TRINITY UNIVERSITY OF ASIA

Graduate School
275 E. Rodriguez Sr. Ave., Kalusugan, Cathedral Hts., Quezon City 1112

DNM 404
Health Care Engineering

Submitted by:
Maricel Agpalza
Richard Bartolata
Nuegene S. Cu
Josie Q. Udan
Robby B. Ylanan
Sun Jing

Professor:
Dr. Joseph Peter B. Regondola
COURSE DESCRIPTION:
The course provides the graduate students with the latest
technological knowledge on the trends in health care facilities and
factors to consider in the development of health care institutions
tailored to the current trends and issues on patient care modalities
and improve employee and client safety and security.
LEVEL OUTCOMES:
At the end of the 1st year, the students should have acquired
an understanding and awareness of themselves a graduate students
that will serves as a change agent in developing and adopting latest
foundation, knowledge and trends in health care facilities in the end
goal of improving patient care modalities and right approach on
policy and operations in line with health care facilities. Specifically,
the student should be able to:
1. develop a well-rounded foundation knowledge on trends and
policies in health care facilities;
2. integrate basic foundational concepts of health care facilities to
improved patient care modalities and operational
effectiveness;
3. Formulate a theoretical foundation that will serves as
reference for health care facilities effectiveness and efficiency
for patient safety.

COURSE LEARNING OUTCOMES (CLO):

At the end of the course and given simulated conditions/situations,

the student should be able to:

1. Apply how health care engineering could contribute to reduce

operational cost.
 2. Identify the different approaches to health care delivery
system in the 21st century.
3. Integrate the factors essential in the management of health
care towards efficient and effective health care organization.
4. Integrate changes in the old facility design to improve and
facilitate nursing care activities in the work setting.
5. Integrate the master planning of facilities by participating in
the preparatory stage of hospital design.

II: Introduction to the course

1. Current state of hospitals in the country
2. Health care reform
3. Definition of terms:
 Health Care Engineering
 Health Care Technology
 Potential Health Care Modalities

III: Relevance of Health Care Engineering

1. Operational cost
2. Health care delivery system
 Integrated delivery system (IDS)
 Corporatization
 Zoning
3. Basic form of a hospital based on its functions:
3.1 Bed – related
3.2 Out – patient
3.3 Diagnostic and therapeutic
 3.4 Emergency room
3.5 Operating room
3.6 Isolation room
3.7 ICU
3.8 Rehabilitation
3.9 Hospitality function
 Food services
 Housekeeping
 Linen
3.10 MIS
3.11 Sewerage system
3.12 Research and training functions
4. Functional relationship, basis for planning and communication
4.1 General hospital relationship between various functions
4.2 Major clinical relationship
5. Technology and its implications to health care facilities, the need
for “6Rs”
5.1 Re- engineering
5.2 Restructuring
5.3 Realigning
5.4 Resizing
5.5 Redesigning
5.6 Revaluing

IV: Organizational Management in Health Care.

1. Challenges in health care
2. Factors to consider
3. 8 – steps at operational process
3.1 Provide process structure
3.2 Provide flexibility
3.3 Provide resource efficiency
3.4 Provide effectiveness
3.5 Provide trust
 3.6 Planning and scheduling
3.7 Workflow management
3.8 Transactional process

V: Building and Facility design:

1. Building attributes
1.1 Efficiency and cost effectiveness
1.2 Flexibility and expandability
1.3 Therapeutic environment
1.4 Cleanliness and sanitation
1.5 Accessibility
1.6 Controlled circulation
1.7 Aesthetics
1.8 Security and safety
1.9 Sustainability
1.10 Emerging issues and trends in strengthening hospital
designs.

VI: Health care master facility

1. Phases and master facility planning
2. Phases of design
3. Sustainable hospital design
3.1 New trends to design and build hospitals
3.2 Consideration in building facilities and measurements
3.3 Leadership in Energy and Environment Design (LEED)
3.4 Interior area
3.5 Sustainable architecture
3.6 Design innovation
3.7 Focus trends in building design
3.8 Redesigning nursing care facilities with emphasis on the
nursing stations
 VII: Latest Trends and Issues in Health Care Facilities
1. During pandemic
2. Other matters
 INTRODUCTION TO HEALTHCARE ENGINEERING

Richard L. Bartolata
DNM Student

CURRENT STATE OF HOSPITALS IN THE COUNTRY

 Shortage of Hospital Beds

Only 4 out of 17 regions of the country (24%) complied with
the standard local hospital bed ratio (76% not compliant)
In international setting, only the National Capital Region
complied with World Health Organization's requirement
(DOH)
How to address: Both public and private hospitals must
provide just compensation to healthcare providers and invest
on infrastructure and facility such as acquisition of new
hospital beds to accommodate the healthcare needs of the
growing population.

 Lack of Resources
Lack of financial resources, materials, equipment and
technological innovations;
Insufficient knowledge, skills and human resources;
Problems related to processes and methodologies.
How to address: National government must find effective and
efficient ways to address these issues and concerns to ensure
successful delivery of healthcare services

 Disaster Preparedness of Hospitals

Public health in disaster is the responsibility of both public and
private hospitals;
Need for flexibility in disaster preparedness and planning;
Disaster resilience is an emergent process not a static
construct;
 Chaos results from zeal without coordination;
Need for integration of disaster preparedness in daily
processes and structures of hospital facilities.

 Healthcare Engineering in Infection Control

Wards near areas with high vehicular activity had more
respiratory Hospital-Acquired Infection (HAI) cases
Indoor air pollution, proximity to congested main
thoroughfare, and increased human foot traffic may contribute
to the susceptibility of patients to HAIs
How to address: Hospital layout (healthcare engineering)
should be considered in infection control.

 Use of a Systems Engineering Approach

Suboptimal dissemination of hand hygiene compliance data,
High nursing turnover,
Clinical time constraints, and
Resource limitations that restricted equipment purchasing
How to address: use of a systems engineering approach

 Physical and Human Resources

Physical infrastructure of hospitals
Number of hospital beds – overall bed to population ratio
follows DOH prescribed standard (1:1000)
Distribution – concentration is in developed areas except for
DOH Regional Medical Centers
Quality – range from most sophisticated to basic; private
facilities are perceived to be of higher quality than government
institutions.
Provision of Services
Public health and primary care services
Hospital Services
Other special services
 HEALTHCARE REFORMS

 Principal Health Reforms

Health Service Delivery

 1980 – Primary Health Care Approach and Integration of
Health Services
 1987 – reorganization of the Ministry (later Department)
of Health through EO 119
 1991 – devolution of health services (RA 7160 Local
Government Code)
 1999 – Introduction of inter-local health zones under
Health Sector Reform Agenda

Regulatory Reforms

 1988 - RA 6675 the Generics Law

 2008 –RA 9502 the Universally Accessible , Cheaper, and
Quality Medicines Law
 2009 –the Food and Drug Administration Law
 Principal Health Reforms

Health Financing Reforms

 1995 –Creation of the Philippine Health Insurance

Corporation
 2010 – Restructuring of premium payments for poorest
income quintiles comprising 40 percent of population
 2011 – Restructuring of benefits through No Balance
Billing Policy for defined diagnostic groups
 Assessment of the Philippine Health System

o Major improvements in immunization coverage, TB

DOTS, and childhood TB.
o Disparities in immunization rates and
implementation of other programs persist
between poor and well-to-do provinces.
o Low utilization of government hospitals due to
perceived low quality.
o Maldistribution of human resources for health.
o High out-of-pocket expenditures
o Absence of integrated curative and preventive
services network;
o Lack of quality assurance mechanisms and low
utilization of existing one (e.g. Philhealth bench-
book)

Conclusions

 Inequity persists as the Philippines’ main health problem

 Present DOH KP or Universal Health Care can provide the
appropriate responses
 The KP thrusts should include measures to specifically address
persistent defects in the health system building blocks,
particularly: out of pocket expenses and quality of services.

Universal Health Care

 UHC guarantees equitable access to quality and affordable

healthcare services for all Filipinos. It will also automatically
enroll Filipino citizens into the National Health Insurance
Program and expand PhilHealth coverage to include free
medical consultations and laboratory tests.
 Other Significant Reforms

 Designating PhilHealth as the national purchaser for health

goods and services for individuals, such as medicines;
 Improvement of health facilities especially in underserved
areas;
 Responding to the gap in health workers throughout the
country;
 Strategic engagement of the private sector;
 Creating and expanding new functions in the Department of
Health (DOH) to improve the delivery of health services.
 National eHealth System and Services Act
 The National eHealth System and Services shall deliver health
services through cost-effective and secure information and
communications technology (ICT).
 It has the potential to be profitable, improve quality, change
the conditions of practice, and improve access to healthcare,
especially in rural and other medically underserved areas.

POTENTIAL HEALTHCARE MODALITIES

Health Care Technology as a Modality

 Healthcare is all about managing information and turning that

into knowledge about the patient.
 Organizing and driving workflow through the use of
technology
 Patient-centered Technology and its impact.
 Configuring the system to meet the hospital’s specific needs.

Electronic Health Records (EHRs) as a Modality

 Help care teams identify worsening patients and pinpoint the
appropriate time to intervene.
 Predict required staffing levels or predict which patients are at
increased risk for complications (e.g., central line infections)
 Impact health care costs
 Artificial intelligence (AI) using analytics to match cancer
patients to clinical trials, which typically takes a great deal of
manpower and expenses.

EHR and Analytics

 Provide insight into the success or failure of quality

improvement measures and error prevention
 Promote interconnectivity of health care
 Enhance level of patient centeredness

Team-Based Care as a Modality

 Promotes comprehensiveness of care and patient satisfaction

and boost health care providers’ self-confidence and team
satisfaction.
 Worthwhile alternative to the current health care structure.
 Reduces health care costs.
 Improves quality of life, reduces anxiety, and decreases
caregiver distress.

Interdisciplinary Model of Care (IMOC)

 Optimizes communication and coordination of care between

the interdisciplinary team and their patients and their families.
 Increases nurse participation, promotes a more patient-
centered method of care, and improves staff cooperation and
collaboration.
 Healthcare Engineering Defined:

 Healthcare Engineering is engineering involved in all aspects

of the prevention, diagnosis, treatment, and management of
illness, as well as the preservation and improvement of
physical and mental health and well-being, through the
services offered to humans by the medical and allied health
professions.

Two Major Fields of Healthcare Engineering

 Engineering for Healthcare Intervention

Engineering involved in the development or provision of any

treatment, preventive care, or test that a person could take or
undergo to improve health or to help with a particular health
problem.

Engineering for Healthcare Systems

Engineering involved in the complete network of

organizations, agencies, facilities, information systems,
management systems, financing mechanisms, logistics, and all
trained personnel engaged in delivering healthcare within a
geographical area.”

Healthcare Technology

 The information technologies (IT) developed with the purpose

to improve productivity of hospitals, clinics, and health
administration services and enhance access to and quality
of healthcare. Examples of such technologies
include healthcare information management
systems, healthcare document
 management, healthcare business intelligence software,
electronic medical records, mobile health services, and patient
monitoring systems, to name a few. 
 This term is typically used to encompass all technologies that
are used in the healthcare field inclusive of both medical
personnel and patients. 
 Healthcare technology, commonly referred to as “healthtech,”
refers to the use of technologies developed for the purpose of
improving any and all aspects of the healthcare system. From
telehealth to robotic-assisted surgery, our guide will walk you
through what it is and how it's being used. 
 Healthcare technology refers to any IT tools or software
designed to boost hospital and administrative productivity,
give new insights into medicines and treatments, or improve
the overall quality of care provided.
 Healthcare technology can be defined as all drugs, devices and
medical and surgical procedures used in medical care, as well
as the organizational and supporting systems within which
such care is provided

References:

Koh D. (2019). Universal healthcare act in the Philippines signed into

law by President Duterte.
https://www.healthcareitnews.com/news/universal-
healthcare-act-philippines-signed-law- president-duterte 

Romualdez A., et al. (n.d.). Health Systems in Transition.

https://books.google.com.ph/books/about/The_Philippines_Health_
System_Review.html
?id=gt_smAEACAAJ&redir_esc=y
NEDA. (2019). Universal Health Care Law and what it means to PH
development.
https://www.neda.gov.ph/explainer-universal-health-care-
law-and-what-it-means-to-ph-
development/

German J.D., Miñ a J.P., Alfonso C.N., Yang K.H. (2018). A study on
shortage of hospital beds
in the Philippines using system dynamics.
2018 5th International Conference on Industrial Engineering
and Applications (ICIEA). DOI: 10.1109/IEA.2018.8387073

Dela Cruz R.Z. & Dela Cruz R.O. (2019). Management of public
healthcare facilities in the
Philippines: issues and concerns.
https://doi.org/10.12968/bjhc.2019.0018

Labarda C., Labarda M.D., Lamberte E.E. (2017). Hospital resilience

in the aftermath of
Typhoon Haiyan in the Philippines. Disaster Prevention and
Management. ISSN: 0965- 3562

Dalmacion G.V., Itable J.R., Baja E.S. (2014). Hospital-acquired

infection in public hospital
buildings in the Philippines: Is the type of ventilation increasing
the risk?
DOI: https://doi.org/10.3855/jidc.8295
Mitchell K.F., Barker A.K., Abad C.L., Safdar N. (2017). Infection
control at an urban hospital
in Manila, Philippines: a systems engineering assessment of
barriers and facilitators.
Antimicrobial Resistance & Infection Control volume 6,
Article number: 90 (2017)

Dayrit M.M., Lagrada L.P., Picazo O.F., Pons M.C. (2018). The
Philippines Health System
Review. Health Systems in Transition Vol. 8 No.

Hoppszallern, Goldsteen, Sanford, Ross, & Schooler. (2016). Health

Care Delivery: New Modalities for the Workforce. Journal of Nursing
Regulation. DOI:https://doi.org/10.1016/S2155-
8256(18)30021-8

Graver S. (2016). Transforming the Continuum of Care With

Technology.
https://www.psqh.com/analysis/transforming-the-
continuum-of-care-with-technology/

Chyu, et al., (2015). Healthcare Engineering Defined.

https://www.healthcare- engineering.org/white-paper
Relevance of Health Care Engineering

Maricel A. Agpalza
DNM Student

Operational Costs

Are the expenses that are related to the operation of a business, or

to the operation of a device, component, piece of equipment, or
facility. They are the cost of resources used by an organization just
to maintain its existence.

The five major entities involved in the value chain are the payer, the
intermediary, the hospital, the purchaser, and the producer.

Payers and intermediaries - The U.S. hospital industry is unique in

the way it’s compensated. Unlike the normal business model
prevalent in other industries, where the end user pays for the goods
and services, this industry derives most of its payments from third-
party payers such as employers, commercial insurance companies,
and government programs.
Hospitals- hospitals are healthcare providers equipped with trained
staff and medical equipment to treat various ailments. Hospitals
provide two types of services: inpatient and outpatient services.
Patients that require care for more than a day are called
“inpatients.” Patients that require care for a shorter period are
called “outpatients.” Hospital companies provide both inpatient and
outpatient services.

Suppliers- Wholesale distributors, group purchasing organizations

(or GPOs), and mail-order distributors assist hospitals in procuring
drugs and medical devices from manufacturers forming up to 40%
of hospital costs. GPOs assist hospitals in managing these expenses
by implementing group buying policies. Mail-order distributors
adopt a different dispensing model than wholesale distributors.
Mail-order distributors order drugs directly from manufacturers or
other wholesalers.

Producers- According to Market line, the global pharmaceutical

industry is continually evolving though both the pharmaceutical and
medical technology industries have lately come under pressure to
produce cost-effective drugs and devices, factors like aging
population, investments in healthcare, and increasing coverage of
health insurance are expected to provide decent margins.
After analyzing the contribution of major external factors to hospital
profit margins, investors should consider the internal factors. You
can break down average hospital costs into salary expenses, supply
expenses, bad debt expenses, and miscellaneous expenses. Labor
costs account for about 49% of expenses, and they’re the biggest
expenses for hospitals
You can further divide salary costs into clinical, nursing, non-clinical,
and physician costs. Clinical costs relate to the salaries paid to
personnel working in hospital laboratories and those working on
research activities. Non-clinical costs include salaries to personnel
engaged mainly in administrative activities. Also, only physicians
who are employees of a hospital are included in these expenses.
Other affiliated physicians are paid directly by the patient or the
insurance programs.
Hospital Supply Chain - Medical supplies account for 17% of total
hospital expenses. As this constitutes a substantial portion of the
total cost structure, hospitals tend to focus on their supply chain to
remove inefficiencies and reduce costs.

Management is faced with a broad array of choices regarding where

and how to apply their resources to respond to problems or to
improve their cost position. To effectively make decisions aimed to
understand factors that actually drive cost performance.
One of the most important challenges facing healthcare managers is
controlling costs. Cost reduction is very difficult in healthcare, and
in fact, the task of merely calculating costs accurately is often
difficult to accomplish.

To effectively make decisions aimed at reducing costs in healthcare,

it is first critical to expose and understand factors that actually drive
cost performance. In many cases, managers attempt simply to “cut
expenses” without regard to the organizational or operational
effects associated with those reduced expenses.

Health Care Delivery System

Integrated Delivery System

According to Enthoven IDS is An organized, coordinated and

collaborative network that:

(1) links various health care providers, via common ownership or

contract, across three domains of integration – economic,
noneconomic, and clinical – to provide a coordinated, vertical
continuum of services to a particular patient population or
community and
There are two main types of integration used in integrated delivery
systems (IDS).

Horizontal integration
 is defined by the Pan American Health Organization as “the
coordination of activities across operating units that are at the
same stage in the process of delivering services” .
 In Horizontal integration grouping organizations that provide a
similar level of care under one management umbrella. This will
lead to consolidation of the organizations’ resources to
increase efficiency and save cost. Examples of horizontal
integration include multihospital systems, mergers and
strategic alliances with neighboring hospitals to form local
networks

Vertical integration
 is defined by the Pan American Health Organization as “the
coordination of services among operating units that are at
different stages of the process of delivering patient services” .
 This will lead to increase efficiency and manage global
capitation, form large patient and provider pools to diversify
risk, reduce the cost of payer contracting, improve quality of
care and provide a seamless continuum of care.
Corporatization is the process of transforming state assets,
government agencies, or municipal organizations into corporations.
It refers to a restructuring of government and public organizations
into their administration.
Corporatization reforms have evolved based on efforts to mimic the
structure and efficiency of private corporations while assuring that
social objectives are still emphasized through public ownership.

