Redeveloping San Marcelino Hospital for Improved Healthcare

MAPUA INSTITUTE OF TECHNOLOGY
School of Architecture, Industrial Design, and Built Environment
A Proposed Integrated Community Hospital: Redevelopment of San

Marcelino District Hospital in Zambales
Reshaping Provincial Hospitals and its Caring-Curing Effect through Therapeutic and Adaptive
Environment
AR200: Architectural Design 9 – Thesis Research Writing
By:
RAMOS, MARK JOSEPH D.
2013150323
Adviser:
ARCHITECT JUNAR P. TABLAN
Submitted on:
December 13, 2016

A Proposed Integrated Community Hospital: Redevelopment of San Marcelino District Hospital in Zambales
Reshaping Provincial Hospitals and its Caring-Curing Effect through Therapeutic and Adaptive Environment
RAMOS, MARK JOSEPH D. / 2013150323 12/13/16
TABLE OF CONTENTS
Part 1: The Problem and Its Background
Chapter 1.1 General Overview
1.1.1 Background of the Study

1.1.2 Statement of the Problem
1.1.3 Project Goals, Objectives and Strategies
1.1.4 Significance of the Study
1.1.5 Scope and Limitation
1.1.6 Assumptions
1.1.7 Conceptual Framework
1.1.8 Definition of Terms
1.1.9 Acronyms
Chapter 1.2 Review of Related Literature and Studies
1.2.1 Related Literature

1.2.2 Related Projects
1.2.3 Related Studies
Chapter 1.3 Research Methodology
1.3.1 Research Design

1.3.2 Population and Sampling
1.3.3 Research Instruments
Chapter 1.4 Summary of Findings and Analysis
1.4.1 Presentation of Collected Data

1.4.2 Need Analysis
1.4.3 Qualitative or Quantitative Analysis
Part 2: Research Focus
Chapter 2.1 Rationale
Chapter 2.2 Principles and Relevance to the Project
Chapter 2.3 Application to the Project
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Chapter 1.1 General Overview
1.1.1 Background of the Study/Overview
Hospitals are very significant establishments for economic and social well-being of the Philippine
society. Their medical and therapeutically functions enable to restore persons to being a
productive unit of the society and for those individuals to appreciate the benefits that can be
acquire. Therefore, achieving the success of hospitals in their mission is important and this is
highly dependent on the hospitals servicing capability.
The Philippine health care system through the years is developing from both urban and rural
areas. Current local health facilities stimulate the on-going progress and keeps the health in the
local communities as effectively as it can, consisting of government and private diagnostic and
treatment establishments spread across the country. The Philippine Government hospitals has a
servicing focus of providing prevention and being a remedial from illness while private hospitals
supports the role of immediate personal care that are restorative in nature.
Philippine hospitals have been characterized in general as operationally not achieving maximum
productivity. Aside from high cost operations and slow services, the facility’s low healing and
security performance levels are among the visible weaknesses. Most of these efficient hospital
facilities have dedicated systems, who initiated improvements in their operating environment but
the issue therefore is whether the environments are inefficient themselves, or if they are efficient,
whether they are implemented ineffectively.
Often government healthcare offer the same services like private hospitals, but the main
difference are the facilities and technologies offered but still some of the best doctors are serving
in the government hospitals. Also, most of Filipinos would go or seek advice from these
government hospitals because fees are not charged and it’s cheaper. However, many government
hospitals have the unnoticed attention that still, it has a role of improving public care and resolving
human health struggles across the local neighborhood.
The San Marcelino District Hospital (SMDH) is one of the government hospitals since San
Marcelino has been leveled up from third-class to first-class municipality. Consistently serving for
many years, it is a provincial special medical care center with seventy-five bed capacity and ten
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medical doctors consisting of different areas located at the intersection of barangay Linusungan
street and the national road in San Marcelino, Zambales. According to the 2010 census, it has a
population of 31,879 people and has quite grown at present years.
The hospital has been recognized as the center of service for the two districts while it is owned
and operated by the local government who plans to extend the responsibility for some
municipalities of Zambales such as San Felipe, San Narciso, San Antonio, San Marcelino and
Castillejos. Today, the San Marcelino District Hospital is wherein its state and resemblance are
being deteriorated affecting its functional relevance which resulting to a non-caring and non-
curing environment.
1.1.2 Statement of the Problem
The decaying condition and absence of large facilities have become the struggle of the San
Marcelino District Hospital to serve as an immediate care for the community. These event leads
to a sudden decrease in demand and interest of the public. The existence of these problems may
create a threat to the sustainability of the hospital. San Marcelino being as a first-class
municipality of Zambales, should have its primary components to serve also the best quality of
services.
An expansion, repair, and renovation contract and agreement issued by the Department of Public
Works and Highways (DPWH) Zambales Second District Engineering Office in the 2013 which
purpose is to maintain the responsibility of the hospital. With this regard, the present hospital is
old and need for a redevelopment to prove its important purpose, probably to enact the
agreement and develop a new upgraded hospital that will cater all local communities nearby.
The proponent aims to answer the following questions:
1. What certain problems are currently existing and experiencing in the Hospital?
2. What solutions can be useful to address the problems of the Hospital?
3. What are the factors could affect the capability and capacity of the Hospital?
4. What are the usual activities in the hospital?
5. What type of environment and facilities that could maximize the healing potential
of the Hospital?
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6. How can the hospital be changed to attract and further cater more people giving
a new experience of services?

7. What other facilities could be added to help the Hospital being at its best?
8. What are the demands of their Hospital that can be supported through
architectural solutions?
9. What will make it different from other community health facility in the country and
from others?
1.1.3 Goals, Objectives and Strategies
Goal:
The goal is to redevelop the present San Marcelino District Hospital that will cater all other local
community nearby.
Objectives:
a) Establish a new development of the hospital serving the top quality medical care
that will cater nearby communities
b) To identify, investigate existing weaknesses and problems about the hospital that
can be solved through architectural design planning
c) To create a design that will help increase the value of medication in the local
community
d) Put in places techniques that will improve future sustainability of the hospital
through Architectural design
e) To establish a design of hospital that symbolize the identity and medical treatment
capacity of San Marcelino
Strategies:
a) Literature reading from various sources such as books, journals, articles and
exploring new applicable solutions including concepts and technologies that can
be applied
b) Formulate both local and international case studies of different hospitals
c) Investigating the existing district hospital by gathering various documents and
information like interviews, surveys, collection of historical data.
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1.1.4 Significance of the Study
The study will benefit the economic lifeline of the San Marcelino, Zambales including other
domestic neighborhood and neighboring municipalities by having increasingly forming closer
connection with other aspects of the health and community sector to make the best use of a
foundation for the promotion and protection of individual and collective health status.
Architectural Significance:
The study will enable to promote new architectural solutions that can mitigate the various problem
situations and conditions of community hospitals’ in the Philippines. Moreover, it will address new
approach in certain similar conditions or problem in the international.
Economic Significance:
The study is necessary not only for the welfare of community, but also to enhance economical
possibility as well. Furthermore, it can help attract, maintain business and growth in the health
care industry, encourages and retain retirees and create new opportunities in the local area.
1.1.5 Scope and Limitation of the Study
The San Marcelino District Hospital will be the focus of the study. Limited to the responsibility of
San Marcelino District Hospital to San Marcelino municipality, including other community and
neighboring municipalities, the effect of the community hospital in the health and economy of
San Marcelino.
The study will propose a project to be a redevelopment of the San Marcelino District Hospital with
a bigger and wider integrated community hospital that will serve as a best source of assistance
regarding health issues that promotes self-satisfaction to the whole community. To develop and
achieve this proposed project, it would include related environmental concepts and new activities
that could bring possibility of the new hospital care experience.
The study will also cover particular solutions that is relevant to the hospital that handle the factors
that could stimulate the whole facility of San Marcelino District Hospital given that it’s not only
for the municipality but also in the province of Zambales.
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1.1.6 Assumptions
The study is anchored on the assumption that San Marcelino District Hospital has the same
content as modern hospitals when it comes healing environment, advance technologies,
maximum capacity and additional services that conveniently need by public especially for those
who can’t financially afford when involved.
1.1.7 Conceptual Framework
SAN MARCELINO SAN MARCELINO

MUNICIPALITY DISTRICT HOSPITAL
COMMUNITY
SITE
DATA ASSUMPTIONS
INFORMATION
COLLECTION
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N
T
A
L E
Y R
S P
R
I
S E
CONCEPT T
ARCHITECTURAL SOLUTIONS SITE CONSIDERATIONS
PROJECT PROPOSAL
A procedure was made to lead the proponent to the project outcome. It begins with determining
the problem and its factors from the hospital through collection of investigation, research, case
studies and interviews. This collected information will lead data analysis and hypothesis through
deep interpretation and assumption of the proponent to guide a concept that will be further
enhance by defining architectural solutions and determining site considerations that will conclude
to the new proposed project redevelopment.
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1.1.8 Definition of Terms
Hospital - a health care institution providing patient treatment with specialized staff and
equipment
Community - a group of people living in the same place or having a characteristic in common
Healthcare - the maintenance and improvement of physical and mental health, especially
through the provision of medical services
Municipal - a city or town that has corporate status and local government
Barangay - formerly referred to as barrio, is the smallest administrative division in the
Philippines and is the native Filipino term for a village, district or ward
Redevelopment - is any new construction on a site that has pre-existing uses
Macroeconomic - the part of economics concerned with large-scale or general economic factors,
such as interest rates and national productivity.
Utopian - modeled on or aiming for a state in which everything is perfect
1.1.9 Acronyms
SMDH – San Marcelino District Hospital

