OVERVIEW "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 clinicallaboratories, 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.

Thus the physical configuration of a hospital and its transportation and logistic systems are inextricably intertwined. and the configuration is heavily dependent on the transportation systems. This requires careful pre-designprogramming. (The trend. and gravity or pneumatic chutes. box conveyors.) BUILDING ATTRIBUTES Regardless of their location. is a principal element of the overall configuration. 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. since it may be repeated many times. and waste. or budget. climate. The transportation systems are influenced by the building configuration. Provide an efficient logistics system. surrounding facilities.These flow diagrams show the movement and communication of people. but no redundant ones. or even circles have been used in an attempt to shorten the distance between the nurse station and the patient's bed. number of beds to a nursing unit. which might include elevators. size. New alternatives are generated by new medical needs and new technology. and number of beds to a patient room. modified triangles. pneumatic tubes. and soiled material    . The hospital configuration is also influenced by site restraints and opportunities. recyclables. is to all private rooms. materials. all hospitals should have certain common attributes. for the efficient handling of food and clean supplies and the removal of waste. and available technology. the form of the typical nursing unit. recently reinforced by HIPAA. Compact rectangles. In a large hospital. budget. Nursing units today tend to be more compact shapes than the elongated rectangles of the past. The chosen solution is heavily dependent on program issues such as organization of the nursing program. manual or automated carts.

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. rather than highly specific ones Be served by modular. electrical. be designed on a modular system basis. adjacent to "hard spaces" such as clinical laboratories. for instance positioning "soft spaces" such as administrative departments. such as the VA Hospital Building System.  . The VA Hospital Building System also allows vertical expansion without disruptions to floors below. designed. and supplies. For large projects. easily accessed. Be open-ended. and bid.     Flexibility and Expandability Since medical needs and modes of treatment will continue to change. if properly planned. and by making prudent use of multi-purpose spaces Consolidate outpatient functions for more efficient operation—on first floor. Make efficient use of space by locating support spaces so that they may be shared by adjacent functional areas. with no first-cost premium. with well planned directions for future expansion. This system also uses walk-through interstitial space between occupied floors for mechanical. These adjacencies should be based on a detailed functional program which describes the hospital's intended operations from the standpoint of patients. hospitals should:     Follow modular concepts of space planning and layout Use generic room sizes and plans as much as possible. this provides continuing adaptability to changing programs and needs. and plumbing distribution. staff. and easily modified mechanical and electrical systems Where size and program allow.

    . Patients. The interior designer plays a major role in this effort to create a therapeutic environment. or agitate patients and staff. photo murals of nature scenes are helpful where outdoor views are not available Designing a "way-finding" process into every project. keeping in mind that some colors are inappropriate and can interfere with provider assessments of patients' pallor and skin tones. and use without asking for help. and elsewhere wherever possible. color. and abusiveness. and pattern should all give cues. and staff all need to know where they are. 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. other physical and mental disabilities. and stress-free as possible. (See VA Interior Design Manual. 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. A patient's sense of competence is encouraged by making spaces easy to find. loss of visual acuity. identify. disorient older or impaired patients. and how to get there and return. visitors. comfortable. Building elements.) 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.Therapeutic Environment Hospital patients are often fearful and confused and these feelings may impede recovery. texture. as well as artwork and signage. Every effort should be made to make the hospital stay as unthreatening. what their destination is.

Incorporating O&M practices that stress indoor environmental quality (IEQ)    Accessibility All areas. 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. both inside and out. should:  Comply with the minimum requirements of the Americans with Disability Act (ADA) and. marking glass walls and doors to make their presence obvious    . The new antimicrobial surfaces might be considered for appropriate locations.For an in-depth view see WBDG—Therapeutic Environments. durable finishes for each functional space Careful detailing of such features as doorframes. if federally funded or owned. finishes. and finish transitions to avoid dirtcatching and hard-to-clean crevices and joints Adequate and appropriately located housekeeping spaces Special materials. Cross-section showing interstitial space with deck above an occupied floor Cleanliness and Sanitation Hospitals must be easy to clean and maintain. such as integral cove base. casework. This is facilitated by:   Appropriate. and details for spaces which are to be kept sterile. the GSA's ABA Accessibility Standards In addition to meeting minimum requirements of ADA and/or GSA's ABA Accessibility Standards.

and offices Compatibility of exterior design with its physical surroundings . and detail Bright. and textures Use of artwork Attention to proportions. food and building maintenance services       Aesthetics Aesthetics is closely related to creating a therapeutic environment (homelike.Controlled Circulation A hospital is a complex system of interrelated functions requiring constant movement of people and goods. A better environment also contributes to better staff morale and patient care.  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. generously-scaled public spaces Homelike and intimate scale in patient rooms. Much of this circulation should be controlled. day rooms. 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. attractive. color. Aesthetic considerations include:       Increased use of natural light. consultation rooms. and soiled materials should be separated from movement of food and clean supplies. scale.) It is important in enhancing the hospital's public image and is thus an important marketing tool. natural materials. open.

Because hospitals place such demands on community resources they are natural candidates for sustainable design. or because they may be highly visible public buildings with an important role in the public health system. including drugs Protection of patients. They are heavy users of energy and water and produce large amounts of waste. and staff Safe control of violent or unstable patients Vulnerability to damage from terrorism because of proximity to high-vulnerability targets. hospitals have several particular security concerns:     Protection of hospital property and assets. Also see LEED's (Leadership in Energy and Environmental Design) USGBC LEED for Healthcare Related Issues The HIPAA (Health Insurance Portability and Accessibility Act of 1996) regulations address security and privacy of "protected health information" (PHI). 310 pgs)provides additional requirements for energy conservation. as well as patient accommodations.3 MB. including incapacitated patients. Section 1. and may affect location and layout of workstations that handle medical records and other patient information. These regulations put emphasis on acoustic and visual privacy." 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  . The Energy Independence and Security Act of 2007 (EISA) (PDF 740 KB. Sustainability Hospitals are large public buildings that have a significant impact on the environment and economy of the surrounding community. 550 pgs) and Executive Order 13423requirements.2 of VA's HVAC Design Manual is a good example of health care facility energy conservation standards that meet EPAct 2005 (PDF 1. paper and electronic.Security and Safety In addition to the general safety concerns of all buildings.

decentralized patient care.       . both in designing new buildings and retrofitting existing structures Preventative care versus sickness care. patient-centered treatment and environments such as promoted by Planetree. and a general shift to computerized patient information of all kinds. for example. designing hospitals as all-inclusive "wellness centers" Use of hand-held computers and portable diagnostic equipment to allow more mobile. 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. and locating kitchens and dining areas on inpatient units so family members can prepare food for patients and families to eat together. This might include providing mini-medical libraries and computer terminals so patients can research their conditions and treatments. VA'sPhysical Security Manuals State laws requiring earthquake resistance. For more information. Requirements to remain operational during and after disasters—see. This might require computer alcoves and data ports in corridors outside patient bedrooms.

Typical Hospital Room Layout (Single Patient Room) .

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Rafael Martin G.DESIGN 7: RESEARCH AND CASE STUDY Musa. 2009121810 .

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