shape this thesis.
DEDICATION
To Dr.Muriithi
TABLE OF CONTENTS
Declaration...........................................................................................................................................................................................................ii
Acknowledgement...............................................................................................................................................................................................iii
Dedication............................................................................................................................................................................................................iv
Table of contents..................................................................................................................................................................................................v
List of figures.......................................................................................................................................................................................................ix
List of tables........................................................................................................................................................................................................xii
Abstract….............................................................................................................................................................................................................1
Chapter 1: Introduction
1.1 Background of study......................................................................................................................................................................................2
1.2 Problem statement…...................................................................................................................................................................................3
1.3 Aims & Objections.......................................................................................................................................................................................4
1.4 Research Questions.....................................................................................................................................................................................4
1.5 Scope & Limitations.....................................................................................................................................................................................4
1.6 Justification of Study….................................................................................................................................................................................5
1.7 Significance of Study….................................................................................................................................................................................5
1.8 Definition of Terms......................................................................................................................................................................................5
1.9 Structure of the Paper…..............................................................................................................................................................................6
Chapter 2: Literature Review
2.1 Introduction.................................................................................................................................................................................................7
2.2 History of hospital planning.........................................................................................................................................................................7
2.2.1 Early times....................................................................................................................................................................................7
2.2.2 Greece..........................................................................................................................................................................................8
2.2.3 Classical antiquity.........................................................................................................................................................................8
2.2.4 Medieval Christian period............................................................................................................................................................8
2.2.5 Renaissance..................................................................................................................................................................................8
th th
2.2.6 18 & 19 Century.......................................................................................................................................................................9
th
2.2.7 20 Century..................................................................................................................................................................................9
2.3 The organisation of Health care facilities.....................................................................................................................................................10
2.4 Hospital planning and design.......................................................................................................................................................................11
2.4.1 Nursing zone..............................................................................................................................................................................11
2.4.2 Clinical zone................................................................................................................................................................................12
2.4.3 Support zone..............................................................................................................................................................................13
2.4.4 Location of the support zone......................................................................................................................................................13
2.5 Planning Guidelines......................................................................................................................................................................................14
2.5.1 Site planning and external circulation........................................................................................................................................14
2.5.2 Provision for growth...................................................................................................................................................................15
2.5.2.1 The nucleus concept....................................................................................................................................................15
2.5.3 Separation of dissimilar traffic....................................................................................................................................................16
2.5.4 Anticipate change........................................................................................................................................................................16
2.5.4 Development of modular spaces...............................................................................................................................................17
2.5.5 Energy conservation and sustainability.......................................................................................................................................17
2.6 Circulation and communication spaces in hospitals....................................................................................................................................18
2.6.1 Access.........................................................................................................................................................................................19
2.6.2 Corridors.....................................................................................................................................................................................20
2.6.3 Lifts.............................................................................................................................................................................................21
2.6.4 Privacy.........................................................................................................................................................................................21
2.7 Emergency Response facilities in hospitals..................................................................................................................................................22
2.8 Types of hospital planning............................................................................................................................................................................24
2.9 The horizontal hospital.................................................................................................................................................................................24
2.9.1 Independent linked slabs hospitals............................................................................................................................................25
2.9.2 Spine and pavilion hospitals........................................................................................................................................................26
2.9.3 Extended courtyard hospitals.....................................................................................................................................................27
2.9.4 Horizontal monolith hospital.......................................................................................................................................................28
2.9.5 Compact courtyard hospitals.......................................................................................................................................................28
2.10 The Vertical hospital..................................................................................................................................................................................29
2.10.1 Simple tower on podium hospitals...........................................................................................................................................30
2.10.2 Complex tower on podium hospitals........................................................................................................................................31
2.10.3 Radial tower on podium hospitals...........................................................................................................................................32
2.10.4 Articulated slab on podium hospitals.......................................................................................................................................33
2.10.5 Vertical monolith hospitals.......................................................................................................................................................34
Chapter 3: Research Methodology
3.1. Introduction.................................................................................................................................................................................................35
3.2. Research purpose........................................................................................................................................................................................35
3.3. Research design and Strategy......................................................................................................................................................................35
3.3.1 Case study method........................................................................................................................................................................35
3.4. Selection Criteria (sampling method)..........................................................................................................................................................37
3.5. Data Collection Methods.............................................................................................................................................................................39
3.5.1 Primary data...................................................................................................................................................................................39
3.5.2 Secondary data..............................................................................................................................................................................40
3.6. Data Collection Tools...................................................................................................................................................................................40
3.7 Data Analysis methods.................................................................................................................................................................................41
3.7.1 Data Analysis Tools........................................................................................................................................................................43
3.7.2 Data Presentation Modes..............................................................................................................................................................43
3.8. Time Horizon...............................................................................................................................................................................................43
Chapter four: data presentation and analysis
4.0 Introduction................................................................................................................................................................................................44
4.1 Kenyatta National Hospital..........................................................................................................................................................................44
4.1.1 Introduction...................................................................................................................................................................................45
4.1.2 Current Status................................................................................................................................................................................46
4.1.3 Hospital Services...........................................................................................................................................................................46
4.1.4 Planning.........................................................................................................................................................................................48
4.1.5 Zoning............................................................................................................................................................................................50
4.1.5.1 Clinical Zone....................................................................................................................................................................50
4.1.5.2 Nursing Zone..................................................................................................................................................................51
4.1.5.3 Support Zone..................................................................................................................................................................51
4.1.6 Circulation....................................................................................................................................................................................53
4.1.6.1 Access.............................................................................................................................................................................53
4.1.6.2 Separation of Dissimilar Traffic.......................................................................................................................................55
4.1.6.3 Internal circulation..........................................................................................................................................................56
4.1.6.4 Ease of wayfinding...........................................................................................................................................................56
4.1.6.5 Circulation spaces...........................................................................................................................................................57
4.1.6.6 Communication spaces.............................................................................................................................................57
4.1.7 Flexibility & growth......................................................................................................................................................................59
4.1.7.1 The Old Hospital.............................................................................................................................................................59
4.1.7.2 Phase 1..........................................................................................................................................................................63
4.1.7.3 Phase II..........................................................................................................................................................................65
4.1.7.4 Phase III….......................................................................................................................................................................68
4.1.8 A& E wing......................................................................................................................................................................................67
4.1.9 The nursing tower.........................................................................................................................................................................70
4..1.10 Emergency design features in the nursing tower......................................................................................................................74
4.1.11 Comparison of the Horizontal typology models at KNH.............................................................................................................77
4.1.12 plannning & design challenges at Kenyatta national hospital....................................................................................................79
4.2 Nanjing Drum Tower Hospital......................................................................................................................................................................81
4.2.1 Introduction..................................................................................................................................................................................81
4.2.2 Nanjing Drum Tower Hospital South Extension............................................................................................................................82
4.2.3 Sustainable design features in the hospital.............................................................................................................................83
4.2.4 The Planning & design of Nanjing Drum Tower hospital..............................................................................................................85
4.2.4.1 Zoning...................................................................................................................................................................................93
4.2.4.2 Circulation..............................................................................................................................................................................94
4.2.4.3 Emergency design features at Nanjing Drum tower hospital................................................................................................96
4.3. Comparison of KNH & Nanjing drum tower hospital.................................................................................................................................97
Chapter five: conclusions and recommendations

5.1 Introduction................................................................................................................................................................................................100
5.2 Conclusions on Literature review...............................................................................................................................................................100
5.3 Conclusions on fieldwork............................................................................................................................................................................104
5.4 Recommendations......................................................................................................................................................................................108
5.5 Recommendations for future research on hospital planning and design.................................................................................................108
List of References.............................................................................................................................................................................................110
LIST OF FIGURES
Chapter 1: Introduction Figure 2-19: Massing diagram showing expansion and growth in a vertical
Figure 1-1: A diagram illustrating the horizontal and vertical planning hospital.pg15
strategies in hospital design .pg2 Figure 2-20: space for independent wheelchair &ambulant person.pg 18
Figure 1-2: vertical planning strategy in hospital design.pg3 Figure 2-21: Space for wheelchair user and semi-ambulant user with clutches
Figure 1-3: Horizontal planning strategy in hospital design.pg3 to pass.pg 18
Figure 1-4: Rush University Medical Center, Chicago, and Figure 2-22: space for two independent wheelchairs users to pass.pg 18
USA.pg4 Figure 1-5: Aerial view of Mbagathi District hospital.pg4 Figure 2-23: Space for independent wheelchair user and semi-ambulant
Figure 1-6: National Cancer Center – Tokyo, Japan (361 feet).pg5 person with walking frame to pass.pg 18
Figure 1-7: The southwest hospital surgery tower in Chongqing, china.pg5 Figure 2-24: space for 2 beds passing.pg19
0
Figure 1-8: Hervey Hospital, Denmark.pg6 Figure 2-25: corridor with recess for turning bed through 180 . pg.19
Figure 1-9: Queen Mary Hospital, Hong Kong.pg6 Figure2-26: Lift for bed movement.pg 20
Figure 2-27: General Service lift.pg20
Chapter 2: Literature Review Fig 2-28: Mattress evacuation down stairway.pg21
Figure 2-1: basic human needs. Pg7 Figure 2-29: Ramp for the physically challenged.pg22
Figure 2-2: Maslow hierarchy of needs.pg7 Figure 2-30: vertical massing hospital model.pg24
Figure 2-3: The priest medieval consultant of classical Greece.pg8 Figure 2-31: horizontal massing hospital model.pg24
Figure 2-4: Greco-Roman Latreia.pg8 Figure 2-32: Independent linked slab.pg25
Figure 2-5: Romano-Christian xenochichium at Ostia, Italy.pg9 Figure 2-33: Khon Kaen university hospital, Thailand.pg25
Figure 2-6: Florence Nightingale ward.pg9 Figure 2-34: spine and pavilion.pg26
Figure 2-35: Samaritan hospital, Arizona, USA.pg26
Figure2-7: The Health pyramid.pg10
Figure 2-36: Extended courtyard.pg27
Figure 2-8: Relationship of the 3 zones in a hospital and their approximate
Figure 2-37: Wexham park hospital, slough, UK.pg27
proportions in a general hospital.pg11
Figure 2-38: Horizontal monolith hospitals.pg28
Figure2-9: Diagram showing the distribution of the 3 zones in a vertical
Figure2-39: compact courtyard hospitals.pg28
hospital.pg11
Figure 2-40: Vertical hospital.pg29
Figure2-10: Diagram showing the distribution of hospital zones in a
Figure 2-41: New York Presbyterian Hospital.pg29
horizontal hospital.pg11
Figure 2-42: simple tower on podium.pg30
Figure 2-11: Relationship and zoning diagram for a healthcare facility.pg12
Figure 2-43: Queen Mary Hospital, Hong Kong.pg30
Figure 2-12: Expanded relationship diagram for a healthcare facility.pg12
Figure 2-44: complex tower on podium.pg31
Figure 2-13: support services on a vertical model.pg13
Figure 2-45: Hervey Hospital, Denmark.pg31
Figure 2-14: support services on a mixed horizontal-vertical strategy.pg13
Figure 2-15: support services off site.pg13 Figure 2-46: Radial tower on podium hospitals.pg32
Figure 2-16: support services on a horizontal hospital model.pg13 Figure 2-47: Rush University Medical Centre.pg32
Figure 2-17: Block schematic plan of Maidstone general hospital.pg15 Figure 2-48: Articulated slabs on podium.pg.33
Figure 2-18: Stack diagram showing expansion and growth in a vertical Figure 2-49: The bunting centre.pg33
hospital.pg15 Figure 2-50: vertical monolith.pg34
Figure 51: Kenyatta national hospital nursing tower block.pg34
ix
Chapter 3: Research Methodology Figure 4-24: Image of the circulation spine in the old hospital.pg59
Figure 3-1:50m long measuring tape used for data collection.pg39 Figure 4-25: The old hospital as it existed before construction of the main
Figure 3-2:5m measuring tape used for data collection.pg39 hospital block.pg60
Figure 3-3: canon digital camera used for data collection.pg 40 Figure 4-26: detailed layout of the old hospital.pg61
Figure 3-4: black pen used for data collection in interviews, notes and Figure 4-27: Layout plan of the old hospital.pg62
sketches.pg 40 Figure 4-28: Typical ward plan of the old hospital before relocation of the
Figure 3-5: sketch pad used in data collection in form of notes and wards in the Nursing tower block.pg62
sketches.pg40 Figure 4-29: Courtyard used as an organising principle at the Paediatric
unit.pg63
Chapter 4: Fieldwork Documentation and Analysis Figure 4-30: Roof lights used to light the single storied deep planned
Figure 4-1: map showing the location of Nairobi in Kenya within Africa.pg45 blocks.pg63
Figure 4-2: map showing the location of KNH within Nairobi.pg45 Figure 4-31: Layout of the phase -1 development at Kenyatta National
Figure 4-3: A monument of the nursing tower at KNH.pg46 Hospital.pg64
Figure 4-4: An Image of Kenyatta National Hospital taken from Ngong Figure 4-32: Layout of the phase development at Kenyatta National
road.pg46 Hospital.pg65
Figure 4-5: An image of the model of Kenyatta National Hospital.pg47 Figure 4-33: Layout of the phase-III development at Kenyatta National
Figure 4-6: A model of Kenyatta National hospital complex.pg48 hospital.pg66
Figure 4-7: Master plan of Kenyatta National Hospital.pg49 Figure 4-34: View of the A& E unit from the parking.pg67
Figure 4-8: 10 storied nursing tower bock home to the entire nursing zone at Figure 4-35: Location of the A&E unit at KNH.pg67
KNH.pg50 Figure 4-36: Ground floor plan of A&E department at KNH.pg68
Figure 4-9: Caption of the single storied clinical zone at KNH.pg50 Figure 4-37: First floor plan of A& E department at KNH.pg69
Figure 4-10: The support services block at KNH housing the C.S.S.D, general Figure 4-38: A model of the KNH Nursing tower block.pg70
stores, kitchen and dining.pg51 Figure 4-39: hard landscaped tower block courtyard.pg70
Figure 4-11: Oxygen plant at KNH.pg51 Figure 4-40: A typical floor plan of the ward.pg71
Figure 4-12: zoning map of Kenyatta national hospital.pg52 Figure 4-41: Aerial view of the nursing tower.pg72
Figure 4-13: main entrance to the Wards and clinics at KNH. Pg53 Figure 4-: A detailed analysis of the typical wards in at Kenyatta National
Figure 4-14: Pedestrian walkways have been used to avoid vehicular and Hospital.pg72
pedestrian conflict.pg53 Figure 4-42: Sectional analysis of the tower block at KNH.pg73
Fig 4-15: Master plan of Kenyatta National Hospital.pg54 Figure 4-43: The four compartments of double wards in a typical floor of the
Figure 4-16: The helipad strategically located at the rear of the A& E unit.pg55 nursing tower.pg74
Figure 4-17: Direct vehicular access at the A& E unit for emergencies.pg55 Figure 4-44: Sketch of a fire resistant door along the 3000mm wide corridors
Figure 4-18: The hospital street as captured in the physical model of KNH.pg56 in the wards.pg74
Figure 4-19: View of the lifts lobby from the hospital street.pg57 Figure 4-45: Analysis of the architectural design emergency features in a
Figure 4-20: Wall fixed signage plates along the secondary streets at typical floor of the nursing tower.pg75
KNH.pg57 Figure 4-21: Mosaic arts along the corridors.pg57 Figure 4-46: The ramp serving the obstetrics wards in the first floor and the
Figure 4-22: Internal circulation map at Kenyatta National hospital.pg58 delivery suite in the Ground floor at KNH.pg76
Figure 4-23: The old hospital block.pg59 Figure 4-47: Fire exit sign at an emergency escape door at KNH.pg76
Figure 4-48: Location of the paediatric department at KNH.pg79
Figure 4-49: Make shift waiting area for paediatric outpatient unit donated by Figure 4-76: Circulation flow plan in a typical nursing floor at Nanjing Drum
Posta.pg79 Tower hospital.pg95
Figure 4-50: A child receiving emergency service at KNH A&E unit.pg80 Figure 4-77: Design emergency features in a typical nursing floor at Nanjing
Figure 4-51: A child looking for play activities at KNH.pg80 drum tower hospital.pg96
Figure 4-52: location of china within Asia.pg81
Figure 4-53: Location of Nanjing within China.pg81 Chapter 5: Conclusions and Recommendations
Figure 4-54: The 1892 Drum tower hospital during winter in1892.pg81 Figure 5-1: Early cruciform halls hospitals.pg100
Figure 4-55: The 1892 memorial Hall and Hospital Archives, Jan 23, 2007.pg81 th
Figure 5-2: horizontal hospital model established in 19 century.pg100
Figure 4-56: Nanjing Drum Tower south extension.pg82 th
Figure 4-57: View of the roof gardens at Nanjing drum tower hospital.pg82 Figure 5-3: Vertical hospital model established in the 20 century.pg100
Figure 5-4: Independent linked slab model.pg101
Figure 4-58: A model of the Nanjing Tower hospital.pg83
Figure 5-5: Independent spine & pavilion model.pg101
Figure 4-59: Roof garden at Nanjing drum tower hospital.pg83
Figure 5-6: Extended courtyard model.p101
Figure 4-60: Façade of the gardenised architecture.pg84
Figure 5-7: Horizontal monolith model.pg101
Figure 4-61: A detail of the gardenised envelope.pg84
Figure 5-8: Compact courtyard model.pg101
Figure 4-62: The 6 healing Gardens at Nanjing Drum hospital.pg84
Figure 5-9: Simple tower on podium model.pg102
Figure 4-63: section through Nanjing Drum Tower hospital showing the tower
Figure 5-10: complex tower on podium model.pg102
and the podium.pg 85
Figure 5-11: Radial tower on podium model.pg102
Figure 4-64: Image of Nanjing drum tower hospital.pg85
Figure 5-12: Articulated tower on podium model.pg102
Figure 4-65: site plan of Nanjing drum tower hospital.pg86
Figure 5-13: Vertical monolith model.pg102
Figure 4-66: Ground Floor plan of Nanjing drum tower hospital South
Figure 5-14: model of Kenyatta national hospital.pg103
Extension.pg87
Figure 5-15: model of Nanjing Drum Tower hospital.pg103
Figure 4-67: Diagrammatic arrangements of departments at the south
Figure 5-16: Use of roof lights in deep plans.pg104
extension at Nanjing drum tower hospital.pg88
Figure 5-17: Use of narrow plans to achieve natural lighting &
Figure 4-68: Section-01 through the south extension of Nanjing Drum Tower
ventilation.pg104
Hospital.pg89
Figure 5-18: Compartmentalization of wards for ease of evacuation.pg105
Figure 4-69: First floor plan of the South extension at Nanjing drum tower
Figure 5-19: Use of ramps for vertical movement of the semi-ambulant.pg105
hospital.pg90
nd, rd th Figure 5-20: Use of vertical gardens to create places of respite.pg106
Figure 4-70: Typical 2 3 & 4 floor plan of the south extension at Nanjing
Drum Tower hospital.pg91 Figure 5-21: Use of light wells for lighting interiors.pg106
th
Figure 4-71: 5 floor plan of Nanjing Drum Tower hospital.pg92 Figure 5-22: Hybrid typology of vertical and horizontal models.pg107
th th Figure 5-23: A hybrid model of spine and pavilion and extended courtyard
Figure 4-72: Typical 6 -13 floor of Nanjing Drum Tower Hospital.pg92
th th models.pg107
Figure 4-74: Zoning plan of the typical 6 -13 nursing floors of the Nanjing
Figure 5-24: Use of circulation as the principle organising element.pg107
Drum Tower Hospital.pg93
th th Figure 5-25: Use of healing gardens for therapeutic benefits.pg108
Figure 4-75: Activity plan of the typical 6 -11 floors of the Nanjing Drum
Figure 5-26: Use of interstitial floors in vertical hospitals for maximum natural
Tower Hospital.pg94
ventilation through stack effect.pg108
Figure 5-27: Provision of vertical gardens in vertical hospitals.pg108
LIST OF TABLES
Table 3-1: Table of study parameters.................................................................................................................................................................................. 41
Table 4-1: Comparative analysis table of the horizontal hospital typologies at Kenyatta National Hospital.......................................................................77
Table 4-2: Comparative analysis table of Kenyatta National Hospital (Kenya) & Nanjing Drum Tower Hospital (China).....................................................97
ABSTRACT
Hospitals may be thought of as icons of pain, sickness and distress, but they are also icons of healing, life, family and hope. They are
therefore important buildings for any community. The planning and design of hospitals has a great impact on the stress levels (to
staff & visitors) and to the patient’s recovery period.
The main factor which differentiates hospitals from other buildings is that no other building type presents such a diverse spectrum
of occupants with varying physical and emotional needs. The hospital is therefore a complex building type. A deep understanding of
the inter-relationship of the parts and their relationship in-turn to the whole hospital is required to make a meticulous healing
environment.
Hospital planning can be grouped into two types; the horizontal hospital and the vertical hospital. The success of these two types
cannot be overstated; however they are characterized by their own unique challenges. It’s precisely because of the limitations
exhibited in the two hospital types and their typologies that a conceptual framework is needed to clearly understand the creation of
a proper healing environment.
1
CHAPTER ONE: INTRODUCTION
1.1 Background of study
There has been quite a number of Bachelors of architecture theses in the University
of Nairobi dealing with hospitals planning and design:-
Shivji, R. (1985).The influence of circulation and services to the functional planning