Hospitals
The Basic Form of Hospital
 bed-related inpatient functions
 outpatient-related functions
 diagnostic and treatment functions
 administrative functions
 service functions (food, supply)
 research and teaching functions

Physical relationships between these functions determine the

configuration of the hospital. Certain relationships between the
various functions are required—as in the following flow diagrams.
These flow diagrams show the movement and communication of
people, materials, and waste. Thus the physical configuration of a
hospital and its transportation and logistics systems are inextricably
intertwined. The transportation systems are influenced by the
building configuration, and the configuration is heavily dependent
on the transportation systems. The hospital configuration is also
influenced by site restraints and opportunities, climate, surrounding
facilities, budget, and available technology. New alternatives are
generated by new medical needs and new technology.
In a large hospital, the form of the typical nursing unit, since it may
be repeated many times, is a principal element of the overall
configuration. Nursing units today tend to be more compact shapes
than the elongated rectangles of the past. Compact rectangles,
modified triangles, or even circles have been used in an attempt to
shorten the distance between the nurse station and the patient's
bed. The chosen solution is heavily dependent on program issues
such as organization of the nursing program, number of beds to a
nursing unit, and number of beds to a patient room. (The trend,
recently reinforced by HIPAA, is to all private rooms.

BUILDING ATTRIBUTES
Efficiency And Cost-Effectiveness
An efficient hospital layout should:
 Promote staff efficiency by minimizing distance of necessary
travel between frequently used spaces
 Allow easy visual supervision of patients by limited staff
 Include all needed spaces, but no redundant ones. This
requires careful pre-design programming.
 Provide an efficient logistics system, which might include
elevators, pneumatic tubes, box conveyors, manual or
automated carts, and gravity or pneumatic chutes, for the
efficient handling of food and clean supplies and the removal of
waste, recyclables, and soiled material
 Make efficient use of space by locating support spaces so that
they may be shared by adjacent functional areas, and by
making prudent use of multi-purpose spaces
 Consolidate outpatient functions for more efficient operation—
on first floor, if possible—for direct access by outpatients
 Group or combine functional areas with similar system
requirements
 Provide optimal functional adjacencies, such as locating the
surgical intensive care unit adjacent to the operating suite.
These adjacencies should be based on a detailed functional
program which describes the hospital's intended operations
from the standpoint of patients, staff, and supplies.

Flexibility and Expandability

Since medical needs and modes of treatment will continue to
change, hospitals should:
 Follow modular concepts of space planning and layout
 Use generic room sizes and plans as much as possible, rather
than highly specific ones
 Be served by modular, easily accessed, and easily modified
mechanical and electrical systems
 Where size and program allow, be designed on a modular
 system basis, s
 This system also uses walk-through interstitial space between
occupied floors for mechanical, electrical, and plumbing
distribution.
 For large projects, this provides continuing adaptability to
changing programs and needs, with no first-cost premium, if
properly planned, designed, and bid.
 Be open-ended, with well-planned directions for future
expansion; for instance positioning "soft spaces" such as
administrative departments, adjacent to "hard spaces" such as
clinical laboratories.

Therapeutic Environment
Hospital patients are often fearful and confused and these feelings
may impede recovery. Every effort should be made to make the
hospital stay as unthreatening, comfortable, and stress-free as
possible. The interior designer plays a major role in this effort to
create a therapeutic environment. A hospital's interior design
should be based on a comprehensive understanding of the facility's
mission and its patient profile. The characteristics of the patient
profile will determine the degree to which the interior design should
address aging, loss of visual acuity, other physical and mental
disabilities, and abusiveness. Some important aspects of creating a
therapeutic interior are:
 Using familiar and culturally relevant materials wherever
consistent with sanitation and other functional needs
 Using cheerful and varied colors and textures, keeping in mind
that some colors are inappropriate and can interfere with
provider assessments of patients' pallor and skin tones,
disorient older or impaired patients, or agitate patients and
staff, particularly some psychiatric patients.
 Admitting ample natural light wherever feasible and using
color-corrected lighting in interior spaces which closely
approximates natural daylight
  Providing views of the outdoors from every patient bed, and
elsewhere wherever possible; photo murals of nature scenes
are helpful where outdoor views are not available
 Designing a "way-finding" process into every project. Patients,
visitors, and staff all need to know where they are, what their
destination is, and how to get there and return. A patient's
sense of competence is encouraged by making spaces easy to
find, identify, and use without asking for help. Building
elements, color, texture, and pattern should all give cues, as
well as artwork and signage.

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 door frames, casework,
and finish transitions to avoid dirt-catching and hard-to-clean
crevices and joints
 Adequate and appropriately located housekeeping spaces
 Special materials, finishes, and details for spaces which are to
be kept sterile, such as integral cove base. The new
antimicrobial surfaces might be considered for appropriate
locations.
 Incorporating O&M practices that stress indoor environmental
quality (IEQ)

Accessibility
All areas, both inside and out, should:
 Comply with the minimum requirements , be designed so as to
be easy to use by the many patients with temporary or
permanent handicaps
 Ensuring grades are flat enough to allow easy movement and
sidewalks and corridors are wide enough for two wheelchairs
to pass easily
 Ensuring entrance areas are designed to accommodate
 patients with slower adaptation rates to dark and light;
marking glass walls and doors to make their presence obvious

Controlled Circulation
A hospital is a complex system of interrelated functions requiring
constant movement of people and goods. Much of this circulation
should be controlled.
 Outpatients visiting diagnostic and treatment areas should not
travel through inpatient functional areas nor encounter
severely ill inpatients
 Typical outpatient routes should be simple and clearly defined
 Visitors should have a simple and direct route to each patient
nursing unit without penetrating other functional areas
 Separate patients and visitors from industrial/logistical areas
or floors
 Outflow of trash, recyclables, and soiled materials should be
separated from movement of food and clean supplies, and both
should be separated from routes of patients and visitors
 Transfer of cadavers to and from the morgue should be out of
the sight of patients and visitors
 Dedicated service elevators for deliveries, food and building
maintenance services

Aesthetics
Aesthetics is closely related to creating a therapeutic environment
(homelike, attractive.) It is important in enhancing the hospital's
public image and is thus an important marketing tool. A better
environment also contributes to better staff morale and patient care.
Aesthetic considerations include:
 Increased use of natural light, natural materials, and textures
 Use of artwork
 Attention to proportions, color, scale, and detail
 Bright, open, generously-scaled public spaces
 Homelike and intimate scale in patient rooms, day rooms,
 consultation rooms, and offices
 Compatibility of exterior design with its physical surroundings

Security and Safety

In addition to the general safety concerns of all buildings, hospitals
have several particular security concerns:
 Protection of hospital property and assets, including drugs
 Protection of patients, including incapacitated patients, and
staff
 Safe control of violent or unstable patients
 Vulnerability to damage from terrorism because of proximity
to high-vulnerability targets, or because they may be highly
visible public buildings with an important role in the public
health system.

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 and water and produce large amounts of
waste. Because hospitals place such demands on community
resources they are natural candidates for sustainable design.

GUIDELINES IN THE PLANNING AND DESIGN OF A HOSPITAL

AND OTHER HEALTH FACILITIES
A hospital and other health facilities shall be planned and designed
to observe appropriate architectural practices, to meet prescribed
functional programs, and to conform to applicable codes as part of
normal professional practice. References shall be made to the
following:
 P. D. 1096 – National Building Code of the Philippines and Its
Implementing Rules and Regulations
 P. D. 1185 – Fire Code of the Philippines and Its Implementing
Rules and Regulations
  P. D. 856 – Code on Sanitation of the Philippines and Its
Implementing Rules and Regulation
 B. P. 344 – Accessibility Law and Its Implementing Rules and
Regulations
 R. A. 1378 – National Plumbing Code of the Philippines and Its
Implementing Rules and Regulations
 R. A. 184 – Philippine Electrical Code
 Manual on Technical Guidelines for Hospitals and Health
Facilities Planning and Design. Department of Health, Manila.
1994
 Signage Systems Manual for Hospitals and Offices. Department
of Health, Manila. 1994
 Health Facilities Maintenance Manual. Department of Health,
Manila. 1995
 Manual on Hospital Waste Management. Department of
Health, Manila. 1997
 District Hospitals: Guidelines for Development. World Health
Organization Regional Publications, Western Pacific Series.
1992
 Guidelines for Construction and Equipment of Hospital and
Medical Facilities. American Institute of Architects, Committee
on Architecture for Health. 1992
 De Chiara, Joseph. Time-Saver Standards for Building Types.
McGraw-Hill Book Company. 1980

1. Environment: A hospital and other health facilities shall be so

located that it is readily accessible to the community and reasonably
free from undue noise, smoke, dust, foul odor, flood, and shall not be
located adjacent to railroads, freight yards, children's playgrounds,
airports, industrial plants, disposal plants.
2. Occupancy: A building designed for other purpose shall not be
converted into a hospital. The location of a hospital shall comply
with all local zoning ordinances.
3. Safety: A hospital and other health facilities shall provide and
maintain a safe environment for patients, personnel and public. The
building shall be of such construction so that no hazards to the life
and safety of patients, personnel and public exist. It shall be capable
of withstanding weight and elements to which they may be
subjected.
3.1 Exits shall be restricted to the following types: door leading
directly outside the building, interior stair, ramp, and exterior stair.
3.2 A minimum of two (2) exits, remote from each other, shall be
provided for each floor of the building.
3.3 Exits shall terminate directly at an open space to the outside of
the building.
4. Security: A hospital and other health facilities shall ensure the
security of person and property within the facility.
5. Patient Movement: Spaces shall be wide enough for free
movement of patients, whether they are on beds, stretchers, or
wheelchairs. Circulation routes for transferring patients from one
area to another shall be available and free at all times.
5.1 Corridors for access by patient and equipment shall have a
minimum width of 2.44 meters. 5.2 Corridors in areas not
commonly used for bed, stretcher and equipment transport may be
reduced in width to 1.83 meters.
5.3 A ramp or elevator shall be provided for ancillary, clinical and
nursing areas located on the upper floor.
5.4 A ramp shall be provided as access to the entrance of the
hospital not on the same level of the site.
6. Lighting: All areas in a hospital and other health facilities shall
be provided with sufficient illumination to promote comfort, healing
and recovery of patients and to enable personnel in the performance
of work.
7. Ventilation: Adequate ventilation shall be provided to ensure
comfort of patients, personnel and public.
8. Auditory and Visual Privacy: A hospital and other health
facilities shall observe acceptable sound level and adequate visual
seclusion to achieve the acoustical and privacy requirements in
designated areas allowing the unhampered conduct of activities.
9. Water Supply: A hospital and other health facilities shall use
an approved public water supply system whenever available. The
water supply shall be potable, safe for drinking and adequate, and
shall be brought into the building free of cross connections.
10. Waste Disposal: Liquid waste shall be discharged into an
approved public sewerage system whenever available, and solid
waste shall be collected, treated and disposed of in accordance with
applicable codes, laws or ordinances.
11. Sanitation: Utilities for the maintenance of sanitary system,
including approved water supply and sewerage system, shall be
provided through the buildings and premises to ensure a clean and
healthy environment.
12. Housekeeping: A hospital and other health facilities shall
provide and maintain a healthy and aesthetic environment for
patients, personnel and public.
13. Maintenance: There shall be an effective building maintenance
program in place. The buildings and equipment shall be kept in a
state of good repair. Proper maintenance shall be provided to
prevent untimely breakdown of buildings and equipment.
14. Material Specification: Floors, walls and ceilings shall be of
sturdy materials that shall allow durability, ease of cleaning and fire
resistance.
15. Segregation: Wards shall observe segregation of sexes.
Separate toilet shall be maintained for patients and personnel, male
and female, with a ratio of one (1) toilet for every eight (8) patients
or personnel.
16. Fire Protection: There shall be measures for detecting fire such
as fire alarms in walls, peepholes in doors or smoke detectors in
ceilings. There shall be devices for quenching fire such as fire
extinguishers or fire hoses that are easily visible and accessible in
strategic areas.
17. Signage. There shall be an effective graphic system composed
of a number of individual visual aids and devices arranged to
provide information, orientation, direction, identification,
prohibition, warning and official notice considered essential to the
optimum operation of a hospital and other health facilities.
18. Parking. A hospital and other health facilities shall provide a
minimum of one (1) parking space for every twenty-five (25) beds.
19. Zoning: The different areas of a hospital shall be grouped
according to zones as follows: 19.1 Outer Zone – areas that are
immediately accessible to the public: emergency service, outpatient
service, and administrative service. They shall be located near the
entrance of the hospital.
19.2 Second Zone – areas that receive workload from the outer
zone: laboratory, pharmacy, and radiology. They shall be located
near the outer zone.
19.3 Inner Zone – areas that provide nursing care and management
of patients: nursing service. They shall be located in private areas
but accessible to guests.
19.4 Deep Zone – areas that require asepsis to perform the
prescribed services: surgical service, delivery service, nursery, and
intensive care. They shall be segregated from the public areas but
accessible to the outer, second and inner zones.
19.5 Service Zone – areas that provide support to hospital activities:
dietary service, housekeeping service, maintenance and motorpool
service, and mortuary. They shall be located in areas away from
normal traffic.
20. Function: The different areas of a hospital shall be functionally
related with each other.
20.1 The emergency service shall be located in the ground floor to
ensure immediate access. A separate entrance to the emergency
room shall be provided.
20.2 The administrative service, particularly admitting office and
business office, shall be located near the main entrance of the
hospital. Offices for hospital management can be located in private
areas.
20.3 The surgical service shall be located and arranged to prevent
non-related traffic. The operating room shall be as remote as
practicable from the entrance to provide asepsis. The dressing room
shall be located to avoid exposure to dirty areas after changing to
surgical garments. The nurse station shall be located to permit
visual observation of patient movement.
20.4 The delivery service shall be located and arranged to prevent
non-related traffic. The delivery room shall be as remote as
practicable from the entrance to provide asepsis. The dressing room
shall be located to avoid exposure to dirty areas after changing to
surgical garments. The nurse station shall be located to permit
visual observation of patient movement. The nursery shall be
separate but immediately accessible from the delivery room.
20.5 The nursing service shall be segregated from public areas. The
nurse station shall be located to permit visual observation of
patients. Nurse stations shall be provided in all inpatient units of the
hospital with a ratio of at least one (1) nurse station for every thirty-
five (35) beds. Rooms and wards shall be of sufficient size to allow
for work flow and patient movement. Toilets shall be immediately
accessible from rooms and wards.
20.6 The dietary service shall be away from morgue with at least 25-
meter distance.
21. Space: Adequate area shall be provided for the people, activity,
furniture, equipment and utility.

Space Medical Records 5.02/staff Area in Square Meters

Administrative Service

Lobby

 Waiting Area 0.65/person

 Information and Reception Area 5.02/staff

  Toilet 1.67

Business Office 5.02/staff

Office of the Chief of Hospital 5.02/staff

Laundry and Linen Area 5.02/staff

Maintenance and Housekeeping Area 5.02/staff

Parking Area for Transport Vehicle 9.29

Supply Room 5.02/staff

Waste Holding Room 4.65

Dietary

 Dietitian Area 5.02/staff

 Supply Receiving Area 4.65

 Cold and Dry Storage Area 4.65

 Food Preparation Area 4.65

 Cooking and Baking Area 4.65

 Serving and Food Assembly Area 4.65

 Washing Area 4.65

 Garbage Disposal Area 1.67

 Dining Area 1.40/person

 Toilet 1.67

 Cadaver Holding Room 7.43/bed

 Clinical Service

 Emergency Room

 Waiting Area 0.65/person

 Toilet 1.67
 Nurse Station 5.02/staff

 Examination and Treatment Area with 7.43/bed

Lavatory/Sink

 Observation Area 7.43/bed

 Equipment and Supply Storage Area 4.65

 Wheeled Stretcher Area 1.08/stretcher

 Outpatient Department

 Waiting Area 0.65/person

 Toilet 1.67

 Admitting and Records Area 5.02/staff

 Examination and Treatment Area with 7.43/bed

Lavatory/Sink

 Consultation Area 5.02/staff

 Surgical and Obstetrical Service

 Major Operating Room 33.45

 Delivery Room 33.45

 Sub-sterilizing Area 4.65

 Sterile Instrument, Supply and Storage Area 4.65

 Scrub-up Area 4.65

 Clean-up Area 4.65

 Dressing Room 2.32

 Toilet 1.67

 Nurse Station 5.02/staff

 Wheeled Stretcher Area 1.08/stretcher

 Janitor’s Closet 3.90

 Nursing Unit
  Semi-Private Room with Toilet 7.43/bed

 Patient Room 7.43/bed

 Toilet 1.67

 Isolation Room with Toilet 9.29

 Nurse Station 5.02/staff

 Treatment and Medication Area with 7.43/bed

Lavatory/Sink

 Central Sterilizing and Supply Room

 Receiving and Releasing Area 5.02/staff

 Work Area 5.02/staff

 Sterilizing Room 4.65

 Sterile Supply Storage Area 4.65

 Nursing Service

 Office of the Chief Nurse 5.02/staff

 Ancillary Service

 Primary Clinical Laboratory Clinical Work 10.00

Area with Lavatory/Sink

 Pathologist Area 5.02/staff

 Toilet 1.67

Radiology

Room with Control Booth, Dressing Area and Toilet 14.00

Dark Room 4.65

X – Ray Film File and Storage Area 4.65

Radiologist Area 5.02/staff

Pharmacy 15.00
Notes:
1. 0.65/person – Unit area per person occupying the space at one
time
2. 5.02/staff – Work area per staff that includes space for one (1)
desk and one (1) chair, space for occasional visitor, and space for
aisle
3. 1.40/person – Unit area per person occupying the space at one
time
4. 7.43/bed – Clear floor area per bed that includes space for one
(1) bed, space for occasional visitor, and space for passage of
equipment
5. 1.08/stretcher – Clear floor area per stretcher that includes
space for one (1) stretcher