DOH – Department of Health
DPWH – Department of Public Works and Highways
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Chapter 1.2 Review of Related Literature and Studies
1.2.1 Review of Related Literature
The Development of Economy in Relationship of Hospital
Hospitals are key cogs in the local economic system, serving as major employment centers that
offer job opportunities spanning a broad range of skill levels (St. Peter’s Hospital, 2006). Their
sizeable payroll expenditures initiate a wave effect through the economy as employees spend
their paychecks on groceries, mortgages, rents, transportation and others.
Although nonprofitable hospitals have no taxes, its workers are not. Therefore, the local
governments can make an advantage to this factor because of the employment capacity of
hospitals. Additionally, hospitals make millions of incomes when it comes to local economy by
purchasing variety of goods and by their capital spending.
According to Mr. Joseph Lupica (2012), "A community hospital is a very attractive partner to be
in a network of care, even without acquisition of a big system. Larger hospitals and systems can
provide capital to help the hospital be a better participant in the network". Indeed, other
governments are starting to recognize that hospitals with deep roots in rural settings are valuable
partners in helping expand their footprint for primary care and population health management.
Ms. Matthews (2015) puts it, community hospitals "very much tend to be part of the economic
engine of the community". What also makes a hospital a true community hospital is the role it
gives to the town by means of contributing to economy. Community hospitals being a secondary
employer to a town usually only behind districts because of its individual recruitment capacity can
give beneficiaries.
Community hospitals are significant in terms of economic lifeline of the community, playing a
unique role that usually tertiary or academic medical health centers in cities do not. Furthermore,
hospitals can provide several benefits to its immediate neighbors. A hospital is recognized by
neighborhood individuals as an area of safety, giving protection, shelter and information in times
of suffering. Hospitals also engage the communities with civic and cultural programs as well as
free health clinics and screenings. Recognizing the importance of partnering with community
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residents, have even offered complimentary meeting spaces to neighborhood groups and
representation on decision making boards.
Philippine hospitals are faced with typical third world illness. What is noted is that there may be
an imbalance in the composition of the hospital system which the number of hospitals may have
a large gap from the higher categories compared to the needs of the whole population.
Like many of the leading causes of hospitalization in the tertiary level hospitals are treatable in
lower categories. Technology quality in private healthcare appears to be within about five to ten
years behind what is used in other developed countries. Government hospitals however, appear
to have technology in much older quality, with equipment as old as twenty years compared.
Measures are needed to upgrade the technology in both private and government hospitals in an
equal manner.
Additionally, the general lack of systematic analysis of the planning, social, and environmental
workability of government hospitals established in the past has put to many failing hospitals
today. The current awareness of new hospital benefits of possible studies especially in the
approach of competitive forces surrounding many hospitals should reduce the number of hospital
failures in the future. While hospitals will increase rapidly in areas which exhibit financial
possibility, designing should consider providing hospital services where there is a social need and
where attractiveness is dominant.
These existing factors are important to the development and success of a hospital as it gives
better life to public and together generates income for macro-economic sector. One form to make
an effective economical hospital is to apply current characteristics and standards even in
government hospitals. By upgradation, people would tend to think first of the nearest hospital
they can be instead of the services they will gather in and have the chance to participate in out-
patient services activities as part of the development. The San Marcelino District Hospital may be
lacking to these ideas.
As society change over the decades, the idea to make structures upgraded was lost as people
move towards in a concept of there are better hospitals even if they must travel at greater
distance. It can be observed that hospital tend to be located near the city and this is because
most people are within the area for these establishments will generate income that’s why they
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only focus on application of modern interventions in these hospitals without thinking that there
are opportunities also behind rural hospitals that needs to be noticed as soon will be decayed.
Influence of Community Hospitals on Local Health System
According to the survey of American Public Health Association (1941), people define health simply
as “the absence of disease, that living without disease is to be healthy.” Such a definition relegates
health to the medical professionals charged with protecting good health and overcoming or
managing poor health.
This broader context of health was repeated in the 1946 World Health Organization Constitution,
which defines health as “a state of complete physical, social, and mental well-being, and not
merely the absence of disease or infirmity”. Unfortunately, a small definition disappoints to
acknowledge the multi-aspects that influences health. Though these definitions of health have
been indicated as “utopians”, they are still important in their identification that numerous health
determinants affect the ability of being healthy and these include biological, social and economic,
environmental, lifestyle, services, and policy factors.
Science has shown that the most important health determinants are based on genes, sex, age,
biological factors and behavior. Still, many external factors as the environment and those social
and economic factors, policies, and services shaping the environment affect the second definition
of health. It is these health determinants which a hospital as foundational institution can shape.
In recent years, research has suggested a linkage between the characteristics of the built
environment and human health outcomes such as respiratory and cardiovascular health, fatal and
non-fatal injuries, physical fitness, obesity, mental health, and social capital. Although the
relationship between cause and effect is not proven, there are proof joining components of the
built environment and health to order incorporation of health considerations in project decisions.
Moreover, these hospitals provide a large foundation in a community and its surrounding. That’s
why considering its services being connected to its environment can be an appropriate approach
to planning conditions.
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“Community residents rely on hospitals to bring life into the world, care for the aged, ensure
safety when a disaster occurs, educate people about the impact of the lifestyles on their health,
and provide comfort at the end of life, in addition to meeting basic health care needs” (St. Peter’s
Hospital, 2006). Hospitals provide these benefits to the community twenty-four hours a day and
seven days a week, offering a level of access unique among the anchor institutions.
Attendance from seminars on health and review of health literature improves health knowledge.
The capacity on gaining and knowing basic health information services needed to make right
health options and persons with better health knowledge have been shown to have better health
conditions. Regular and convenient access to healthcare also helps control or prevent disease to
occur.
For instance, Moist (2008) discovered that “people who had to travel a greater distance to their
dialysis treatment were at greater risk of dying and experienced worsened quality of life due to
their health.” Community hospitals commonly provide information and classes to the public on
various health topics as well as free or low cost health services, such as disease protection and
immunizations.
In addition, hospitals attract other medical practices to the immediate neighborhood. In this way,
people who live and work near major hospitals can receive better access to health information
and services, more convenient access to medical care and to a wider choice of medical
professionals. This access can result in better health outcomes.
Another role of the community hospital is to give employment opportunities through the presence
of businesses, often have teaching and internship components from small to large. It is not often
for rural people to find employment from the place where they live. In fact, travelling to work is
commonly the longest hour-taking made each day. However, community hospitals can provide
some jobs to individuals who are looking for a limited work opportunity such as a person who is
unable to drive or a person who is flexible about the type of work they get and prioritizes a
convenient location to their home.
Other areas where community hospitals can be involved in primary health care are in regular
immunization sessions, under growth monitoring, health and nutrition education. Drs. Solon,
Clemente, and Tan are among the many authorities on health care who have stressed the
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broadening of the role that hospitals can take, from one of purely curative and rehabilitative to
one which would include preventive functions (DOH, 1994).
This developing character will increase the effectiveness of every capital expenditure allocated to
health care expenditure in both private and public in improving the health status of many Filipinos.
Relieving the hospitals from the pressures of needs for the medication of diseases will allow them
to focus on the non-preventable diseases and make these services available and affordable to the
majority number of Filipinos.
In conclusion, hospitals are not only instruments that decisively affect the nature or outcome of
health needs, but determines the character and development of the whole health system by
creating a huge amount of capacity to provide good welfare to the community. Two factors raise
the health system such as giving services that give basic health information for better public
health decision and giving opportunity to those medically skilled people located in rural settings
that needs a suitable job location to liberate them from being exhausted for long hours of travel
and instead save energy allocated for better services.
For instance, the San Marcelino District Hospital although exists, problems occurring about
educating and giving opportunity should be addressed and eradicate with such following the
context of contemporary standardization. If it is resolved, further efficiency and capacity to cater
and serve the community is still an achievable one.
Redefining Health with Hospital Sustainability
According to Gieryn (2002), “hospitals like all buildings, are both shaped by people and capable
of shaping occupant’s behaviors and feelings.” They are complex places that are simultaneously
physical, social and symbolic environments (Gesler et al., 2004). It has been said that hospital
designs affect to the patient’s treatment. However, designs should consider the factors that has
the best positive impacts on patients and how can it maximize their contributions.
It is highly suggested that healthcare facilities designed today must change their use even their
shape to be more flexible and adaptable due to demands of need and the issue to an effective
healthcare environment. The idea of future hospitals to be designed according to provisions will
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be difficulty because of the occurrence of modern medical technologies, the ability to manage
long-term illness through development and creating a home environment as an extension for
hospitals can be a consideration.
According to Arup (2015), "The deliberate design of a therapeutic environment creates financial
benefits in the long term. Good indoor air quality can improve recovery times, good energy design
can cut utility costs, the use of natural light can improve productivity and patient outcomes, and
appropriate interior finish and material selection can reduce cleaning and maintenance costs."
Creating a therapeutic environment is absolutely necessary. A healthcare should not threaten its
occupants but instead it should support more comfortability needs and make an effective
medicinal practice over patients. The approach suggested to enhance the natural lighting, security
of patients, acoustical factors, patient control, ergonomics, way-finding and reduce the spread of
infection.
According to Dr. C. Everett Koop (1992), “we need to place emphasis on health care and not
cure. Curing costs billions, but caring comes from the soul.” Futurists have predicted that in the
twenty-first century, ambulatory care will be just as important to hospitals as acute care, that
more than fifty percent of the average hospital’s revenue will come from ambulatory services.
Outpatient specialty procedures now include, ophthalmology, OB-Gyne, ENT, orthopedic, general,
plastic, podiatry, urology, gastroenterology, pain block, and neurology. Medicare and Medicaid
acceptance and reimbursement is a primary factor in the development of hospital facilities. In
more recent years, significant advances in diagnostic and therapeutic technologies have permitted
more patients to be seen on an ambulatory basis. Management of many illnesses and diseases
associated with the aging process is now addressed without admitting patients to the hospital.
Considering the predicted reduced demand for institutional care, the ambulatory and home care
becomes the focus for less acute health interventions. The ambulatory setting will become more
capable and receptive to the diagnosis and treatment of our aging citizens than is possible now.
Presently, we see the actual possibility of a dynamic and preventive approach.
As we are experiencing, continued focus will be placed on accessibility and the convenience to
the consumer. The principle of designing an environment that is therapeutic will embody the
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future hospitals and the characteristics of being in a maximum adaptable and flexible can be a
key to make a sustainable facility over times.
The International Union of Architects has the following statements that, “Architecture for health
must be more than economical, technical, sophisticated engineering of diagnostic and treatment
performances of medicine.” Architecture for health should mean being aware of the human and
of the human environment. Humanizing the environment is not realized merely by designing a
pleasant and colorful surroundings.
As preparing to plan for the healthcare environments for the new generation of ambulatory care,
we must first erase the presumption of today’s health care delivery facility model as being a single
place. Dismissing the simplification of a level of types of care based purely on the level of acuity.
This approach will be modified through the years. Planning a new hospital is a chance to break
the bonds created by the present organizational structure. The planning structure for a project
should not reflect the present, but the future hospital. Planning should reflect program and
systems should be designed for easy adaptability. Flexibility as a key goal leads to larger patient
rooms in separable suites. Large free-span spaces for professional and support services and
sufficient extra space to support periodic remodeling.
A new concept is emerging that far surpasses today’s approach to patient-focused care. As
Michael Brill (1995) states, “we must rethink the healthcare physical environment not as a place
but as a tool.” A new approach is required to address the infinite of interconnecting issues and
considerations of the new generation. This concept is a health care delivery through total
integration into the personal conduct of life styles.
A focus is needed in the understanding between the connection and effects of a good environment
to the health. To create a healthcare facility is also creating an equipment that will help in the
treatment process of the patient. Moreover, this can contribute to overall sustainability of services
and from the person to have not only a longer life but with a longer healthy life. In addition, the
emphasis should be on ambulatory care environment that will increase outpatient services which
focus is to educate and spread information about health knowledge.
It’s vital that the functionality of a hospital remains at the forefront of the design process. For a
hospital to operate successfully, every aspect of the design must be considered. The simple layout
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can affect the life and death circumstances of a patient because time is often a critical factor in
a patient’s care. Since the main objective of sustainable design is built to create environments
that are livable, comfortable, safe and productive (from Sustainable).
The sustainability concept of hospital is complex in its form and ranges from different aspects
affecting several fields. However, sustainably designed building is a better building in this era.
This would help not only to lasts the structure itself but also to preserve the responsibility which
all the public will benefit.
1.2.2 Related Projects