Versus and design of hospitals
Ochieng, G. (1989) Curative Environment: Stress reduction in hospitals
Oyaro, E. (1992).Architectural expressions in hospital forms
Momanyi, J. (2003).Hospital design: A search for flexibility in hospitals
Muriithi , G.(2005).Architecture for spinal injury hospital.
Njuguna, W. (2006).Development of paediatric hospital in Nairobi
Mulang’a, M. (2007) Health care design: Creating a healing environment.
Kaseda, E. (2013).Environmental strategies for hospital design in warm
humid climate.
Whereas the precedent theses are rich in aspects pertaining to hospital design,
none has carried out a comparative analysis of the typologies in hospital planning
and design.
Therefore, the author finds a gap of knowledge to fill in the planning and design of
hospitals by analysing and comparing the typologies in hospital planning and
design.
re 1-1: A diagram illustrating the horizontal and vertical planning strategies in hospital designThis area has not been studied before; hence it will contribute new
rce: Author’s sketch, June 12th 2014 knowledge to the bulk of information available on hospitals planning and design.
2
1.2 Problem statement
Most of human history has seen the vast majority of people living in rural areas.
However the urban population has risen steadily over the last two centuries. The
1800s started with just a 3% of the world’s population living in urban areas. By 1900
the urban population had increased to 14% and then doubled to almost 30% by
1950.In 2008, for the first time, the world’s population was evenly split between
the urban and rural areas. Urban growth is projected to continue its increase with
expectations that 70% of the world population will be urban by 2050. Thus, urban
growth trend places a particular emphasis on developing sound planning and
2: vertical planning strategy in hospital design Source: Author modified sketch, July 2design
nd 2014 strategies within urban areas (World health organisation, 2010).
The hospital being a complex building type needs to respond to the urban growth
Versus trend by developing sound planning and design strategies. This would help in
addressing the problems in the planning and design of hospitals which range from
site limitations in urban areas, difficulties in achieving growth and flexibility,
challenges in achieving maximum natural lighting and ventilation, challenges in
carrying out evacuation in times of emergencies, circulation stress and mixing of
incompatible traffic which lead to cross-infections among other problems.
The horizontal hospital by nature utilizes a great deal of land to fully accommodate
its functional requirements compared to the vertical hospital. The sustainability of
the horizontal hospital especially in urban areas is therefore questionable since
land is at a premium and the footprint is limited. On the other hand, the vertical
hospitals are not without their problems; it is argued that the usual vertical hospital
is inflexible, experiences vertical traffic stress and heavily relies on lifts which may
present challenges in carrying out evacuation in case of emergencies among other
Figure 1-3: Horizontal planning strategy in hospital design
Source: Author modified sketch, July 2nd 2014
Problems.
Therefore there is need to study and analyse the two hospital typologies and their
models in order to help address the problems in hospitals planning and design.
1.3 Aims and objectives
1. To investigate the typologies in the planning and design of hospitals.

2. To investigate the current global trend in the planning and design of
hospitals.
3. To analyse and compare the typologies in the planning and design
of hospitals in order to determine their levels of efficiency.
1.4 Research questions

1. Which typologies exist in the planning and design of hospitals?
2. What is the current global trend in the planning and design of hospitals?
3. Which are the most efficient typologies in the planning and design of
hospitals?
Figure 1-4: Rush University Medical Center, Chicago, USA. A 386 bed vertical urban hospital
Source: August 4th 2014
1.5 Scope and limitations
Hospital planning and design is broad. Due to limitations of time and resources, the
study was limited to the analysis and comparison of the typologies in the planning
and design of hospitals. The spatial analysis covered the three basic zones in a
hospital and how they have been manipulated to achieve a hospital organism.
These are the clinical, nursing and support zones.
The field work was limited to Kenyatta national hospital in Nairobi as it provided an
opportunity to investigate both the horizontal and vertical strategies in the same
context. In addition, Nanjing drum tower hospital was selected as an international
case study to provide a comparative base with Kenyatta national hospital.
Figure 1-5: Aerial view of Mbagathi District hospital
A 250 bed urban horizontal hospital Source: Google Earth, August 6 th 2014
1.6 Justification of study

The impetus of the study arises due to the need to address the challenges in
hospital planning and design especially in urban areas where there are tight site
constraints.
1.7 Significance of study

This study will benefit Architects and developers by providing guidelines to achieve
an appropriate, efficient and sustainable healing environment. Additionally the
study will assist government institutions by implementing the findings and
recommendations in their projects.
Figure 1-6: National Cancer Center – Tokyo, Japan (361 feet) 1.8 Definition of terms
Source: -September 19th 2014
 Horizontal hospital- This is a hospital model that utilizes horizontal planning
strategy. The zones are linked together laterally so that the movement is
mainly horizontal. They are limited to 4 floors
 Vertical hospital- This is a hospital model that utilizes vertical planning
strategy. The zones are arranged one above the other so that the
movement pattern is mainly vertical. They rise above 4 floors
 Circulation spaces- These are spaces that provide access within the hospital
departments. They comprise of corridors, internal lobbies etc. within a
department for moving between rooms/spaces within an individual
department.
 Communication spaces- They are spaces providing access between
departments. They comprise of hospital streets, Lifts, Ramps, staircases etc.
that provide access between departments.
 Flexibility-Ability of a hospital to accommodate change and growth without
destruction of existing systems.
Figure 1-7: The southwest hospital surgery tower in
Chongqing, china (394 feet (120 meters) with 2,200 beds Source: -September 19th 2014
5
 Hospital Street-The primary circulation corridor from which all other

secondary corridors branch.
1.9 Structure of the research paper

Chapter 1: Introduction
This chapter serves as the introduction of the topic of study. It highlights the
background of the study, problem statement, aims and objectives, research
questions, the scope and limitations, definition of terms, relevance of the study and
the research methodology used to undertake the investigation.
Chapter2: literature Review
The chapter begins with the history of hospital planning over the centuries to give a
clear understanding of the trend in hospital planning and design over time. The
chapter further explores the parameters in hospital planning and design and the
Figure 1-8: Hervey Hospital, Denmark Bed capacity-1,616 beds typologies and models in hospital planning and design.
Year Built-1976 Chapter 3: Research Methodology
Source: Source: August 3rd 2014 This chapter outlines the process of selection of the area of study and the case
studies that are a representative of the research by describing all the methods of
data collection, presentation and analysis. Case study method was selected for this
study due to exploratory nature of the study.
Chapter 4: Field work
This chapter is on case studies, data analysis and presentation and examines a local
and international case study to provide a comparative base. The two case studies
are Kenyatta National hospital (Kenya) and Nanjing Drum Tower Hospital (China)
Chapter 5
This chapter is on conclusions and recommendations of the study. It succinctly
highlights the salient conclusions deduced from the findings of the study. This
chapter concludes with recommendations based on the findings of the study.
Figure 1-9: Queen Mary Hospital, Hong Kong Bed capacity-1,400 beds
Year Built-1991 6
Source: Source: , August 3rd 2014
CHAPTER TWO: LITERATURE REVIEW

2.1 Introduction
The study of man from his beginnings shows that the desire for health along with
food, shelter and clothing ranks high among the fundamental basic needs. The
hospital has developed over the centuries to serve this basic urge (American
institute of hospitals consultants, 1969).
People’s expectations from hospitals have changed over the centuries. In the
middle ages they were primarily associated with death. Some of the finest hospitals
were built for pilgrims far from home since they had nowhere to go when they fell
sick. They were offered care in cruciform halls with the nuns’ nursing station at the
Figure 2-1: basic human needs Source:en.m.wikipedia.org/ human needs, Sep 2nd 2014
centre and the altar at the end. The aim was to protect the healthy pilgrims from
infection and to prepare the sick for the death. The idea that hospitals were about
life rather than death began to dawn gradually (James & Tatton-Brown, 1986).
2.2 History of hospital planning

2.2.1 Early Times
rd
In the early 3 century B.C, medicine and healing were linked to the gods.
Consequently, the hospital forms that existed closely resembled the forms of the
temple. The temples enshrining these gods became centres of healing, although in
a basic manner with priests as medical consultants (Rosenfield & Rosenfield, 1969).
Figure 2-2: Maslow hierarchy of needs

Source: en.m.wikipedia.org/Maslow, Sep 2nd 2014
7
2.2.2 Greece
th
By the end of 6 century B.C, medical clinics had developed in Greece to
complement the temples that acted as healing centres. The Greek physicians who
were free citizens held consultations and treated their private patients. These
clinics were eventually private institutions but the state funded similar institutions
to provide health care to the citizens.
2.2.3 Classical Antiquity

According to Rosenfield & Rosenfield (1969), Later in Classical antiquity, the
rational processes of thought were reflected in the plan form which gradually
achieved a character of its own. The order and clarity became evident, Clear
patterns of circulation were delineated and attention paid to functional groupings.
Figure 2-3: The priest medieval consultant of classical Greece
Source: Rosenfield. (1969) Hospital architecture and beyond, 2.2.4 Medieval Christian Period
July 5th 2014
The clarity in the classical antiquity was lost during the medieval Christian period.
Hospital buildings again became undistinguishable from general medieval
architectural forms. Concepts of rational planning and logical sequences of function
disappeared (Rosenfield & Rosenfield, 1971).
2.2.5 Renaissance
In Italy, Renaissance brought back a certain rational clarity to the plan form.
Orderliness and careful attention to circulation was demonstrated but the Alter was
still the focal point.
Figure 2-4: Greco-Roman Latreia

Source: Rosenfield. (1969) Hospital architecture and beyond,
July 5th 2014
th
2.2.6 18th &19 Century
th
Hospital planning took the functional and scientific dimension in the late 18 and
th
19 centuries forerun by Florence Nightingale. The pavilion type which segregated
patients into small groups and ensured there was natural light and ventilation
evolved. There was orderliness and clarity; patterns of circulation were delineated,
functional groupings were assembled and a greator respect was shown to human
dignity (Cox & Groves, 1990).
1846- The discovery of anaesthetics. The use of anaesthetics permitted carefully
planned deliberate procedures .An operating theatre became a part of every
hospital, and more beds had to be provided to accommodate an increasing number
of survivors.
1866-9 – Lister’s use of carbolic sprays for antiseptic surgery which reduced the
number of post-operative fatalities. This increased the range of surgery and surgical
theatres
1886- Introduction of aseptic techniques, the sterilizing of equipment. This
hristian xenochichium at Ostia, Italy Source: Rosen field. (1969) Hospital architecture and beyond,
extended theJuly 12thof2014
area ancillary accommodation
1895- Roentgen used x-rays as an aid to diagnosis hence the need for x-ray rooms
arose.
Laboratories similarly added a new dimension to medicine and extended the use of
pharmaceuticals.
The primary function of hospitals turned slowly from custodial care to active
intervention. They became places to save and improve the quality of life (James &
Tatton-Brown, 1986).
th
2.2.7 20 Century
As from the 20th century to the present day, the architectural form of the hospital
has changed from the low horizontal pavilions to a vertical hospital. The vertical
Figure 2-6: Florence Nightingale ward

July 12th 2014
hospital superseded the pavilion plan and became the accepted architectural form
for hospitals during the twenties (Hudenberg, 1969).
2.3 THE ORGANIZATION OF HEALTH CARE FACILITIES

All systems of healthcare delivery comprise of a range of institutions which are
graded according to their degree of sophistication and specialization as well as the
level of care they can provide (Ministry of health, 2010).
Classification of health facilities in Kenya is based on the following criteria:
a) Services offered e.g. inpatient, outpatient, specialised treatment.