Technology and its implications to 6R’s

 Re- engineering
 Restructing
 Realigning
 Resizing
 Resigning
 Revaluing
 Reconfiguration

Web Refernces:

https://www.doh.gov.ph/sites/default/files/publications/
planning_and_design_hospitals_other_facilities.pdf

https://marketrealist.com/2014/11/analyzing-hospital-expenses/
https://www.mayo.edu/research/centers-programs/robert-d-
patricia-e-kern-center-science-health-care-delivery/research-
activities/health-care-systems-engineering-program/clinical-
engineering-learning-laboratories

Organizational Management in Health Care

Neugene Rowan S. Cu
DNM Student

Introduction
By definition according to Ashford University (2020) Organizational
management is a management activity that aims to fulfill the
company's goal by handling adequately all the processes and
resources available. It is a discipline whose main objective is to plan,
organize and execute activities that achieve the company's pre-
established aspirations.
Behind every successful organization is a solid strategy that has
paved the way for its achievements. This roadmap to success is
composed of analysis, meetings, objectives, and sometimes years of
planning. However, strategic organizational management is the
driving force behind why some companies are able to achieve much
higher levels of success.
The steps and framework of an organizational management strategy
varies from business to business, but the idea behind it remains the
same. An article from the Balanced Scorecard Institute states that
strategic management is the comprehensive collection of ongoing
activities and processes that organizations use to systematically
coordinate and align resources and actions with mission, vision and
strategy throughout an organization.
Strategic management activities transform the static plan into a
system that provides performance feedback to decision making and
enables the plan to evolve and grow as requirements and other
circumstances change. Being able to plan, manage, and lead different
groups of individuals are skills that organizational management
professionals need in order to complete their jobs efficiently. In
healthcare, which is a dynamic setting, organizational management
is very much critical to maintain the integrity and functioning of the
organization. Managers need to be innovative and flexible in seeking
out solutions towards everyday problems that the healthcare
organizations are facing. From supply management to facility
improvement, organizations need to be resilient in times of
challenges in order to achieve its longevity in service.
Challenges in health care
The Top Healthcare Management Problems and Solutions according
to the Baxter Organization (2020)
1. Rising Costs in Healthcare
A 2017 survey of healthcare CEOs revealed that 57% believe one of
their top 6 concerns were spiraling costs and ways of bringing them
under control. Staff inefficiency and unwillingness to prevent
wastage was a major contributing factor to cost overruns, with the
end result being that providers often have to charge more for basic
health services while lowering their operating margins.
The lack of transparency and inefficiency in the healthcare vertical
means providers themselves don’t know what to charge patients. A
recent report in the Wall Street Journal uncovered that a hospital
was charging $50,000 for knee replacement surgery that only cost it
about $10,000.
According to the New England Journal of Medicine, only 17% of care
professionals believed their employers had ‘mature’ or ‘very mature’
levels of transparency.
Hence, it comes as no surprise that patients are skipping visits to the
doctor altogether — a recent poll revealed 44 percent of Americans
declined to consult their doctors when they were sick. Another 40
percent added they didn’t follow up on recommended treatment or
medical test due to fear of higher bills.
There are a few ways to tackle this challenge.
One is to eliminate paper records for patient files and shift to digital
mediums. This cuts out costs related to physical file storage, paper
procurement, printing, and the like.
Another cost-saving solution is to shift marketing budgets away
from traditional mediums like print and television, and instead,
channel it towards cheaper, digital mediums.
The third solution involves individual patients more than the
healthcare provider. Due to the rising costs of healthcare, it’s a good
idea to reevaluate retirement funding strategies, as well as
purchasing long-term care insurance. Some folks might also want to
evaluate the option of withdrawing money from life insurance
policies in order to cover costs.
2. Mounting Privacy Issues and Electronic Health Records
Healthcare providers and family physicians in both the United States
and Canada were federally mandated to start storing patient records
on digital mediums. As a result, 59% of hospitals use some form of
electronic records, with the number still increasing.
But these systems aren’t without their unique challenges.
“EHRs are great for gathering information into one tool, but the
workflows to manage this are sometimes confusing and
overwhelming for the staff, causing burnout,” said Matthew Ernst,
director of training at Thomas Jefferson University. “When staff get
overwhelmed and start to feel burnout, their productivity goes
down and possible patient safety issues can creep in.”
First and foremost is the cost of simply acquiring this software. EHR
software doesn’t come cheap and adds on to the escalating cost of
healthcare delivery in the first place.
Second, software acquisition is followed by training challenges as
both physicians and office staff must learn how to use it. Some
people think of EHR implementation as simply technical in nature,
but that’s downplaying the cultural element of it.
Healthcare administration has traditionally been a very paper and
process-heavy approach, so training nurses and doctors to record
information differently requires a change management approach,
too.
The third challenge is the time and resources needed to replace your
homegrown IT system.
It’s possible that you already ran operations on a rudimentary
electronic system — while it’s likely leagues behind the mandate’s
requirements for EHR, it’s still something your employees are
comfortable with.

There are a couple of solutions to these problems.

One is to hire EHR consultants that have dealt with EHR or similar
large-scale software implementation projects before — that will
assist in getting all stakeholders aligned on the budget, timelines,
and project deliverables. However, consultants entail an additional
cost but it’ll make overall implementation much smoother.
Another solution is to look towards the expertise of your board
members. It’s possible that some of them have experience in IT
systems implementations in finance, manufacturing, or other
verticals. Such individuals can steer the ship, so to speak, by giving
strategic advice and overseeing the implementation process.
Despite these problems, it’s important to note that storing health
records digitally is a long-term play. While there will be challenges
in the short-term, the long-term benefits — such as improved
patient care and patient satisfaction — far outweigh them.
3. Increasing Cybersecurity Threats
With patient records and information moving to digital platforms,
there’s a higher risk of this data attracting malicious actors. After all,
there’s a ton of personally identifiable information available on
hospital servers – a potential goldmine for cyber criminals.
According to IBM, over 100 million patient records were
compromised in 2015, making it the top sector targeted by hackers
– surpassing even the banking and financial industry. Another
report outlined that data breaches have cost healthcare providers
over $6.2 billion.
The FBI believes electronic health records sell for up to $50 each on
the black market compared to social security numbers, which only
fetch $1. Healthcare providers are a comparatively easier target
than banks and insurance companies because they don’t spend
comparable amounts on cybersecurity or invest in employee
training programs in the same vein.
Some ways to tackle the cybersecurity threat in healthcare include:
1. Building a cohesive culture around security: Employees are often
the weakest link in the chain. Cybersecurity training and education
can go a long way to show caregivers such as doctors and nurses
how they can guard against intrusion attempts and what best
practices to deploy for ironclad security.
2. Ensuring devices are up-to-date: Physicians, nurses, and
healthcare administrators routinely use personal devices and
laptops to access patient data. That in of itself entails a security risk
as said devices come under malware or phishing attempts. All
devices used to access the hospital’s network must have antivirus
systems and other protective measures.
3. Data backups: Even the best plans are liable to failure. If an attack
infiltrates your hospital’s system, it’s essential that data backups are
available and stored away from the main system to avoid
corruption. In the same vein, access to protected information should
only be on a need to know basis and shouldn’t be available to all
individuals on the hospital’s system. It’s critical for the healthcare
industry to make use of cyber security consultants to ensure that all
information is protected and that the necessary measures are in
place.

4. Spiraling Equipment Cost

Healthcare equipment is costly and drives a significant portion of
overall operational budgets. That’s why it’s important to procure
versatile and future-proof equipment, especially as you’re not going
to be able to constantly switch it around.
To make it clear, below is an example:
A case in point is integrated operating rooms.
Initially introduced in the late 90s — as video routing and
distribution capabilities became more advanced — integrated
rooms were the main buzzword in the healthcare space. As
endoscopy procedures became more popular, they had a
knockdown effect requiring more screens, images, and cameras.
Doctors needed to view images in high-quality as well as have
capabilities to record video and capture images. Hospitals were sold
on the idea and invested millions of dollars in acquiring compatible
touch panels, routers, and other machinery to assist in the
development of the integrated operating room.
However, since that decision, rapid advancements in technology has
meant even machines purchased ten years ago are completely
obsolete and hospitals haven’t seen the return on their investment.
Cameras, for example, aren’t high-definition and video recording
capabilities are limited.
New versions of integrated operating rooms, also referred to as
hybrid operating rooms, have similar cost concerns. Plus there’s an
ongoing debate on their functionality – should they be restricted to
specific surgery types like neuro or cardiac or be universal in their
approach?
Future procurement strategies for your operating room have to
carefully analyze which technologies will still be relevant in the next
ten years and what equipment you could possibly do without.
After all, costs matter – even a reduction of twenty to thirty
thousand dollars can go a long way and help bring down the cost of
surgeries itself.
Lighting is another case in point.
At one stage, with the emergence of minimally invasive surgery
(such as endoscopy), many healthcare professionals thought
surgical lights would disappear completely. That didn’t happen.
In fact, it’s mandatory to have at least one set of surgical lights in the
OR.
But the type of lighting used in operating rooms is definitely up for
debate. Surgical headlamps are increasingly a popular alternative to
expensive overhead lights which are costly to purchase and
cumbersome to maintain.
Overhead lights were a mainstay in integrated operating rooms but
there are concerns about their usefulness and utility. Do hospitals
really need this large, clunky equipment when there are smaller
alternatives available?

Plus, surgical headlamps easily last ten years or more and can be
repaired without requiring a complete shutdown of the OR. That’s
another consideration for healthcare administrators.
Replacing lights, for example, will mean installing a new mount. But
with surgical headlamps, your surgeons can strap it on when they
need to, and without any specific installation techniques.
Factors to Consider
Many things can affect the choice of an appropriate structure for an
organization, the following five factors are the most common: size,
life cycle, strategy, environment, and technology.
Organizational size
The larger an organization becomes, the more complicated its
structure. When an organization is small — such as a single retail
store, a two‐person consulting firm, or a restaurant — its structure
can be simple.
In reality, if the organization is very small, it may not even have a
formal structure. Instead of following an organizational chart or
specified job functions, individuals simply perform tasks based on
their likes, dislikes, ability, and/or need. Rules and guidelines are
not prevalent and may exist only to provide the parameters within
which organizational members can make decisions. Small
organizations are very often organic systems.
As an organization grows, however, it becomes increasingly difficult
to manage without more formal work assignments and some
delegation of authority. Therefore, large organizations develop
formal structures. Tasks are highly specialized, and detailed rules
and guidelines dictate work procedures. Interorganizational
communication flows primarily from superior to subordinate, and
hierarchical relationships serve as the foundation for authority,
responsibility, and control. The type of structure that develops will
be one that provides the organization with the ability to operate
effectively. That's one reason larger organizations are often
mechanistic—mechanistic systems are usually designed to
maximize specialization and improve efficiency.
Organization life cycle
Organizations, like humans, tend to progress through stages known
as a life cycle. Like humans, most organizations go through the
following four stages: birth, youth, midlife, and maturity. Each stage
has characteristics that have implications for the structure of the
firm.
 Birth: In the birth state, a firm is just beginning. An
organization in the birth stage does not yet have a formal
 structure. In a young organization, there is not much
delegation of authority. The founder usually “calls the shots.”
 Youth: In this phase, the organization is trying to grow. The
emphasis in this stage is on becoming larger. The company
shifts its attention from the wishes of the founder to the wishes
of the customer. The organization becomes more organic in
structure during this phase. It is during this phase that the
formal structure is designed, and some delegation of authority
occurs.
 Midlife: This phase occurs when the organization has achieved
a high level of success. An organization in midlife is larger, with
a more complex and increasingly formal structure. More levels
appear in the chain of command, and the founder may have
difficulty remaining in control. As the organization becomes
older, it may also become more mechanistic in structure.
 Maturity: Once a firm has reached the maturity phase, it tends
to become less innovative, less interested in expanding, and
more interested in maintaining itself in a stable, secure
environment. The emphasis is on improving efficiency and
profitability. However, in an attempt to improve efficiency and
profitability, the firm often tends to become less innovative.
Stale products result in sales declines and reduced
profitability. Organizations in this stage are slowly dying.
However, maturity is not an inevitable stage. Firms
experiencing the decline of maturity may institute the changes
necessary to revitalize.
Although an organization may proceed sequentially through all four
stages, it does not have to. An organization may skip a phase, or it
may cycle back to an earlier phase. An organization may even try to
change its position in the life cycle by changing its structure.
As the life‐cycle concept implies, a relationship exists between an
organization's size and age. As organizations age, they tend to get
larger; thus, the structural changes a firm experiences as it gets
larger and the changes it experiences as it progresses through the
life cycle are parallel. Therefore, the older the organization and the
larger the organization, the greater its need for more structure,
more specialization of tasks, and more rules. As a result, the older
and larger the organization becomes, the greater the likelihood that
it will move from an organic structure to a mechanistic structure.
Strategy
How an organization is going to position itself in the market in
terms of its product is considered its strategy. A company may
decide to be always the first on the market with the newest and best
product (differentiation strategy), or it may decide that it will
produce a product already on the market more efficiently and more
cost effectively (cost‐leadership strategy). Each of these strategies
requires a structure that helps the organization reach its objectives.
In other words, the structure must fit the strategy.
Companies that want to be the first on the market with the newest
and best product probably are organic, because organic structures
permit organizations to respond quickly to changes. Companies that
elect to produce the same products more efficiently and effectively
will probably be mechanistic.
Environment
The environment is the world in which the organization operates,
and includes conditions that influence the organization such as
economic, social‐cultural, legal‐political, technological, and natural
environment conditions. Environments are often described as either
stable or dynamic.
 In a stable environment, the customers' desires are well
understood and probably will remain consistent for a relatively
long time. Examples of organizations that face relatively stable
environments include manufacturers of staple items such as
detergent, cleaning supplies, and paper products.
 In a dynamic environment, the customers' desires are
continuously changing—the opposite of a stable environment.
This condition is often thought of as turbulent. In addition, the
technology that a company uses while in this environment may
need to be continuously improved and updated. An example of
an industry functioning in a dynamic environment is
electronics. Technology changes create competitive pressures
for all electronics industries, because as technology changes, so
do the desires of consumers.
In general, organizations that operate in stable external
environments find mechanistic structures to be advantageous. This
system provides a level of efficiency that enhances the long‐term
performances of organizations that enjoy relatively stable operating
environments. In contrast, organizations that operate in volatile and
frequently changing environments are more likely to find that an
organic structure provides the greatest benefits. This structure
allows the organization to respond to environment change more
proactively.
Advances in technology are the most frequent cause of change in
organizations since they generally result in greater efficiency and
lower costs for the firm. Technology is the way tasks are
accomplished using tools, equipment, techniques, and human know‐
how.
In the early 1960s, Joan Woodward found that the right combination
of structure and technology were critical to organizational success.
She conducted a study of technology and structure in more than 100
English manufacturing firms, which she classified into three
categories of core‐manufacturing technology:
 Small‐batch production is used to manufacture a variety of
custom, made‐to‐order goods. Each item is made somewhat
differently to meet a customer's specifications. A print shop is
an example of a business that uses small‐batch production.
 Mass production is used to create a large number of uniform
goods in an assembly‐line system. Workers are highly
dependent on one another, as the product passes from stage to
stage until completion. Equipment may be sophisticated, and
workers often follow detailed instructions while performing
simplified jobs. A company that bottles soda pop is an example
of an organization that utilizes mass production.
 Organizations using continuous‐process production create
goods by continuously feeding raw materials, such as liquid,
solids, and gases, through a highly automated system. Such
systems are equipment intensive, but can often be operated by
a relatively small labor force. Classic examples are automated
chemical plants and oil refineries.
Woodward discovered that small‐batch and continuous processes
had more flexible structures, and the best mass‐production
operations were more rigid structures.
Once again, organizational design depends on the type of business.
The small‐batch and continuous processes work well in organic
structures and mass production operations work best in
mechanistic structures.
8 Steps at Operational process
Provide Process Structure
The Process Structure The process structure is a horizontal
approach where instead of organizing along the product or function,
the organization is structured along the key processes. Typically, a
process refers to a set of related tasks and activities that work
together in a predetermined sequence to transform inputs into user
consumable outputs. The main challenge is to identify the core
business processes which produce product or service that is directly
consumed by the customers. A divisional structure can be
reorganized horizontally by identifying the dependencies between
different divisions or sub-divisions. Similarly, a matrix can be sliced
horizontally along the product management and inter-connected
based on interdependencies, such decomposition and realignment
results in identification of core business processes. Once the core
processes are identified, multi-skilled teams around the sub-
processes are created and each team is lead by a process owner.

The process owners have the complete responsibility for each core
process. Strengths of process structure

1. Strong Customer Orientation: The entire structure is formulated

to serve the customers; the performance of the teams can be easily
measured by the customer satisfaction and value that is created by
the process group.

2. Rapid Response: The customer focus enables the designated

process owners and team leaders to have direct relationship with its
customers; hence the employees have broader view of the product
and customer requirements. The absence of functional boundaries
and lack of deep hierarchy encourages collaboration within the core
process groups resulting in faster response to customer needs.

3. Encourages Teamwork: The fundamental entity of a process

structure is a team, not the management or individual employees. It
is the performance of the team that can be directly evaluated from
customer satisfaction; teams are rewarded for the good work and
not the individuals. Teams have the freedom to take decisions, think
creatively and plan their actions collectively.

Weakness of process structure

1. Identification of core processes: The success depends upon

correct identification of core processes; usually the managers
identify too many processes driven by their personal biases. If
the processes that are finally identified are not fundamental to
the organization, the structure gets aligned to improper
business objectives leading to ineffective reengineering.
2. Threatens middle management: Process structure involves
radical change in the roles of middle management, they have to
give up their authority and become coaches and facilitators of
team decisions. The horizontal structure by construction
requires lesser management and can only succeed if managers
take initiative to prepare the team members in the necessary
skills required to create a multi-skilled, self-managed team.
This is a self contradiction with the aspirations of
management; it implies that they have to be an instrument of
their own demise.
 3. Limited career growth: While process structure can be very
inspiring for young entrants, it also limits in-depth skill
development. Lack of either functional or managerial hierarchy
means that there is a possibility of talent saturation. After
certain duration, the individuals may find that their services
are more valuable to organization than their own self and may
perceive it as win-lose situation.

