Tarlac State University

College of Architecture and Fine Arts

Department of Architecture

San Isidro Campus, Tarlac City

ARCHIT
ECTURA
(Space
L planning
RESEA
DESIGN
2)
5RCH Level 2
WORK Hospital
NO. 1 Submitted by:

Dumalaon, Micahelle Joy

Gando, Zedric C.

Tiglao, Reynell S.

Soliman Jr., Jesus

Ugale, Lara Mae

Submitted to:

Ar. Arlen M. Guieb

Clinical Establishment Act Standards for Hospital (Level 2)
Definition

A hospital is a clinical establishment providing patient treatment by qualified

and trained staff and equipment through Allopathic - Modern system of medicine;
where the patients are 'admitted' and stay overnight or more and they are referred
as 'inpatients'; while some patients may go to a hospital just for diagnosis,
treatment, or therapy and then leave, they are referred as 'outpatients' without
staying overnight. In a hospital, treatment by staff from AYUSH may also be
provided.

Hospitals usually have facility to admit and care for inpatients whilst the
others often clinical establishments are described as clinics or day care centers.
There are other exceptions too like Hospice etc.

The general hospital, may have multiple departments taking care of many
kinds of disease and injury, and normally has an emergency department to deal
with immediate and urgent care.

Specialized hospitals may include trauma centers, rehabilitation hospitals,

children's hospitals, Mental hospitals or, and hospitals for dealing with specific
medical needs such as psychiatric problems (psychiatric hospital) or Sanatorium,
certain disease categories such as neuro, cardiac, oncology, or orthopedic, IVF and
so forth.

Some hospitals are affiliated with universities for medical research and the
training of medical personnel such as physicians and nurses, often called teaching
hospitals. Guidelines lay down by MCI or other legal bodies shall be applicable to
such hospitals

A hospital can be situated in rural or urban setting. It can be run by Public

Sector (Central government/State government/Local government/Public Sector
undertaking/Registered Society etc.) or by Private Sector (Individual Proprietorship/
Registered Partnership/Registered Company /Co-operative Society/Trust /Charitable
etc.).

Hospital Level 2 is the clinical establishment that provides secondary

healthcare services by various health professionals such as doctors, nurses, allied
health workers, dentists, pharmacists, and pathology and imaging professionals. It
can be a general hospital providing multi-specialty services having facility for
surgery, anesthesia, and emergency management. Secondary health care is
provided by public and private health care organizations both.

These hospitals may provide following services as per the requirement of the
community viz. General Medicine, General Pediatrics, General Surgery, Obstetrics &
Gynecology, Orthopedics, Emergency Medicine, Critical Care Medicine (e.g. HDU,
ICU), ENT, Ophthalmology, Dermatology, Community Health, Palliative Medicine,
Geriatric Care, Family Medicine, Dentistry including sub specialties, Blood Storage
Centre/Blood Bank etc.

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. (The trend, recently
reinforced by HIPAA, is to all private rooms.)

"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

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, such
as the VA Hospital Building System. 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. The VA Hospital Building System also allows
vertical expansion without disruptions to floors below.
 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 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.
 Incorporating O&M practices that stress indoor environmental quality (IEQ)

Accessibility

All areas, both inside and out, should:

 Comply with the minimum requirements of the Americans with Disability Act
(ADA) and, if federally funded or owned, the GSA's ABA Accessibility
Standards
  In addition to meeting minimum requirements of ADA and/or GSA's ABA
Accessibility Standards, 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.

Abstract

Since the second half of the twentieth century to today, the architectural
design of the hospital building has undergone great changes. These are related to
the role that it plays within the city and the community, but also to the recovery of
values that are different from those of quantity and function, characterizing modern
hospitals in the first half of the twentieth century. These ‘new values’, really
recovering from the past and agreeing to a humane and humanistic vision of reality,
together with the recent technological discoveries and new ways of treatment and
care, influence the design choices in hospitals contemporaries.

The proposed research Architectural of hospital space: Changes and Design

Methods seek to define the characteristics and the architectonic qualities of the
contemporary hospital. It is care center and hub of scientific and medical knowledge
and it is also the important place for observations on the relationship between the
man and the built environment.

The study of typological and theoretical contribution, the analysis of

representative examples of recent architecture, Italian and international, give
scientific basis - to the reflections that define the variant and invariants typological
characters, (1) to explain the meaning of the changes, specifying the architectural
quality, (2) to provide the guidelines for design.

Architectural value of the hospital building

Functional aspects of a hospital building often overshadow the others that

characterize its architecture. The reason for of this “inattention” in favor of the
fictional aspects concerns the difficulty to define the quality of the architecture is
and how this can be assessed. Once, the architectural quality was synonymous with
safety and functional efficiency. Now, it is searched in the aesthetic and cultural
values. Moreover, there isn’t a scale of absolute values of quality depending on the
different "users" and aims. Specifically in hospital buildings, assessment tools and
related quality indicators are numerous. They are referred more to specific sanitary
functions than others. These appraise the hospital only as a building system and not
as architecture. As such, the hospital building has to consider the physical and
psychological needs of the person (the sick in particular). The hospital plays a
catalytic role within urban environment, carries out some positive correspondences
for the city and the citizens. It works to promote the recovery of the values of
belonging and integration with the socio-cultural context.