b) Physical facilities e.g. number of beds, rooms, treatment and diagnostic
facilities.
c) Catchment population- the potential population served by the health
facility.
d) Staff-both in numbers and fields of specialization.
Based on this criterion, the health facilities are then classified into 6 distinctive
Figure2-7: The Health pyramid Source: ministry of health, 2010 levels. The Community hospitals like the village health centres are classified as
level-1. Dispensaries and health centres are classified as level 2 and level 3
respectively.
Level 4 comprise of the sub-county hospitals in the new constitution formerly

known as district and sub-district hospitals. County hospitals, formerly provincial
hospitals are classified as level-5 hospitals. The national referral hospitals are
classified as level 6 hospitals.
10
The central government through the relevant ministry used this classification to
come up with standard model architectural drawings upon which the design of any
public health facility within the country by the government was based. The new
constitution 2010 has since devolved health services to the county governments’.
2.4 HOSPITAL PLANNING AND DESIGN

It has been argued that a study of traffic requirements suggests a hospital
operating more like a number of villages than a single organism. Hospitals should
be assembled in a way that it will be more than a mere collection of functions and
2-8: Relationship of the 3 zones in a hospital and
departments
pproximate proportions in a general hospital. Source: Source: Author modified sketch, July 10 th 2014needed in the practice of medicine. The avenues of circulation should
be organised to create order in the movement of persons, supplies and services.
Everyone should be able to arrive at, move around and leave the hospital building
without unnecessary effort, anxiety, embarrassment or confusion (Rosenfield &
Rosenfield, 1969).
Activities within the hospital building are grouped into three distinct zones. These
are:
1. Clinical zone
2. Nursing zone
Figure2-9: Diagram showing the distribution of 3. Support zone
the 3 zones in a vertical hospital
Source: Author modified sketch, July 10th 2014
The key to hospital planning is the manipulation of these zones and their
relationships to produce a fully functional, integrated hospital (James & Tatton-
Brown, 1986).
2.4.1 Nursing zone
11
Figure2-10: Diagram showing the distribution of
hospital zones in a horizontal hospital
The nursing zone can generally be referred to as the patient wards. Its purpose is to
foster patients throughout their stay in hospital. James and Tatton-Brown (1986)
assert that:
 Maternity beds should be sufficiently separated from the rest of the hospital
to avoid contamination, but still be part of the hospital with reasonably
ready access to the clinical and support zones. The beds of the mothers
should conjoin the delivery suite.
 Recovery beds should be adjacent to the operating suite since the patients
are under constant supervision.
 Intensive care beds should be adjacent to the recovery beds since acutely ill
patients require the same kind of expert nursing as recovery patients
 Paediatric beds may be part of an intermediate care nursing unit in a very
small hospital or occupy the space of a full typical intermediate nursing unit
Figure 2-11: Relationship and zoning diagram for a healthcare facility with pertinent modifications or comprise a separate building conjoined
Source: Metric handbook planning and design with clinical division.
2.4.2 Clinical zone
This is the working area for medical treatment and observation. The clinical zone
should be located on the most accessible floor from the street or road, from the
inpatients quarters and from the outpatient clinics. It comprises of various
departments needed for medical treatment and observation. Of importance to
note in the clinical zone is:
 Laboratories serve both inpatients and outpatients. It’s therefore

preferable that this department be so situated that it is accessible to
both. The labs should also be accessible by radiotherapy and the
surgical theatres.
12
Figure 2-12: Expanded relationship diagram for a healthcare facility
Source: metric handbook planning design
 Radiation services serve both inpatients and outpatients. In modern

medicine, there are situations in which the work of the departments
of labs and radiation intermingle.
 Surgical theatres should be contiguous to labs and reontology. This
is due to the necessity of consultation between surgeons and lab
scientists which is often done when the patient is on the operation
table. Most surgery operations are done on inpatients rather than
outpatients.
Figure 2-13: support services on a vertical model Source: Author modified sketch, July 14 th 2014
 Emergency service should be accessible from the main road with a
separate entrance shielded from sight of the main hospital entrance.
Emergency patients may need immediate laboratory tests, x-rays and
even surgical intervention. Following emergency treatment, a patient
may need intensive care, thus intensive care unit and surgical
theatres, and recovery beds should be provided in the accident and
emergency department.
2.4.3 Support zone

Figure 2-14: support services on a mixed horizontal- vertical strategy
Source: Author modified sketch, July 14th 2014 The support zone is the third main section of the hospital. Its purpose is to satisfy
all the physical and material needs of the nursing and clinical zones. Such needs
include: food, energy, goods and services. It has to provide for the reception,
handling, distribution, storage and disposal of everything that comes into and
goes out of the hospital (Wheeler, 1964).
2.4.4 Location of the support zone

Figure 2-15: support services off site
Source: Author modified sketch, July 14th 2014 Until recently, most buildings have been planned with comprehensive support
zones within the building, either in the basement (vertical scheme) or in a
separate block (horizontal scheme).Today, due to mainly technological
13
Figure 2-16: support services on a horizontal

hospital model
developments in catering, sterilizing and laundry equipment, it is more efficient

to provide these services on an area or regional basis. This, with the increasing
use of commercially supplied disposals, has resulted in the reduction of the
support zone within the hospital.
2.5 PLANNING GUIDELINES

In his book, Hospital planning handbook, Rex Whitaker (1976) outlines the
general principles of planning that may apply to any complex building and
particularly medical facilities. The principles provide some guidance to architects
interested in hospital design .They are outlined as follows:
2.5.1 Site Planning/External Circulation
Careful consideration must be given to site access for the public and staff and for
the service and emergency vehicles. It is desirable to screen ambulance and
service entrances (including morgue) from patient areas. Ambulances shouldn’t
pass through parking areas where they may be subject to delay.
The location of parking places can have a great impact on internal hospital
circulation. People always seek way out of the shorter route, and no number of
signs indicating where the outpatient entry is will force people to use that entry
if there is an entry close to where they left their cars. Obstetric patients should
be provided with drive-up and parking space close to the entrance. Healthy staff
members and visitors can be asked to walk some distance from their cars.
Physicians should be assured space by designating a specific area. It seems self-
evident but it is sometimes forgotten that patients to clinics and emergency
14
rooms are often old and infirm, that they may require assistance in walking and
that parking spaces for these people should be as close as possible to the
entrance.
2.5.2 PROVISION FOR GROWTH
2.5.2.1 The nucleus concept

The rate of increase both in complexity and the size of
hospital is unprecedented. The nucleus concept arose due
to the need for flexibility. It aims to build a hospital in
phases. It is a highly versatile and economical answer to
the problem of growth and change.
The size of the nucleus is designed to be fully operational
Figure 2-17: Block schematic plan of Maidstone general hospital

th
Source: Author modified sketch, July 19 2014 in its
own
right.
15
Figure 2-19: Massing diagram showing expansion and growth in a vertical hospital
Figure 2-18: Stack diagram showing expansion and growth in a vertical Source: Author’s sketch-September 2014
hospital
Source: Author’s sketch
2.5.3 Separation of dissimilar traffic
The five classes of people who create hospital traffic are: Inpatients, outpatients,
hospital employees, staff physicians and visitors. In the horizontal hospital, there
are three avenues of horizontal traffic; one for supplies, one for staff and
patients and another for visitors.
To reduce the mixing of incompatible kinds of traffic which the vertical hospital
implies, one set of elevators should be provided for ancillary and professional
transactions and another for transporting visitors. However this system is
inflexible .To relive the elevators of the ancillary load and also to obtain quick
unscheduled deliveries, various conveyors and dumbwaiters are employed. An
average vertical hospital should have three Systems; dumbwaiters and
conveyors for ancillary services, service lifts for staff and patients and finally
visitors’ elevators.
Whether the hospital is vertical, horizontal or a combination of both, it’s not

possible to route these three avenues separately into every part of the hospital.
Nevertheless, keeping categories of traffic separated should be followed as far as
possible. The more separation is achieved, the less chance of infecting the
patients. Separation also cuts down exposure of those patients whose condition
and appearance might upset passerby and who would in turn prefer not to be
seen by passerby.
2.5.4 Anticipate change
16
Hospitals are subject to the demands of new developments in function and
technology. It’s reasonable to eliminate as many fixed vertical elements as
possible. This would mean reducing the number of columns, consolidating
mechanical shafts and keeping elevator shafts, stairs and other vertical
circulation from dividing floor space into small compartments.
All of these elements are practically impossible to move once built and therefore
inhibit change.
2.5.5 Development of modular spaces

Modular spaces provide flexibility. Room sizes are seldom critical that a variation
of 10%-20% will not make any difference in their usefulness. If a module can be
developed that is acceptable for a variety of occupancies, change in use will
require minimum alteration
2.5.6 Energy conservation/sustainability
Studies have concluded that a natural environment is essential to creating a
genuine state of the art-healing environment (AECOM, 2012). Spending time in
outdoor places of respite has been shown to reduce stress (important for staff
and visitors) and views to nature have been credited with reduced pain levels
and a shorter stay in hospitals. This would entail:
 Buildings’ orientation-The hospital blocks should be designed such that
the long axis is along the East-West axis.
 Narrow plan-This helps to achieve maximum natural lighting penetration
and cross-ventilation into the wards.
 Sun shading all glazed areas-This should be realized by use of vertical and
horizontal sun-shading elements, deep roof overhangs, balconies etc.
 Use of High thermal mass on walls (thick walls)-all external walls should
be at least 200mm thick.
 Placing window openings on the North and South facing walls.

 Landscaping – use of well-chosen native trees in the courtyards and roof
gardens within the hospital to create spaces of respite.
2.6 circulation and communication spaces in hospitals

The form of a hospital building is strongly influenced by the choice of access and
circulation routes. Circulation systems once designed remain as fixed elements
from which the hospital can change or grow for expansion to meet future needs.
The circulation systems are difficult to modify once in place and difficult to insert
where they do not exist. It’s essential to understand the nature of circulation in a
hospital before attempting to devise concepts relating to it. However, this
doesn’t mean that an architect should think of circulation first and then about
Figure person
2-21: Space for wheelchair user andbuilding
semi-ambulant
other aspects of planning. The architect has to consider all pertinent issues
user with clutches to pass
dent wheelchair &ambulant to pass Source: hospital notes, 2013
Source: hospital building notes, 2013 simultaneously. Nevertheless, in the process of synthesing the numerous factors
and considerations involved in planning, the very first glimmer of a concept has
to include the pattern of circulation (Rosenfield & Rosenfield, 1969).
Circulation and communication spaces allow for movement of ambulant and

semi-ambulant people (including those using crutches, sticks and walking frames
and wheelchair users). They should also allow for bed and trolley movement.
Circulation spaces provide access within the hospital departments. They

comprise of corridors, internal lobbies etc. within a department for moving
between rooms/spaces within a department. On the other hand, communication
spaces provide access between departments. They comprise of hospital streets,
lifts, ramps, and staircases etc. that provide access between departments.
ee 2-23:
2-22: Space
space for
for independent
two independent
wheelchair
wheelchairs
user and
users
semi-ambulant
to pass person with walking frame to pass Source: Hospital building notes, 2013
ce: Hospital building notes, 2013
18
The entrance to the hospital buildings and the circulation within it should be
designed with due consideration for wheelchair users, people with visual,
ambulatory disabilities and the physically frail who constitute a large proportion
of the hospital users.
Circulation in hospitals should flow seamlessly to avoid confusion and loss of

time which could be a matter of life and death to patients in critical conditions.
The pattern of circulation should be obvious to the visitors and the patients.
Circulation in hospitals can be classified into two categories; the external

circulation and the internal circulation. The external circulation influences the
functional organisation of the interdepartmental relations whereas the internal
circulation influences the functional organisation of intradepartmental relations
within the hospital.
2.6.1 Access
One of the primary success factors for proper healthcare design is convenient
Figure 2-24: space for 2 beds passing and easy access to and from the facility. This includes simple way finding, safe
Source: hospital building notes, 2013
and weather protected vehicular drop-offs and convenient access to parking.
The external access points have their location around the hospital street. A
modern healthcare facility requires multiple entrances:
 Main patient entrance for inpatients and visitors.
 Emergency department entrance for emergency cases and Ambulances.
 Outpatient Entrance.
 Service Entrance usually at the rear of the site.
All traffic, including outpatient, admission, staff and visitors should enter
through a common main entrance which becomes one of the hubs of hospital
activities and may contain other facilities such as shops, banks, cafeteria etc. The
19
0
Figure 2-25: corridor with recess for turning bed through 180
Source: hospital building notes, 2013
main entrance, probably leading directly to the outpatient department should

have an easy access from the public highway and some parking for cars. (Nuffield
Provincial Hospitals Trust, 1955).
Internal traffic is the most important single determinant of the location of

departments within a hospital. Traffic between hospital departments consists of
inpatient, outpatients, hospital employees, staff physicians and visitors. The
smooth running of the hospital requires that traffic be allowed to move as
directly and conveniently between origin and destination. The location of
outpatient rooms is of particular importance .separation of routes taken by
outpatient, emergencies and inpatient should be given consideration early in the
planning process. Patient travel distances should be reduced to a minimum. The
simplest way of reducing interdepartmental distances is by linking the ends of
the corridors to form a ring to achieve growth
The accident and Emergency (A&E) department will need its own entrance
because It is open 24hours and since there are clinical and aesthetics reasons for
not allowing accident traffic to mix with outpatient and visitors. The entrance to
Figure2-26: Lift for bed movement the emergency service should be shielded from sight of the main hospital
Source: Hospital building notes, 2013 entrance. It should have space for unloading about 3 vehicles simultaneously and
there should be parking space where waiting cars can be parked without
obstructing access and maneuverability in front of the entrance. The door
opening to the Accident and Emergency department should be wide enough
(1800 min) to permit a stretcher with attendants and even transfusion apparatus
to pass through with ease and dispatch. Provision space for wheelchairs and
wheel stretchers should be made at the entrance.
2.6.2 Corridors
20
Figure 2-27: General Service lift

Source: Hospital building notes,
Corridors should be designed for the maximum expected circulation flow to
cater for trolleys, wheelchairs and wheeled-beds. The circulation and
communication spaces should be unobstructed; any projections should be
avoided, for example by recessing radiators and fire extinguishers.
Corridors connect spaces and in emergencies form part of escape routes. They
must be simple and safe to negotiate, and aid navigation around the building.
They should be designed for maximum expected circulation flow which includes
the trolleys, wheelchairs, wheel stretchers
2.6.3 Lifts
All lifts in healthcare buildings should have minimum internal dimensions of
1100mm wide x 1400mmm deep that is capable of accommodating a minimum
of 8 people 630 kg. At least one wheelchair-accessible lift should be in operation
between each floor of a healthcare facility. Each lift should open onto a landing
of adequate depth, in order not to restrict traffic flow in front of the lift
entrance, or onto a protected lobby. Lifts should not open directly onto
Fig 2-28: Mattress evacuation down stairway Source: hospital building notes, 2013
corridors.
2.6.4 Privacy
Privacy and confidentiality are important aspects of the relationship between a
patient and staff members. Two places where these aspects suffer from poor
design are:
 The reception desk, where one side of a telephone call can be overheard
by people waiting.
 Clinical rooms during consultations and treatments, where personal
topics must be discussed freely and in confidence without fear of
being
Figure 2-29: Ramp for the physically challenged. Source: Metric planning handbook
21
seen or overheard; there should be no waiting outside doors or along
corridors.
2.7 EMERGENCY DESIGN FEATURES IN HOSPITALS