Most Effective

1. High Customer Orientation: It is best suited when the

organization’s external strategy demands customer oriented
goals in very competitive environment. The external
environment is rather uncertain and unpredictable and can be
best approached by high customer focus within the
organization.

2. Non-Routine Tasks: The organization manages tasks that are

non-routine, which require constant modifications according
to customer demands. Also there exists interdependencies
within the tasks, both factors justifies creating multi-skilled
teams.

Provide flexibility
Process flexibility is a concept used in process management which
refers to how an operation responds to outside factors, normally
changes to supply or demand. Utilizing process flexibility well
should reduce the cost of external factors which impact on a
process.
Provide resource efficiency
Resource efficiency is the maximising of the supply of money,
materials, staff, and other assets that can be drawn on by a person
or organization in order to function effectively, with minimum
wasted (natural) resource expenses.
Provide effectiveness
Process effectiveness is a measure of a process’s ability to produce
desired results or effect that can be qualitatively evaluated. It refers
to a qualitative output of some process to measure the degree of
achievement of goals or requirements associated with the given
process.
Process effectiveness serves as one of the main sources of
information for making well-founded decisions on better process
management. In particular, it allows decision makers to:

Measure process performance

Develop better management strategies and tactics.
Plan for improvements.
Conduct further process evaluations.
As a basic qualitative characteristic, process effectiveness allows
auditing for the ability to achieve desired goals and objectives. It is
used in various fields of management to determine if some process
is performed as it’s planned to be.
For instance, in business management it can be used to evaluate
effectiveness of the selling process and find out if this process
produces a desired effect, so that prospective and current buyers
wish to purchase products and services being offered.
5. Provide trust
Institutional Trust: Trust in the Organization. This is the traditional
source of trust.
However, as indicated at the start of this paper, it is also the source
of trust most in danger, as institutional trust has been on the decline
[1]. Institutional trust in the context of BPM means that there is a
flow-on effect of the (dis)trust into the institution to the (dis)trust in
a business process provided by this organization. Building
institutional trust is largely grounded in building trustworthy
processes by ways of demonstrating compliance, commitment to
security and privacy, sufficiently qualified and appropriately
incentivized employees, etc. Trust-building beyond these ‘hard’
process facts could be finding ways of how the trust in the
organization spills over to trust in the process. Well-known for this
is the capability maturity model. Here an increased organizational
maturity score is a proxy for process reliance.
The inclusion of institutional trust in a PAIS could come in the form
of proactive statements that highlight the credibility of the various
components of the organization (e.g., highlight maturity levels,
qualifications of resources involved, ethical standards, etc.).
Institutional trust may be the only form of trust for entire new
processes in which no historical process data or data for social trust
is available yet. Processes that become trusted because of
institutional forms of trust are processes that benefit from the
additional assurance that the organization can provide assets to the
process, especially as a way to mitigate vulnerability (e.g., lending
process in a retail bank). (Roseman, 2019)
6. Planning and Scheduling
Operations planning is an important part of any business. Effective
and efficient management of operations is the hallmark of a
successful company. Operations management is an old concept, but
as many of the techniques of operations management have gained
attention in the business media, the definition has become
somewhat unclear, making effective management of operations
seem more complicated than it really is.
Operations management, also called “operations planning” or
“operations scheduling,” is a term assigned to the planning of
production in all aspects, from workforce activities to product
delivery. While this type of planning is almost exclusively seen in
manufacturing environments, many of the techniques are used by
service-oriented businesses. Simple to implement, operations
management can be applied using nothing more than a spreadsheet
program.
Operations management is primarily concerned with the efficient
use of resources. While it is sometimes referred to as production
planning and employs many of the same techniques, the primary
distinguishing characteristic is that production planning is narrowly
focused on the actual production whereas operations management
looks at the operation as a whole.
How Does Operations Management Work?
Operations management has a broad focus: inventory levels must be
managed, materials ordered/stored, capacity maximized,
relationships with suppliers maintained, and the interactions within
the system monitored.
Many methods satisfy these items of focus; however, there are some
generalities involved in their processes. Each involve the
observation of the current state, analysis of the costs associated, the
establishment of performance goals, and the monitoring of efforts
toward those goals.
Primary concerns are capacity planning and production
management.
Static vs. Dynamic Scheduling
There are two main types of operation scheduling: static and
dynamic. Static scheduling carries an assumption that all steps in a
process can be defined and will not change. Dynamic scheduling
assumes that steps in the process will change so nothing is
scheduled until the demand is received. Dynamic scheduling works
well in environments where there is a high degree of customization.
An example of a static plan would be a retail clothing company. In
this case, production levels are determined up to one year in
advance. An example of a dynamic plan would be a floral shop. In
these cases, while there may be a few arrangements for display and
possible purchase, the primary focus is on creation of arrangements
after an order is received.
7. Workflow Management
Workflow management is the process of optimizing a company’s
business processes using automation. This process includes
mapping, planning and coordinating all parts of a business’
structure — from managing all points of interactions on a customer
success journey to handling day-to-day administrative tasks.

8. Transactional Process
A Transactional Process is a partially ordered sequence of activities
which is executed in a way that guarantees transactional
consistency for all activities or a subset of them. Activities can be
either transactional (e.g., they are again transactional processes or
conventional database transactions) or non-transactional (e.g.,
invocations of application services). Activities are ordered by means
of control flow and data flow dependencies.

References:

Ashford University (2020). Operations Process

Schuldt H. (2009) Transactional Processes. In: LIU L., Ö ZSU M.T.

(eds) Encyclopedia of Database Systems. Springer, Boston, MA.
https://doi.org/10.1007/978-0-387-39940-9_734

Rosemann, M.(2019): Proposals for Future BPM Research

Directions. In: Proceedings of the 2nd Asia Pacific Business Process
Management Conference (AP-BPM 2014). Eds. C. Ouyang and J.-Y.
Jung. Brisbane, 3-4 July, 1-15
Building and Facility Design

Robby B. Ylanan
DNM Student

Introduction

"A functional design can promote skill, economy, conveniences, and

comforts; a non-functional design can impede activities of all types,
detract from quality of care, and raise costs to intolerable levels." ...
Hardy and Lammers

Hospitals are the most complex of building types. Each hospital is

comprised of a wide range of services and functional units. These
include diagnostic and treatment functions, such as
clinical laboratories, imaging, emergency rooms, and surgery;
hospitality functions, such as food service and housekeeping; and
the fundamental inpatient care or bed-related function. This
diversity is reflected in the breadth and 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. No one person can reasonably have
complete knowledge, which is why specialized consultants play an
important role in hospital planning and design. The functional units
within the hospital can have competing needs and priorities.
Idealized scenarios and strongly-held individual preferences must
be balanced against mandatory requirements, actual functional
needs (internal traffic and relationship to other departments), and
the financial status of the organization.

In addition to the wide range of services that must be

accommodated, hospitals must serve and support many different
users and stakeholders. Ideally, the design process incorporates
direct input from the owner and from key hospital staff early on in
the process. The designer also has to be an advocate for the patients,
visitors, support staff, volunteers, and suppliers who do not
generally have direct input into the design. Good hospital
design integrates functional requirements with the human needs of
its varied users.

The basic form of a hospital is, ideally, based on its functions:

 bed-related inpatient functions

 outpatient-related functions
 diagnostic and treatment functions
 administrative functions
 service functions (food, supply)
 research and teaching functions
Physical relationships between these functions determine the
configuration of the hospital. Certain relationships between the
various functions are required as in the following flow diagrams.

These flow diagrams show the movement and communication of

people, materials, and waste. Thus the physical configuration of a
hospital and its transportation and logistics systems are inextricably
intertwined. The transportation systems are influenced by the
building configuration, and the configuration is heavily dependent
on the transportation systems. The hospital configuration is also
influenced by site restraints and opportunities, climate, surrounding
facilities, budget, and available technology. New alternatives are
generated by new medical needs and new technology.

In a large hospital, the form of the typical nursing unit, since it may
be repeated many times, is a principal element of the overall
configuration. Nursing units today tend to be more compact shapes
than the elongated rectangles of the past. Compact rectangles,
modified triangles, or even circles have been used in an attempt to
shorten the distance between the nurse station and the patient's
bed. The chosen solution is heavily dependent on program issues
such as organization of the nursing program, number of beds to a
nursing unit, and number of beds to a patient room.

BUILDING ATTRIBUTES
Regardless of their location, size, or budget, all hospitals should have
certain common attributes.

Efficiency And Cost-Effectiveness
An efficient hospital layout should:

 Promote staff efficiency by minimizing distance of necessary

travel between frequently used spaces
 Allow easy visual supervision of patients by limited staff
 Include all needed spaces, but no redundant ones. This
requires careful pre-design programming.
 Provide an efficient logistics system, which might include
elevators, pneumatic tubes, box conveyors, manual or
automated carts, and gravity or pneumatic chutes, for the
efficient handling of food and clean supplies and the removal of
waste, recyclables, and soiled material
 Make efficient use of space by locating support spaces so that
they may be shared by adjacent functional areas, and by
making prudent use of multi-purpose spaces
 Consolidate outpatient functions for more efficient operation
on first floor, if possible for direct access by outpatients
 Group or combine functional areas with similar system
requirements
 Provide optimal functional adjacencies, such as locating the
surgical intensive care unit adjacent to the operating suite.
These adjacencies should be based on a detailed functional
program which describes the hospital's intended operations
from the standpoint of patients, staff, and supplies.
Flexibility And Expandability
Since medical needs and modes of treatment will continue to
change, hospitals should:

 Follow modular concepts of space planning and layout

 Use generic room sizes and plans as much as possible, rather
than highly specific ones
 Be served by modular, easily accessed, and easily modified
mechanical and electrical systems
 Where size and program allow, be designed on a modular
system basis
 Being open-ended, with well planned directions for future
expansion; for instance positioning "soft spaces" such as
administrative departments, adjacent to "hard spaces" such as
clinical laboratories.

 
Cross-section showing interstitial space with deck above an
occupied floor.

Therapeutic Environment
Hospital patients are often fearful and confused and these feelings
may impede recovery. Every effort should be made to make the
hospital stay as unthreatening, comfortable, and stress-free as
possible. The interior designer plays a major role in this effort to
create a therapeutic environment. A hospital's interior design
should be based on a comprehensive understanding of the facility's
mission and its patient profile. The characteristics of the patient
profile will determine the degree to which the interior design should
address aging, loss of visual acuity, other physical and mental
disabilities, and abusiveness.

Some important aspects of creating a therapeutic interior are:

 Using familiar and culturally relevant materials wherever

consistent with sanitation and other functional needs
 Using cheerful and varied colors and textures, keeping in mind
that some colors are inappropriate and can interfere with
provider assessments of patients' pallor and skin tones,
disorient older or impaired patients, or agitate patients and
staff, particularly some psychiatric patients.
 Admitting ample natural light wherever feasible and using
color-corrected lighting in interior spaces which closely
approximates natural daylight
 Providing views of the outdoors from every patient bed, and
elsewhere wherever possible; photo murals of nature scenes
are helpful where outdoor views are not available

Designing a "way-finding" process into every project. Patients,

visitors, and staff all need to know where they are, what their
destination is, and how to get there and return. A patient's sense of
competence is encouraged by making spaces easy to find, identify,
and use without asking for help. Building elements, color, texture,
and pattern should all give cues, as well as artwork and signage

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
 Adequate and appropriately located housekeeping spaces
 Special materials, finishes, and details for spaces which are to
be kept sterile, such as integral cove base. The new
antimicrobial surfaces might be considered for appropriate
locations.

Accessibility
All areas, both inside and out, should:

 Comply with the minimum requirements of the Batas

Pambansa Bilang 344, An Act to Enhance the Mobility of
Disabled Persons by Requiring Certain Buildings, Institutions,
Establishments and Public Utilities to Install Facilities and
Other Devices.

BATAS PAMBANSA Blg. 344

An Act to Enhance the Mobility of Disabled Persons by

Requiring Certain Buildings, Institutions, Establishments,
and Public Utilities to Install Facilities and Other Devices

Section 1. In order to promote the realization of the rights of

disabled persons to participate fully in the social life and the
development of the societies in which they live and the
enjoyment of the opportunities available to other citizens, no
license or permit for the construction, repair or renovation of
public and private buildings for public use, educational
institutions, airports, sports and recreation centers and
complexes, shopping centers or establishments, public parking
places, workplaces, public utilities, shall be granted or issued
unless the owner or operator thereof shall install and
incorporate in such building, establishment, institution or
public utility, such architectural facilities or structural features
as shall reasonably enhance the mobility of disabled persons
such as sidewalks, ramps, railings and the like. If feasible, all
such existing buildings, institutions, establishments, or public
utilities may be renovated or altered to enable the disabled
persons to have access to them: Provided, however, That
buildings, institutions, establishments, or public utilities to be
constructed or established or which licenses or permits had
already been issued may comply with the requirements of this
law: Provided, further, That in case of government buildings,
streets and highways, the Ministry of Public Works and
Highways shall see to it that the same shall be provided with
architectural facilities or structural features for disabled
persons.
In the case of the parking place of any of the above institutions,
buildings, or establishments, or public utilities, the owner or
operator shall reserve sufficient and suitable space for the use
of disabled persons.

Section 2. In case of public conveyance, devices such as the

prominent awareness of the rights of the disabled and foster
understanding of their special needs. Special bus stops shall be
designed for disabled persons. Discriminating against disabled
persons in the carriage or transportation of passengers is
hereby declared unlawful.
 Section 3. The Minister of Public Works and Highways and the
Minister of Transportation and Communications; in
coordination with the National Commission Concerning
Disabled Persons, shall prepare the necessary rules and
regulations to implement the provisions of this Act.

Section 4. Any person violating any provision of this Act or of

the rules and regulations promulgated hereunder shall, upon
conviction by a court of competent jurisdiction, suffer the
penalty of imprisonment of not less than one month but not
more than one year or a fine of P2,000 to P5,000 or both, at the
discretion of the court: Provided, That in the case of
corporations, partnerships, cooperatives or associations, the
president, manager or administrator, or the person who has
charge of the construction, repair or renovation of the building,
space or utilities shall be criminally responsible for any
violation of this Act and/or rules and regulations promulgated
pursuant thereto.

Section 5. All laws, executive and administrative orders, rules

and regulations inconsistent with the foregoing provisions are
hereby repealed or amended accordingly.

Section 6. This Act shall take effect upon its approval.

Approved: February 25, 1983

 Ensuring grades are flat enough to allow easy movement and

sidewalks and corridors are wide enough for two wheelchairs
to pass easily
 Ensuring entrance areas are designed to accommodate
patients with slower adaptation rates to dark and light;
marking glass walls and doors to make their presence obvious
Controlled Circulation
A hospital is a complex system of interrelated functions requiring
constant movement of people and goods. Much of this circulation
should be controlled.

 Outpatients visiting diagnostic and treatment areas should not

travel through inpatient functional areas nor encounter
severely ill inpatients
 Typical outpatient routes should be simple and clearly defined
 Visitors should have a simple and direct route to each patient
nursing unit without penetrating other functional areas
 Separate patients and visitors from industrial/logistical areas
or floors
 Outflow of trash, recyclables, and soiled materials should be
separated from movement of food and clean supplies, and both
should be separated from routes of patients and visitors
 Transfer of cadavers to and from the morgue should be out of
the sight of patients and visitors
 Dedicated service elevators for deliveries, food and building
maintenance services

Aesthetics
Aesthetics is closely related to creating a therapeutic environment
(homelike, attractive.) It is important in enhancing the hospital's
public image and is thus an important marketing tool. A better
environment also contributes to better staff morale and patient care.
Aesthetic considerations include:

 Increased use of natural light, natural materials, and textures

 Use of artwork
 Attention to proportions, color, scale, and detail
 Bright, open, generously-scaled public spaces
 Homelike and intimate scale in patient rooms, day rooms,
consultation rooms, and offices
  Compatibility of exterior design with its physical surroundings

Security and Safety

In addition to the general safety concerns of all buildings, hospitals
have several particular security concerns:

 Protection of hospital property and assets, including drugs

 Protection of patients, including incapacitated patients, and
staff
 Safe control of violent or unstable patients
 Vulnerability to damage from terrorism because of proximity
to high-vulnerability targets, or because they may be highly
visible public buildings with an important role in the public
health system.

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 and water and produce large amounts of
waste. Because hospitals place such demands on community
resources they are natural candidates for sustainable design.

EMERGING ISSUES
Among the many new developments and trends influencing hospital
design are:

 The decreasing numbers of general practitioners along with

the increased use of emergency facilities for primary care
 The increasing introduction of highly sophisticated diagnostic
and treatment technology
 Requirements to remain operational during and after disasters
 Laws requiring earthquake resistance, both in designing new
buildings and retrofitting existing structures
  Preventative care versus sickness care; designing hospitals as
all-inclusive "wellness centers"
 Use of hand-held computers and portable diagnostic
equipment to allow more mobile, decentralized patient care,
and a general shift to computerized patient information of all
kinds. This might require computer alcoves and data ports in
corridors outside patient bedrooms. For more information, see
WBDG Integrate Technological Tools
 Need to balance increasing attention to building security with
openness to patients and visitors
 Emergence of palliative care as a specialty in many major
medical centers
 A growing interest in more holistic, patient-centered treatment
and environments. This might include providing mini-medical
libraries and computer terminals so patients can research their
conditions and treatments, and locating kitchens and dining
areas on inpatient units so family members can prepare food
for patients and families to eat together.