A Level 2 hospital shall have as minimum, all of Level l capacity, including,

but not limited to, the following:

1. An organized staff of qualified and. competent personnel with Chief of

Hospital/Medical Director and appropriate board certified Clinical Department
Heads;

2. Departmentalized and equipped with the service capabilities needed to support

board certified/eligible medical specialists and other licensed physicians rendering
services in the specialties of Medicine, Pediatrics, Obstetrics and Gynecology,
Surgery; their subspecialties and ancillary services;

3. Provision for general ICU for critically ill patients.

4. Provision for NICU (Neonatal Intensive Care Unit)

5. Provision for HRPU (High Risk Pregnancy Unit)

6. Provision for respiratory therapy services;

7. A DOH licensed tertiary clinical laboratory;

8. A DOH licensed level 2 imaging facility with mobile x-ray inside the institution and
with capability for contrast examinations.

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.

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 motor pool 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 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
Medical Records 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 Area with Lavatory/Sink 10.00
Pathologist Area 5.02/staff
Toilet 1.67
Radiology
X – Ray Room with Control Booth, Dressing Area 14.00
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 – 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
 Level 2 Hospital
Model Organizational Structure for a Level 2 Hospital
(100 to 200 Bed Capacity)

Number of
Organizational Unit Positions
Bed Capacity
100 150 200

A. Office of the Medical Center Chief 4 4 5

1. Office of the Medical Center Chief 2 2 2
2. Integrated Hospital Operations and Management 2 2 3
Program

B. Medical Service 122 161 192

1. Office of the Chief of Medical Professional Staff 2 2 2
2. Outpatient Department 9 11 12
3. Emergency Medicine Department 19 26 31
4. Clinical Departments 26 35 48
5. Special Care Areas 4 6 6
6. Department of Pathology 2 2 2
a. Blood Bank 6 8 9
b. Anatomic and Clinical Laboratory 13 18 20
7. Department of Radiology 8 11 11
8. Dental 3 3 4
9. Health Information Management 5 7 9
a. Admitting/Information 5 6 7
10. Nutrition and Dietetics 9 13 15
11. Pharmacy 7 8 10
12. Medical Social Work 4 5 6
C. Nursing 122 180 227
Service
1. Office of the Chief Nurse 4 4 4
2. Clinical Nursing Units 55 83 108
3. Operating Room 14 21 26
4. Delivery Room 11 17 21
5. Special Care Areas
a. Post Anesthesia Care Unit 7 10 11
b. Intensive Care Unit 6 9 10
c. Neonatal Intensive Care Unit (NICU) 14 21 27
d. Pulmonary/Respiratory Unit 5 7 9
6. Central Supply and Sterilization 6 8 11
D. Hospital Operations and Patient Support 44 59 69
Department
1. Office of the Administrative Officer 2 2 2
2. Human Resource Management 4 5 6
3. Procurement 4 5 5
4. Materials Management 5 6 7
5. Engineering and Facilities Management 8 13 15
a. Housekeeping/Laundry 3 5 5
6. Budget 3 3 3
7. Accounting 5 6 7
8. Cash Operations 5 7 9
9. Security To be contracted
Total Number of Positions 292 404 493

Organizational Chart
Level 2 Hospital
100, 150 and 200 Bed Capacity

Basic Structure

Office of the Medical Center

Chief

Integrated Hospital
Operations
And Management Program
(IHOMP Unit)

Medical Service Medical Service Medical Service

Medical Service

Office of the Medical Center

Chief

Medical Service

Outpatient Department Outpatient Outpatient

Emergency Medicine Anatomic and Admitting/Info

Department Clinical
Laboratory
Blood Bank Nutrition and
Clinical Departments

Department of Pharmacy
Special Care Areas

Dental Medical Social

Special Care Areas:

Intensive Care Units (ICU), Surgical Intensive Care Unit (SICU), Post-Intensive Care
Unit (PICU), Neonatal
Intensive Care Unit (NICU), etc.

Nursing Service

Office of the Medical Center

Chief

Nursing Service

Clinical Service Operating Room Delivery Room

Special Care Areas Central Supply &

Sterilization
Hospital Operations and Patient Support Service

Office of the Medical Center

Chief

Hospital Operations and

Patient Support Service

Budget
Human Resource
Management

Cash Operators
Procurement

Accounting
Materials
Management

Billing & Claims

Housekeeping,
Linen and Laundry
 CHECKLIST FOR REVIEW OF FLOOR PLANS LEVEL 2
HOSPITALS
1. PHYSICAL PLANT