Hospitals are not exempt from devastation of a disaster. In hospitals, patients
have differing physical abilities and a range of psychological characteristics which
all impact on the degree of assistance that they will require to evacuate from a
building safely. In the case of fire for instance, a bed-ridden patient though
noticing fire would not be in a position to escape unless otherwise assisted.
Adequate facilities for safe evacuation of patients and even for combating the
hazard should therefore be in place. Certain architectural design emergency
features should be considered in hospitals to aid in evacuation. These include:
1. Exit signs. They should be provided and set to flash(less than 5 hertz)
when a fire alarm sounds. These signs should be connected to the
emergency power systems. The colour of the exit door should contrast
with the surrounding surface so as to make it distinguishable by the
people with sight problems (Neufert, 2003). These exit signs should be
visible and should be placed on the doorframes and not on the
doorleaves.This will enable an individual to identify an escape route at all
times even when the door is open. The exit signs should have
contrasting colours that are conspicuous to the visually impaired.
2. Doors-An accessible door should have the following features: A sign,
door handle, glazing and a kicking plate. These make the building more
accessible to wheel chair confined persons. Revolving doors are not
suitable for use by patients and people with prams. The emergency doors
should be fire resistant and are normally located in stairwells, corridors
and other areas as required by fire codes.
3. Exit/Escape routes-A minimum of two accessible exits, or horizontal exits
for all accessible areas of the building should be provided (Dawson,
1999).Incase of fire, one exit can be used as an escape route.
4. Ramps –They are used for ease of movement for the mobility
impaired, where there is a level difference and ease of manouvre for
semi- ambulant is required. The ramps are particularly helpful in
evacuating semi-ambulant persons with ease and speed from floor to
floor.
5. Emergency staircases –Every multileveled building should have a set of
emergency staircases to aid in evacuation of ambulant people. In
hospitals, the emergency staircases should be wide enough to allow for
mattress evacuation (min 1500).The emergency stairs should neither
have open risers nor protruding nosing. The emergency staircases should
preferably open to the courtyard and not within the hospital building.
Whereas emergency evacuation in horizontal hospitals is fairly achievable due to

horizontal contiguity, evacuation is vertical hospitals is challenging due to
vertical contiguity. Vertical hospitals heavily rely on lifts which are unsafe to use
in case of emergencies such as fire. This requires additional genius design
features by the architect to ease in evacuation such as:
1. Helipad- A helipad is a typical designated helicopter landing and take-off

area. It’s useful for high-rise buildings and it forms a good area for
attending evacuees.
2. Roof gardens- The roof-garden itself is a key sustainable design element
in that it minimizes the building’s heat island effect, reduces demand on
storm water systems, improves surrounding air quality and reduces
noise
pollution. As such, it not only provides an amenity for the building’s

occupants, but and it forms a good area for attending evacuees.
2.8 TYPES OF HOSPITAL PLANNING

th
Since the beginning of 19 century various strategies have been devised in the
planning of the modern hospital. The hospital planning can be grouped into two
primary types:
1. Horizontal hospitals
2. Vertical hospitals.
In the vertical planning strategy, the zones are arranged one above the other
such that the movement pattern is mainly vertical.
In the horizontal planning strategy, the zones are linked together laterally so that
the movement is mainly horizontal (James & Tatton-Brown, 1986).
igure 2-30: vertical massing hospital model Source: Author modified sketch, July 20th 2014
2.9 The horizontal hospital
Versus
Horizontal hospitals planning go as far as the Greek civilization period. The
horizontal hospital can be broken down into several categories. These are:
a) Independent linked slabs hospitals

b) Spine and Pavilion hospitals.
c) Extended courtyard hospitals
d) Horizontal monolith hospitals c
e) Compact courtyard hospitals
Horizontal hospital planning requires large sites to fully accommodate their

functional requirements.
2-31: horizontal massing hospital model Source: Author modified sketch-July 20 th 2014 24
2.9.1 Independent linked slabs hospitals
In this type of hospital planning, allocation is done for three basic zones; nursing,
clinical and ancillary. The three zones are linked horizontally, usually at ground
level by means of a wide corridor. They are usually low rise.
Example: Khon Kaen university hospital, Thailand

Figure 2-32: Independent linked slab
st
Source: Author modified sketch, July 21 2014
Figure 2-33: Khon Kaen university hospital,

st
Thailand Source: Author modified sketch, July 21
2014.
It utilizes Independent parallel linked slabs with varying storey heights. This type
25
of planning strategy requires large site to allow independent expansion of
buildings (James & Tatton-Brown, 1986).
2.9.2 Spine and pavilion hospitals
These hospitals have a strong central spine usually with clinical and
support zones to one side of the spine and the nursing zone to the other
side of the spine. The nursing unit is high-rise usually up to four levels.
Example: Samaritan hospital, Arizona USA
Phase-1 of Samaritan Hospital, Arizona, USA completed in 1977.It has a capacity

for 275beds and provides for expansion of up to 1100beds.It uses the spine and
Figure 2-34: spine and pavilion pavilion strategy to provide for open ended incremental growth.
Source: Author modified sketch, July 21st 2014
Figure 2-35: Samaritan hospital, Arizona, USA.

The simple spine corridor/street, allows for unlimited growth at almost any
point, either of the street itself or of individual departments. On the other hand,
such streets can be up to 400 m long in a completed development creating

boredom (Hudenberg, 1969).
2.9.3 Extended courtyard hospitals
This type of a hospital is planned around open courtyards. The zones are linked
horizontally at upper levels as well as the ground floor via a central spine
corridor system which affords easy access for patients, visitors and goods to all
departments. Height is usually limited to four storeys but never usually exceeds
two stories (Oyaro, 1992).
Example: Wexham park hospital, slough, UK.
Figure 2-36: Extended courtyard The hospital is a single storey layout utilizing the extended courtyard strategy. It
is a 300 bed general hospital completed in 1966. It fully exploits advantages
presented by the extended courtyard strategy:
 -Natural light
 -Ventilation from roof lights
 -Landscaped courtyards
 -Domestic scale
 -Ease of evacuation in case of fire
 -Provision for future extension
 -Simple load bearing structure
Figure 2-37: Wexham park hospital, slough, UK 27

2.9.4 Horizontal monolith hospitals

These kind of hospitals were and are built in the USA and UK mostly during the
period of 1965-75.They incorporate interstitial floors which permit easy
installation of engineering services and equipment.The hospitals were mainly
experimental and are limited to science research centres (Oyaro, 1992).
The advantages presented by this type of a hospital include
 Natural lighting
 Landscaped courtyard providing places of rest and natural ventilation

gure 2-38: Horizontal monolith hospitals. Source: Author modified sketch, July 21st 2014 Ease of evacuation in case of emergency
 Simple load bearing
However this hospital type is inflexible to future extension and growth
2.9.5 Compact courtyard hospitals

These kinds of hospitals were first built in the UK in the mid 1960’s.The main aim
was to reduce the content,size and cost of hospitals in the UK.The resulting
design concept was called “Best-Buy”.In this strategy,planning is centralised
around a courtyard/s and nursing zones occupy the periphery and usually rise
up to four levels.The greatest limitation of this hospital is expansion when
completed (Oyaro, 1992).
However this hospital type presents several advantages which include: Economic
utilization of the site, landscaped courtyard providing places of rest and natural
ventilation, ease of evacuation in case of emergency, they are of domestic scale,
ventilation from roof lights and natural lighting.
Figure2-39: compact courtyard hospitals Source: Author modified sketch, July 21st 2014
28
2.10 THE VERTICAL HOSPITAL

Towards the end of the19th century, technology was improving; Industrial
methods of transportation and handling of supplies were successfully adapted to
hospital needs. The vertical hospital emerged and with a rare dissent became the
accepted form of the hospital. In the vertical planning strategy the hospital zones
are arranged one above the other such that the movement pattern is mainly
vertical. The steel skeleton frame and the elevator made it possible to fit the
scattered elements in the horizontal hospital to a single mass (Oyaro, 1992).
In the vertical planning strategy, the clinical zone is placed in the podium at
street level with the supporting zone in the basement and the nursing zone in
the tower. The vertical hospital achieves economy in use of land since it occupies
relatively little space on site and lends itself well to the vertical stacking of
Figure 2-40: Vertical hospital communications and services. The vertical hospital may be the only practicable
Source: Author’s sketch, July 22nd 2014
solution where the ground space is at a premium. It unifies circulation patterns
through the use of vertical communication by elevators. The ward may be
naturally ventilated if it is narrow enough as may be the podium if it spreads
widely around courtyards James & Tatton-Brown, 1986).
The vertical hospital has three systems of services:

1. dumbwaiters and conveyors for ancillary services
2. Visitors’ elevators.
3. Service lifts for staff and patients
The vertical hospital can be broken down into several categories. These are:
1. Simple tower on podium hospitals
2. complex tower on podium hospitals
3. Radial tower on podium hospitals
29
ure 2-41: New York Presbyterian Hospital. The neo-gothic structure stands 376 feet (114.6 meters) high
urce , July 21st 2014
4. articulated slab on podium hospitals

5. vertical monolith hospital type
2.10.1 Simple tower on podium hospitals
This is the simplest high-rise hospital strategy. It consists of a tower on a podium.
The nursing zone is contained in the tower while the clinical and support zone
are contained in the podium. The tower-on podium design enables a precisely
defined programme to be realized in one complete building operation on a
restricted site. However it is argued that this can result in buildings which do not
readily respond to the need for growth and change during their lifespan (Oyaro,
1992).
Example: Queen Mary hospital

Bed capacity-1,400 beds
Year Built-1991
Queen Mary hospital is situated in Pok Fu Lam on Hong Kong Island. It is 449 feet
Figure 2-42: simple tower on podium (137 meters) tall and was completed in 1991.The facility provides surgical,
Source: Author modified sketch, July 21st 2014 general medical and emergency services to Hong Kong and the surrounding
region. The hospital has 1,400 beds and is also a teaching hospital for the
University of Hong Kong’s medical and dentistry faculties.
30
Figure 2-43: Queen Mary Hospital, Hong Kong

Source: Source: July 21st 2014
2.10.2 Complex tower on podium hospitals

These types of hospitals are similar in many aspects to the simple tower –on
podium type but the tower façade are protruded or recessed to create aesthetic
interest, variety and environmental response. Just like the simple tower-on –
podium, the nursing zone is contained in the tower while the clinical and support
zones occupy the podium.
Example: Hervey hospital

Bed capacity-1,616 beds
igure 2-44: complex tower on podium Source: Author modified sketch, July 24 th 2014
Hervey hospital is located in Herlev, Copenhagen in Denmark. It was built in 1976
and it stands at 394 feet (120 meters) high. Hervey hospital is also a teaching
hospital for the University of Copenhagen. It serves 82,000 patients every year
with a bed capacity of 1,616.
Figure 2-45: Hervey Hospital, Denmark

Source: Source: July 24th 2014
31
2.10.3 Radial tower on podium hospitals

This type of hospital has a podium with a circular tower. The nursing zone is
contained in the tower whereas the clinical and support zone are in the podium.
Circulation is usually vertical and central.
Example: Rush university medical centre

Architects: Perkins + Will
Location: Rush University Medical Center, 1653 West Congress Parkway,
Chicago, IL 60612, USA
Figure 2-46: Radial tower on podium hospitals Source: Author modified sketch , July 25th 2014 2
Area: 830000 ft
Bed capacity: 386 beds
Year built: 2012
The organizational concept at Rush University medical centre consists of a
rectangular seven-story base, containing diagnostic and treatment facilities,
topped by a five- story curvilinear nursing tower (ArchDaily, 2013). The podium
connects to existing diagnostic treatment facilities to create a new continuous
interventional platform. Part of the ground level of this base contains an
emergency department, which has been designed to be an advanced emergency
response centre. The geometry of the bed tower maximizes views and natural
light for patient rooms while also creating an environment for efficient and safe
health care.
Figure 2-47: Rush University Medical Centre

Source: Source: July 25th 2014 32
2.10.4 Articulated slab on podium hospitals

This type of hospital has more than one tower rising from the podium but these
towers are linked and share one central vertical circulation. Each tower houses
one particular zone of activity, either nursing or clinical only; usually the nursing
tower rises highest.
Example: The bunting centre

Architects: AECOM
Location: Baltimore, United States.
Bed capacity-260 beds
Figure 2-48: Articulated slabs on podium Source: Author modified sketch , July 25th 2014
Site area-1.5 acres (parking offsite)
2
Building area-700,000 ft
Year built-2010
The bunting centre is primarily an inpatient hospital consisting of nursing units
and diagnostic and treatment spaces. Within the surrounding blocks are existing
related facilities, namely an outpatient clinic, the original hospital (currently
being regenerated into outpatient and administrative functions), as well as
associated parking structures (AECOM, 2012).
Figure 2-49: The bunting centre

Source: Source: July 25th 2014
33
2.10.5 Vertical monolith hospital
These are usually small hospitals put up at restricted areas for example in town.
Most of such hospitals are special hospitals.
One set of elevators is used for ancillary and professional transactions and
another for transporting visitors. However this system is inflexible .To relive the
elevators of the ancillary load and also to obtain quick unscheduled deliveries,
various conveyors and dumbwaiters are employed. An average vertical hospital
Figure 2-50: vertical monolith Source: Author modified sketch

Example: Kenyatta national hospital nursing tower block
The 10-storey nursing tower block houses all the wards and theatres in the
hospital. Currently, the hospital has 50 wards, 20 outpatient clinics, 24 theatres
(16 specialised).
igure 51: Kenyatta national hospital nursing tower block Source: Author, 22 nd August 2014
34
CHAPTER THREE: RESEARCH METHODOLOGY
3.1. Introduction.
This chapter seeks to outline the various means through which the author will
undertake to achieve the aims and objectives of the research outlined in chapter
one. To understand the research problem, detailed case study research will be
used to investigate selected local hospitals in Nairobi as well as international
case studies.
3.2. Research purpose.
The study is an exploratory research. The purpose of this research is to compare
the planning and design of the horizontal and the vertical urban hospitals. This is
due to the urban growth trend and the resultant limited footprint available for
development in urban areas. This places a particular emphasis on developing
sound planning and design strategies within the urban areas to achieve a
sustainable and efficient hospital organism.
3.3. Research design and Strategy.

The main research objectives outlined in chapter one were:
1. To investigate the typologies in the planning and design of hospitals.
2. To investigate the current global trend in hospital planning and design.
3. To compare and contrast the horizontal and the vertical hospital models.
3.3.1 Case study method

The case study method was chosen for this study since it is a qualitative
analysis where careful and complete observation of an individual/a
situation/an institution is done. Efforts are made to study each and every
aspect of the concerning unit in minute details and then from case data
generalizations inferences are drawn (Kothari, 2004).
Groat & Wang (2002) identify several characteristics in the case study
method should be outlined in order to answer the research questions
appropriately. These characteristics are:
1) Focus on the cases in their context-Phenomena should be studied
in their context especially when the boundaries between context
and phenomena are not clearly defined. In this case the hospitals
were studied in their planning and design context as this
determines whether a hospital will be horizontal or vertical.
1) The capacity to explain casual links-Case studies can either be
descriptive or exploratory in purpose (Yin, 1994).The selection of
hospitals to be analysed for the case study was important in
explaining the subject matter of the thesis by analysing the planning
and design of the vertical and the horizontal hospital.
2) The role of theory development-This is guided by theoretical
development whether the case study’s purpose is to develop or to
test theory. It should be a sufficient blueprint for the study that will
suggest what data must be collected and what criteria should be
used for analysing it. An important part of the research was through
theoretical analysis of the planning and design of both the vertical
and the horizontal hospitals. It was possible to carry out the study
with clear goals in mind.
3) Use of multiple sources of evidence-The strength of the case study
method is incorporation of data from multiple sources. There was
sourcing of secondary data from several authors in literature
review. Similarly, several methods of data collection were used to
ensure all
relevant data was collected. These were observation, interviews,
surveys and use of instruments.
3.4. Selection Criteria (sampling method)
A sample design is a definite plan for obtaining a sample from a given
population. It refers to the technique or the procedure the researcher would
adopt in selecting items for sample. According to Kothari (2004), the researcher
must consider the following points while developing sampling design.
Type of universe-This is the set of object to be studied and they should be clearly
defined. They can be finite or infinite. In this study, the type of universe is the
horizontal and the vertical hospitals.
Sampling unit-The sampling unit should be decided before selecting a sample it

may be a geographical one such as a town, a city or a village. In this study,
Nairobi was selected because of its diverse composition of hospitals of all levels.
Sampling frame- This is where the samples shall be drawn from. It contains the
names of all items of a universe (in this case of finite universe only).It shall be
comprehensive, correct reliable, appropriate and as a representative of the
population as possible. Based on the literature review, horizontal hospitals are
limited to four floors. This implies that any hospital above five floors shall be
considered vertical.
Size of sample-This refers to the number of items to be selected from the

universe to constitute a sample. It should be optimum, not too large and not too
small. The parameters of interest in a research study must be kept in view, while
deciding the size of the sample. There’s only one level 6 hospital in Nairobi which
has applied both the horizontal and vertical planning strategy and therefore
qualifies as a case study to fulfill the research objectives.
Parameters of interest-In determining the sample design, one must consider the
question of the specific population parameters which are of interest. As
mentioned earlier, the study is a comparison of the planning and design of the
vertical versus the horizontal hospital model. This will be analysed against the
findings in the literature review.
Budgetary constraint-Cost considerations have a major impact upon decisions

relating to not only the size of the sample but also the type of sample. This fact
can even lead to use of non-probability sample. This study was restricted to
Nairobi and its immediate environs due to budgetary constraints.
Sampling procedure-The technique to be used in selecting the items for the

sample must be decided upon. This technique or procedure stands for the
sample design itself and there are several to choose from. There are basically
two types of sample designs:
Probability sampling (random sampling)-Every item of the universe has an equal

chance of inclusion in the sample.
Non-probability (purposive sampling)-Items for the sample are selected

deliberately by the researcher and his choice concerning the items remains
supreme. For this study, purposive sampling was used to select the case studies
and this is how it was done:
Area selection- Nairobi will be used as the case study area. Nairobi provides a mix
of public and private hospitals in large numbers. The area is also at close
proximity to the University of Nairobi which shall be used as the centre for data
analysis.
Case study selection- The investigation shall be limited to one selected local case
study in Nairobi. This shall be Kenyatta National Hospital
The hospital was selected as both the horizontal and the vertical models are
available concurrently for study in the old and the main hospital complex
respectively. Kenyatta national hospital is the biggest referral hospital in Kenya
hence presenting a good opportunity to study the complexity and simplicity of a
national hospital. The hospital has transformed from a horizontal hospital to a
vertical hospital over time. The old hospital was designed using the horizontal
planning strategy whereas the main hospital complex has predominantly
employed the vertical planning strategy in its nursing tower.
3.5. Data Collection Methods
The methods used to collect primary data were:

Figure 3-1:50m long measuring tape used for data collection
Source: wwwmaplin.co.uk
3.5.1 Primary data
1. Observation (structured)
The author’s interest shall be to observe the planning, functional organisation,

zoning, and space utilization in the Hospitals under investigation. This shall be
done by recording observation in writing, using annotated diagrams, sketches
and through photographic recording.
2. Interviews (non-structured)
The author shall seek to interview various categories of hospital users to get
their reaction on the functioning and organisation of the hospitals under
Figure 3-2:5m measuring tape used for data
collection investigation. The respondents shall comprise of the hospital management, staff
Source: and visitors
3. Physical measurements
The author shall use physical measurements to determine certain measurable

aspects such as corridor sizes, inter-departmental distances and ward sizes. This
shall be done using 5M and 50 M measuring tapes.
3.5.2 Secondary data

Figure 3-3: canon digital camera used for data collection
1. Architectural drawings
Source:
Existing master plans and architectural drawings of the hospitals under
investigation shall be collected from the relevant authorities to aid in data
collection and analysis.
2. Background information
Background Information such as the establishment, catchment population, bed
capacity and bed occupancy levels shall be collected from the hospital
administration. This shall help in analysing and determining whether the facilities
Figure 3-4: black pen used for data collection in are overstretched, underutilized or optimized.
interviews, notes and sketches Source: Author
3.6. Data Collection Tools.
The following tools shall be used to collect data:
a) 50 metres long measuring tape

b) 5 metres long measuring tapes.
c) 12.1 megapixels Canon digital camera
d) Notebook
e) sketch pad
Figure 3-5: sketch pad used in data collection f) Black Pen.
in form of notes and sketches Source: Author
40
3.7 Data Analysis methods.
The research focused on the planning and design of hospitals with a view of
comparing the vertical versus the horizontal hospital models.
Study parameter Representation Analysis

Size of site Master plan, Google maps Availability of land
Availability of Land bank for future
Size of developed & undeveloped Land Master plan, site plan growth, projection for vertical/horizontal
future expansion
Typology Master plan, images Vertical typology, horizontal typology
Clinical zone, nursing zone, support zone,
Zoning Master plan, site plan manipulation of the zones to form a fully
integrated hospital and their relationship
with each other
Horizontal planning strategy Site plan ,sectional drawings Horizontal planning strategy ,Lateral
linking of zones, horizontal movement of
activities
Vertical planning strategy Site plan ,sectional drawings Vertical planning strategy ,vertical linking
of zones, vertical movement of activities
floor plans ,sectional drawings Exit signs, Fire resistant doors, Ramps,
Ease of evacuation Exit/Escape routes, Emergency staircases,
Helipad, Roof gardens
Flexibility and growth Master plan ,floor plans ,sections Phasing, proposed developments
Ease of way finding Site plan ,floor plans Signage, pattern of movements, clearly
defined circulation paths, articulation of
entry points
Separation of traffic Master plan ,floor plans ,sections Walkways, driveways, service lifts,
patients /staff lifts, visitors lift
Patient admission travel Site plan, floor plans Track patient admission travel from entry
to exit.
41
Occupancy levels in wards floor plans Number of beds per wards, check for bed
utilization levels, total bed capacity of all
wards
Scale sections ,Images Dominance levels, size of buildings in
relation to surrounding environment,
hospital level (LEVEL1-LEVEL 6)
Different access routes for outpatient,

Access site plan ,sections, Images inpatient, support facilities, accident and
emergency unit,
Drop-offs & parking Site plan ,Images Designated drop-off points for
matatus/Buses, taxis
Communication spaces Site plan, floor plans ,sections, Images Hospital street, Lifts ,Staircases, Ramps,
main lobbies, Atriums, Courtyards,
covered walkways
Circulation spaces floor plans ,sections, Images Internal corridors, internal lobbies,
waiting areas, Airlocks
Sensitivity to semi-ambulant needs floor plans ,sections, Images Ramps, lifts for the disabled
Services Site plan, floor plans ,sections, Images, Wet areas, stores
Landscaping Master plan ,sections, Images Garden seats, planting material, places of
rest
Ventilation/air flow floor plans ,sections, Images Stack effect, cross ventilation, window
sizes and their location
Lighting floor plans ,sections, Images Depth of wards, location of windows, size
of windows
Places of rest site plan ,sections, Images Roof gardens, landscaped courtyards,
shaded garden seats, children play areas
Neighbourhood Google maps, Master plan ,sections, Images Type of activities in the neighbourhood
Catchment population Hospital records Estimated number of patients per day,
outstretched departments
Materials Floor plans, Elevations, sections, Images Building materials, colours, texture
Table 3-1: Table of study parameters Source: Author
42
3.7.1 Data Analysis Tools.
Due to the explorative nature of this study, comprehensive analysis of the
selected hospitals will involve analysis software shown in figure3-8.These are:
1. Graphisoft Archicad version 16(Educational version)-This is both a 2D and

3D drafting software for drafting and drawing models.
2. Google sketch up version 8-This is purely a 3D tool that is useful in quick
modeling of building.
3.7.2 Data Presentation Modes

Research findings were represented using:
1) Tables-These are used to convey columns of texts for ease of comparison of

the findings. Tables have been used to carry the comparison of the vertical
versus the horizontal models.
2) Figures-These are divided into two as follows:
 Photography-Image representations of hospitals are used to illustrate
existing conditions of different components in hospitals.
 Illustrations-These are the most essential in this research to compare and
analyse the planning and design of hospitals with the aim of comparing
the vertical and the horizontal hospital models.
3.8. Time Horizon

The time horizon shall be cross-sectional as it studies a certain phenomenon at a
particular given time.
th th
The research shall be carried out in 4weeks as from 4 August -30 August 2014
43
CHAPTER FOUR: DATA PRESENTATION AND ANALYSIS
4.0. Introduction
The main aim of this research is to compare the planning and design of hospitals
with an emphasis on typologies .This will help in addressing the challenges in
hospital planning and design which range from site limitations in urban areas,
provision for growth and flexibility, challenges in achieving natural lighting and
ventilation, ease of evacuation, separation of incompatible traffic among other
challenges.
The research is exploratory in nature, and therefore the case study approach has
been identified as the main research strategy. The case study approach provides
the best opportunity for analysing and comparing the models and their
typologies in the selected case studies.
The selected case hospitals are:
1) Kenyatta National Hospital-both horizontal and vertical planning strategies
2) Nanjing Drum Tower hospital-china-Vertical planning strategy
4.1 KENYATTA NATIONAL HOSPITAL
4.1.1 Background
Kenyatta National Hospital is located along Hospital Road, off Ngong Road, in
Nairobi, Kenya.
Kenyatta National Hospital was established in 1901, as the Native Civil Hospital
with a bed capacity of 40 beds. During that period the Hospital was handing
about 712 in inpatients and 6,425 outpatients annually. In 1964 it was renamed
Kenyatta National Hospital in honour of the first President of Kenya, Mzee Jomo
Kenyatta. The hospital has expanded through three major phases under the
funding of the British Government. In 1971, phase I comprising of outpatient
clinics, Casualty, Central Sterile Supplies Department (CSSD), Intensive Care Unit
(ICU), radiology, Medical Wards, and Medical school teaching blocks, hostels,
Figure 4-1: map showing the location of Nairobi in and maintenance department was completed. Phase II comprising of Sterile
Kenya within Africa
Source: www.unep.com; 07/11/2014 Processing Unit (SPU), Pharmacy No.40, Catering facilities, stores and mortuary
was completed in1972. Phase III was completed in 1981 which included the 10
storey Tower Block. Under the Health Rehabilitation programme (1992 – 1998)
funded by the World Bank, The Doctors’ Plaza, private wing facilities, new
mortuary and an oxygen plant were established.
The Hospital operated as Department of the Ministry of Health up to 1987 when

it became a State Corporation Vide a legal Notice No.109 with a Board of
Management aiming to improve the management of the institution. It covers an
area of 45.7 Hectares and within the KNH complex is the college of Health
Sciences (University of Nairobi), Kenya Medical Research Institute, National
laboratory, Government Chemist (MO and the Kenya Medical Training College.
Figure 4-2: map showing the location of KNH within Nairobi

Source: goggle maps: 07/11/2014
4.1.2 Current status
Currently the hospital has 50 wards, 20 outpatient clinics, 24 theatres (16
specialised) and an accident and emergency department. Out of the total bed
capacity of 1800,225 beds are for the Private Wing. Data from the hospital’s
records reveal that the annual average bed occupancy rate is 115% but goes up
to 210 % in medical, orthopaedic and paediatric wards. In addition, on any given
day the hospital hosts in its wards between 2500 and 3000 patients. On average
the hospital caters for over 80,000 in-patients and over 500,000 outpatients
annually.
Figure 4-3: A monument of the nursing tower at KNH Source: Author (14 th August4.1.3
2014) Hospital Services
The hospital is the biggest referral facility in the region offering a wide range of
specialised services including diagnostic services such as laboratories,
radiological interventions/imaging, endoscopy and radiation/oncology.
In addition the hospital receives referral cases from provincial hospitals in the
country and within the Eastern, Central and Southern Africa region. The hospital
offers primary and secondary healthcare services to Nairobi and its environs. It
provides facilities and resources for training, teaching and research to the
college of Health Science (University of Nairobi), Kenya Medical Training College
and other training institutions both local and international. Specialised surgical
services offered include open-heart surgery, kidney transplants, neurosurgery,
orthopaedics, laparoscopy and endoscopy.
Figure 4-4: An Image of Kenyatta National Hospital taken from Ngong road Source: Author (14 th August 2014)
OLD HOSPITAL MAIN KITCHEN NURSING TOWER

HOSPITAL
MORTUARY
SERVICE
ROAD
DELIVERY SUITE
ADMIN
BLOCK
HELIPAD
A& E
OUTPATIENT
CLINICS
LANDSCAPED
GARDEN
ENTRANCE -A OUTPATIENT
PARKING ENTRANCE-B
BUS STOP MAIN PARKING TO A& E ONLY
Figure 4-5: An image of the model of Kenyatta National Hospital
th
Source: Author (15 August 2014) 47
4.1.4 Planning of Kenyatta National Hospital
Kenyatta national hospital has adopted both the vertical and horizontal planning
strategies in its master plan. This is clearly evident from the construction phases
through which the hospital has undergone through to its current state.
The old hospital and the clinical areas have purely utilized horizontal planning
strategy whereas the nursing areas have adopted vertical planning strategy in
the 10-storey nursing tower.
On its entirety, Kenyatta national hospital reads as a simple tower on podium
hospital. However, it cannot be classified as such since the nursing tower doesn’t
have a podium. Consequently, the nursing tower can only be classified as a
vertical monolith typology with the clinical areas reading as a distinct extended
courtyard horizontal typology model.
The combination of the vertical and horizontal hospital typologies has helped in
achieving economic utilization of the land since the site is in a prime location.
Kenyatta National hospital lies on a site of 45.7 ha (113 acres).However the main
hospital complex which is the primary area of study in this research utilizes
approximately 18% of the site (20acres).60% of the site (68 acres) has been
utilized by the staff housing, Mary Griffin Hostels, University of Nairobi medical
school, Students’ hostels, Kenya Medical Training College (K.M.T.C), Adult
teaching centre and Government laboratories.
22% (25 acres) of the site is available for future expansion of the hospital. Among
the proposed developments in this land are: The proposed Paediatric emergency
e 4-6: A model of Kenyatta National hospital complex Source: author (15 thcentre
August(P.E.C)
2014) that will provide exclusive healthcare services to children in a child
friendly environment away from the mix with adult patients, the proposed burns
unit, the proposed construction of a bunker and equipment of cancer unit and
the envisaged expansion of the nursing tower to cater for the rapidly increasing
need for medical services.
48
Figure 4-7: Master plan of Kenyatta National Hospital
th
Source: Author (17 August 2014)
4.1.5 Zoning
Kenyatta national hospital has been zoned into three distinct zones.
These zones are:
1. Clinical zone
2. Nursing zone
3. Support zone.
4.1.5.1 Clinical zone
The clinical zone is the working area for administration, medical treatment and
observation. The zone has been located on the most accessible areas from the
access routes and Hospital Street. It comprises of:
Figure 4-8: 10 storied nursing tower bock home to the entire  The administration block
nursing zone at KNH  The old hospital
Source: Author  Accident & Emergency wing/casualty
 The old & the new mortuary
 The doctors plaza
 Observation
 Outpatient clinics
 Medical records
 Main pharmacy
 Emergency lab
 Medical clinic
 Paediatrics unit
 Surgical unit
 Gynecology unit
 block
le storied clinical zone at KNH. The hospital runs through it to the nursing tower X-raycreating
department
horizontal contiguity.
50
4.1.5.2 Nursing zone
The nursing zone is the patient quarters/wards. It fosters patients throughout
their stay in hospital. It comprises of:
 The nursing tower block
 Obstetrics wards
4.1.5.3 Support zone
The support zone satisfies all the physical and material needs of the nursing and
clinical zones. It comprises of:
 Kitchen & dining  Oxygen plant
 General stores  Boiler house
 Drug stores  Incinerator
Figure 4-10: The support services block at KNH housing the  Central Sterile and Supplies  Maintenance department
C.S.S.D, general stores, kitchen and dining Source: Author Department(C.S.S.D)  laundry
 Theatre Sterile Supplies
Unit(T.S.S.U)
The three zones have been intrinsically tied together to act as one homogenous
unit. Varying typologies have been used to assemble the three basic hospital
zones. The nursing zone has adopted the vertical model and it is the most
outstanding and dominating element in the Kenyatta national hospital complex.
The clinical zone has adopted single storied horizontal planning strategy except
the Accident and emergency /casualty wing which is double storied. However,
the ground floor is used by patients whereas the first floor is office space for the
hospital management. The support zone adopts the horizontal planning.
nd
Interestingly, the kitchen is located in the 2 floor of the support zone and
rd th
directly links to the wards located in the 3 to 10 floors. The oxygen plant is
purely an engineering adventure
Figure 4-11: Oxygen plant at KNH Source: Author
Figure 4-12: zoning map of Kenyatta national hospital

Source: Author 52
4.1.6 CIRCULATION
The external circulation has greatly influenced the functional organisation of the
interdepartmental relations at Kenyatta National Hospital.
4.1.6.1 Access
The main vehicular and pedestrian entrance to the hospital is from the hospital
road .The Bus drop-off point is also located along the hospital road which links to
Ngong road. Ngong road is majorly used to access the Mortuary, academic
institutions within the hospital as well as servicing the hospital.
13: main entrance to the Wards and clinics at KNH. This entrance forms the Hospital Street.
The external circulation is a primary success factor in the planning and design of
uthor
Kenyatta National Hospital. It provides a convenient and easy access to and from
the facility. This has been achieved through; simple way finding, safe public
vehicular drop-offs, convenient access to parking and separation of vehicular and
pedestrian traffic.
Careful consideration has been given to site access for the public, staff, servicing
and emergency vehicles. The accident and Emergency (A&E) department has its
own entrance (Gate-B) which is specifically designated for emergency cases.
The location of parking places has desirably influenced the location of the
hospital street (labeled no.37 in the circulation diagram)
4-14: Pedestrian walkways have been used to avoid vehicular and pedestrian conflict.
e: Author
53
Fig 4-15: Master plan of Kenyatta National Hospital