References:

Collins, G. (1968). Cost Analysis and Efficiency Measures for

Hospitals. Inquiry, 5(2), 50-61. Retrieved November 10, 2020, from
httpwww.jstor.orgstable41348628

https://www.doh.gov.ph/sites/default/files/publications/
planning_and_design_hospitals_other_facilities.pdf

Peters, Alexandra & Otter, Jon & Moldovan, Andreea & Parneix,
Pierre & Voss, Andreas & Pittet, Didier. (2018). Keeping hospitals
clean and safe without breaking the bank; summary of the
Healthcare Cleaning Forum 2018. Antimicrobial Resistance &
Infection Control. 7. 10.1186/s13756-018-0420-3. Retrieve from:
https://www.researchgate.net/publication/328815059_Keeping_ho
spitals_clean_and_safe_without_breaking_the_bank_summary_of_the
_Healthcare_Cleaning_Forum_2018/citation/download

Iyendo Jnr, Timothy & Uwajeh, Patrick & Ezennia, Ikenna. (2016).
The therapeutic impacts of environmental design interventions on
wellness in clinical settings: A narrative review. Complementary
Therapies in Clinical Practice. 24. 10.1016/j.ctcp.2016.06.008.
Retrieve from:
https://www.researchgate.net/publication/304746818_The_therap
eutic_impacts_of_environmental_design_interventions_on_wellness_i
n_clinical_settings_A_narrative_review/citation/download

Kendall, Stephen & Kurmel, Thomas & Dekker, Karel & Becker, John.
(2012). HEALTHCARE FACILITIES DESIGN FOR FLEXIBILITY
Healthcare Facilities Design For Flexibility: A Report On Research
For The National Institute of Building Sciences. Retrieve from:
https://www.researchgate.net/publication/292115841_HEALTHCA
RE_FACILITIES_DESIGN_FOR_FLEXIBILITY_Healthcare_Facilities_De
sign_For_Flexibility_A_Report_On_Research_For_The_National_Instit
ute_of_Building_Sciences/citation/download

Farr, Anna & Kleinschmidt, Tristan & Yarlagadda, Prasad &

Mengersen, Kerrie. (2012). Wayfinding: A simple concept, a complex
process. Transport Reviews. 32. 10.1080/01441647.2012.712555.
Retrieve from:
https://www.researchgate.net/publication/262868108_Wayfinding
_A_simple_concept_a_complex_process

https://www.lawphil.net/statutes/bataspam/bp1983/
bp_344_1983.html
https://www.asianhhm.com/facilities-operations/sustainable-
hospital-design#:~:text=The%20new%20trend%20to
%20design,quality%20and%20a%20supportive%20healing

Health Care Master Facility

Josie Q. Udan
DNM Student

Phases and Master Facility Planning

What is a facilities master plan?

A Facilities Master Plan, sometimes referred to as a Strategic Facility
Plan, is a document that describes an organization’s facilities
alongside their purpose and plans for the future. It outlines how the
facilities will be utilized in accordance with the organization’s
business plan. Generally, facilities master plans are designed to be
amended and evolved as time goes on (James Watts, 2016).

A strategic facility plan (SFP) is “a plan that sets strategic facility

goals based on the organization’s strategic (business) objectives.
The strategic facilities goals, in turn, determine short-term tactical
plans, including prioritization of, and funding for, annual facility
related projects ” (International Facility Management Association,
2009, cited in Cahnman, S.F., 2020).

SFP includes three primary components

 An understanding of the organization’s culture and core values

and an analysis of how existing and new facilities must
manifest that culture and core values within the physical space
or support their change;
 an in-depth analysis of existing facilities – including location,
capability, utilization and condition;
 and an achievable and affordable plan that translates the goals
of the business plan into an appropriate facility response
(Cahnman, S.F., 2020).

Design: Facility Master Planning 101

Cahnman, S. F. (2020), advocates that building a strong foundation

and strategic future requires mastering the basics. Hospitals and
health systems are increasingly challenged to justify facility
replacements, expansions and renovations based on sound strategic
planning and budgeting. In the past, facility projects grew from the
immediate wants and needs of departments, often tied to physician
recruitment or donor interest.

Furthermore, Cahnman, S.F. (2020), opines that many projects were

not properly vetted or prioritized considering longer term
operational and financial objectives or correct location for campus
transformation. In this age of declining health care revenues and
need for increased productivity, every dollar must be well spent and
every new or renovated square foot well planned.

The abovementioned expert shares the following best practices in facility

master planning:
(a) Futureproofing health care buildings

The evolution of multihospital health systems has further

complicated master planning. System strategies may include the
shift of outpatient care to lower cost off-site settings or
consolidation of services to certain campuses. Expansion of services
could involve leasing space, joint ventures or investment in
technology that enables care delivery in nontraditional settings,
such as telehealth.

It is important for health facilities managers, architects and

engineers to understand the fundamental process of strategic
facility master planning and how it informs future development.

When properly executed, facility master plans support the goals and
objectives of the health care provider by anticipating and preparing
for the future, extending the useful life of buildings and minimizing
disruption from unforeseen industry change. This, in turn, provides
a framework to judge and define upcoming project requests.
 (b) "Area Calculation Method for Health Care"
monograph

Once these goals are identified, the facility master plan or campus
master plan provides the physical framework, including “site-
specific integration of programmed elements, natural conditions
and constructed infrastructure and systems.” For instance, strategic
business objectives may support development of a new medical
office building on campus.

The strategic facility plan will develop the project scope, including
approximate size, departmental program and budget based on
anticipated patient volumes, service line market and operations. The
campus master plan will evaluate the site location and configuration
of the buildings, including required adjacencies and potential
physical constraints and potentials.

In the current dynamic health care climate, master plans are

typically developed every five years to capture changes in business
strategy, usually looking forward at most 10 years. As health
systems merge, a master plan may be key in assessing facilities and
determining how multiple campuses can support one new mission.
Master plans can be refreshed as often as necessary to reflect major
changes affecting the facilities.

(c ) Strategic analysis

The best master plans are based on strategic business planning and
data analyses that will affect the development of facilities. In some
cases, a business plan and market analysis are already developed
that outlines strategy. If not, this may be completed while the rest of
the facility assessment is underway.
Short- and long-term external conditions are identified affecting
health facility planning based on historical data, trends and future
growth opportunities at the facility and system level. This analysis
may be completed internally, by health care specialty consulting
firms or in-house teams at larger health care architecture practices.
It may include:

 Demographic profiles of a hospital’s service areas: primary,

secondary and tertiary that define the age, income and type of
patients served.
 Use patterns and population health demand by service line that
can forecast what services will grow or shrink in the future.
 The ambulatory services deployment strategy that looks at
where outpatient settings are most appropriately located.
 Key economic drivers by geographic market that may affect
patient population and utilization.
 Community and cultural impact, preferences and issues that
may be less tangible.
 Opportunities for growth, including increasing market share.
 Physician recruitment plans for growing service lines.
 Impact of new technologies that could optimize services.

The strategic business plan then builds a case for responding to

health care conditions. The results are patient volume projections
and a gap analysis by service line or department that will help
identify future space needs or current deficiencies.

The volume projections will later be used to develop key room

counts that generate departmental square footage benchmarks. For
instance, a business plan may identify a market demand based on
demographics for more orthopedic services that will generate a
need for more beds, or diagnostic and treatment services.
The projected patient volumes will be analyzed to create
departmental requirements and determine which other clinical
services will be affected. Space needs may encompass more beds,
operating rooms, imaging and physical therapy.

(d) Existing facility assessments

The facility assessment will inform planning by creating an

understanding of facility and campus potential and limitations.
When assessing an existing facility, the first step is to accumulate
previous documentation that can assist in understanding the
physical environment.

These may include The Joint Commission statement of conditions,

capital asset inventories, previous master plans and patient
experience surveys. Adjunct studies for infrastructure, engineering,
information technology, medical equipment, site and civil
engineering, parking, wayfinding and security assessments are also
helpful.

Ideally, departmental directors or managers complete short

questionnaires in advance offering their perspectives on any facility
deficiencies affecting clinical and functional operations, technology,
and patient and family experience.

This forms the basis of discussion when touring departments. The

departmental tours allow planners to further understand existing
conditions as well as evaluate location and adjacencies, functional
layout, technology, code compliance, infrastructure and overall
image. Some common evaluation tools to judge departments include
numerical rating systems, matrices based on topic or color
designations such as “red, yellow, green” to give a quick “poor, fair,
good” snapshot.

The result is a high-level description of each department’s attributes

and deficiencies and renders opinions on which are most in need of
renovation, growth or replacement. This is further substantiated by
benchmarking studies.

Benchmarking of data provides a measure of the health facilities’

effectiveness compared to standards or best practices. Two widely
used benchmarks are patient volume per key room and
departmental gross square feet (DGSF) per key room. Evaluating
each department’s existing square footage, there can be a
comparison of both current and future space needs based on
workload, staffing, and anticipated growth or operational
improvement.

Development of guiding principles can further help in prioritizing

facility needs through definition of goals, strategies and objectives.
These principles are written aspirations for how the facility may
improve such things as operations, clinical practice and patient
experience. They serve as a guidepost for judging the importance of
different facility proposals.

Guiding principles can be developed through discussions with high-

level administrators or through a workshop with multiple
constituents based on issues gleaned during the facility assessment.
Ultimately, the facility planner will present all the facility needs and
opportunities to a leadership group, which will then rank potential
initiatives based on these principles.
Typical guiding principles include items such as enhancing
operational efficiency, better wayfinding for patients and families,
improving safety and reduction in hospital acquired infections,
revenue enhancement and a new external image to the community.
Whenever possible, these goals should be measurable.

When the strategic facility plan is complete, there should be clear

direction and consensus on the size and scope of what physical
improvements or new construction are contemplated and order of
priorities for capital investment.

(e) Campus/facility master plan

Once priorities have been set, the next step is to convert these
strategic facility plans into actionable scenarios, creating physical
planning options. Most master plans will develop projects for the
next one to five years with long-term strategies upwards of 10
years. Options are evaluated on “guiding principles” criteria
developed between the client and consultant but also include best
adjacencies: staff, material, patient and family flow, and ease of
phasing.

The best options allow for futureproofing. High-level cost modeling

is completed to provide an order-of-magnitude comparison between
schemes. Usually, at least two but no more than five options are
developed for consideration.

Once the final option is approved, a more detailed capital need and
implementation strategy is developed. The project cost model will
include construction costs, equipment and furnishings, soft costs
and escalation based on projected phasing and may include a cash-
flow analysis. The health care organization can then use this
information to calculate their return on investment.

The final facility master plan documentation package typically

includes the following for one or more locations:

 Facility assessments define all the existing conditions at a high

level to form a basis for decisions related to the physical plant.
 Planning guidelines verbalize why and how future changes
should be developed.
 Functional plans indicate how different service lines can be
zoned within a building and their relationship to each other.
 Departmental level space programs quantify the size of each
department both existing and in the future to form the
assumptions for space planning.
 Campus and site development plans create zones for expansion
considering vehicular site access, building entries and open
space.
 The final master plan includes the recommended solution and
other reviewed options with phasing.
 Any adjunct studies, including engineering infrastructure,
security and parking, are incorporated if important to
development of the master plan.
 The cost model and phasing schedule as defined above forms
the basis for financial decisions.

Continually changing

Health care is continually changing, but today the crystal ball is even
more unclear.

Key health care trends that will affect facility planning in the next
decade will include rapid advances in technology, new models of
clinical care, greater service efficiency, patient centeredness and
family empowerment while costs increase and reimbursements
decline.

Major disruptors such as governmental policies and new outside

players from the retail sphere are hard to predict.

Facility master planning should create a framework based on key

planning goals that can allow flexibility and create value when
future configuration and growth potential is uncertain.

An ongoing process

Accordingly, the process of strategic facility planning should be

ongoing as facilities, real estate and infrastructure should be
consistently evaluated. This ensures that public sector buildings and
other real estate assets are optimized in a way that is best suited to
match the vision, and to meet the policy objectives of the sector or
organization. As such, the planning model requires a life-cycle
analysis, which includes an evaluation of total ownership cost and
life-cycle cost. This is in contrast to the relative value output of
building assets in economic terms but social externalities as well.

In Capsule
4 Steps of Facility Planning
A flexible and implementable strategic facility planning based on the
specific and unique considerations of organization needs to be
developed through a 4 step process.

4 step process of facility planning are as follows:

1. Understanding.
 2. Analyzing.

3. Planning.

4. Acting.

1. Understanding

The first step, understanding, requires a thorough knowledge of

your organization’s mission, vision, values, and goals.
Many organizations follow a balanced scorecard of 4 key
measurements: financial performance, customer knowledge;
internal business processes; and learning and growth.

The strategic plan focuses on the longer-term, big-picture needs,

and vision of the organization. Because the SFP meshes with the
strategic business plan of each unique organization, alignment is
critical for success.

Facility managers must begin the development of the SFP by

thoroughly understanding the needs of the organization.

Through existing internal analysis and business imperatives, the

work that an SFP team completes is entirely dependent upon the
organization’s specific needs and should address both strategic and
long-range planning.

Conversely, it should also address the evaluation of current facilities

and the conceptualization, planning, and implementation of new
facilities.

A thorough understanding of the current situation is necessary to

analyze the needs properly
and compare existing conditions to those needs.

Commonly, strategic plans provide a combination and range of

recommendations to maximize the value of a corporation’s assets.

The facility manager considers factors such as the organization’s

mission, vision, culture and core values; the current position of the
business and its current real estate asset base; its overall direction
and the projects currently underway within the corporation; how
the business may change; and how those changes may affect the real
estate needs of the corporation.

Once these considerations are well understood, a business-driven

approach is taken to analyze the organization’s facilities and to set
tangible goals and plan targets.

Often, organizations take a strictly cost-driven approach to their

facilities.

Although they are quick to implement and are often cost-effective,

this approach is nevertheless lacking in vision, fails to adequately
address the actual delivery of the business goods and/or services,
and has only a moderate long-term impact on improving the overall
performance of the business as a whole.

In contrast, a business-driven approach, despite necessitating a

longer timeframe, delivers a clear vision for the future, earns
employee support, and enhances performance, which strengthens
the business competitively.

Using this business-driven approach, the team studies the real

estate assets that the corporation currently holds using gathered
data, modeling tools, and scenario alternatives.

This data often includes lease and ownership data, building

assessments, square footages, space utilization standards, and
location characteristics.

To provide a comprehensive plan, the facility manager and SFP team

explore the various business goals of each unit in the business and
integrate these goals into the facility plan analyses.
This input defines future space, and real estate needs to be based on
overall corporate goals starting with anticipated services, expected
staffing changes, and potential new technologies.

The team uses these needs to predict future headcounts,

demographics, space utilization, maintenance requirements, capital
investment, and operating costs.

At this stage, a clear understanding of the goals of the SFP, as well as

the approval process and measures for success, will be complete and
have the second stage follow.

2. Analyzing

Second, exploration of the range of possible futures and triggers is

needed to analyze your organization’s facility needs using analytical
techniques — such as systematic layout planning (SLP), strengths,
weaknesses, opportunities and threats analysis (SWOT), strategic
creative analysis (SCAN), or scenario planning.

Use analytical techniques, such as SWOT analysis, SCAN, SLP, or

scenario planning, to explore the range of possible futures and the
triggers used to analyze an organization’s facility needs.

Once a clear definition of the business’ situation has been

established, the facility manager, planners, and designers begin to
consider how to balance current facility needs with long-term needs
and issues.

These needs and issues may include workforce demographics,

manufacturing processes, organizational structure and culture,
community and government regulatory requirements, market
position, and capacity rates and volumes. All of these combine to
define the individual elements of the SFP.

The comparison of the current inventory and conditions with the

future needs provides the gap that the SP will address.

Analysis Tools

Several tools may be used to compare, analyze, coordinate, and

clarify this gap and the alternatives, scenarios, and
recommendations that are made.

(a) Scenario Planning

Scenarios are tools for thinking ahead to anticipate the changes that
will impact your organization. Scenarios can be considered
instructive simulations of possible operating conditions.

This approach might be used in conjunction with other models to

ensure planners truly undertake strategic thinking. Scenario
planning may be particularly useful in identifying strategic issues
and goals.

1. Select several external forces and imagine related changes that

might influence the organization, such as the global
marketplace, technology, change in regulations, demographic
changes, etc. Scan newspapers and Internet sources for key
headlines to suggest potential changes that may affect the
organization. Utilize IFMA’s and other association’s trend
reports.
 2. For each potential change, discuss three different future
organizational scenarios (including the best case, worst case,
and all right/reasonable case), which may arise within the
organization as a result of each change. Reviewing the worst-
case scenario often provokes strong motivation for needed
changes.

3. Suggest what the organization might do, or potential strategies,

in each of the three scenarios to respond to each change.

4. Planners soon detect common considerations or strategies that

must be addressed to respond to possible external changes.

5. Select the most likely external changes to affect the

organization, over the next three to five years, for example, and
identify the most reasonable strategies the organization can
undertake to respond to these changes.

The product of this process is not a final, cut-in-stone document.

Still, it provides insight into how different decisions will affect the
organization’s return on investment, cash flow, debt load, work
processes, and productivity of its employees.

Scenarios will guide decision-makers and provide advance

consideration of the potential impacts of different facility decisions.

(b) Systematic Layout Planning (SLP)

The SLP method was developed by Muther (1973) to create

conceptual block layouts.

The method successively adds complex data categories until a block

layout has been generated, making it a strategy to the tactical tool.
 1. Document the present operation (Deliverable: flowcharts).

2. Define the activities and planning horizon (Deliverable: table).

3. Develop activity relationships (Deliverable: relationship

diagram).

4. Develop a square footage requirements spreadsheet

(Deliverable: spreadsheet).

5. Develop block plan layouts (Deliverable: block plan layout).

6. Development of an equipment layout (Deliverable: equipment

layout).

(c) SWOT Analysis

SWOT Analysis is another planning tool used to strategically

evaluate the strengths, weaknesses, opportunities, and
threats in a project or a business venture.

SWOT uses business objectives and identifies both internal and

external factors that are either favorable or unfavorable to achieving
that objective.

The four areas considered are;

 Strengths: attributes of the organization helpful to achieving

the objective and describing how they can be leveraged.

 Weaknesses: attributes of the organization harmful to

achieving the objective and how they can be minimized or
neutralized.
  Opportunities: external conditions helpful to achieving the
objective.

 Threats: external conditions harmful to achieving the

objective.

(d)Brainstorming (AGIR-a gang in a room)

This technique better ensures that various views and aspects are
represented, particularly if the individuals are chosen well. The
downside may be too much input, which may yield inconsistencies.

However, done properly, brainstorming provides an opportunity for

creative, innovative concepts that might otherwise be overlooked.