Foreign
Butaro District Hospital
To make a more comprehensive output of
architecture that solves target health outcomes
and the sustainability of Butaro’s broader
healthcare system, the MASS design group
worked with leaders in the US and Rwanda to
develop effective solutions that affect health
outcomes which includes patient and staff flow
and natural ventilation.
Burera, Rwanda By removing the interior corridors and using

Year: 2011 large radius fans and louvered windows, the
Firm: MASS Design Group hospital reduces airborne disease transmission
Type: Government District Hospital and provides a template for other high exposure
resource limited settings.
The design of the hospital is patiently-centered and by defying traditional ward structures by
shifting beds from the perimeter to along a central half-height wall to increase privacy as well as
allow for increased natural ventilation and views. It has a clear wayfinding system directs patients
at all levels of literacy with bilingual, color-coded signage.
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The Johns Hopkins Hospital Massachusetts General Hospital relocated

outpatient services to a new facility for better
patient-centered care. The center is designed
to embody a level of warmth and comfort
rarely associated with healthcare facilities.
The building’s circulation is designed to create

a feeling of openness and ease of movement.
The main corridors and waiting areas are
located adjacent to the exterior walls, which
are floor to ceiling glass on all ten levels,
giving patients an uninterrupted sense of
orientation with the outdoors and access to
natural light.
The separation between professional and staff

Baltimore, Maryland
work areas and patient areas provides
Year: 2012
patients and visitors with a clear, organized
Firm: Perking+Will
experience.
Type: Teaching Hospital
Its design is a set of buildings that gave a new approach to addressed the experience of the
space rather than focusing exclusively on function, as most hospitals are designed. The design
considers the psychological benefits of providing visual stimulation such as color, open spaces,
green spaces and an abundance of natural light in an environment.
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Massachusetts General Hospital
John Hopkins Hospital uses the design as a

total experience for healing in addition with
urban design. The project proposes to
redefine the hospital experience with goal is
to emphasize transformative patient-centric
care. The towers rise from an eight-story base
and are defined by curved and articulated
forms, color, and outdoor garden spaces.
(Yawkey Center for Outpatient Care -

Ambulatory Care) Boston, MA, United States The hospital provides a design that accounted
for the accommodation of the most advanced
Year: 2003
medical technology with the psychological and
Firm: Steffian Bradley Architects environmental design for patient-oriented
Type: Government General Hospital care.
A great wayfinding idea has made the hospital a patient concerned facility that direct the
occupants from right or left ways in elevators where they are greeted as they go to waiting areas
and brought to the appropriate treatment rooms. There are individual cubicles for the exchange
of any private information to promote the privacy of the patient processes. The windows from
the facility’s main corridor is glaze-designed for visual effects both day and night, from patient
views within and from exterior perspectives. Natural lighting and the modulated glass collage
plays different levels of visual attraction to maximize attention.
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Local
Asian Hospital and Medical Center

Asian Hospital and Medical Center
is a tertiary care hospital in the
Southern Luzon corridor of
Metropolitan Manila. Officially
inaugurated and opened to the
public on May 11, 2002. It is the
Muntinlupa, Philippines first hospital in the Philippines that
was designed with an ambience
Year: 2002
that promotes healing and
Founder: Jorge Garcia, MD provides comfort for patients and
their families and friends.
Type: Private Tertiary Hospital
Asian Hospital and Medical Center is strategically located in the Filinvest City in Alabang,
Muntinlupa City. It has 1,041 employees and 1,000 medical staff all trained to provide high quality
and compassionate patient care. Over 500 doctors hold their clinics at the MOB, which has 145
clinics and offices.
St. Luke’s Medical Center
Quezon City, Philippines
The Center has provided high-quality

healthcare. It has provided outstanding out-
patient care. Today it is the foremost and most
admired hospital in the Philippines and an
acknowledged leader in Asia.
St. Luke's delivers on its mission of healing by
Year: 1903 gathering under one roof the finest medical