Source: Author 54
4.1.6.2 Separation of dissimilar traffic
At planning level, Kenyatta National Hospital has achieved to separate dissimilar
traffic through provision of multiple entrances to the hospital. These include:
 Main entrance for inpatients and visitors (Gate A)

 A&E entrance for emergency cases and Ambulances(Gate-B)
 Pedestrian entrance at the bus drop-off point
 Service Entrance at the rear of the site
 Convenient location of the Helipad at the rear of A& E
 Designated pedestrian walkways
strategically located at the rear of the A& E unit to avoid conflict of air and road traffic during emergencies.
The separation of dissimilar traffic has helped in minimizing the pedestrian and
vehicular traffic as well as minimizing collision of dissimilar vehicular traffic e.g.
ambulances and visitors’ vehicles. It has also helped in avoiding collision of Air
and road traffic during emergencies at the Accident and Emergency unit.
The separation of the academic institutions from the main hospital has greatly
helped in controlling and managing the human traffic within the hospital. The
academic institutions occupy a designated zone within the site. Despite the
separation, they are still able to link seamlessly with the main hospital while still
maintaining the privacy of the patients and the visitors. These institutions are:
The University of Nairobi (U.o.N) medical school which links with the Mortuary,
Kenya Medical Training College (K.M.T.C), Adult teaching centre, U.o.N students’
hostels and, Mary Griffin hostels.
The academic institutions are accessed via the service road (Old Mbagathi road)
which branches from Ngong Road. This helps in separating the traffic from the
Figure 4-17: Direct vehicular access at the A& E unit
for emergencies hospital and the academic zone while the two still acting as one homogenous
Source: Author. unit.
55
4.1.6.3 Internal Circulation
Hospital Street
The internal circulation has contributed majorly to the functional organisation of
intradepartmental relations within Kenyatta National hospital.
The hospital street which is the primary circulation spine in the hospital runs
through the hospital from the parking lots through the nursing Tower block to
the service road which branches from Ngong road.
The strategic location of the hospital street enables patients and visitors to
access the hospital both from the Ngong road and from Hospital road with ease.
These two roads are the major matatus drop-off points for users of public
Figure 4-18: The hospital street as captured in the transport. The hospital street (labeled 37) has the most human traffic since it’s
physical model of KNH
Source: Author
the principal internal circulation channel in the hospital. There is conflict of
dissimilar traffic such as the patients, visitors, trolley bays, wheeled beds and
staff since they all converge at the hospital street.
Secondary circulation streets branch from the hospital street to the various
departments hence tying the various components of the hospital together.
4.1.6.4 Ease of way finding
Way finding at Kenyatta National hospital is convenient and easy. Signage has
been used as the major tool to direct the patients and visitors to and from the
hospital.
Figure 4-19: View of the lifts lobby from the hospital

street
Source: Author
4.1.6.5 Circulation spaces
The circulation spaces at Kenyatta National Hospital comprise of the tertiary
corridors, internal lobbies, internal staircases and the internal ramp at the A& E
department. The circulation spaces have been used to facilitate movement
between rooms/spaces within the individual departments. The internal corridors
range from 1.8m wide to 3m wide depending on their location within the
departments.
4.1.6.6 Communication spaces

The communication spaces at Kenyatta National hospital comprise of the
hospital street, the secondary streets, a set of 10 lifts in the nursing tower,2
service lifts,1-public staircase in the nursing tower ,4- Emergency staircases in
st
the nursing tower, a ramp from the delivery suite to obstetric wards in the 1
floor and Series of courtyards. These circulation spaces have been used to
Figure 4-20: Wall fixed signage plates along the
secondary streets at KNH Source: Author provide access between departments at Kenyatta National hospital.
The hospital street which is the primary circulation route in the hospital is
approximately 6m wide. It has been designed for the maximum expected
circulation flow to cater for trolleys, wheelchairs, wheeled-beds, patients and the
traffic from visitors.
During the visiting hours, there is heavy traffic and long queues since the 10 lifts
are not adequate to serve the patients, visitors, staff and food items. The only
available alternative is the public staircase at the lift lobby. This staircase is
inadequate given the high traffic of visitor’s accessing the wards in the nursing
tower block.
The widths of the secondary streets vary from 2.4m to 3.0 m depending on their
location within the hospital.
Figure 4-21: Mosaic arts along the corridors
Source: Author
Figure 4-22: Internal circulation map at Kenyatta National hospital Source: Author 58
4.1.7 FLEXIBILITY & GROWTH

Flexibility and growth at Kenyatta National Hospital is exhibited through the
development of the hospital in phases. These are:
4.1.7.1 The old hospital
Model: Horizontal hospital model.
Typology: Spine and Pavilion
The old hospital is a 3-storied spine and pavilion typology. It has a strong spine
with clinical and nursing zones on either sides of the spine. In this typology, the
circulation has been used as the principle organising element.
Advantages
 Along the central spine are emergency fire escape doors that open to the
landscaped courtyards. This is convenient for emergency evacuation.
Figure 4-23: The old hospital block Source: Author  The narrow plan characteristic of this typology maximizes on natural
lighting and ventilation in the building. This is a sustainable approach to
hospital design as it alleviates the need for artificial lighting
 The narrow plan maximizes on natural ventilation.
 Patients have views to the landscaped gardens hence offering
therapeutic benefits which create a conducive healing environment.
 The simple spine corridor /street allows for unlimited growth at almost
any point, either of the street itself or of individual departments. This is
clearly evident at the node where the old hospital intersects with the
main hospital to forming a unified composition
Disadvantages
 The central corridor is too long and monotonous. This creates
boredom and increases the intra-departmental distances.
 This typology requires a big piece of land to develop hence not suitable
Figure 4-24: Image of the circulation spine in the old hospital Source: Author in small and congested sites
59
Figure 4-25: The old hospital as it existed before construction of the main hospital block Source: Author
60
1.5 metres wide Windows 3.6 metres wide Staircase to upper floors
lighting the central spine central spine
The node linking the old

hospital with the main hospital
complex
Emergency fire escape door
Figure 4-26: detailed layout of the old hospital Source: Author
61
The narrow plan allows for natural ventilation and lighting to the wards.
The pocket landscaped courtyards offer therapeutic benefits to the patients in

the wards
The central aisle allows for emergency evacuation to the pocket courtyards
through doors located along the circulation spine.
Lighting to the central aisle is achieved through windows located strategically

along the spine
Figure 4-27: Layout plan of the old hospital Source: Author
Figure 4-28: Typical ward plan of the old hospital before relocation of the wards in the Nursing tower block Source: Author 62
4.1.7.2 Phase 1

Typology: Extended courtyard.
The hospital has expanded through3 major phases under the funding of the
British Government.Phase-1 comprising of outpatient clinics, casualty, central
sterile and supplies department (C.S.S.D), intensive care unit (ICU), radiology,
medical wards, medical school teaching blocks, hostels and maintenance
department were completed in1972.
Phase 1 development employs the use of the extended courtyards typology. In

this typology, pockets of courtyards are used as the principle organising
Figure 4-29: Courtyard used as an organising principle at
the Paediatric unit Source: Author elements. This typology presents several advantages
 maximum utilization of natural light

 Ventilation from roof lights
 Landscaped courtyards
 Domestic scale
 Ease of evacuation in case of fire
 Provision for future extension
 Simple load bearing structure
However the typology still has its own limitations e.g. In areas where deep plans
have been used, it becomes hard to achieve natural lighting and ventilation. This
necessitates the use of roof lights which are only functional in single storied
buildings unless an atrium has been provided
Figure 4-30: Roof lights used to light the single storied
deep planned blocks Source: Author
63
Figure 4-31: Layout of the phase -1 development at Kenyatta National Hospital 64

Source: Author
4.1 7.3 Phase II
Phase II comprising of Sterile Processing Unit (SPU), Pharmacy No.40, Catering

facilities, stores and mortuary was completed in1972.
65
Figure 4-32: Layout of the phase development at Kenyatta National Hospital Source: Author
4.1.7.4 Phase III
Phase III was completed in 1981.This included the 10 storey Tower Block.
Under the Health Rehabilitation programme (1992 - 1998) funded by the
World Bank, The Doctor Plaza, and private wing facilities, new mortuary
and an oxygen plant were established.
66
Figure 4-33: Layout of the phase-III development at Kenyatta National hospital. Source: Author
4.1.8 A&E Wing

Typology: Extended courtyard
The A&E wing adopts the extended courtyard typology in its planning and
design. This brings several advantages that are crucial in an accident and
emergency wing. These are:
 Reduction of intradepartmental distances

 Creation of landscaped courtyard that is being used as a resting place
 Ease of circulation and way finding
Figure 4-34: View of the A& E unit from the parking
Source: Author  Ease of evacuation in case of fire
 Provision for future growth
The department is strategically located within the Kenyatta National Hospital

master plan and is easily serviced by vehicles, pedestrian and choppers. The
department is at close proximity to the helipad which makes it efficient to attend
emergency cases via air transport. Vehicular access to the department is via a
dedicated emergency entrance (Gate-B). This aids in avoiding the mixing of
incompatible traffic which may cause delay while accessing the emergency
department.
The department has a deep plan which creates challenges in achieving natural
lighting throughout the building. This problem is mainly due to the double
storied nature of the building which makes it hard to light the ground floor using
roof lights. The lack of adequate atriums makes it hard to light the interiors of
the building using natural light.
Figure 4-35: Location of the A&E unit at KNH Source: Author
67
LEGEND
Figure 4-36: Ground floor plan of A&E department at KNH

Source: Author 68
LEGEND
69
Figure 4-37: First floor plan of A& E department at KNH
Source: Author
Interstitial floor 4.1.9 The nursing tower
Model: Vertical hospital model.

Typology: Vertical monolith
The 10-storey nursing tower block houses all the wards and theatres in the
hospital. Currently, the hospital has 50 wards, 20 outpatient clinics, 24 theatres
(16 specialised).
Out of the total bed capacity of 1800,225 beds are for the Private Wing.
The annual average bed occupancy rate is 115% but goes up to 210 % in medical,
orthopaedic and paediatric wards. Based on the hospital records, on any given
day the hospital hosts in its wards between 2500 and 3000 patients.
On average the hospital caters for over 80,000 in-patients and over 500,000
outpatients annually. Each of the typical floors in the tower block has 8 wards. A
Figure 4-38: A model of the KNH Nursing tower block set of 2 wards;1 male and 1 female. A set of 2 wards share facilities such as the
Source: Author
service lift, nurse’s station, emergency fire escape and the reception.
The Wards are grouped into clusters of 10 beds each.
The tower block is serviced by a set of 10 lifts and one public staircase. However
due to the high number of patients accessing the wards during visiting hours,
one can barely get a lift ride. This results to long queuing lines and many visitors
opt to use the only staircase available. The lifts are for use by all classes of
people ranging from staff, patients, and visitors. This results to mixing of
incompatible traffic in the vertical circulation.
Based on the author’s observation, the vertical circulation is the biggest
challenge being faced by the hospital. At some instances, the hospital has
reported suicide cases whereby patients jump from the 1200mm high balcony
rails to the hard landscaped courtyard. According to the hospital Engineer, the
challenge is how to balance safety and security of patients in the wards.
Figure 4-39: hard landscaped tower block courtyard Source: Author
70
71
Figure 4-40: A typical floor plan of the ward Source: Author
Figure 4-41: Aerial view of the nursing tower

Source: Author
Figure 4-: A detailed analysis of the typical wards in at Kenyatta National Hospital
Source: Author 72
Figure 4-42: Sectional analysis of the tower block at KNH 73

Source: Author
4.1.10 Emergency design features in the nursing tower.

Patients have differing physical abilities and a range of psychological
characteristics which all impact on the degree of assistance that they will require
to evacuate from a building safely. Kenyatta National Hospital has incorporated
architectural design emergency features for safe evacuation of patients in case
of disasters like fire. These include:
1) Emergency staircases –The 10 storied nursing tower has a set of 4

emergency staircases to aid in evacuation of ambulant people. The
emergency stairs are approximately 1500mm wide. This width is good
enough to allow for mattress evacuation. The emergency stairs are
Figure 4-43: The four compartments of double wards in
accessed via fire escape doors. However, the emergency stairs open
a typical floor of the nursing tower
Source: Author within the hospital in the Ground floor. Whereas it is preferable for the
emergency stair to open to a courtyard and not within the hospital
building, the emergency stairs open to the latter due to security reasons.
2) Fire Doors-The typical floor of the nursing tower is divided into 4 sets of
double wards. Each of these sets is accessed via a fire resistant door that
has the following features: an “exit “sign, door handle, glazing, a kicking
plate. This makes the building more accessible to all including the wheel
chair confined persons.
3) Compartmentalization of wards- The typical floor of the nursing tower is
divided into 4 compartments accessed by fire scape doors from either
side. This division can be helpful in containing the spread of fire since it
would allow for evacuation of patients from one ward to the other in the
same floor. The fire resistant doors would also help in combating the
spread of fire to the other wards in the same floor.
re 4-44: Sketch of a fire resistant door along the 3000mm wide corridors in the wards.
ce: Author
74
Figure 4-45: Analysis of the architectural design emergency features in a typical floor of the nursing tower Source: Author
75
4) Exit/Escape routes-Each set of the double wards in the typical floor plan
of the nursing tower has 2 accessible exits for horizontal
evacuation/escape route and an internal emergency escape staircase
for vertical evacuation.
5) Exit signs-All doors along the corridors in the nursing tower and
emergency staircases have visible exit signs fixed on door frames. This
enables an individual to identify the escape routes at all times even when
the door is open.
6) Ramps – The Obstetrics wards in the first floor of the nursing tower have
access to a ramp that .This ramp creates ease of movement for the
p serving the obstetrics wards in the first floor and the delivery suite in the Ground floor at KNH.
patients, fromSource: Author
the wards to the delivery suite in the ground. The ramp
can be particularly helpful in evacuating semi-ambulant persons with
ease and speed from the first floor to the courtyard in the ground floor.
However this ramp is only limited to the first floor.
7) Wide corridors– The main circulation corridor at the lifts lobby is
approximately 6metres wide. The interior circulation aisle in the wards is
approximately 3 metres wide. The wide corridors can be particularly
helpful in emergency evacuation. Patients and visitors can be evacuated
into the 6metres wide corridor as they await transfer to safer areas.
ure 4-47: Fire exit sign at an emergency escape door at KNH Source: Author
76
4.1.11 Comparison of the Horizontal typology models at KNH
PARAMETER EXTENDED COURTYARD MODEL SPINE & PAVILLION MODEL
LAYOUT
IMAGE
Deep plan Narrow plan
PLAN
TYPOLOGY Horizontal hospital model- mixture of single, Horizontal hospital model- 3 storied
double and 3- storied blocks. building.
Requires a relatively smaller site compared Requires a relatively larger site compared to
SIZE OF SITE to the spine and pavilion type. the extended courtyard.
Patients can easily be evacuated directly Patients can be evacuated out of the
EASE OF EVACUATION from the building blocks into the landscaped building through the fire escape doors
courtyards. situated along the central circulation
corridor.
The typology allows for both vertical and The typology allows for unlimited growth at
FLEXIBILITY AND GROWTH horizontal growth with ease. Flat roofs almost any point, either of the street itself
can be particularly helpful in attaining or of individual departments.
vertical growth.
SEPARATION OF DISSIMILAR The multiple secondary streets allows for It’s difficult to separate dissimilar traffic
TRAFFIC separation of dissimilar traffic. since there’s only one central circulation
spine.
The arrangement of departments around The departments are arranged laterally
PATIENT ADMISSION courtyards reduces the departmental along the central spine. This result to longer
TRAVEL/DEPARTMENTAL distances since closely related departments departmental distances compared to the
DISTANCES can be arranged around a courtyard. extended courtyard typology.
Domestic scale. Has a maximum of 3 floors Domestic scale. Has a maximum of 3 floors
SCALE in the kitchen and dining block. in the old wards.
The typology has deep plans. This makes it The typology has a narrow plan throughout.
difficult to achieve maximum natural air This is particularly helpful in achieving
ventilation through cross ventilation via the maximum natural air ventilation through
NATURAL VENTILATION courtyards. The roof vents have been used cross-ventilation.
to provide natural air ventilation in the
single storied blocks .However they are
ineffective in double storied blocks.
The deep plans make it challenging to The narrow plans helps in achieving
NATURAL LIGHTING achieve maximum naturally to all spaces in maximum natural lighting to all spaces in the
the building. The roof lights have been used building as well as providing therapeutic
to provide natural lighting but this is views to the landscape from the wards
ineffective in double storied blocks.
Table 4-1: Comparative analysis of the horizontal models at Kenyatta National Hospital Source: Author
4.1.12 plannning & design challenges at Kenyatta national hospital
To a great extent Kenyatta national hospital is successful in its planning and
design. However, the author was able to identify a few challenges through
observation and interviews from the hospital administrators. These are:
1) There is high vertical circulation stress in the nursing tower block due to
overdependence on lifts and lack of adequate public staircases to
complement the lifts. Currently there is only one public staircase in the lifts
lobby.
2) The quality of healing environment for children at the paediatric department
ure 4-48: Location of the paediatric department at KNH Source: Author, 24th August is
2014
compromised. The following limitations were identified in the paediatric
section
a) Their location is compromising the accessibility of emergency
services for children since they are in the adult environment.
b) Inappropriate location: the current location of the paediatric section
is hidden into the other facilities and is not easily accessible to
customers in time of emergencies.
c) The space for the paediatric emergency unit is quite small hence
limiting the provision of essential emergency services.
d) The paediatric emergency units are always congested, crowded
and the ventilation is lacking for children and their parents.
e) The clinics are in the mix-up of environment with adult clinics.
f) Space limitation prohibits the running of specialized clinics on daily
basis, hence limiting the efficacy of the children care.
g) The waiting areas are too small hence compromising the children
environment in health facilities.
Figure 4-49: Make shift waiting area for paediatric outpatient unit donated by Posta.
Source: Author, 19th August 2014
h) The clinics do not include other support services e.g. children play
areas, laboratories and X-rays which are required for appropriate
paediatric care, hence children mix a lot with adults as they move
searching for such services.
i) Lack of sufficient space to run all specialized clinics such as ENT,
surgery, Eye and Orthopaedic leaves similar predicament for
children to be mixed with other adults in these respective clinics.
j) Paediatric department does not have specialised services such as
minor theatre, dental, cardiology, surgery, orthopaedic services at
one stop which are crucial in the provision of quality paediatric
health care. The current Paediatric outpatient clinic and Paediatric
ure 4-50: A child receiving emergency service at KNH A&E unit Source: Author, 21 st August 2014
Emergency Unit lacks space to house or run these services and make
the patients move where they are provided. The department is
allocated one day for theatre cases excluding emergencies. This has
led to increased congestion and overcrowding of children in the
wards. In addition, it is the only department without a minor theatre
in the hospital, making it impossible to decongest wards and clinics.
This mix –up of children who require minor and major surgery has a
negative multiplier effect of the increased cross-infections and
eventually leads to higher mortality rates.
Figure 4-51: A child looking for play activities at KNH