As such, it is suggested that a professional facilitator should conduct

these types of sessions.

(e)Strategic Creative Analysis (SCAN)

Strategic Creative Analysis is a process for strategic planning,

decision making, and analyzing case studies. An example of a
strategic planning technique that incorporates a SWOT analysis is
SCAN analysis.
 (f) Benchmarking

Benchmarking is a very useful SFP tool for comparing and

measuring your organization against others, anywhere in the world,
to gain information on philosophies, practices, and measures that
will help your organization take action to improve its performance.

In summary, benchmarking is the practice of being humble enough

to admit that others are better at something and being wise enough
to learn how to match and even surpass them at it.

Benchmarking utilizes much of the organizational understanding

gained in the first step of SFP to compare practices and metrics to
recognized leaders.

Networking with peer organizations, competitors, and especially for

facility organizations, visiting award-winning service organizations
provides insight to bring back and adapt to your operations.

Adaptation is the key—recognizing a good process or practice and

use it in your specific way within your organization is the essence of
successful benchmarking.

For SFP to serve as the right mechanism to analyze and improve

current facility operations, a proactive approach to benchmarking
practices and services of those organizations recognized as industry
leaders is needed.

Benchmarking may be undertaken as part of a broader

process reengineering initiative, or it might be conducted as a
freestanding exercise.
 (g) Organizational Simulation

Organizational simulation is a prominent method in organizational

studies and strategic management. This tool aims to understand
how organizations operate.

The organizational simulation can describe the coordination of

facility operations based on understanding and analyzing the impact
of interrelated facility alternatives and activities.

This method can measure organizational performance and support

strategic thinking.

3. Planning

Third, once the analysis is completed, plans for potential responses

and periodic updates to existing plans in response to changes in the
market need to be developed to meet the long-range needs of your
specific organization.

Develop plans that meet the long-range needs of the organization.

At a minimum, the SFP should be reviewed annually and further

updated periodically as conditions require.

As a result of the analyses performed, decisions will become

apparent, or recommended courses of action can be supported by
the completed analysis.

These recommendations will become the essence of the SFP.

To be organizationally mandated, most facility managers will need

to present the recommendations to senior management, obtain buy-
in (often involving some negotiation and adjustment to the plan),
and get final approval and funding for the proposed plan.

IFMA uses and recommends the balanced scorecard methodology

for integrating planning into the organization’s objectives, but
recognizes that every organization has selected methods for
business processes and facility management conforms to align with
the organization’s methodologies.

The following are major steps in setting up the plan:

 Document the primary objectives to be addressed (the gap) in

the SFP.

 Evaluate sites, zoning, costs, labor, competition, and all factors

critical for success.

 Conduct financial and risk analysis to focus on finding the

maximum value.

 Develop alternatives with recommendations and priorities.

 Develop a process for marketing the recommended SFP to gain

management approval.

 Obtain financial and other approvals needed to launch the

action phase.

It is important to note that once approved, and the SFP may

continue to evolve and adapt to changing conditions within and
outside the organization. The flexibility of a good SFP will
accommodate the minor adjustments.
4. Acting / Action

Fourth, take action as planned to implement the strategic facility

planning successfully.

Take actions as planned and implement the SFP. Feedback from

actions taken can be incorporated into the next plan and/or project
to provide continuous improvement to future SFPs.

After approval, the SFP is then ready for implementation.

Implementation of an SFP typically requires the development of a

specific project or project to deliver new, altered, or reconfigured
space to meet the organizational need. This specific project is a
unique process that is supplemental to the SFP.

Regardless of the tools used in the development of an SFP, the SFP

should be viewed as a living document that reports findings and
makes considered recommendations for implementing the plan
within a realistic time frame, yet maintains the flexibility to adapt as
business requires.

While implementation is in progress, flexibility to adapt to changed

conditions may be required.

It is prudent to view an SFP as the “current SFP” since any major

change in market conditions, economic outlook, or other forces
could require varying degrees of change to the original document.

This is another reason that scenarios are very helpful—since they

anticipate some of these potential changes. The SFP is a major
facility management tool used to support the organization—
alignment with the organizational vision, mission, goals, and
objectives are always critical for the success of the SFP.

Documentation of especially successful or problematic portions of

the SFP, if noted, can provide valuable feedback for the next
iteration of planning.

The cyclical nature of planning and continuous improvement

provides opportunities to learn from each process.

Conclusion

The cyclical nature of constant planning for the changing future and
adopting plans along the way are normal events. These changes and
updates must be managed to ensure they are achievable.

The strategic facility planning identifies the type, quantity, and

location of spaces needed by the organization. It contains two main
components, the first being an in-depth analysis of existing facilities
and the other an achievable and affordable plan to meet the
organization’s needs.

Using the organizational business plan, the differences should be

identified between the current situations and analyzed needs.

Gap analysis, a business resource assessment tool enabling an

organization to compare its actual performance with its potential
performance, is an appropriate tool to be used.

Financial analysis is also required to determine the yield on the

highest return at the lowest risk.
A proactive approach to benchmark practices and services of
leading organizations in the industry will be helpful for strategic
facility planning and serves as a mechanism to understand, analyze,
and improve the current facilities operation.

Since differences in organizational type, culture, and processes

strongly influence how strategic facility planning is accomplished,
the recommended strategic facility planning will need to be adjusted
by the different types, cultures, and processes of your specific
organization.

The purpose of the SFP plan, therefore, is to develop a flexible and

implementable plan based on the specific and unique considerations
of the individual business.
(www.iedunote.com/facility-planning)

Phases of Design

 HEALTH CARE FACILITIES PLANNING AND DESIGN

Health care facilities planning is a unique area of endeavor. The

unique character of this work comes from the fact that the patient
and family are silent users of the space represented by all the
members of the planning and design team. This responsibility to
uphold the future well-being of these patients gives the process an
added dimension.

Kim, D. (2019), states that the health facility planning and design
phases are as follows:

 Programming
 Schematic design (SD)
 Design development (DD)
 Construction documentation (CD)
 Construction administration (CA)

In order for this process to produce a good result, all

participants should be completely clear in their understanding
of the decisions to be made. This is a process of interaction and
challenge. All ideas to improve the design solution and all
relevant facts must be openly and honestly sought out,
discussed, and evaluated.

Programming Phase

Programming is the first major phase of work that the project

team undertakes. Programming has several important
purposes:

1. Input from health care facility users is gathered in this

phase. By preparing a thorough program, each
element of the department can be described in detail.
2. Communication with and guidance from the entire
team are recorded to be used and refined throughout
the process of creating the new facility.
3. Adherence to budget, criteria, and other project
parameters can be checked and controlled as space is
calculated and functional relationships recorded.
4. An orientation to the future is ensured by including
new technology considerations and avoiding reliance
on the solutions of the past.

Programs are prepared for the use of the team by health

facility architects, by consultants who specialize in this
area, or by experienced health care users.
 Regardless of the authorship source, it is imperative that
the programmer be a full member of the planning team
who stays with the work of creating the project.

The program will be refined as the project goes forward,

and continuity is important when programming decisions
are reconsidered in the light of developing design
solutions. Programs consider each space, each
department, and each system to be included.

Programs describe the following:

(1) the activity to be carried out in each space,

(2) the people to be accommodated,

(3) the technical and support equipment to be included,

(4) the furniture and furnishings to be supplied,

(5) the physical environment (and environmental

controls),

(6) critical relationships within and among spaces,

(7) the size and makeup of each department,

(8) relationships among departments, and

(9) the size and makeup of the entire project.

A thoroughly prepared program contains the following components:

 Space listings and area tabulations

 Diagrams
 Room data sheets
 Equipment and furniture
 Technical data sheets on critical equipment systems
 Written functional statements

Space listings and area tabulations are the heart of the

program. A number of forms are possible. Commonly, these
listings are organized into functional groupings, and then
quantities are added. These space listings must be established
using some mutually agreed on forecast of future workload.
This can take the form of procedures, visits, or operating room
minutes. It is essential that the need for space be directly
linked to and driven by a disciplined forecast of future activity.

The areas shown are net, i.e., exclusive of walls, doors,

structure, and sometimes cabinetry. The areas need to be
based on serious discussions among the users plus attention
paid to codes and standards that apply to the project. The areas
shown need to include full consideration to equipment and
other technology that will operate within these rooms.
Allowances for departmental gross area must be included to
provide appropriate circulation, walls, doors, cabinetry,
mechanical and electrical systems, etc. The remarks column
within the space listing spread sheet can contain cues for
designers and planners to read further or to refer to functional
diagrams included in other sections of the program document.

The inclusion of room and department diagrams increases the

usefulness of the program document. The facility planning and
design process is highly dependent on graphics, drawings, and
other visual items and is conducted largely by professionals
who use graphics to record and communicate ideas.

Department organization and critical relationships between

spaces can be illustrated simply by an adjacency matrix
diagram. This information provides critical guidance for the
design team.
Room data sheets are extremely valuable vehicles for carefully
recording information about each space. An example
demonstrates the range of facility information that can be
shown for the designers and engineers working on the project.

Space programs are concerned with describing rooms/spaces

that contain technical equipment. Equipment and furniture lists
are important to guide designers and to create a complete
picture of the project budget

If understanding a particular equipment item is critical to the

successful layout of the room or must be considered in
developing engineering systems then a technical data sheet can
be added to this part of the program document. It is unlikely
that a specific choice of equipment will be made in final form at
the programming stage of a project, but including the technical
data sheet as an example will ensure that appropriate space,
floor loading, HVAC, and other provisions are made.
Manufacturer-supplied material can be used and marked as
“Preliminary—subject to change.”

Each programmed department should be described in writing

by including a written functional statement. Department health
care staff are well equipped to supply this information, which
should include

 An overall summary of the department

 Staffing
 Hours of operation
 Workload history and forecasts
 Description of activities, procedures, etc.
 Any unique planning considerations
 Schematic Design Phase

The American Institute of Architects’ Handbook of Professional

Practice describes the schematic design phase of a project as having
the following purpose:

 Schematic Design establishes the general scope, conceptual

design, scale, and relationships among the components of the
project. The primary objective is to arrive at a clearly defined,
feasible concept and to present it in a form that achieves
understanding and acceptance. The secondary objectives are to
clarify the project program, explore the most promising
alternative design solutions, and provide a reasonable basis for
analyzing the cost of the project.
 Schematic design often begins with the creation of block
diagrams that address the overall relationships between and
among the various departments of the project. Block diagrams
are drawn to a relative scale and show each floor of the project.
Major entrances to the building are established for each type of
traffic. Circulation routes are studied on each floor to carefully
separate traffic. Vertical circulation (stairs, elevations, service
lifts, etc.) is planned.

At this very early stage of design, provisions for the communications

and data technology must be considered and included within the
block diagrams. Allowances for information technology (IT)
equipment and cabling pathways within the building must be shown
with sufficient accuracy that technology professionals can judge
their adequacy. This is not a planning element that can be added in
at a later stage of design.

Block diagrams should be drawn using a planning grid that will

reflect a structural grid system. This will facilitate planning in later
stages and avoid conflicts between desired floor plan arrangements
and the structural system.

Block diagrams will also be considered in section showing vertical

relationships from one floor to the next. The building height will be
defined in this phase, and issues of floor-to-floor height can be
decided. Departments that have high levels of engineered systems
can be located to give maximum volume in the overhead spaces,
allowing easy routing of ducted and piped systems without conflict.

Once all alternative block diagrams have been thoroughly

considered and reviewed with hospital personnel, a single direction
can be established for more detailed schematic design. Alternative
layouts for each department are studied using drawings called
bubble diagrams.

Bubble diagrams can help the team Study by showing

• Room-to-room relationships
• Circulation of staff and patients
• The basic size and shape of key spaces
• Provisions for critical support spaces
• Engineering and technology requirements

The success of the planning at this level depends in part on the

completeness of the program documents prepared in the
programming phase. Program material will guide the team as it
studies and evaluates alternative layouts. Bubble diagrams are
drawn to scale and also follow the planning grid. The selected
diagram layout will be developed in more detail as single-line
schematic drawings.

Schematic plans are often difficult to fully interpret, and so three-

dimensional (3D) sketches are quite useful in judging the success
of the plan in meeting the objectives set out in the program. Physical
models also can be employed to illustrate elements of the schematic
plan, but their usefulness is somewhat limited by the comparative
lack of detail available.

During schematic design, it is also useful to prepare documents

called outline specifications. Outline specifications describe the
various construction contract elements in words citing industry
standards, methods, and levels of quality. These documents provide
an opportunity to clearly spell out each part of the construction, and
they form an important part of the basis for estimating the cost of
the project. The program-based equipment listings can be carried
forward to be included within the outline specifications so that
adequate consideration of the cost of equipment is made a part of
the job. Further, these specifications should include clear technical
provisions for

• Special piping systems

• Special wiring/cabling systems
• Information technology support
• Communications systems
• Critical environmental controls
• Other fixed items such as casework

Schematic design documents must be submitted together for a

formal approval by all the user groups and to be accepted as the
basis for moving ahead into the next phase of design.

Design Development Phase

Design development is the project phase in which the design is

refined and coordinated among all the disciplines involved on the
team. The schematic design work carried out in the preceding phase
is brought forward, and detailed information is added. Each element
of the project is worked out at a larger scale, and changes are
incorporated as the team members see more detail and can arrive at
additional decisions.

Design development begins with plans and sections drawn at

increased scale so that users can see the functional and technical
details of each space. As information is added, each room in the
project should be assigned a unique identification number. This
allows the team to track the refinement of the design of each room.
Room data sheets prepared during programming can now be
brought forward and keyed to these unique numbers. Similarly,
equipment lists and technical data sheets are also keyed to the room
numbering system. Each room or space will then have a data file
that architects and engineers can use for design. Users will use the
data file for monitoring the progress of the design and measuring
the success of the design of each space in meeting functional and
technical needs.

Design development floor plans, contain the details that were not
shown in schematic design. These include

 Wall thickness and special wall construction, including

shielding or structural support
 Code-required construction for control of smoke spread, fire
stopping, etc.
 Doors
 Fixed elements such as plumbing fixtures, cabinetry, etc.
 Equipment placement
 Furniture placement
 Building structure and engineering spaces

Design development also should include drawings that

illustrate all wall and ceiling surfaces. Elevation drawings of
wall surfaces will illustrate the placement of electrical, piping,
communication, and data outlets to scale, giving mounting
heights above the floor and clearances for convenient use by
hospital staff. These elevation drawings also show equipment
(fixed and movable) to be attached or connected to ensure that
the equipment will function and that adequate clearance is
provided for service access.

Reflected ceiling plans are useful in controlling the design of the

ceiling plane. Each element (lighting, HVAC, fire-protection
sprinkler heads, special systems, and ceiling- mounted
equipment) can be installed and operate properly.

During design development, additional information and detail

are created. These are interior finish materials selection and
casework and workstation design.

Each space or room will have materials assigned by the design

team to be reviewed by users. One method of managing this
new information is with a finish schedule. Much of these data
can come directly from the room data sheets created during
programming. This information will now need to be updated
and refined. The finish schedule will eventually become an
important component of the construction process. The design
and placement of casework, workstations, shelving, and other
cabinetry are an important part of design development. Each
user must be satisfied that the patient care and other work
processes to be supported by these items are thoroughly
understood by the designers. Each element must be carefully
considered. Computers, displays, benchtop equipment, and
other critical elements must be drawn to scale and included in
the design. It is quite common to build full-sized mockups or
models of these workstations so that users can try out the new
design before it is built. Workstations should be tested for user
comfort, success in accommodating equipment, visual access to
patients, etc.
 There is no satisfactory substitute for a full-size mockup in
discovering and correcting flaws in the design. The same can
be said for critical full-room mockups as well. These have been
used to excellent results in developing designs of rooms that
contain critical new technology features.

Design development also addresses the full coordination of all

the design disciplines involved in producing a complete
architectural and engineering design for the project. Each
department, each space, and all physical elements of the
project are brought up to a similar level of design refinement.
All systems (HVAC, structural, site/civil) and all specialty areas
must be carefully designed and coordinated to avoid conflict.
Design development leans heavily on the work done during
programming and schematic design.

Design development documents must be published for user

and hospital approval. Prior to this approval being obtained as
notice to proceed into final working drawings, a cost estimate
based on the design development package must be prepared.
This is a critical juncture of the project effort, and the
completeness of the work done to this point will help to avoid
serious problems later in the project.

Construction Documentation Phase

(Working Drawings)

Most design issues will have been answered during the preceding
phases of work. The construction documents phase is principally
concerned with the creation of drawings and written instructions to
be used by the various building trades in constructing the project.
These documents become part of the contract between the owner
and the builder. They have important legal consequences. They must
be clear, accurate, and free from ambiguity.
The construction documents consist of three basic elements:

1.Specifications (written about in earlier sections)

2.Drawings
3. Written contract provisions

Each element makes reference to the other and must be consistent,

using similar language to mean the same in each instance. Each
element is briefly discussed here.

Specifications generally fall into two categories, namely:

Descriptive specifications use words and make reference to industry

standards to describe a method of construction or to describe a
building product/material.

Performance specifications use words and make reference to

industry standards to make clear how a part of the construction is to
perform.

Both types are used successfully in health care facility construction.

The project’s final specifications are developed from the earlier
outline specifications prepared during schematic design and design
development. Specification writing is a highly specialized endeavor
that is the responsibility of the design team and typically is carried
out by a design professional with special qualifications in this area.

In medical facility construction, it is very common to have

unresolved issues even this late in the design. An example of this is
the procurement of certain types of equipment such as medical
imaging systems that will be attached to the building but will be
supplied by a third-party vendor. Such issues will need to be dealt
with in the specifications so that the builder is fully aware that these
late decisions will be coming and that funds must be included to
accommodate the work to be done.

Certain items to be specified may be covered by proprietary

specifications. These are items where no competitive alternative
exists, and the owner is willing to state an exact make, model, or
product name to be used exclusively.

Drawings will be prepared during this phase that will become a legal
part of the contract for construction. These drawings are based on
the work of earlier phases. The intended audience is the builder and
individual trade workers, so the drawings focus on providing the
data needed to successfully construct the building. Each element to
be constructed is drawn in detail, with all dimensions and
explanatory notes shown. In the case cited earlier of a delayed
decision regarding equipment (say, for imaging), the drawings must
show how the work is to be undertaken to allow for a later decision.