expertise, the most advanced medical
Type: Teaching General Hospital
technology and facilities, and a deep-rooted
culture of compassion.
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It supports this mission with research and continuing education for those who serve. The total
dedication to quality and caring of the St. Luke's family is what distinguishes the hospital as a
center of healthcare excellence in Asia. The hospital is home to ten Institutes, eight Departments,
and twenty-three Centers. These centers of excellence bring to the Philippines the latest medical
advances and treatment modalities. More than a thousand hospital-affiliated medical consultants
see out-patients in more than 450 private clinics.
Related Studies
According to Laursen’s (2014) review, “The healthcare system has become increasingly aware of
how focus on healthcare environment might affect patient satisfaction. The focus on
environmental design has become a field with great potential because of its possible impact on
cost control while improving quality of care.”
This literature was to create a past and present study about evidence based design of healthcare
facilities. From investigating the built environment in relation with design interventions, it has
been known of the visual environment aspect had a positive effect on patient’s health treatment.
Furthermore, the studies designate a decrease in patient’s anxiety and stress levels when exposed
to environment built design interventions. The visual aspects can play a significant major role in
hospital designs which in return makes a hospital have a better healing environment.
“The frustration levels of both patients and clinicians have probably never been higher. Yet the
problems remain. Health care today harms too frequently and routinely fails to deliver its potential
benefits” (from the Institute of Medicine Quality Chasm report 2001).
The review found scientific studies that record the effect of a variety of elements in design which
is single-rooms from multi-bed rooms, reducing of noise, improving the lighting inside the
building, giving better ventilation, use of ergonomic aspects to designing, encouraging workplaces
and improving the layout or rooms that can support the reducing of errors, stress, improving the
sleep, reducing the pain, and outcomes. It has been proven that there is not only a large body
but a much larger of discovery to hospital designing.
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A scientific literature is being suggested that the ways hospitals are designed contributes to a
more positively patient outcome that this measurement of chance is unnecessary. Improving the
physical settings of a hospital can be an important design instrument in making is safer, more
healing ability, and good places to work with.
“The effects of the physical environment on the healing process and well-being have proved to
be increasingly relevant for patients and their families as well as for healthcare staff” (from
Building and Environment).
Huisman studies show that proof of staff outcomes is insufficiently supported. With the
development of a people-oriented approach to healthcare facility, the involvement of this review
is significant to a health care facility designing. It discusses things to consider in future of
designing a healthcare such as single patient rooms, identical rooms and lighting.
Environments that are perceived to be more attractive also have been shown to have beneficial
effects such as reducing stress or improving impressions of quality of care (from Preventive
Medicine).
The study investigated by Dijkstra whether the plants inside are helpful for patients in reducing
stress condition. Another is by understanding the relationships of stress, natural elements and
attractiveness and finding that the more plants there are predicted higher sense of attractiveness.
These results approved that plants can make a higher perception of attractiveness of a room
which promotes to reduce stress of patients. The study grants a support to the conclusion that
indoor plants are stress reducers because they highly contribute to the attractiveness of a room.
21
CHAPTER 1.3 Research Methodology
This whole study has a data gathering process that involves the focus in the surroundings of the
San Marcelino District Hospital in Zambales. An overall process has been to work with the built
environment to discover its present conditions and existing problems to be gathered in different
methods and use the knowledge gained from working with one method to the other methods.
Some of these will include:
 Observations
 Photo gathering
 Data collecting
 Interviews/surveys
 Discussions
 Case study
The applied research was carried from three scales. From scale one the San Marcelino District
Hospital Administration Division were interviewed in depth and this followed by detailed
walkthrough inspections and case study of the whole facility toured by the maintenance
personnel. Photo gathering was used during the inspection and used as documenting to both the
positive and negative performance in the hospital. In scale two, staffs and patients were
coordinated with a survey regarding the performance characteristics of the present hospital to be
improved or redeveloped in a secondary hospital. Lastly, scale three involves extensive follow-up
of interviews, oral investigation, archival investigations with such condition of the current hospital.
1.3.1 Research Design
This study is a mixed-method research with a combination of descriptive, historical and

observational design wherein the focus is on present situations. This involves oral, archival and
case study investigation.
Under the descriptive method, the technique used is the survey and which the results and findings
will be compared with the standards. Interviews were conducted with the three hospital
administrators, followed by surveys of staff and patient questionnaires. A total of 23 staffs filled
out the survey questionnaire and 31 patients responded.
22
Archival research was gathered by documents regarding profile, statistics of population, socio-
demographics and patient information in the hospital. In addition, literature research including
design issues and new organizational plan structure were also conducted.
1.3.2 Population and Sampling
A combine random and convenient sampling is utilized in the study. With everyone in the
population of Zambales of being selected as a subject to observation and since there would be a
wide range of population, convenient sampling was used.
The difference of the samples from representing the whole population is they are the patients or
have been the patents and staffs of the current hospital which will be a used in the survey. Since
the survey will have an interrogation or rating of the quality of the facility, it is best to have a
sample that is basely experienced the natural or personal environment of the hospital.
Target sample would range 50-60 persons with 50 percent respondents from the staff and
patients that will represent the 5 municipalities that the hospital serves. Staff retirees and previous
patients can also be included as a respondent.
1.3.3 Research Instrument
To provide and gather more relative information, the descriptive method includes the use of
questionnaires on surveys and interviews. Questionnaires was used as one of the observational
research instrument from the study. Survey was divided into two section which is the respondents
thinking with his/her visit in a hospital and the questionnaire mainly about the quality of the
hospital itself while interviews were conducted to confirm and compare to the reviews and
thoughts of the respondents.
The survey was gathered during the second day of the week, Monday. The questionnaires will
answer how are the residents, patients and mainly the staffs of the hospital will react to the
existing condition of the hospital from every of its aspects and qualities.
23
CHAPTER 1.4 Summary of Findings and Analysis
The findings of the study are predicated through a tabular presentation from the staffs and survey
gathered through questionnaires. Overall, the 23 staffs and 31 patients indicate that most
categorical profile answerable by yes or no and by rating from excellent, good, fair to poor
perception.
Patients Survey: 31 respondents

Rate of the Qualities of the present San Marcelino District Hospital
SMD Hospital Qualities Excellent Good Fair Poor
(*these qualities are summarized and
translated from Tagalog)
Overall Site Surrounding Design 1 10 15 5

Building Design 1 10 17 3
Environmental Quality 3 12 16
Layout of the building 2 18 11
PWD Accessibility 3 10 18
Security and Privacy 2 8 21
Overall Quality Services 5 17 9
Staffs Survey: 23 respondents

Rate of the Qualities of the present San Marcelino District Hospital
SMD Hospital Qualities Excellent Good Fair Poor
(*these qualities are summarized and
translated from Tagalog)
Overall Site Surrounding Design 1 10 11 1

Building Design 7 15 1
Environmental Quality 7 9 7
Layout of the building 7 13 3
PWD Accessibility 2 14 7
Security and Privacy 7 4 12
Overall Quality Services 3 15 4 1
24
Patients survey: 31 respondents
Have you/your family come to any hospitals for the past 12 months? (including the SMDH)
Yes IIIII-IIIII-IIIII-IIIII-IIIII 25
No 6
How often do you/your family member visit every year? (including the SMDH)
1 to 5 visits IIIII-IIIII-IIIII-IIIII-II 22
6 to 15 visits IIII 4
16 or more visits
I don’t know IIIII 5
Would you consider redeveloping the present primary hospital to a secondary hospital?
Yes IIIII-IIIII-IIIII-IIIII-IIIII-IIIII-I 31
No 0
Staff survey: 23 respondents

How long have you been working here?
1 to 12 months IIIII 5
1 to 10 years IIIII-IIIII-IIII 14
11 to 20 years I 1
20 and above years III 3
Would you consider redeveloping the present primary hospital to a secondary hospital?
Yes IIIII-IIIII-IIIII-IIIII-I 21
No II 2
Summary
The patients and staff surveys were intended to provide the pointers to perceive the problems
that were considered. Therefore, the 23 staffs and 31 patients survey were more of qualitative in
25
the San Marcelino hospitals’ nature. Most major pointed aspects were the Environmental quality
of the hospital and its Security and Privacy purposes for the public and the whole building.
Patients in the survey has 13 male and 18 female respondents while Staffs has 5 male
respondents and 18 female respondents. Overall respondents with the age below 40 has 61% in
total while 40 and above ages has 39%. Some of the staffs and patients thought the survey was
being done by the government that’s why they refuse to give names and put high ratings which
made other answers not honest. Another is staffs tend to make good impression to their hospital
not realizing that the patients are experiencing the opposite of their answers.
1.4.1 Presentation of Collected Data