Source: Author, 21st August 2014.
80
4.2 NANJING DRUM TOWER HOSPITAL

4.2.1 Introduction
Nanjing Drum Tower Hospital is affiliated with the Nanjing University Medical
School. The hospital serves as a major medical, academic and research center in
China. The hospital is one of the earliest western medical hospitals in China. It
was founded in 1892 by Dr. William Edward Macklin from Canada on his mission
to China under the auspices of the American Presbyterian and the American
Methodist mission groups.
Originally, the hospital was named Nanjing Christian Hospital, but was widely
known as “Ma Lin Hospital,” after the Chinese name of the founder. In 1902, the
hospital was renamed Drum Tower Hospital. The original hospital was a four-
story 1892 horizontal hospital.
Figure 4-52: location of china within Asia. Source: (Nov 20 th 2014)
The old hospital building was fully renovated in 2006, and, on January 23, 2007
the historic building was formally re-dedicated as The 1892 Memorial Hall and
Hospital Archives. The 1892 Memorial Hall includes a series of memorial
galleries, a dedicated archives center, and a spacious conference hall.
Figure 4-54: The 1892 Drum tower hospital Figure 4-55: The 1892 memorial Hall and
Figure 4-53: Location of Nanjing within China during winter in1892 Hospital Archives, Jan 23, 2007
th
Source: (Nov 20th 2014) Source: www.njglyy.com (Nov 20 2014) th
Source: www.njglly.com (Nov 20 2014)
81
4.2.2 Nanjing Drum Tower Hospital South Extension
Nanjing Drum Tower Hospital South Extension is a general hospital extension

project. It combines inpatient, outpatient departments, emergency unit,
medtech and medical academic exchange departments altogether.
Architects: Lemanarc SA.

Location: Zhongshan North Road, Nanjing, Jiangsu, China.
Architect in Charge: Vincent Zhengmao Zhang.
2
Area: 260,000 m .
Year of completion: 2012.
Figure 4-56: Nanjing Drum Tower south extension Typology: Vertical hospital typology; 13 floors.
Source: (20th Nov 2014)
Model: Simple tower on podium.
Bed capacity: 2,800 beds.
Site: 9.4 acres.
Nanjing Drum Tower Hospital South Extension was designed in 2003 and
completed in 2012.It sits on a 9.4 acres site between Zhongshan road and Tianjin
road in Nanjing municipality, china.
According to the architect; Vincent Zhengmao Zhang, the earlier expansion of

the hospital i.e. the outpatient tower was driven by the need of development of
modern medical technology as well as the increasing municipal population.
Despite the remarkable scales, most of these early expansions are hardly more
than simple and urgent addition and extension of existing function to meet the
Figure 4-57: View of the roof gardens at Nanjing drum rapidly increasing need for medical service. As a result, the functional layouts of
tower hospital Source: (20th Nov 2014) many floors are not well organized and streamlined for the operation of the
hospital as a whole. For instance, the existing outpatient department is on the
Renovated 1892
old hospital
east side of Zhongshan road, connected with the main buildings of the hospital,
South Outpatient which is on the west side, only through a narrow underground passageway. This
extension Department
creates extra inconvenience to both patients and staff.
The Nanjing Drum tower hospital has a total of 2800 beds, of which 1600 beds
are in the new south expansion wing. The overall gross floor area of the hospital
2
is 260,000 m .Contrary to the general expectation of a high rise hospital building
in China, the architect made a seemingly surprising choice: instead of stacking
floors one upon another and resulting in a high floor area ratio, the design team
decided to ‘lay it down’ to create a series of gardens at the floor area ratio of 5:2.
Such preference for low rise building went squarely against the design trend,
which is dominated by the frenzy for skyscrapers. The low rise plan not only
reduced the stress on vertical traffic which is a constant trouble for large general
hospitals, but also creates large areas of urban space with human scales.
Figure 4-58: A model of the Nanjing Tower hospital Source: (20 th Nov 2014)
However, by choosing a more scattered, low rise plan, the architects were facing
various challenges: from organizing the arrangement for the newly built areas,
understanding and analyzing the operation and rules of the hospital, to the
planning of ideal operating model for the new hospital.
4.2.3 Sustainable design features in the hospital

The Nanjing Drum hospital tower won the 2013 healthcare WAN award for its
healing gardens. Interestingly, the English word “hospital” originates from Latin,
meaning “Gathering Guests”, but in Chinese, the term “Hospital” (Yi Yuan)
translates directly as the “Healing Gardens”. Inspired by such difference of inter-
cultural interpretation, the design aims to achieve home-like experience within
Figure 4-59: Roof garden at Nanjing drum tower hospital the hospital by combining the function of healing with that of garden or
Source: Source: (20th Nov 2014) courtyard. (World Architecture Awards, 2013)
The idea of ‘gardenised architecture’ is the core of the design for the project.
More specifically, the attention was to create an ubiquitously accessible ‘system
of gardens’ within the hospital by variation of means from master plan
arrangement to the smallest details of facades and envelopes.
In the traditional Chinese Culture, a garden is the border between home and the
outside world. Walking into the garden means you can block all external
interference, and achieve true relaxation in both body and mind. To gardenise
the hospital is not only to achieve the sensory beauty, but more importantly also
to bring spiritual comfort to people. (Vincent Zhengmao Zhang-Architect south
extension) The huge rainless hospital is composed of 6 large courtyards, more
than 30 light wells and innumerable micro-gardens woven on the building’s
envelopes. Equipped with the external sun shades and the lateral natural
Figure 4-60: Façade of the gardenised architecture Source: (20 th Nov 2014)
ventilation system that help significantly reduce the air-condition energy
consumption; Drum Tower Hospital is a truly energy-saving green hospital.
Figure 4-61: A detail of the gardenised envelope Source: (20 th Nov 2014) Figure 4-62: The 6 healing Gardens at Nanjing Drum hospital Source: (20 th Nov 2014)
4.2.4 The Planning & design of Nanjing Drum Tower hospital
The Nanjing drum tower hospital has fully exploited the vertical
planning strategy both in its earlier expansion and in the South
extension.
The hospital can generally be classified as a simple tower on podium model since
it consists of a tower on a 4 storey podium. This model has presented several
advantages in the planning and design of the hospital. These are:
4-63: section through Nanjing Drum Tower hospital showing the tower and the podium.
: (20th Nov 2014)  The vertical arrangement of departments has helped in achieving
practicable solution in economic utilization of land in a prime location.
The hospital occupies relatively little space in an urban area and lends
itself well to the vertical stacking of communications and services.
 The provision of basement parking has been particularly helpful
in reducing the vehicular and pedestrian conflict within the site.
 There is increasing vertical privacy gradient. The public and semi-public
zones i.e. the support and clinical zones are located in the basement
and the podium. The private zone i.e. the nursing wards is located in the
tower.
 The vertical circulation channels comprising of lifts and staircases are
centrally located. This makes it possible to link all the zones vertically. It
also helps in reducing the departmental distances within the hospital.
 The simple tower on podium helps in achieving a low rise plan by having
the clinical zone located in the podium at street level with the supporting
zone in the basement and the nursing zone in the tower. This helps in
reducing the vertical traffic stress which is a constant trouble in vertical
Figure 4-64: Image of Nanjing drum tower hospital Source: (20 th Nov 2014) hospitals.
However, the model doesn’t readily respond to the need for future growth and
expansion.
Figure 4-65: site plan of Nanjing
th drum tower hospital .
Source: Author modified (20 Nov 2014)
e 4-66: Ground Floor plan of Nanjing drum tower hospital South Extension Source: Author modified (Nov 20 th 2014)
Figure 4-67: Diagrammatic arrangements of departments at the south extension at Nanjing drum tower hospital Source:
Figure 4-68: Section-01 through the south extension of Nanjing Drum Tower Hospital
th
Source: Author modified (Nov 20 2014)
89
Figure 4-69: First floor plan of the South extension at Nanjing drum towerThe floor plan has utilized a deep plan with double banked spaces. The
hospital
Source: Author modified (Nov 21st 2014) second floor houses the imaging suite, inpatient, coffee bar, outpatient
surgery, clinic surgery and lithiasis centre
90
re 4-70: Typical 2nd, 3rd & 4th floor plan of the south The second, third and fourth floors are clinical zones. The floors have a deep plan
ension at Nanjing Drum Tower hospital Source: Author modified (Nov 21 st with
2014)double banked spaces which makes it challenging to achieve maximum
natural lighting and ventilation. This has resulted in extensive use of air
conditioners in the hospital.
Figure 4-71: 5th floor plan of Nanjing Drum Tower hospital Source: Author modified (Nov 21 st 2014)
Figure 4-72: Typical 6 -13 floor of Nanjing Drum Tower Hospital Source: Source: (20 th Nov 2014)
th th
th
The 5 floor is purely dedicated for hospital equipments and air conditioners.
th th
The 6 -11 floors are dedicated as the nursing zone. They contain a total of
1,600 beds, nursing stations and offices for the doctors.
4.2.4.1 Zoning
93
gure 4-74: Zoning plan of the typical 6 th-13th nursing floors of the Nanjing Drum Tower Hospital Source: Author modified (27 th Nov 2014)
4.2.4.2 Circulation
Figure 4-75: Activity plan of the typical th th floors of the Nanjing Drum Tower Hospital
6 -11 94
th
The internal circulation at Nanjing

Drum Tower hospital is composed
of lifts and staircases for vertical
movement and contiguity.
To reduce the mixing of

incompatible kinds of traffic which
the vertical hospital implies, the
architect has provided a set of 2
service lobbies comprising of 2
service lifts and a staircase and
another set of 2 central lobbies
with 4 lifts and a staircase. The
service lobby is used by patients,
ancillary and professional
transactions. The central lobby is
mainly used by visitors.
re 4-76: Circulation flow plan in a typical nursing floor at Nanjing Drum Tower hospital Source: Author modified (27 th Nov 2014)
95
4.2.4.3 Emergency design features at Nanjing Drum tower hospital.

Nanjing Drum tower Hospital has incorporated architectural emergency design
features for safe evacuation of patients in case of disasters like fire. These
include:
1) Emergency staircases –The 14 storied building with 3

basement floors has a set of 4 emergency staircases to aid
in evacuation of ambulant people. The emergency stairs are
approximately 1800mm wide to aid in mattress evacuation
2) Compartmentalization of wards- The typical floor of
th th
the nursing floor i.e. 6 to 13 is divided into 4
compartments .This division can be helpful in containing the
spread of fire since it would allow for evacuation of patients
to safety from one ward to another.
3) Fire Doors- Each of the 4 wards compartments is
accessed via a fire resistant door. The fire resistant doors
would also help in combating the spread of fire to the
other wards in case of fire.
4) Exit/Escape routes- Each of the 4 wards
compartments has 3 accessible exits for horizontal
evacuation/escape route and an internal emergency
escape staircase for vertical evacuation.
5) Provision of staircases in the central lobby-Each of
the 2 central lobbies has a 2100mm wide staircase that
can be used to evacuate patients and visitors in
emergencies like fire that would render the lifts non-
functional.
Figure 4-77: Design emergency features in a typical nursing floor at Nanjing drum tower hospital
th 96
4.3. Comparison of KNH & Nanjing drum tower hospital
PARAMETER Kenyatta National Hospital Nanjing Drum tower hospital

(Kenya) (China)
LAYOUT
IMAGE
SECTION -11 floors with no basement and podium -16 floors including 3 basement parking and podium
-Interstitial floor for stack ventilation -It doesn’t have an interstitial floor for stack effect
97
Narrow plan Deep plan-triple banked rooms
Sufficient natural ventilation through cross depends on mechanical ventilation - high presence of
ventilation & stack effect-no air conditioners. air conditioners
TYPICAL WARD
PLAN
TYPOLOGY It’s a purely vertical hospital