Written documents called General Conditions, Special Conditions, and

Supplemental Conditions are included as important parts of the
contract. These set down the various procedures to be followed by
the contract parties in constructing the project. The American
Institute of Architects publishes a model of these documents (AIA
document A201) that is the standard of the construction industry.

Codes, Standards, and Industry Data

There are literally thousands of documents published by more

thousands of authorities that provide information, best practices,
professional criteria, and otherwise control every part of a project
from inception to completion.

Building codes have the force of law over the project. The team must
comply with the provisions of the building code applied by the
authority having jurisdiction over the project. This is usually a
building department at the municipal or state level.
 Department of Health
(Republic of the Philippines)

November 2004

GUIDELINES IN THE PLANNING AND DESIGN OF A HOSPITAL AND

OTHER HEALTH FACILITIES

A hospital and other health facilities shall be planned and designed

to observe appropriate architectural practices, to meet prescribed
functional programs, and to conform to applicable codes as part of
normal professional practice. References shall be made to the
following:

 P. D. 1096 – National Building Code of the Philippines and Its

Implementing Rules and Regulations
 P. D. 1185 – Fire Code of the Philippines and Its Implementing
Rules and Regulations
 P. D. 856 – Code on Sanitation of the Philippines and Its
Implementing Rules and Regulations
 B. P. 344 – Accessibility Law and Its Implementing Rules and
Regulations
 R. A. 1378 – National Plumbing Code of the Philippines and Its
Implementing Rules and Regulations
 R. A. 184 – Philippine Electrical Code
 Manual on Technical Guidelines for Hospitals and Health
Facilities Planning and Design. Department of Health, Manila.
1994
 Signage Systems Manual for Hospitals and Offices. Department
of Health, Manila. 1994
 Health Facilities Maintenance Manual. Department of Health,
Manila. 1995
  Manual on Hospital Waste Management. Department of Health,
Manila. 1997
 District Hospitals: Guidelines for Development. World Health
Organization Regional Publications, Western Pacific Series.
1992
 Guidelines for Construction and Equipment of Hospital and
Medical Facilities. American Institute of Architects, Committee
on Architecture for Health. 1992
 De Chiara, Joseph. Time-Saver Standards for Building Types.
McGraw-Hill Book Company. 1980

1 Environment: A hospital and other health facilities shall be so

located that it is readily accessible to the community and reasonably
free from undue noise, smoke, dust, foul odor, flood, and shall not be
located adjacent to railroads, freight yards, children's playgrounds,
airports, industrial plants, disposal plants.

2 Occupancy: A building designed for other purpose shall not be

converted into a hospital. The location of a hospital shall comply
with all local zoning ordinances.

3 Safety: A hospital and other health facilities shall provide and

maintain a safe environment for patients, personnel and public. The
building shall be of such construction so that no hazards to the life
and safety of patients, personnel and public exist. It shall be capable
of withstanding weight and elements to which they may be
subjected.

1. 3.1  Exits shall be restricted to the following types: door

leading directly outside the building, interior stair, ramp, and
exterior stair.
2. 3.2  A minimum of two (2) exits, remote from each other, shall
be provided for each floor of the building.
3.3 Exits shall terminate directly at an open space to the outside of
the building.

4. 4  Security: A hospital and other health facilities shall ensure

the security of person and property within the facility.
5. 5  Patient Movement: Spaces shall be wide enough for free
movement of patients, whether they are on beds, stretchers, or
wheelchairs. Circulation routes for transferring patients from
one area to another shall be available and free at all times.
1. 5.1  Corridors for access by patient and equipment shall
have a minimum width of 2.44 meters.
2. 5.2  Corridors in areas not commonly used for bed,
stretcher and equipment transport may be reduced in
width to 1.83 meters.
3. 5.3  A ramp or elevator shall be provided for ancillary,
clinical and nursing areas located on the upper floor.
4. 5.4  A ramp shall be provided as access to the entrance of
the hospital not on the same level of the site.
6. 6  Lighting: All areas in a hospital and other health facilities
shall be provided with sufficient illumination to promote
comfort, healing and recovery of patients and to enable
personnel in the performance of work.
7. 7  Ventilation: Adequate ventilation shall be provided to ensure
comfort of patients, personnel and public.
8. 8  Auditory and Visual Privacy: A hospital and other health
facilities shall observe acceptable sound level and adequate
visual seclusion to achieve the acoustical and privacy
requirements in designated areas allowing the unhampered
conduct of activities.
9. 9  Water Supply: A hospital and other health facilities shall use
an approved public water supply system whenever available.
The water supply shall be potable, safe for drinking and
adequate, and shall be brought into the building free of cross
connections.
10 Waste Disposal: Liquid waste shall be discharged into an
approved public sewerage system whenever available, and solid
waste shall be collected, treated and disposed of in accordance with
applicable codes, laws or ordinances.

11 Sanitation: Utilities for the maintenance of sanitary system,

including approved water supply and sewerage system, shall be
provided through the buildings and premises to ensure a clean and
healthy environment.

12. 12  Housekeeping: A hospital and other health facilities

shall provide and maintain a healthy and aesthetic
environment for patients, personnel and public.
13. 13  Maintenance: There shall be an effective building
maintenance program in place. The buildings and equipment
shall be kept in a state of good repair. Proper maintenance
shall be provided to prevent untimely breakdown of buildings
and equipment.
14. 14  Material Specification: Floors, walls and ceilings shall
be of sturdy materials that shall allow durability, ease of
cleaning and fire resistance.
15. 15  Segregation: Wards shall observe segregation of
sexes. Separate toilet shall be maintained for patients and
personnel, male and female, with a ratio of one (1) toilet for
every eight (8) patients or personnel.
16. 16  Fire Protection: There shall be measures for detecting
fire such as fire alarms in walls, peepholes in doors or smoke
detectors in ceilings. There shall be devices for quenching fire
such as fire extinguishers or fire hoses that are easily visible
and accessible in strategic areas.
17. 17  Signage. There shall be an effective graphic system
composed of a number of individual visual aids and devices
arranged to provide information, orientation, direction,
identification, prohibition, warning and official notice
 considered essential to the optimum operation of a hospital
and other health facilities.
18. 18  Parking. A hospital and other health facilities shall
provide a minimum of one (1) parking space for every twenty-
five (25) beds.
19. 19  Zoning: The different areas of a hospital shall be
grouped according to zones as follows:
1. 19.1  Outer Zone – areas that are immediately accessible
to the public: emergency service, outpatient service, and
administrative service. They shall be located near the
entrance of the hospital.
2. 19.2  Second Zone – areas that receive workload from the
outer zone: laboratory, pharmacy, and radiology. They
shall be located near the outer zone.
3. 19.3  Inner Zone – areas that provide nursing care and
management of patients: nursing service. They shall be
located in private areas but accessible to guests.
4. 19.4  Deep Zone – areas that require asepsis to perform
the prescribed services: surgical service, delivery service,
nursery, and intensive care. They shall be segregated
from the public areas but accessible to the outer, second
and inner zones.

19.5 Service Zone – areas that provide support to hospital activities:

dietary service, housekeeping service, maintenance and motorpool
service, and mortuary. They shall be located in areas away from
normal traffic.

20
Function:Thedifferentareasofahospitalshallbefunctionallyrelatedwit
heachother.

1. 20.1  The emergency service shall be located in the ground

floor to ensure immediate
 access. A separate entrance to the emergency room shall be
provided.

2. 20.2  The administrative service, particularly admitting office

and business office, shall be located near the main entrance of
the hospital. Offices for hospital management can be located in
private areas.
3. 20.3  The surgical service shall be located and arranged to
prevent non-related traffic. The operating room shall be as
remote as practicable from the entrance to provide asepsis.
The dressing room shall be located to avoid exposure to dirty
areas after changing to surgical garments. The nurse station
shall be located to permit visual observation of patient
movement.
4. 20.4  The delivery service shall be located and arranged to
prevent non-related traffic. The delivery room shall be as
remote as practicable from the entrance to provide asepsis.
The dressing room shall be located to avoid exposure to dirty
areas after changing to surgical garments. The nurse station
shall be located to permit visual observation of patient
movement. The nursery shall be separate but immediately
accessible from the delivery room.
5. 20.5  The nursing service shall be segregated from public areas.
The nurse station shall be located to permit visual observation
of patients. Nurse stations shall be provided in all inpatient
units of the hospital with a ratio of at least one (1) nurse
station for every thirty-five (35) beds. Rooms and wards shall
be of sufficient size to allow for work flow and patient
movement. Toilets shall be immediately accessible from rooms
and wards.
6. 20.6  The dietary service shall be away from morgue with at
least 25-meter distance.

21 Space: Adequate area shall be provided for the people, activity,

furniture, equipment and utility.
Space Area in Square Meters
Administrative Service

Lobby
Waiting Area 0.65/person
Information and Reception
5.02/staff
Area
Toilet 1.67
Business Office 5.02/staff
Medical Records 5.02/staff

Area in Square
Space
Meters
Office of the Chief of Hospital 5.02/staff
Laundry and Linen Area 5.02/staff
Maintenance and Housekeeping Area 5.02/staff
Parking Area for Transport Vehicle 9.29
Supply Room 5.02/staff
Waste Holding Room 4.65
Dietary
Dietitian Area 5.02/staff
Supply Receiving Area 4.65
Cold and Dry Storage Area 4.65
Food Preparation Area 4.65
Cooking and Baking Area 4.65
Serving and Food Assembly Area 4.65
Washing Area 4.65
Garbage Disposal Area 1.67
Dining Area 1.40/person
Toilet 1.67
Cadaver Holding Room 7.43/bed
Clinical Service

Emergency Room
Waiting Area 0.65/person
Toilet 1.67
Nurse Station 5.02/staff
Examination and Treatment Area with
7.43/bed
Lavatory/Sink
Observation Area 7.43/bed
Equipment and Supply Storage Area 4.65
Wheeled Stretcher Area 1.08/stretcher
Outpatient Department
Waiting Area 0.65/person
Toilet 1.67
Admitting and Records Area 5.02/staff
Examination and Treatment Area with
7.43/bed
Lavatory/Sink
Consultation Area 5.02/staff
Surgical and Obstetrical Service
Major Operating Room 33.45
Delivery Room 33.45
Sub-sterilizing Area 4.65
Sterile Instrument, Supply and Storage Area 4.65
Scrub-up Area 4.65
Clean-up Area 4.65
Dressing Room 2.32
Toilet 1.67
Nurse Station 5.02/staff
Wheeled Stretcher Area 1.08/stretcher
Janitor’s Closet 3.90

Space Area in Square Meters

Nursing Unit
Semi-Private Room with Toilet 7.43/bed
Patient Room 7.43/bed
Toilet 1.67
Isolation Room with Toilet 9.29
Nurse Station 5.02/staff
Treatment and Medication Area
7.43/bed
with Lavatory/Sink
Central Sterilizing and Supply Room
Receiving and Releasing Area 5.02/staff
Work Area 5.02/staff
Sterilizing Room 4.65
Sterile Supply Storage Area 4.65
Nursing Service
Office of the Chief Nurse 5.02/staff
Ancillary Service

Primary Clinical Laboratory

Clinical Work Area with
10.00
Lavatory/Sink
Pathologist Area 5.02/staff
Toilet 1.67
Radiology
X – Ray Room with Control Booth,
14.00
Dressing Area and Toilet
Dark Room 4.65
Film File and Storage Area 4.65
Radiologist Area 5.02/staff

Pharmacy
15.00

Notes:

1. 0.65/person–Unitareaperpersonoccupyingthespaceatonetime
2. 5.02/staff – Work area per staff that includes space for one (1)
desk and one (1) chair,

space for occasional visitor, and space for aisle

3. 1.40/person–Unitareaperpersonoccupyingthespaceatonetime
4. 7.43/bed – Clear floor area per bed that includes space for one
(1) bed, space for

occasional visitor, and space for passage of equipment

5. 1.08/stretcher–
Clearfloorareaperstretcherthatincludesspaceforone(1)stretche
r

Sustainable Hospital Design

Carbonnier, E., PhD, LEED AP BD+C Associate Principal, Vice

President of Sustainability
(2018) shares his rationale for the need of sustainable hospital
design as follows:

“The healthcare industry expends a great deal of energy operating

hospitals and treating patients using the most modern systems and
technologies. As a result, healthcare facilities have a massive carbon
footprint. According to a study published in The Lancet Planetary
Health  journal, the healthcare sector is responsible for anywhere from
3-10 percent of all carbon emissions worldwide.”

Therefore, Carbonnier, E. (2018 ), asserts that the need for hospital

design guidelines that better enable sustainability is evident. By
focusing on passive, active, and renewable design details such as
building orientation, solar shading, improved HVAC systems,
increased daylighting, and drought-resistant gardens, architects and
building planners can design hospitals that protect the environment
while continuing to improve patient wellness and recovery time,
and staff retention rates.

Moreover, Carbonnier, E. (2018), shares the following thoughts on

sustainable hospital design:

(a) Achieving Sustainability in Hospitals Can Be a Challenge

One of the greatest challenges you’ll face when implementing
sustainable features in your hospital is cost. Materials used for
sustainable design features such as heat-reflecting roofs, insulated
tinted glass, and eco atriums can be more expensive compared to
less sustainable alternatives.
THE GOOD NEWS IS THAT SUSTAINABLE DESIGN FEATURES CAN
OFFSET HIGH COSTS OVER TIME, BECAUSE REDUCED ENERGY USE
WILL ULTIMATELY DECREASE YOUR HOSPITAL’S TOTAL
OPERATIONAL COSTS.

(b) Essential Hospital Design Guidelines That Promote

Sustainability
Reducing hospital carbon emissions is challenging, but can be
achieved when you focus on passive design strategies first, active
strategies second, and renewables third to reduce energy
consumption in the most efficient way. To target sustainable
hospital design, consider the following features:
 Orientation: Healthcare facilities may have significantly large
exterior facades or envelopes, which have a direct relationship
to energy expenditure. Unprotected large facades or envelopes
facing the sun in warm climates may stress cooling needs and
have long-term energy expenditure impact. Carefully designing
a facade or envelope to match climatic preference and solar
orientation can reduce energy consumption, lower cooling
equipment sizing, and reduce stress on cooling equipment.
 Shading: Permanent horizontal overhangs, vertical fins, or
recessed windows block unwanted solar radiation and reduce
cooling demand. Seasonal strategic shading can also improve
your hospital’s energy efficiency. You can accomplish this by
planting trees around the building that block sunlight at peak
hours of the day to keep the interior of the hospital cool. You
can also site the building in a way that takes advantage of
sunlight. For example, in the morning hours, you may want
plenty of natural sunlight at the entrance to make that area
brighter, reducing the need for artificial lighting. Likewise,
patient rooms can be placed on the shadier side of the building
to keep patients more comfortable.
 Eco Atriums: Interior green spaces result in improved air
quality, improve acoustical performance, reduce energy
consumption, and create a positive biophilic healing
environment. Not only do green spaces and gardens absorb
less heat than concrete and asphalt, but also they require very
little water. Drought-tolerant, native plants used in xeriscape
design can withstand the heat and save water resources. You
can also feature sustainable eco atriums in areas that are hot
and humid. At Shunde Hospital of Southern Medical
University in Shunde, China, we designed an eco atrium made
from stacked beams that surround the building’s entrance.
These beams provide natural ventilation and dehumidify the
 air, allowing plant life to thrive. Green spaces make a hospital
feel welcoming to patients.
 Urban Cool Islands: Cool roofs reduce a facility’s carbon
footprint by reflecting sunlight rather than absorbing it.
Because roof temperatures can reach 150 degrees Fahrenheit
under the hot California sun in the summer, we used cool roofs
at the Kaiser Permanente La Habra Medical Office Building and
the Kaiser Permanente Skyport Medical Office Building.
Additionally, at the entry to the Skyport building, we used
heat-island-preventative pavement, which reflects heat in
ways similar to cool roofs. By using a reflective, permeable
pavement at the entrance and designing more green spaces
around the building, less heat is absorbed and the property
stays cooler.
When you design a hospital for sustainability, it’s important to use
the natural environment and regenerative strategies to your
advantage whenever possible. Regenerative architecture seeks to
bring into existence and replenish resources rather than exhaust
them. Regenerative design principles such as building siting for
natural shade orientation, solar shading, biophilic interiors, and grid
independence help reduce your building’s carbon footprint.
 (c)Partner With an Architect to Implement Sustainable,
Regenerative, High-Performance Hospital Design Guidelines
Architects who have experience designing sustainable hospitals
understand what is required to build energy-efficient facilities. From
awareness of the best design features to building science
considerations and knowledge of state and local requirements, a
trusted architectural firm can help you promote sustainability while
prioritizing the changes or additions that are most cost-effective and
beneficial. At HMC, we not only use energy reduction strategies in all
our recent work, we know what it’s going to take for hospitals in
California to meet the state’s ambitious zero net energy goals .
Leadership in Energy and Environment Design (LEED)

Zero Net Energy Design Strategies: Creating a New Normal

Designing a Zero Net Energy (ZNE) building, one that produces as

much energy using on-site renewables than it consumes on an
annual basis is more attainable than ever before. ZNE is getting
easier over time, as more and more energy-efficient products are
introduced, better materials and design techniques are discovered
making it easier for buildings to use less and less energy.