Population of Zambales
Source: Philippine Statistics Authority
Source: PSA
According to the Administration Director, the hospital serves among the field of 5 municipalities
such as San Felipe, San Narciso, San Antonio, San Marcelino and Castillejos. With this, the
population is gathered to with such boundaries to these areas.
26
Source: PSA
There is a total population of 163, 927 from the five municipalities serving by the hospital and
among these municipalities, Castillejos has the most populated with 48,845 or 7 percent greater
than San Antonio with 34,217 population followed by San Marcelino with 31,879 population, then
San Narciso with 26,966 and lastly San Felipe with the least 22,020 population. The population
will then be the cover which is convenient to the proponent. This will act as a boundaries to other
respondents in the study.
Profile of the Zambaleños (from Philippine Statistics Authority)
Age
In 2010, the median age of the population of the province was 24.3 years, which means that half
of the population was younger than 24.3 years. This is higher than the median age of 22.6 years
that was recorded in 2000.
Moreover, 32.6 percent of the household population were under 15 years old. Children aged 0
to 4 years are 11.2 percent comprised the largest age group, followed by those in the age groups
27
5 to 9 years with 10.8 percent and 10 to 14 years which is 10.6 percent. Males outnumbered the
females in the age groups 0 to 54 years. On the other hand, there were more females than males
in the older age groups with 55 years and over.
Voting age
Three fifths of the population were of the voting age. The voting-age population which is 18 years
and above accounted for 61.6 percent of the household population of the province in 2010, up
from 58.4 percent in 2000. There were more males with 50.3 percent than females with 49.7
percent among the voting-age population.
Working age
The dependency ratio is decreased to 60 dependents per 100 persons in the working age. In
2010, the young dependents from 0 to 14 years comprised 32.6 percent of the household
population while the old dependents with 65 years and over posted a share of 4.9 percent. The
working-age population is 15 to 64 years accounted for the remaining 62.5 percent.
The overall dependency ratio was 60, which indicates that for every 100 working-age population,
there were about 60 dependents with 52 young dependents and eight old dependents. This ratio
is lower than the dependency ratio in 2000, which was recorded at 66 dependents per 100
working-age population with 59 young dependents and seven old dependents.
Sex
The ratio was 103 males per 100 females. Of the 532,836-household population in 2010, males
accounted for 50.8 percent while females comprised 49.2 percent. These figures resulted in a
sex ratio of 103 males for every 100 females, which is like the sex ratio recorded in 2000 with
102 males per 100 females.
Marital status
There were more males than females among the never-married persons. Of the household
population 10 years old and over, 44.7 percent were married while 40.4 percent were never
28
married. The rest of the population were categorized as follows: in common-law/live-in marital
arrangement 8.8 percent, widowed 4.7 percent, and divorced/separated 1.3 percent.
Among the never-married persons, 55.6 percent were males while 44.4 percent were females.
For the rest of the categories for marital status, the females outnumbered the males.
Education
More females had attained higher levels of education. Of the household population aged five
years and over, 32.1 percent had attended or completed elementary education, 39.0 percent had
reached or finished high school, 8.9 percent were college undergraduates, and 8.1 percent were
academic degree holders. Among those with an academic degree, the females with 56.4 percent
outnumbered the males with 43.6 percent. Similarly, more females with 64.9 percent than males
with 35.1 percent had pursued post baccalaureate courses.
Persons with disability
In 2010, around 8,700 persons or 1.6 percent of the 532,836-household population had a
disability. This proportion of persons with disability is higher than the proportion in 2000, which
was 1.1 percent of the 432,877-household population of the province during that year. The
number of PWD for the same year was around 4,800.
Persons with functional difficulty
Of the 473,212-household population five years and over, 3.6 percent or 17,073 persons had at
least one type of functional difficulty either in seeing, hearing, walking or climbing steps,
remembering or concentrating, self-caring, or communicating. There were more females with
53.7 percent than males with 46.3 percent among those persons with at least one type of
functional difficulty.
Moreover, of the total 17,073 persons aged five years and over with at least one type of functional
difficulty, 72.6 percent reported difficulty in seeing, even if wearing eyeglasses. There were 21.8
percent who had difficulty in walking or climbing step; 20.4 percent had difficulty in hearing, even
29
if using a hearing aid, 10.6 percent had difficulty in remembering or concentrating, 10.5 percent
had difficulty in communicating, and 9.3 percent had difficulty in self-caring.
Overseas Workers
Of the 415,520-household population 10 years old and over in Zambales, 2.4 percent or 9,842
persons were overseas workers. Male overseas workers outnumbered their female counterparts
as they comprised 67.0 percent of all the overseas workers from this province. Overseas workers
aged 45 years and over made up the largest age group, comprising 29.3 percent of the total
overseas workers from this province in 2010, followed by the age groups 30 to 34 years with 16.6
percent, 35 to 39 years with 15.9 percent, and 25 to 29 years with 14.3 percent.
Household population
The number of households in 2010 was recorded at 122,158, higher by 30,545 households
compared with the 91,613 households posted in 2000. The average household size in 2010 was
4.4 persons, lower than the average household size of 4.7 persons in 2000.
Oral Investigations:
An interview was conducted regarding in the past background to future and further development
and plans of the present hospital. The main questions in the interview are:
 What are the condition of the hospital today? Is it fully functioning?

 What are the problem/s of the hospital? How do you presently address these problem/s?
 If the hospital were to redevelop, what facilities and services desired would be added?
Persons in the interview includes in coordination with the San Marcelino District Hospital
Administration officer IV Lydia Miraflor Cruz, Administration Director Veronica Bada Fontelera,
Chief of the Hospital Nicolas Rayos Guiang M.D., Mr. Joel from the Maintenance Division and a
person from the San Marcelino Municipal Planning and Development Office.
In accordance with Mrs. Cruz, the San Marcelino District Hospital was built July 7, 1967. The
hospital was a project of the Department of Health until it was accredited by Phil Health whom is
30
a government-owned and operated tax-exempt corporation attached to the Philippine
Department of Health in the 1996. At first, it was a clinic hospital with from 15-bed occupancy
and further expand to 25 until it has 89 beds today. From her 35 years working at the hospital,
it is noticed that the spaces allocated for public services are insufficient because the population
is uncontrollable and it is rising very fast comparing to the hospital which has a slow progress.
Furthermore, the Planning and Development Secretary Office elaborated that the hospital’s lot
where it was currently standing was given the past mayor, Mayor Rabanes in 1967. Today it has
been recognized as the only accessible hospital in the middle of the province of Zambales, one
hour travel from the hospital to Iba’s Ramon Magsaysay Hospital and one hour travel from the
hospital to Subic-Olongapo’s hospitals. Yet, it is indeed a need for development because it is also
a haven to Zambaleños.
The future development and plan of the hospital was discussed by the Administration Director
Veronica Bada Fontelera that in 2017, the hospital will be a three-story hospital with over 100
bed occupancy. Chief of the Hospital Nicolas Rayos Guiang M.D. also states that a one hectare
land will be added from the back of the hospital which cost two million from the government
price. In addition, the expansion will be a land area for disposal of waste, power house providing,
working place for maintenance, water tank location, for expansion of offices and others.
Moreover, Mr. Joel from the Maintenance group told and show the current repairing and
expansion of the hospital. The hospital has a newly constructed three-story building connection
for bigger outpatient services while presently repairing its second floor for a future location of
private rooms when finished. In addition, there will be a three-story senior citizen ward added
from the left side of the hospital and its chapel will be converted into a cafeteria connected to
doctors and nurse quarters.
Summary of Findings
The different persons of the Administration and Municipality had given their information and
thinking for the San Marcelino District Hospital and as confirm, there is no new from its age of
forty-nine. The problems are saying that the hospital could not manage to catch up with the
service responsibility because of its deterioration.
31
Since the hospital has been into adding rooms from time to time, the expansion of the hospital
can be achievable but, the insufficient capability of the facilities to assist all rooms and beds is
resulting to their unbalanced environment. Therefore, it could be interpreted that the hospital is
in a critical condition when it comes to health servicing, otherwise, it may result to very slow
respond to majority.
Archival:
Summary of the San Marcelino District Hospital Historical Background and Profile – Phil Health
Accredited
The San Marcelino District Hospital was authorized by Congress to operate as a primary hospital
with a 25-bed capacity then on July 7, 1967. On August 7, 1974, the bed capacity was increased
from 25 to 50 beds. On November 3, 1983, the field health services from Subic, Castillejos, San
Marcelino, San Antonio, San Narciso and San Felipe were integrated to the Hospital, hence the
San Marcelino Emergency Hospital was named as San Marcelino District Hospital. On April 1993,
the hospital was devolved to the Provincial government of Zambales and the different municipal
health units were devolved to the municipal government where they are located, as mandated
under the local government Code or under R.A. 7160.
The SMDH was approved to increase its bed capacity from 50-75 by the Congress on March 19,
1992, or under R.A. 7243. However, this was not implemented because of the devolution and
because of lack of funds in the Provincial Government of Zambales. Being the only government
hospital in the south which is 27 km from James L. Gordon Memorial Hospital and 57 km from
the President Ramon Magsaysay memorial Hospital in Iba, Zambales more patients especially the
indigent constituents seek medical services in this hospital hence, the increase of patients seeking
for consultation or hospitalization.
From then, the occupancy from 50-75. This was approved by the DOH-CHD license on September
29, 2009, with a Level 2 or Secondary level of care. With the approved bed capacity of 75 the
need for additional personnel for Nurses and Doctors. However, the Province of Zambales is not
allowed by the law to create additional positions for Nurse and doctors because of the 55-45
budgetary limitations. Hence, the hospital opted to hire Nurses, Medical Technologist, Pharmacist
32
and Doctors on a contractual basis, the immediate solution to augment the services which need
professionals.
To better serve the patients, the need to upgrade the laboratory from secondary to tertiary. Most
of the equipment needed are now available and it is listed additional equipment for the purpose.
Hospital Management System:
At present the hospital system is a part of the provincial system, wherein the Chief Executive is
the provincial Governor who is the head over and above the Chief of hospital. Under this system,
the governor is the disciplining and appointing officer of all the staff and personnel of the hospital.
This is in accordance with the R.A. 7160. At present, there are 70 Plantilla positions, 48 casuals,
26 contractual, 44 job orders and 2 detailed.
Findings
The historical background of the San Marcelino Hospital in a sense have the same principle from
the oral investigation gathered from the administration interview. The lack of provincial budget is
preventing the hospital for the expansion or development and progress of the hospital that’s why
the administration of the hospital has put into a move to have their own budget to use for future
buying of expansion lot without the help of the Phil Health. Since the administration already know
that will not be prevented, the existence of deterioration among the hospitals’ facilities is
expected.
Annual Report Statistics of San Marcelino District Hospital from the year 2015
Source: SMDH
33
The hospital upgrading from the 75-bed capacity to 89 beds has an overall 87.14 percent or 77-
78 are occupied in average accommodation in the 2015 year-round. From the peak month,
October, the hospital has over 400 in and out-patients serviced.
Comparing both the in-patient and out-patient services and number of people, the number of
out-patients has three times more than the in-patients. The 9,855 in-patients from 34,633 out-
patients can be a large ratio. Therefore, considering the upgradation for out-patient services
would be necessary or either keeping a balance between services to support more in general
majority.
34
Morbidity
Source: SMDH
The ten leading causes of morbidity are: Influenza and Pneumonia, Intestinal infectious diseases,
Hypertensive diseases, Injury of unspecified body region, Arthropod-borne viral fevers and viral
hemorrhagic fevers, other diseases of the urinary systems, pregnancy with abortive outcome,
Tuberculosis, Cerebrovascular diseases and Diabetes. A total of 2,915 patients with unanimously
1,158 patients from under 1 age to 19 of age has the highest, while 1,190 patients from the
middle 20 to 59 years of age, and lastly the least number from senior citizens with 567 patients
from 60 and over. The number also of male patients with 1,501 overcome the female patients
with 1,414.
35
Mortality
Source: SMDH
The ten leading causes of Mortality/Deaths are: Cerebrovascular diseases, Disorders related to
length of gestation and fetal growth, Hypertensive diseases, Influenza and pneumonia, Ischemic
heart diseases, Diabetes, Digestive organs, Tuberculosis and Intestinal infectious diseases. With
a total of 243 mortality deaths from these diseases, lowest with 46 deaths from under 1 age to
19, 79 deaths from ages 20 to 59 and with the highest 105 from the senior citizens ages 60 and
above. The female deaths with 124 overcome the male deaths with 106.
Summary
From the data morbidity and mortality rate, the focus of a new facility could rely based on the
present population of the leading diseases and causes of deaths. The application of extensive
care and cure can be achievable by observing through yearly records and converting it to the
solution of the deterioration of the facilities to a more convincing and fit services.
36
Additional information is from the Whole Building Design Guide, General Design Guidance for
Healthcare Buildings which states that healthcare facilities should provide a therapeutic
environment in which the design takes place to not only just focus from where only the use is for
treatment but also to reduce airborne infections or spread of sickness that may happen inside a
healthcare facility.
Therefore, in healthcare designing there’s a need of being correspondingly to include not just
only the problem surrounding the treatment of diseases, but also the promotion of health and
prevention of disease essentially the creation of a safe and therapeutic care environment.
Hospital Considerations
Since hospitals provide a wide range of services and are made up of many functional units, they
are the most complex of building types. Good hospital design integrates functional requirements
with the human needs of its varied users. This need for diverse functions is reflected in the
specificity of regulations, codes, and oversight that govern hospital construction and operations.
Each of the wide-ranging and constantly evolving functions of a hospital including highly
complicated mechanical, electrical and telecommunications systems requires specialized
knowledge and expertise. Hospital design is also influenced by site restraints and opportunities,
environment, surrounding facilities, budget and available technology. All hospitals should have
certain common attributes regardless of their location, size or budget. Factors to consider would
be:
Efficiency and Cost-Effectiveness