typology
+ +
Combines both vertical and
horizontal typologies in its planning and design
MODEL Spine and pavilion + extended courtyard + Vertical Simple tower on podium model
monolith models
SIZE OF SITE Occupies approximately 20 acres in a 113 acres Occupies approximately 9.4 acres of an urban site
urban site
The horizontal typologies used allow for both The model doesn’t readily respond to the need for
FLEXIBILITY AND vertical and horizontal growth with ease. The use future growth and expansion
GROWTH of flat roof is particularly helpful in achieving
vertical growth.
In the horizontal typologies, the patients can be Evacuation of patients is achieved through the
easily evacuated into the landscaped compartmentalization of the wards in the typical
courtyards. The compartmentalization of the nursing floors coupled with the fire escape doors. This
nursing tower and use of fire escape doors can can facilitate evacuation of patients to safety from
EASE OF facilitate evacuation of patients to safety from one one compartment to the other in the same floor.
EVACUATION compartment to the other in the same floor. However due to its height and lack of ramps,
The ramp in the first floor can also be useful in evacuation is not as efficient as at Kenyatta National
evacuation of semi-ambulant people hospital
SEPARATION OF Multiple entrances to the site is particularly The provision of multiple entrances helps in achieving
DISSIMILAR helpful in separation of dissimilar traffic at separation of dissimilar traffic at planning level.
TRAFFIC planning level. The provision of adequate service and central lobbies
in the nursing floors also helps in separating patients,
staff and visitors traffic.
There is inadequate lifts in the nursing tower with The provision of adequate lifts and staircases in both
CIRCULATION only one available public staircase. This creates the service and the central lobbies ensures smooth
long waiting lines during visiting hours. flow of traffic
There is minimal vehicular and pedestrian traffic Further the provision of basement parking greatly
since parking is controlled to a dedicated section reduces pedestrian and vehicular traffic
of the site
The vertical model has narrow double banked The model has deep triple –banked spaces that
plan. The provision of an interstitial floor in the necessitate the need for air conditioners to achieve
second floor coupled with a central light well is mechanical ventilation.
NATURAL particularly helpful in achieving maximum natural The lack of an interstitial floor worsens the situation.
VENTILATION ventilation through stack effect and cross
ventilation.
The narrow wards plan helps in achieving The deep triple-banked ward plan necessitates the
NATURAL LIGHTING maximum natural ventilation need for artificial lighting to light some areas
Table 4-2: Comparative analysis of Kenyatta National Hospital & Nanjing Drum Tower Hospital Source: Author
CHAPTER FIVE: CONCLUSIONS AND RECOMMENDATIONS
5.1 Introduction
Having undertaken a comparative analysis of the typologies in hospital planning
and design, principle conclusions and recommendations have been drawn.
These are based on the application of the findings of the literature review to the
selected local and international case studies. The literature review established
variables that were used to carry out a comparative analysis of the design
typologies at Kenyatta national hospital (Kenya) and Nanjing drum tower
hospital (China).
Figure 5-1: Early cruciform halls hospitals 5.2 Conclusions on Literature review.
Source: Rosen field. (1969) Hospital architecture and
beyond, July 12th 2014 The author established that the hospital has developed over centuries from the
th
cruciform hall temples in the early 6 century B.C. where medicine and healing
were
ure 5-2: horizontal hospital model established in 19 th century Source: Author, 12th Junelinked
2014 to the gods to the functional and scientific approach led by Florence
th th
Nightingale in the 19 century. Towards the 20 century, the architectural form
of the hospital evolved from the low horizontal pavilions to the vertical planning
strategy. Thus, the vertical hospital is seen to be the current global trend in
hospital planning and design as evident from the literature review and case
studies.
The author further established that the hospital planning is grouped into 2
typologies. These are the horizontal and the vertical typologies. The horizontal
typology is limited to 4 floors whereas the vertical typology rises above 4 floors.
In the vertical planning strategy, the author established that the zones are
Figure 5-3: Vertical hospital model established in the 20th
century arranged one above the other so that the movement pattern is mainly vertical.
Source: Author, 12th June 2014
100
However, in the horizontal planning strategy, the author established that the
zones are linked together laterally so that the movement is mainly horizontal.
It is the conclusion of the author from the literature review that both the horizontal
and the vertical typologies have 5 models each. These are:
Figure 5-4: Independent linked slab model Source: Author modified 15th June 2014
Horizontal typology models
a) Independent linked slabs model.
b) Spine and Pavilion model.
c) Extended courtyard model.
d) Horizontal monolith model.
Figure 5-5: Independent spine & pavilion model e) Compact courtyard model.
Source: Author modified 15th June 2014
Vertical typology models
a) Simple tower on podium model.
b) Complex tower on podium model.
c) Radial tower on podium model.
d) Articulated slab on podium model.
Figure 5-6: Extended courtyard model e) Vertical monolith model.
The activities within a hospital are grouped into three distinct zones as deduced
from the literature review. These are: the clinical, the nursing and the support
zones. The author established that it is the manipulation of these zones and their
relationships to each other that determine the hospital typology and model.
Figure 5-7: Horizontal monolith model The main objective of this research was to carry out a comparative analysis of
Source: Author modified 15th June 2014 the hospital typologies and models based on a set of variables. This was meant
to determine the most efficient hospital models in hospital planning and design.
The research was further meant to address the challenges in hospital planning
and design. Therefore, the author considered the comparative analysis as the
best strategy to provide solutions to the various challenges in hospital planning
Figure 5-8: Compact courtyard model
and design by analysing and comparing their mode of application in the different
101
typologies and models. As such the author took to deduce the parameters that
underpin efficacy in hospital planning and design. These parameters were
summarized as:
 Site planning.
Figure 5-9: Simple tower on podium model
Source: Author modified 17th June 2014  Circulation.
 Departmental distances.
 Provision for future growth and extension.
 Energy conservation and sustainability.
Figure 5-10: complex tower on podium model
 Ease of evacuation in cases of emergency.
Source: Author modified 17th June 2014  Natural ventilation.
 Natural lighting.
The author established that the size and value of the site greatly influences the
typology to be adopted in the planning and design of the hospital. Circulation
was established to be a major influence in the planning and design of hospitals
Figure 5-11: Radial tower on podium model since once the circulation systems are designed, they remain as fixed elements
from which the hospital can change or grow for expansion to meet future needs.
External circulation influences the functional organisation of the
interdepartmental relations whereas the internal circulation influences the
functional organisation of intradepartmental relations within a hospital.
Figure 5-12: Articulated tower on podium model
Source: Author modified 17th June 2014 The author further established that a natural environment is essential to creating
a genuine state of the art-healing environment. Spending time in outdoor places
of respite has been shown to reduce stress levels in hospitals. Views of nature
have been credited with reduced pain levels and a shorter stay in hospitals since
they provide therapeutic effect to patients. This is provided by incorporating
Figure 5-13: Vertical monolith model landscaped courtyards within the hospital.
5.3Conclusions on fieldwork
Due to limitations of time and resources, this research thesis only covered 2
horizontal hospital models and 2 vertical hospital models in the fieldwork. These
are:
Horizontal typology
1. Spine and Pavilion model
2. Extended courtyard model
Vertical typology
1. Simple tower on podium model
2. Vertical monolith model
Horizontal typology
Through the comparative analysis of the two horizontal models covered in the
Figure 5-14: model of Kenyatta national hospital Source: Author 15 th Aug 2014
fieldwork i.e. the spine and pavilion model and the extended courtyard
model, the author established that:
The spine and pavilion model utilizes the circulation as the principle organising
element. This model presents several advantages .These are:
 Ease of evacuation in times of emergencies by having emergency fire
escape doors along the central spine.
 The narrow plan characteristic of this typology maximizes on natural
lighting and ventilation.
 The narrow plan aids in offering views of nature to all patients from the
landscaped gardens hence creating therapeutic benefits to patients
 The simple central spine allows for unlimited growth at almost any point,
either of the street itself or of individual departments.
However the model has its own limitations, for instance, the central corridor
can be too long and monotonous. This creates boredom and increases the
Figure 5-15: model of Nanjing Drum Tower hospital Source: (20th Nov 2014)
intra-departmental distances. The model also requires a big piece of land to
develop due to its longitudinal alignment hence not suitable in small and
congested sites
In the case of the extended courtyard model the author established that
courtyards are used as the principle organising elements. This model presents
several advantages which include:
 Provision for natural light through the pocket courtyards.
 Ventilation from roof lights
 The multiple landscaped courtyards offer therapeutic effects to patients.
 It is of domestic scale hence creates a home like environment
Figure 5-16: Use of roof lights in deep plans Source: Author 14 th Aug 2014
 Ease of evacuation to the multiple courtyards in case of fire.
 Provision for future through lateral extension.
 Simple load bearing structure.
However the model still has its own limitations e.g. In areas where deep plans
are used, it becomes hard to achieve natural lighting and ventilation.
Vertical typology
Through the comparative analysis of the two vertical models covered in the
fieldwork i.e. the vertical monolith (KNH nursing tower block-Kenya) and the
simple tower on podium (Nanjing Drum tower hospital-China), the author
deduced the following conclusions:
 A hybrid of the horizontal and the vertical typologies can be particularly
helpful in reducing the vertical traffic stress which is a constant trouble in
vertical hospitals. This strategy has been used at Kenyatta national
Figure 5-17: Use of narrow plans to achieve natural lighting & ventilation
hospital whereby the nursing zone is located exclusively in a 10 story
Source: Author 14th Sep 2014
nursing block whereas all the support and clinical zones are located in
horizontal typology models.
 The use of interstitial floor in vertical hospitals helps in achieving
maximum natural ventilation through stack effect. This significantly
reduces the air-condition energy consumption. This conclusion was
drawn from the case study carried out at Kenyatta National Hospital
nursing tower block.
 Compartmentalization of wards in the vertical tower can be greatly
helpful in carrying out emergency evacuation from one ward to another
in the same floor through the fire escape doors. This emergency design
strategy has been employed both at Nanjing Drum Tower hospital and at
Figure 5-18: Compartmentalization of wards for ease of evacuation the nursing tower block at Kenyatta National hospital.
Source: Author 24th Sep 2014  The vertical planning is convenient in urban areas where land is at a
premium. However, the height should be controlled in order to reduce
the stress on vertical traffic. This was concluded from Nanjing Drum
Tower hospital whereby the architect made a seemingly surprising
choice: instead of stacking floors one upon another and resulting in a
high floor area ratio, the design team decided to ‘lay it down’. Such
preference for low rise building went squarely against the design trend,
which is dominated by the frenzy for skyscrapers. It went contrary to the
general expectation of a high rise hospital building in China The low rise
plan not only reduced the stress on vertical traffic which is a constant
trouble for large general hospitals, but also creates large areas of urban
space with human scales.
 The circulation in vertical hospitals should not entirely depend on lifts.
The high stress on vertical traffic at Kenyatta national hospital nursing
tower block is attributed to lack of adequate public staircases. The only
single public staircase available is overly congested during visiting
hours.
Figure 5-19: Use of ramps for vertical movement of the semi-ambulant
This results to high traffic and slow movement of visitors in the 8 working
lifts servicing the 10 floors.
 The simple tower on podium is convenient in small urban sites since it
provides an opportunity to locate the public and semi-private areas in the
podium and basement while as the private spaces are located in the
tower. This creates an increasing vertical privacy gradient. This conclusion
was drawn from Nanjing Drum tower hospital.
 The provision of healing gardens within the hospital creates a home-like
experience within the hospital by combining the function of healing with
that of garden or courtyard as it is the case at Nanjing Drum tower
hospital.
Figure 5-20: Use of vertical gardens to create places of respite  Incorporation of large courtyards, light wells and innumerable micro
Source: July 25th 2014 gardens woven on the building’s envelopes as is the case with Nanjing
Drum Tower hospital helps in achieving maximum natural lighting and
ventilation as well as achieving gardenised architecture in a hospital. This
brings therapeutic benefits to the patients.
Figure 5-21: Use of light wells for lighting interiors

5.4 Recommendations
From the findings obtained following the study on comparative analysis of
hospital design typologies, it is evident that there needs to be interventions in
the planning and design of hospitals.
The author draws a few recommendations which can be adopted in the planning
Figure 5-22: Hybrid typology of vertical and and design of hospital towards enhancing healing environments in hospitals.
horizontal models
These are:
Source: Author, 16th Dec 2014
1) A hybrid system: The author recommends a hybrid of two models in

order to benefit from the strengths associated with each model while
alleviating the weaknesses prevalent in a given model. For example; a
hybrid of a vertical and a horizontal typology would be particularly
helpful in reducing the number of floors in the vertical hospitals hence
reducing the stress on vertical circulation that is a constant trouble in
vertical hospitals. Similarly a hybrid of the spine and pavilion and
extended courtyard would be rich since it would incorporate the
Figure 5-23: A hybrid model of spine and pavilion and
extended courtyard models Source: Author, 16th Dec 2014 circulation as the principle organising element and simultaneously
benefit from the courtyards associated with the extended courtyard
model
2) Adoption of circulation as the principle organising element in the
planning and design of hospitals. This is majorly because circulation
remains as fixed elements once designed hence difficult to change or
alter them once in place.
3) Provision of opportunities for future growth and expansion, either
vertical, horizontal; or a mixture of both in the initial design stage. This
would
: Use of circulation as the principle organising element Source: www.world health design.com (20 allow for flexibility in hospital architecture.
th Nov 2014)
107
4) Incorporation of healing gardens within the planning and design of
hospitals in order to create therapeutic benefits to patients.
5) Provision of interstitial floors in all vertical hospitals to maximize on
natural ventilation through stack effect.
6) Provision of ramps, adequate public staircases to complement the lifts in
the vertical hospitals hence reducing the stress on vertical circulation.
7) Provision of vertical gardens in the vertical hospitals to order to increase
Figure 5-25: Use of healing gardens for therapeutic benefits the green cover as well as culminating as areas for attending evacuees
during emergency evacuation
8) Separation of the paediatric wing from the main hospital complex in
order to provide an exclusive child-friendly healing environment for
children away from the mix with adult environment.
5.5 Recommendations for future research

The author recommends further investigation on the models that were not
covered in the fieldwork due to limitations of time and money. This would be
Figure 5-26: Use of interstitial floors in vertical hospitals
particularly helpful in forming a comprehensive comparative analysis of all
for maximum natural ventilation through stack effect Source: Author 13 th Sep 2014
typologies and models in hospital planning and design. The recommended
models for further investigation are:
Horizontal typology models
1) Independent linked slabs model.
2) Horizontal monolith model.
3) Compact courtyard model.
Vertical typology models
1) Complex tower on podium model.
2) Radial tower on podium model.
3) Articulated slab on podium model.
Figure 5-27: Provision of vertical gardens in vertical hospitals
108
References
1) AECOM (2012). Design Excellence for Mid-Sized Urban/ Inner Suburban
Medical Centers. Digital Case Studies, 5-10.
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Wiley-interscience.
3) American Institute of Hospitals Consultants (1969). Functional planning
of General hospitals. New York: McGraw Hill.
4) ArchDaily (December 26, 2013). Nanjing Drum Tower Hospital / Lemanarc
SA. ArchDaily. Retrieved on 11 July 2014 http://www.archdaily.com/?
p=461173
5) Cox, A., & Groves, P. (1990). Hospitals and health-care facilities: A
design and development guide. London: Butterworth Architecture.
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http://www.nationalarchives.gov.uk/doc/open-government-licence/
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New Jersey: Wiley.
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development. London: Architectural Press.
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New Delhi: New Age International Ltd.
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environments for special patient populations. New York: Van Nostrand
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12) Ministry of Health (2010). Kenya Health System Description. National
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13) Neufert, E. (2012). Architects' data. Oxford: Wiley-Blackwell.
14) Nuffield Provincial Hospitals Trust (1955). Studies in the functions
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110

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THE PLANNING AND DESIGN OF HOSPITALS:

Submitted by: MAINA HARUN WANYEKI

Author: Maina Harun Wanyeki

Tutor: Dr. Kamenju Year Co-ordinator: Arch.Musau Kimeu

Chairman, Department of Architecture and Building science: Arch Erastus Abonyo

Chapter five: conclusions and recommendations

CHAPTER ONE: INTRODUCTION

1.1 Background of study

Shivji, R. (1985).The influence of circulation and services to the functional planning

1.3 Aims and objectives

1. To investigate the typologies in the planning and design of hospitals.

1.4 Research questions

1.6 Justification of study

1.7 Significance of study

 Hospital Street-The primary circulation corridor from which all other

1.9 Structure of the research paper

CHAPTER TWO: LITERATURE REVIEW

2.2 History of hospital planning

Figure 2-2: Maslow hierarchy of needs

2.2.3 Classical Antiquity

Figure 2-4: Greco-Roman Latreia

Figure 2-6: Florence Nightingale ward

The Planning & Design of Hospitals

2.3 THE ORGANIZATION OF HEALTH CARE FACILITIES

Classification of health facilities in Kenya is based on the following criteria:

a) Services offered e.g. inpatient, outpatient, specialised treatment.

Level 4 comprise of the sub-county hospitals in the new constitution formerly

2.4 HOSPITAL PLANNING AND DESIGN

2.4.1 Nursing zone

 Laboratories serve both inpatients and outpatients. It’s therefore

 Radiation services serve both inpatients and outpatients. In modern

2.4.3 Support zone

2.4.4 Location of the support zone

Figure 2-16: support services on a horizontal

developments in catering, sterilizing and laundry equipment, it is more efficient

2.5 PLANNING GUIDELINES

2.5.1 Site Planning/External Circulation

2.5.2 PROVISION FOR GROWTH

2.5.2.1 The nucleus concept

The size of the nucleus is designed to be fully operational

Figure 2-17: Block schematic plan of Maidstone general hospital

Whether the hospital is vertical, horizontal or a combination of both, it’s not

2.5.4 Anticipate change

2.5.5 Development of modular spaces

 Placing window openings on the North and South facing walls.

2.6 circulation and communication spaces in hospitals

Circulation and communication spaces allow for movement of ambulant and

Circulation spaces provide access within the hospital departments. They

Circulation in hospitals should flow seamlessly to avoid confusion and loss of

Circulation in hospitals can be classified into two categories; the external

main entrance, probably leading directly to the outpatient department should

Internal traffic is the most important single determinant of the location of

Figure 2-27: General Service lift

2.7 EMERGENCY DESIGN FEATURES IN HOSPITALS

Whereas emergency evacuation in horizontal hospitals is fairly achievable due to

1. Helipad- A helipad is a typical designated helicopter landing and take-off

pollution. As such, it not only provides an amenity for the building’s

2.8 TYPES OF HOSPITAL PLANNING

a) Independent linked slabs hospitals

e) Compact courtyard hospitals

Horizontal hospital planning requires large sites to fully accommodate their

Example: Khon Kaen university hospital, Thailand