Useful Zero Net Energy Design Strategies

Designing a successful zero net energy building takes commitment
from the whole team, requiring a good understanding of not only the
end goal, but also how each decision can affect the project’s
outcome. While each project is unique, some design strategies that
have proven to be successful are:
 Sun, Earth, Wind & Light. The most fundamental design
inquiry is a 21st century site analysis tapping into IoT
databanks of environmental data. Combined with the latest
visual programming tools and geospatial information systems
(GIS) they can unwrap environmental tomes like never before. 
 Decarbonization Simulations. During the design phase,
energy modeling can be a helpful tool for gaining a better
understanding of how the building is projected to perform and
its impact on the environment. This allows architects to make
climate responsive decisions that attempt to decarbonize our
environment before construction even begins.
 Regional Envelope. The building envelope is the most cost-
effective measure to improve the energy efficiency and 
thermal comfort of a building. Wall mass, insulation, phase
change material, orientation, air infiltration, natural
ventilation, and solar shading are just a few passive strategies
leading to long-term building decarbonization. 
 Solar Tempering. Solar tempering optimizes the sun’s heat to
achieve maximum passive solar heating. South-facing windows
with deep eaves allow the low winter sun to heat the building’s
interior. The eaves, in conjunction with blinds, block out the
higher summertime sun, allowing it to stay cooler inside.
 Renewable Energy. Emphasizing passive strategies lowers
energy consumption and avoids over designing renewable
energy solutions. In many sun belt regions, solar panels can be
a great way to harness the sun’s natural energy and utilize it to
offset a building’s energy demand. 
 Thermal Comfort Efficiencies. From hydronic radiant walls,
floors, and ceilings to ductless heat pumps, the landscape of
indoor heating and cooling is offering highly-efficient
 alternatives to traditional forced-air systems. Combining these
solutions with automation helps control wasted energy. 
 Energy Efficient Lighting & Appliances. LED lighting has
been a game-changer for energy efficient lighting, with the
ability to change from cool to warm tones. Specifying energy
efficient appliances is also an easy way to cut down on a
building’s overall energy demand. 
 Heating Water Wisely. Once a building is operational, heating
water is a huge expense. By selecting a water heating system
that is efficient, appropriately sized, and that reduces water
use, this factor in overall energy consumption can be
minimized.
 Smart Buildings. Going virtual is the new frontier to optimize
property management. Smart buildings leverage digital twin
technology by creating a virtual twin of the actual building. The
digital twin accrues, manages and synthesizes data from
building systems to reduce operational costs, forecast
problems, seek energy efficiencies, and optimize asset
performance and user experience.
BEYOND THESE DECARBONIZATION TECHNIQUES, THERE’S
AMPLE ROOM FOR INNOVATION WHEN DESIGNING FOR ZERO NET
ENERGY.
Almost every design decision has the opportunity to reduce,
conserve, or generate energy.  
References

Cahnman, S. F. (2020). Design: Facility master planning 101.

www.hfmmagazine.com/articles/3844-facility-master-planning-
101

Carbonnier, E. (n.d.) Hospital Design Guidelines to better Enable

Sustainable Practices. www.hmcarchitects.com

Carr, R.F. (2017). Health care Facilities.www.wbdg.org

Currie, J.M. (2004). An Overview of Health Care facilities Planning.

Smithgroup, Inc. Washington, D.C. www.web.unhas.ac.id

Design and Technology: Key Steps of the Facility Planning Process

(n.d.). www.strang-inc.com

DOH (2004). Guidelines in the Planning of a Hospital and Other

health Facilities. www.doh.gov.ph/sites/default

Facility Planning: Steps, Process, Objectives, Importance.

www.iedunote.com/facility-planning

Gopee, N. (2014, 2017). Leadership and management in Health Care.

L.a., USA: Sage

Joint Commission Resources (2009). Planning, Design, and

Construction of Health Care Facilities, 2nd ed

Reiling, J. (2006). Safe Design of Health Care facilities.

Doi:10:1136/qshc.2006.019422
Rich, C., Singleton, J.K., Wadhwa, S. (2013). Sustainability for
Healthcare Management: A Leadership Imperative. 2nd ed. NY:
Routledge

US Green Building Council. (n.d.)“About LEED.

https://www.usgbc.org/ShowFile.aspx/Document ID=18694

Watts, J. (2016).How to Develop a Facilities Master Plan in 7 Simple

Steps.www.marganinti.com

What is Strategic Facility Planning (SFP)? www.servicefutures.com

WHO (2011) Public Health and Environment (PHE), Health Through

a Better Environment. www.who.int/phe/en

https://practicegreenhealth.org

https://healthierhospitals.org
Latest Trends and Issues in Health Care Facilities

Sun Jing
DNM Student

1. Hospital restructuring during pandemic.

A crisis management plan is a fundamental tool for being able to

respond effectively to an emergency like the current pandemic. This

should take into account several organizational aspects of a hospital.

In particular for the COVID-19 pandemic, the European Centre for

Disease Prevention and Control enlisted the following:

establishment of a core team and key internal and external contact

points; human, material and facility capacity; communication and

data protection; hand hygiene, personal protective devices and

waste management; triage, first contact and prioritization; patient

placement, moving of the patients in the facility, and visitor access;

environmental cleaning.
The pharmacy department was central to the coping of these ever-

changing scenarios. Among the challenges facing the pharmacy

department, the main ones involved staffing, supplying and

distributing drugs and off-label use of drugs requiring a

reformulation of the response method in a very short time.

The new COVID-19-related activities that the hospital began in

addition to ordinary practice, resulting in an extraordinary

workload.

An overall increase in the study period of the ICU and Infectious

disease beds, which were completely dedicated to COVID-19

affected patients.

A critical issue in this respect was the shortcoming in the supply of

drugs and devices.

It is essential to provide an emergency plan for exceptional

phenomena such as the pandemic to be drawn up in "peacetime".

The emergency plan must provide for continuous training, periodic

review and must involve all sectors of the hospital organization.

2. Nursing workflow and structure during pandemic.

1 Allocate shift patterns scientifically and reasonably according to

nurses’ competency

Competency refers to individuals’ knowledge, skills, abilities and

qualities; nursing competency includes core abilities required for

fulfilling one's role as a nurse. Nurses are essential in the healthcare

system and they assist as first responders, direct care providers,

information providers/educators and mental health counsellors

when disasters occur. Not surprisingly, nurses are playing an

important role in nursing care and health education during the

COVID‐19 pandemic.

It is crucial to evaluate nurses’ work ability and professional

competence (including age, years of service and expertise) for shift

and team arrangement. Work ability is defined as an individual's

ability to perform tasks and to meet the required skill and

competency levels at work. Making these evaluations in a timely

manner would allow low seniority nurses to benefit from the

support of more experienced colleagues and feel less pressure in

caring for patients, while high seniority nurses could assist in their

areas of professional expertise, where they can be most useful. This

would ultimately result in reasonably arranged shifts that optimise

the use of the nursing workforce.

2 Make use of the existing nursing workforce more efficiently and

formulate emergency plans to optimise nursing workforce

allocation and improve nursing quality

The COVID‐19 epidemic is a major public health emergency. The

virus has spread faster and wider than any other and is the most

difficult to contain. It is both a crisis and a major test for China and

worldwide. COVID‐19 is rapidly developing and highly contagious;

therefore, infected patients were gathered for treatment and

intensive care in isolation wards. Various medical institutions

responded positively to set up temporary isolation wards, and

nurses volunteered to work there. Nursing managers are faced with

great challenges because work responsibilities, workflow, work

efficiency, workforce allocation, shifts flexibility and nursing quality

should need to be improved in a short period of time to match the

current, severe situation.

2.1 Implement flexible shifts and fixed allocation to enhance work

efficiency and reduces work pressure

Flexible shifts allow to make flexible adjustments while maintaining

the basic shift structure. It is based on the hierarchical management

to allocate and utilise the existing nursing workforce reasonably,

improve work efficiency and ensure nursing quality. A study found

that unpredictable shift patterns resulted in higher fatigue levels,

compared to regular fixed shifts.Flexible shifts can guarantee that

nurses have time to rest and reduce nurses’ workload and stress,

especially during the middle‐of‐the‐day and night shifts.

6.2.2 Optimise the nursing workflow and formulate emergency plan

to carry out emergency work in an orderly manner

Importantly, the COVID‐19 outbreak has inspired nursing managers

to formulate emergency plans, establish emergency nursing teams

and carry out emergency knowledge and skills training as well as

simulation exercises for nurses, which are important measures to

respond to emergencies effectively. Moreover, it is not only

necessary to train nurses’ specialised knowledge, skills and

emergency capabilities, but also to identify training needs in first

aid, field triage, advanced basic life support and infection control.

Moreover, palliative care training is essential during the COVID‐19

pandemic. Therefore, nursing managers should optimise the

workflow and clarify work responsibilities as soon as possible

according to the epidemic situation and the characteristics of the

isolation wards. Summarising experience, formulating emergency

plans and building emergency teams should be implemented in

preparation for emergencies.

6.3 Strengthen the communication between nursing managers and

front‐line nurses to meet the needs of nurses and arrange shifts

humanely

Due to a severe shortage of nurses during the early stage of the

COVID‐19 epidemic, nursing managers could not take into account

nurses’ personal needs when scheduling shifts. The situation had

improved with the increase of volunteer nurses and the

strengthening of communication. Nurses expressed that they took

the initiative to communicate with the nursing managers if shifts

were unreasonable or they felt tired; nursing managers responded

by trying to accommodate their needs and making reasonable

schedules.
Communication between nurses and nursing managers affects

shifts’ arrangements and helps to understand nurses’ professional

perspective. Moreover, nursing managers must carefully review

current shift patterns and examine their impact on nurses’ physical

condition to guarantee nursing quality and patients safety.

Strengthening the communication between nursing managers and

front‐line nurses would allow the accommodation of nurses’ needs

while arranging shifts as humanely as possible.

6.4 Provide psychological strategies to promote nurses’ physical and

mental health

Nursing work is physically and mentally laborious. During the

COVID‐19 outbreak, nurses providing front‐line care for infected

patients in isolation wards in China are at higher risk of infection

and stress. They are work around the clock, wear protective gear

(e.g. suits, goggles, N95 masks, and gloves) that impedes drinking
water or using the restroom for four to eight hours, which easily

causes discomfort (e.g. hypoxia), wear diapers or refraining from

eating to avoid taking breaks and shave their hair to reduce the

spread of infection and to change into protective gear more quickly .

At the same time, nurses are witnessing the death of patients and

facing the risk of respiratory transmission. Therefore, it is

understandable that their bodies and minds are under great

pressure.

3. Latest trends in hospital facility design and architecture.

Embracing the employee environments

Now, healthcare providers are facing a new challenge in providing

quality healthcare, retaining top talent. Recent trends illustrate that

improved workplace environments increase staff satisfaction and

are a critical factor in a facility’s success.

As companies like Google, Abercrombie & Fitch, HubSpot, and Apple

received accolades and recognition for their updated, flexible work

environments and company culture, it was not long before clinical

teams began to expect similar advancements. To address these

changing expectations, and as part of the primary criteria when

embarking on new projects, healthcare organizations are beginning

to acknowledge and highlight their greatest asset, their people.

Additionally, staff support spaces are no longer an afterthought

when designing new infrastructure.

Dark, windowless break rooms with towering lockers and tables

crowded with mismatched chairs, or nursing rooms in converted

storage closets are no longer acceptable to prospective employees.

Workplace environments should incorporate natural light, respite

areas with comfortable furniture, coffee bars, beautiful artwork,

wellness rooms, daybeds, outdoor spaces, and more.

Increasing female leadership

Making room for new technology

The integration of technology in healthcare and its impact on

existing facilities will require institutions to consider completely

new models and spaces for healthcare delivery. This will require

institutions to be at the leading edge of new delivery models for

care, including:

Leasing space from developer-led buildings to fast-track

construction and provide greater flexibility in providing appropriate

responses to the changing healthcare landscape

Placing a heavier emphasis on incubator space for research and

development in the creation of new treatments for each individual

patient

An increased focus on data collection to anticipate future health

conditions and study overall trends

Promoting preventative medicine with a regionalized approach to

healthcare delivery through outpatient sites and tele-medicine

Personalized medicine manufacturing within the healthcare

campus

In response to the growing demand for next-generation

personalized medicine such as cellular, gene, and immune therapies,

the pharmaceutical industry has been constructing large FDA

regulated (cGMP) genomic manufacturing facilities outside dense

population centers.

While this approach initially reduces land acquisition and

construction costs, the model isolates manufacturing operations

from the patient and the life science ecosystem that fosters

discovery and collaboration. Remote facilities also require expensive

dedicated couriers, delaying the return of time-critical therapies to

patients, while increasing the risk that the product might be

damaged or lost during transport.

In 2020 and beyond, expect to realize automated personalized

medicine platforms that perform gene manipulations within, or

directly adjacent to, the point of care or academic medical research

centers. This decentralized model can scale up quickly, requires

significantly less space, and reduces the time it takes to return

manipulated cells to the patient while increasing quality assurance.

While the first generation may include hospital staff performing FDA

regulated operations, using pharmaceutical industry personnel will

enhance quality control and lessen any possible conflicts of interest

in therapy development.

Holistic approach to population health

Population health management is a holistic approach to healthcare

that considers the overall environment of an individual and their

community. Determining factors include economic stability,

neighborhood and physical environment, education, support system

(family, friends, work, religious affiliation), access to transportation,

nourishment and healthcare. Research clearly demonstrates that

60% of health is determined by social, behavioral, and

environmental factors.

These factors have dramatic impacts, such as a 10-year lifespan

difference found between residents from affluent neighborhoods

versus low-income neighborhoods. This means that the number one

determining factor of life expectancy isn’t how much you work out

or what type of food you eat, it’s your zip code.

Healthcare organizations know that patients will return to home

environments that vary from person to person. These home

environments not only affect an individual’s overall health, but the

recovery process as well.

To improve outcomes, healthcare organizations are now looking at

factors outside of the hospital setting. To evaluate and better

understand these inequities, healthcare systems are engaging with

community organizations to identify problem areas and develop a

strategic approach to managing population health.

4. Best practices of the Nursing Service in the Philippines

focusing on structural area amidst the pandemic.

Delivering community nursing services during pandemic

Teleconsultation

During the pandemic, teleconsultation has come to light as a feasible

solution for the precaution and prevention of COVID-19. It has the

potential to provide timely information with reassurance and

confidence that help is a phone call away. It increases

communication with healthcare providers while fulfilling the

requirements of social distancing. For older persons with stable

health conditions, community nurses provided teleconsultation to

assess their general wellbeing, health and self-monitoring measures,

for example, for blood pressure. The ongoing monitoring was

essential for targeted interventions and care escalation when the

medical conditions were not well-controlled and/or when the

patient had had a recent change in medication.

During teleconsultation, community nurses needed to be well-

versed with the patient's chronic condition to perform detailed

assessment through questioning of the patient and/or caregivers on

baseline conditions, disease-specific symptoms and presence of red

flags. However, this proved challenging to conduct with older

persons who have hearing impairment. Moreover, the social,

physical, environmental and non-verbal cues of older persons are

critical aspects of health assessment and management. Therefore,

teleconsultation via phone or video might not adequately replace

FTF consults when an older person is unable to describe their

conditions due to language barriers, mental/cognitive impairment

or lack of self-monitoring devices.

Home visits with essential needs

Social and fitness activities organised by government agencies for

older persons have been suspended since 11 March 2020. Older

people may experience social isolation due to lack of meaningful

activity engagement and less face time with others. Community

nurses also observed that some older persons' health deteriorated,

probably due to social isolation and deconditioning. For those who

were not contactable, screening was done at the door during a

‘surprise’ visit to ensure wellbeing and safety. It was important to

balance the need for close monitoring by social and healthcare

providers with the need for social distancing. Care escalation was

warranted for a few senior residents during home visits due to

health deterioration.

The community outpatient parenteral antibiotics therapy (CoPAT)

service continued during the pandemic. The CoPAT service provided

frail patients with limited mobility with an alternative to inpatient

hospitalisation when they required prolonged intravenous

antibiotics .
Several older people had their medical consultations postponed.

Some were reluctant to visit specialist clinics for appointments, and

some did not top up their chronic disease medications due to fear of

contracting COVID-19. Community nurses remained accessible to

ensure care continuity and constant supply of medication through

the medication delivery services to patients' residences. They

assisted older persons in medication self-management through

health coaching, medication consolidation and short-term

medication packing at home.

Moving towards the post-CB phase, the clinical outcomes of

teleconsultation and home visits will be evaluated. Nevertheless, it

was reassuring to note that none of the patients visited by SGH

community nurses during the pandemic tested positive for COVID-

19.

Virtual outreach
Community outreach and screening activities were suspended

during the CB period. A virtual ‘live’ outreach programme for older

individuals was conducted by community partners. Community

nurses were invited to deliver health talks on falls prevention in

Mandarin and a local dialect. It was well-received by the audience.

They commented that the facts and tips of falls prevention were

helpful for them at home.

Practising beyond the community

COVID-19 patients were admitted to appropriate tiered facilities,

such as hospitals, community care facilities (CCFs) and community

recovery facilities (CRFs), for medical care and support. Patients

were transferred between these facilities according to their needs

and discharged when they were well and no longer infectious.

An important knowledge gap was observed regarding proper

preventive measures against COVID-19. Compared to potential

transmission routes, the proportion of people that identified

appropriate ways to protect themselves was low, and there was also

a disconnect between preventive practices identified by

respondents and those they report to have adopted. Some

respondents reported social distancing and avoiding large crowds in

response to the virus, despite not having selected them as

preventive measures in the survey. This suggests that while public

health messaging may have been able to emphasize the importance

of adopting certain practices, the rationale behind these preventive

measures has not been well-communicated to these populations.

Alternatively, people may be practicing certain measures but are

unsure of the effectiveness of these measures for disease

prevention. With the exception of handwashing, the relatively low

proportion of people adopting preventive practices demonstrates a

need to increase or improve public health knowledge translation in

outbreak scenarios in contexts that may not have regular access to

information, as well as to explore other potential barriers to uptake

that may exist among low-income populations.

This study examined KAP on COVID-19 among households

experiencing extreme poverty in the Philippines during the earlier

stages of the pandemic. In the context of a fragile health system and

the spread of misinformation concerning COVID-19, it is important

to understand how populations that have limited access to health

services and information perceive this issue, and in particular,

appropriate responses or preventive measures. This population

showed high degree of knowledge of transmission routes, but with

the exception of handwashing, they had limited knowledge in the

identification and adoption of other preventive practices. Those who

identified a greater number of transmission modes also adopted

more preventive practices. This association between knowledge and

practices demonstrates the importance of prompt and accurate

public health communication. As many COVID-19 response

strategies employed by high-income countries are unlikely to be

feasible in LMIC settings, targeted health education and tailored

guidance for public health response must be developed with careful

consideration of extreme low-income households.