 An efficient hospital layout should promote staff efficiency by minimizing distance of
necessary travel between frequently used spaces allowing visual supervision of patients,
and providing an efficient logistics system for supplies, food and removal of waste and
make efficient use of multi-purpose spaces and consolidate spaces when possible.
Flexibility and Expandability

 Medical needs and modes of treatment will continue to change. Therefore, hospitals
should follow modular concepts of space planning and layout with the use generic room
sizes and plans as much as possible and by use of modular, easily accessed and easily
37
modified mechanical and electrical systems and be open-ended with well-planned
directions for future expansion.
Therapeutic Environment
 Patients and visitors should perceive a hospital as unthreatening, comfortable, and stress-
free. The designer plays a major role in this effort to create a therapeutic environment.
This can be accomplished by using cheerful and varied colors and textures, by allowing
ample natural light wherever possible, by providing views of the outdoors from every
patient bed, and by designing a way-finding process into every environment.
Cleanliness and Sanitation

 Hospitals must be easy to clean and maintain. This is facilitated by appropriate, durable
finishes for each functional space, careful detailing of such features as doorframes,
casework, and finish transitions to avoid dirt-catching and hard-to-clean crevices and
joints and adequate and appropriately located housekeeping spaces.
Accessibility
 All areas both inside and out, should comply with all standards and minimum requirements
of with Disability Act and ensure grades are flat enough to allow easy movement and
sidewalks and corridors are wide enough for two wheelchairs to pass easily.
Security and Safety

 Hospitals have several security concerns such as protection of patients and staff, hospital
property and assets including drugs, and vulnerability to terrorism because of high
visibility. Security and safety must be built into the design with these things in mind.
Sustainability
 Hospitals are large public buildings that have a significant impact on the environment and
economy of the surrounding community. They are heavy users of energy, water and
produce large amounts of waste. Because of this, sustainable design must be considered
when designing and building hospitals.
38
Case Studies:
Local
San Marcelino District Hospital, Zambales
San Marcelino District Hospital is situated in a 5,993-square meter land located at the intersection
of barangay Linusungan street and the national highway.
Projected horizontally with two levels,

the present hospital is in repair and
renovation process. It is planned to
expand by the 2017 adding bed
capacity and being a 3-story hospital.
EXTERIOR SPACES:
From the back of the hospital this is a view from the

administration building. (administration building is separated
from the main hospital building)
Service Area The Morgue

39
This is view from the pathway separating the main

hospital to the administration building. Beside the
morgue is the storage then the administration
building.
Doctors and Nurse Quarters Parking Area for Doctors
At the left is the waste disposal area and next to it

supposed to be an ambulance parking area but it
becomes an extension for Doctors parking area
View of the doctors’ quarter and the hospital from the left of the site
Located at the right side of the site, this is the newly

constructed outpatient and office services.
40
INTERIOR SPACES:
Medical office
Entrance to operating room

beds in the hallways
The hallways can have a

characterization of being unwell
design and not well-lit resulting to a
poor visibility of rooms and
wayfinding.
Nurse Station Ramp up to second floor Entrance to Ward

41
Pharmacy
Door to Admitting Section
On-repair stairs to second floor
On-repair second floor future private rooms
The OB-Gyne Ward located at second

floor, maternal patients have no choice
but to climb the “on-repair” stairs during
the repair because the hospital is still on
service.
42
The previous chapel converted to a canteen outdoor waiting area for out-patient (8:30am)
Facilities:
A. First Floor - Emergency Room, Information/Admitting Section, Offices: Cashiering, Billing and
Administrative, General consultation: Orthopedic cubicle, Rehydration room – oresol corner,
Dental cubicle, Outpatient, Family planning and Under five clinic, X-Ray department, Laboratory,
Pharmacy, Medical Ward, Nursing Service, OB/Gyne Ward, Isolation Room, Office of the Chief of
Hospital, Recovery Room, Operating Room, Delivery Room, Labor Room, NICU, Dietary Section,
Records Section, Laundry Room, Store Room, Supply Room
B. Second Floor - Surgical Ward, Pediatric Ward, Private room/air-conditioning unit, TV, and
refrigerator, infirmary room, veterans room, dengue room, measles room and comfort room
C. Others - Doctor’s quarter, conference room, Nurses quarter, Gentlemen’s quarter, Archives-
records, Power house, Waste holding area, Garage and Morgue
Ramiro Community Hospital, Tagbiliran City
Ramiro Community Hospital is a 100-bed,

level 3 healthcare facility founded in 1975
by Dr. Luther Z. Ramiro and Mrs. Dinah L.
Ramiro, a physician-teacher team. After
years of selfless dedication in their own
fields in a missionary hospital and in the
public schools respectively, they responded
43
to a higher calling and embarked on a Christian endeavor to serve the Boholanos in their
healthcare needs.
Now on its third decade of service and after undergoing insurmountable challenges, the hospital
has emerged as the leading healthcare provider in the province. It has positioned itself for
continued growth in the future, from leading-edge technology to high quality medical care and
services.
Entrance Hallway
The entrance and hallways of the hospital are characterized by wide range and span to promote
visibility and accessibility especially to PWDs.
Facilities:
Adult & Pediatric Cardiac Care

Location: Ground Floor North Wing of the Hospital, Staffed 8 AM–6 PM Mondays to Saturdays
 Echocardiography with Color Doppler studies, ECG, Cardiac Exercise Testing, Holter
Monitoring
Clinical Laboratory
Location: Ground Floor South Wing of the Hospital, Staffed 24 hours/7days a week
 Hematology, Clinical Chemistry, Immunology & Serology including Hepatitis, AIDS testing,
Clinical Microscopy, Diagnostic Microbiology, Blood Banking including aphaeresis,
Hispathology
44
Critical Care & Other Special Nursing Services

Critical Care Units
 Medical–Surgical Intensive Care Unit, Neonatal Intensive Care Unit, Pediatric Intensive
Care Unit
Special Nursing Units

 Main Operating and Recovery Rooms, Ophthalmology Operating Room, Delivery Rooms,
Emergency Room, Ambulatory Care Unit
Radiology
Location: Ground Floor South Wing of the Hospital, Staffed 24 hours/7days a week
 64–slice Computed Tomography Scan, Computed Radiography, X-Ray, Fluoroscopy,
Ultrasound for General and OB-GYN Ultrasonography, Test Results
Dietary & Pharmaceutical Therapeutic Care

Ambulance Service
Endoscopy Unit
Location: Second Floor East Wing of the Hospital, Staffed 8 AM–4 PM Mondays to Saturdays
 Bronchoscopy, Digestive Endoscopy
Provincial Hospital, Negros Oriental
The Negros Oriental Provincial

Hospital (NOPH) is centrally located in
the province, in the capital city of
Dumaguete. The goal of the hospital
is to provide customer-friendly,
accessible and affordable, quality
health care in partnership with other
sectors for public service excellence.
45
At present, it has an authorized bed capacity of 250 beds, seventy-seven percent of which are
services beds and twenty-three pay beds and Medicare. It is the referral hospital of patients
coming from all the twenty-two municipalities of the province with a total population of 1.3 million.
Facilities
The hospital has three major components namely, medical, nursing and administrative services.
Medical service is departmentalized into four major clinical services namely: medicine surgery,
pediatrics and obstetrics-gynecology while the Department of Anesthesiology is complete.
Subspecialty services EENT-Ophthalmology, Neurosurgery, Orthopedics, Pulmonary medicine and
Nephrology are also available.
Additional hallmark that is fully significant and which identifies Negros Oriental Provincial Hospital
from others is that of the newly constructed and Hi-Tech Equipped Diagnostic Center with dialysis,
CT Scan, Mammography, Ultrasound, treadmill, Mobile X-ray, and Clinical Blood Analyzer, Bactec
Automated Microbial Detection System, refrigerated Centrifuge, VDRL Rotator, ventilator machine
to beef up the Radiology and laboratory departments respectively.
46
The ancillary services are composed of Dental, Radiology, Pharmacy, Laboratory, Medical
Records, Medical Social Service and the dietary services.
As a government hospital, its primary purpose is to provide a comprehensive health care that
includes the promotion, prevention, curative and rehabilitation aspect of health services as well
as education and training and perhaps to some extent research. Republic Act 7160, the Local
Government Code of 1991 embodied that the hospital services of the NOPH and the District
Hospitals of the province are now under the Administration of the Provincial Government of
Negros Oriental.
47
Foreign:
Community Hospital, Yishun
The role of the Community Hospital at Yishun is

to provide the best in “slow medicine,” which
uses the latest medical technology in a setting
that is tethered to the natural rhythms of the
human body and spirit and to the natural
relationships of family, community and the
environment.
To support this goal, the concept is of a hospital as a rain forest, the hospital as a living system
built around care, and harnessing the sun, rain, soil and air to sustain life. The building is
comprised of five major components: a four-story podium for outpatient and rehabilitation
services, a public and rehabilitative garden layer, a seven-story inpatient ward tower, a canopy
roof layer, and a structural system that delivers vertical landscaping. An open-air, two-story public
plaza is the front porch of the facility and includes a water feature and bird aviary to fill the space
with an active, living environment.
In response to Singapore’s warm and humid climate, the building’s naturally ventilated, occupant-
controlled skin draws in the prevailing winds, daylight and regional sounds and smells. Wide
verandas, deep overhangs, ventilated roof structures and a material strategy of lightweight and
low thermal conducting materials both respect and work with nature. Railings, doors and window
blinds are locally sourced and sustainably harvested woods.
In keeping with “slow medicine” philosophy, the hospital is designed for active participation
between patients, staff, families, caregivers and the community. The purposeful density of
gardens, amenities and varied, intimately scaled modes of circulation is meant to encourage both
rest and social interaction."
48
49
Haraldsplass Hospital, Bergen, Norway
Architects: C. F. Moller Architects
Location: Bergen, Norway
Landscape: Asplan Viak Energy
Client: Stiftelsen Bergen Diakonissehjem (SBD)
Size: 10000 sqm/108 beds (10000 sqm parking/400

parking spaces)
Year of Competition: 2012
The winning design by C. F. Moller Architects for a new 10,000 square meter ward building for
Haraldsplass Hospital in Bergen, Norway has been described by the as, “a whole new kind of
hospital”. The traditional hospital corridors, to be replaced by open common areas and efficient
logistics. The new building will lie at the foot of the Ulriken mountain, with the river
Mollendalselven in front.
Haraldsplass Hospital was built in 1986 and has approximately 184 beds. The new building will
cover 10,000 sqm. and give the hospital a further 108 beds on three story. There will also be new
underground parking facilities for approximately 400 cars.
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The innovative approach to hospital design: “Here the patient is placed in the center, and given
a place in a varied and beautiful land-scape. The drawings show attractive new experiences for
staff and patients alike, while the needs of relatives are accommodated in a beautiful and well-
nuanced arrivals area.”
The atrium draws daylight into the building, where lush vegetation with bamboo plants in water
pools and a bed of grass, flowers and creeping plants help to ensure a good indoor climate. All
patients will have access to views of the valley and the city, as the new building follows the course
of the Mollendalselven river, with an angled facade.
The project has also been highlighted as being very eco-friendly, amongst other reasons because
the facade size is small relative to the gross area. By taking new approaches to ventilation and
reusing waste heat from the existing hospital, the new ward can achieve passive house standard.
51
52
Kangbuk Samsung Hospital
Architects: Hyun Joon Yoo Architects
Location: Seoul, South Korea
Collaborators: Kookbo Design Co. Ltd,

Samsung Everland Co. Ltd
Client: Kangbuk Samsung Hospital
Size: 5,697 sqm
Project Year: 2010
Kangbuk Samsung Hospital opened the first door of the medicine in the historic gyeonggyojang
in 1968 for contributing actively to improve public health through medical research and public
health projects. Since then, the hospital has worked to create a healthy society without diseases
for the past 40 years through the best health services with highly qualified staffs and modern
technologies.
Kangbuk Samsung Total Healthcare Center provides the highest level of medical care and services
with trained medical staff and state of the art medical equipment. The first and foremost priority
is the well-being and will serve in a discreet and respectful manner that goes beyond expectations.
The center provides the most efficient, patient-oriented health screening environment. Two
separate examination areas, one for men and one for women, are connected in the center. In
each area, examination rooms are arranged along the borders, allowing patients to move in a
circular, motion without having to walk around long distances. Natural plants, streams, and rocks
were placed throughout our facilities to give clients or patients a sense of relaxation and comfort.
Gowns are made of organic material to avoid the allergic reactions.
53
Departments
1. Anesthesia Pain Medicine, Cardiothoracic surgery, Circulation Division, Dental clinic,

Department of Radiology, Department of Surgery, Dermatology, Division of
Gastroenterology, Division of infectious diseases, Division of nephrology, Division of
Pathology, Division of Rheumatology, E.N.T (ears, nose throat) Otolaryngology,
Emergency Medicine, Family practice faculty, Internal medicine of Endocrinology, Internal
medicine of Respiration, Laboratory Medicine, Mental Health Medicine, Neurology
department, Neurosurgery, Nuclear Medicine, Obstetrics, Occupational Environment
Medicine, Oncology and Hematology, Ophthalmology, Orthopedics, Pediatric Department,
Plastic Surgery, Radiation Oncology, Rehabilitation Medicine and Urology
Typical hospitals are in a huge size building and their rooms are small. Consequently, most of
hospital rooms have no window and they are separated from outdoor space. If we define the
term "health" as a recovering naturalness, the current typical hospital design that separates the
man from nature is ironically a total opposite to the original goal of hospital.
54
Hospital Character:
 Hospital with Nature

 Hospital with Easy-to-find Paths
 Central Park in the Hospital
 Hospital Rooms with a Window
 Minimal and Functional Rooms
Summary
The case study was conducted to know how present related local and foreign hospitals improve
their facilities from designing a good balance nature inside and outside which connects to the
curing and caring effect of the hospital. The weakness and strength of these hospitals can be
interpreted to help the outcome to be more accurate at a success. Furthermore, these ideas and
latest innovation on foreign hospitals will also assessed to integrate those to solutions for the
better outcome of the design.
Environment is an important factor to consider in designing a hospital, the application of elements

inside and outside the hospital can promote a good approach into a curing effect while providing
a sense of calmly interior design like giving sunlight, sound proofing the rooms, air ventilating,
passive cooling, creating a feeling of entertainment can make a patient or staff be at home.
Moreover, since the hospital has a wide contribution when it comes to footprint. It is not a way
to make an adjustment through the surroundings but also consider that the building itself should
55
be justified that it is a right to be in its place. Thus, being an environment and patient-centered
design is the better approach in designing a hospital. Therefore, environment can also be a vital
aspect to a hospital.
1.4.2 Need Analysis
The purpose is to find out what the patients and staffs already know and what their preferences
are. Seeking information related to qualities needed and known, preferences in improving with
prior to experiences and common problems to the present hospital. The intended respondents
were the hospitals’ patients and staffs to relate their experience and observation based for the
results.
The responses from the survey gathered the result of what should be collected and analyzed to
find patterns or qualities that may need extra improvement. The quality of the hospital according
to its Environmental aspects has the poorest level and next to it is the Security and Privacy aspects
which gather also a poor level. Others can be the layout and overall quality services of the
building. From this, the staff and patient respondent know also that there is a need for
improvement to the environment, security, layout and quality services of the hospital.
1.4.3 Qualitative or Quantitative Analysis
The whole study by the instruments of gathering data through interviews and surveys, the method
of research used implies qualitative. The interview gathered to put more in detail of what is the
past and latest state of the hospital and it has no surprise by gathering the profile and historical
background of the hospital by which it changes by time as the population of the people rises.
Moreover, from the hospitals’ current age, the proof of the existence of decaying facility’s service
is undeniable and cannot be prevented. In addition, from the respondents rating to the qualities
of the hospital grant the majority in a result that the hospital is in a critical condition when it
comes from deterioration of its environment, security needs and quality of services. Therefore,
the hospital continuing to be old has these certain states that needs improvement, upgrade,
considerations and changes.
56
CHAPTER 2.1 Rationale
The San Marcelino District Hospital has been the only healthcare serving from the south of
Zambales. And studies prove that government hospitals standing in rural has the opportunity to
empower once the community’s economical and local healthcare system aspects. The being old
of the hospital shows that it provided a lot of services and from continuous expanding which
together the same as its population, the present hospital cannot handle the serving capabilities
and this events causes the deterioration of the hospital’s environment resulting to slow down its
caring and curing ability. Thus, preventing it to cater and fill its responsibilities.
To meet the certain goals of the project redevelopment, the hospital should have a sense of
having a healthy environment. And with the principles of Therapeutic design, this can be
achievable.
CHAPTER 2.2 Principles and Relevance to the Project
Reshaping Provincial Hospitals through Therapeutic Environment (from the Whole Building Design
Guide)
A healthcare has therapeutic environment when it does all the following:

1. Supports clinical excellence in the treatment of the physical body
2. Supports the psycho-social and spiritual needs of the patient, family, and staff
3. Produces measurable positive effects on patients' clinical outcomes and staff effectiveness
Therapeutic Environment originated from the fields of the psycho-social (the interrelation of social
factors and individual thought and behavior) effects of environment, effects of environment to the
immune system, and how the brain perceives architecture. Four key principles of therapeutic
environment:
1. Reduce or eliminate environmental stressors
2. Provide positive distractions
3. Enable social support
4. Give a sense of control
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PRINCIPLES TO REDUCE OR ELIMINATE ENVIRONMENTAL STRESSORS
1. Artwork and aesthetics can enhance the soothing and calming qualities of a space
2. Adequate space should be provided in public areas and waiting rooms to avoid crowding
3. Perceived waiting time can be mitigated by positive distractions
4. Visual and noise privacy
5. Odors that are objectionable or medical can create stress
6. Wayfinding the built environment should provide clear visual cues to orient patients and
families, and guide them to their destination and return. Landscaping, building elements,
daylight, color, texture, and pattern should all give cues, as well as artwork and signage
7. Reduce or eliminate sources of noise (other patients, public address systems, equipment
clatter, loud conversations at nurse stations)
8. Acoustical treatment of corridors adjacent to patient rooms (carpet tiles, rubber flooring)
9. Acoustical separation of staff work areas from patient rooms (even low noise levels
combined with poor acoustics can reduce sleep quality and negatively affect other
outcomes)
10. Appropriate lighting systems (lighting can be a stressor that alters mood, increases stress,
disrupts daily rhythms, and modulates hormone production)
11. Provide lighting that supports natural circadian rhythm. (Provide natural daylighting where
possible, or bright white lights in the daytime) Ensure absolute darkness in the evening
(for nighttime movement only red lights should be present in the rooms)
12. Maintain good indoor air quality (100% outside air where climatic conditions allow)
13. Color while subjective, can be a design factor in reducing environmental stress when
understood and used in the context of the color preferences of a project-specific
population.
PRINCIPLES TO PROVIDE POSITIVE DISTRACTION
1. Views of nature, from patient rooms, and wherever possible in lobby, waiting and other
high stress areas
2. Access to nature (healing gardens)
3. Chapel, meditation room and meditation gardens
4. Artwork depicting nature, including back-lighted photographs of nature
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5. Music (live piano in public area, recorded music in patient room when programmed
specifically to create a healing environment)
6. Mild physical exercise (corridors, public spaces, and gardens that invite walking when
appropriate)
7. Pets and other activities or elements that allow for a sense of stimulation that help nurture
a patient's sense of positive well-being
PRINCIPLES TO ENABLE SOCIAL SUPPORT
1. Family zone in patient room (with furniture for sleeping, phone and internet connection,
reading light with separate control, and out of the way of staff)
2. Provide places where patients can engage socially with family and other caregivers (such
as the patient-care feature of a Family kitchen on inpatient units where family members
can prepare food for patients and families to eat together)
3. Provide accommodation for accompanying family member to be with patient throughout
the examination and treatment process
4. Organize Family Focus Groups and Patient and Family Advisory Councils to be an active
part of the design process, tuning in to the specific needs of the population and community
to be served
5. Ensure culturally appropriate environments
6. Consider sociopetal versus sociofugal spaces (Sociopetal spaces facilitate social behaviors
and the development of social groups like for example, nonfixed seating, round tables,
etc.)
PRINCIPLES TO GIVE A SENSE OF CONTROL
The ability of the patient to control the environment directly contributes to successful patient
outcomes. A sense of control extends from privacy and lighting to choosing artwork being hung
in the patient's bedroom during the hospitalization, to ordering meals from room service.
1. Private patient rooms result in better outcomes
2. Give the patient as much privacy and control over it, as is consistent with the need for
nursing supervision
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3. Give the patient control over the immediate environment (radio, TV, reading light, night
light)
4. Wayfinding (the built environment should provide clear visual cues to orient patients and
families, and guide them to their destination and return. Landscaping, building elements,
daylight, color, texture, and pattern should all give cues, as well as artwork and signage)
5. Provide mini-medical library and computer terminals so patients can research their
conditions and treatments
6. Choice of lighting (patients and staff can benefit from personal dimming controls)
7. Choice of artwork
8. Volume and programming control of televisions in waiting areas
9. Room service or menu selection
10. Storage area for patient belongings
The application of these factors has been focused on the patient and family. However, there are
also recognized potential benefits for staffs in terms of satisfaction, effectiveness, and retention,
from environmental factors such as:
1. Noise reduction
2. Same-handed patient rooms
3. Access to daylight
4. Appropriate lighting
5. Providing off-stage areas for respite
6. Proximity to other staff
7. Appropriate use of technology
8. Decentralized observation, supplies and charting
These principles if applied may have the purpose of not only to assist modern medical
technologies, security and standards but to also to include the patient and family in a psychosocial
environment. The qualities of the environment which a patient receives care affects patient
results. The effects can be positive or negative but not both, because no environment is neutral.
Therapeutic Environments as a whole should be productive not only by improving the health of
the patients but also together, reducing their time of wait or by increasing satisfaction from staffs
and their recruitment.
60
CHAPTER 2.3 Application to the Project
The proponent plans a redevelopment of the hospital to have an upgraded structure having
advance technologies and contemporary secondary hospital setting. Principles included in creating
a therapeutic environment will all be applied to the formulation of development solution of the
project. Moreover, following the standards of the laws and design guidelines that will help in the
creation of the hospital.
The approach of therapeutic environment design in the project will act as a basis for the main
architectural solution. Through a healing environment, the hospital will not only boost its ability
to fasten curing process that promotes a patient-centered facility but also being nature-oriented.
And this manner will grant sustainability and can be used as a new upcoming approach to hospital
developments particularly in rural.
61

Redeveloping San Marcelino Hospital for Improved Healthcare

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MAPUA INSTITUTE OF TECHNOLOGY

School of Architecture, Industrial Design, and Built Environment

A Proposed Integrated Community Hospital: Redevelopment of San

AR200: Architectural Design 9 – Thesis Research Writing

RAMOS, MARK JOSEPH D.

ARCHITECT JUNAR P. TABLAN

December 13, 2016

Part 1: The Problem and Its Background

Chapter 1.1 General Overview

1.1.1 Background of the Study

Chapter 1.2 Review of Related Literature and Studies

1.2.1 Related Literature

Chapter 1.3 Research Methodology

1.3.1 Research Design

Chapter 1.4 Summary of Findings and Analysis

1.4.1 Presentation of Collected Data

Part 2: Research Focus

Chapter 2.1 Rationale

Chapter 2.2 Principles and Relevance to the Project

Chapter 2.3 Application to the Project

1.1.1 Background of the Study/Overview

1.1.2 Statement of the Problem

The proponent aims to answer the following questions:

a new experience of services?

1.1.3 Goals, Objectives and Strategies

1.1.5 Scope and Limitation of the Study

1.1.7 Conceptual Framework

SAN MARCELINO SAN MARCELINO

ARCHITECTURAL SOLUTIONS SITE CONSIDERATIONS

SMDH – San Marcelino District Hospital

1.2.1 Review of Related Literature

The Development of Economy in Relationship of Hospital

Influence of Community Hospitals on Local Health System

Redefining Health with Hospital Sustainability

1.2.2 Related Projects

Burera, Rwanda By removing the interior corridors and using

The Johns Hopkins Hospital Massachusetts General Hospital relocated

The building’s circulation is designed to create

The separation between professional and staff

John Hopkins Hospital uses the design as a

(Yawkey Center for Outpatient Care -

Type: Government General Hospital care.

Asian Hospital and Medical Center

St. Luke’s Medical Center

Quezon City, Philippines

The Center has provided high-quality

St. Luke's delivers on its mission of healing by

Year: 1903 gathering under one roof the finest medical

1.3.1 Research Design

This study is a mixed-method research with a combination of descriptive, historical and

1.3.2 Population and Sampling

1.3.3 Research Instrument

Patients Survey: 31 respondents

Overall Site Surrounding Design 1 10 15 5

Layout of the building 2 18 11

Security and Privacy 2 8 21

Overall Quality Services 5 17 9

Staffs Survey: 23 respondents

Overall Site Surrounding Design 1 10 11 1

Layout of the building 7 13 3

Security and Privacy 7 4 12

Overall Quality Services 3 15 4 1