1.1 Administrative Service

1.1.1 Lobby

1.1.1.1 Waiting Area

1.1.1.2 Information and Reception Area

1.1.1.3 Toilet

1.1.2 Business Office

1.1.3 Medical Records Room

1.1.4 Office of the Chief of Hospital

1.1.5 Laundry and Linen Area

1.1.6 Maintenance and Housekeeping Area

1.1.7 Parking Area for Transport Vehicle

1.1.8 Supply Room

1.1.9 Waste Holding Room

1.1.10 Dietary

1.1.10.1 Dietitian Area

1.1.10.2 Supply Receiving Area

1.1.10.3 Cold and Dry Storage Area

1.1.10.4 Food Preparation Area

1.1.10.5 Cooking and Baking Area

1.1.10.6 Serving and Food Assembly Area

1.1.10.7 Washing Area

1.1.10.8 Garbage Disposal Area

1.1.10.9 Dining Area

 1.1.10.10 Toilet

1.1.11 Cadaver Holding Room

1.2 Clinical Service

1.2.1 Emergency Room

1.2.1.1 Waiting Area

1.2.1.2 Toilet

1.2.1.3 Nurse Station

1.2.1.4 Examination and Treatment Area with Lavatory/Sink

1.2.1.5 Observation Area

1.2.1.6 Equipment and Supply Storage Area

1.2.1.7 Wheeled Stretcher Area

1.2.2 Outpatient Department

1.2.2.1 Waiting Area

1.2.2.2 Toilet

1.2.2.3 Admitting and Records Area

1.2.2.4 Examination and Treatment Area with Lavatory/Sink

1.2.2.5 Consultation Area

1.2.3 Surgical and Obstetrical Service

1.2.3.1 Major Operating Room

1.2.3.2 Delivery Room

1.2.3.3 Sub-sterilizing Area/Work Area

1.2.3.4 Sterile Instrument, Supply and Storage Area

1.2.3.5 Scrub-up Area

1.2.3.6 Clean-up Area

1.2.3.7 Dressing Room

1.2.3.8 Toilet
 1.2.3.9 Nurse Work Area

1.2.3.10 Wheeled Stretcher Area

1.2.3.11 Janitor’s Closet

1.2.4 Nursing Unit

1.2.4.1 Patient Room

1.2.4.2 Toilet

1.2.4.3 Isolation Room with Toilet

1.2.4.4 Nurse Station

1.2.4.5 Treatment and Medication Area with Lavatory/Sink

1.2.5 Central Sterilizing and Supply Room

1.2.5.1 Receiving and Releasing Area

1.2.5.2 Work Area

1.2.5.3 Sterilizing Area

1.2.5.4 Sterile Supply Storage Area

1.3 Nursing Service

1.3.1 Office of the Chief Nurse

1.4 Ancillary Service

1.4.1 Secondary Clinical Laboratory

1.4.1.1 Clinical Work Area with Lavatory/Sink

1.4.1.2 Pathologist Area

1.4.1.3 Toilet

1.4.2 Radiology – 1st Level

1.4.2.1 X – Ray Room with Control Booth, Dressing Area and

Toilet

1.4.2.2 Dark Room

1.4.2.3 Film File and Storage Area

1.4.2.4 Radiologist Area

 1.4.3 Pharmacy

2. PLANNING AND DESIGN

2.1 Floor plans properly identified and completely labeled

2.2 Conforms to applicable codes as part of normal professional

service:

2.2.1 Exits restricted to the following types: door leading directly

outside the building, interior stair, ramp, and exterior stair

2.2.2 Minimum of two (2) exits, remote from each other, for each floor
of the building

2.2.3 Corridors and ramps for ingress and egress at least 2.44 meters
in clear and unobstructed width

2.2.4 Exits terminate directly at an open space to the outside of the

building

2.2.5 Minimum of one (1) toilet on each floor accessible to the

disabled

2.3 Meets prescribed functional programs:

2.3.1 Main entrance of the hospital directly accessible from public road

2.3.2 Ramp or elevator for clinical, nursing and ancillary services

located on the upper floor

2.3.3 Administrative Service

2.3.3.1 Business office located near the main entrance of the

hospital

2.3.4 Emergency Room

2.3.4.1 Located in the ground floor to ensure easy access for

patients

2.3.4.2 Separate entrance to the emergency

2.3.4.3 Ramp for wheelchair access

2.3.4.4 Easily accessible to the clinical and ancillary services

(laboratory, radiology, pharmacy, operating room)
 2.3.4.5 Nurse station located to permit observation of patient
and control of access to entrance, waiting area, and treatment
area

2.3.5 Outpatient Department

2.3.5.1 Located near the main entrance of the hospital to ensure

easy access for patients

2.3.5.2 Separate toilets for patients and staff

2.3.6 Surgical and Obstetrical Service

2.3.6.1 Located and arranged to prevent non-related traffic

through the suite

2.3.6.2 Operating room and delivery room located as remote as

practicable from the entrance to the suite to reduce traffic and
provide greater asepsis

2.3.6.3 Operating room and delivery room arranged to prevent

staff and patients to travel from one area to the other area

2.3.6.4 Dressing room arranged to avoid exposure to dirty areas

after changing to surgical garments

2.3.6.5 Nurse station located to permit visual observation of

patient and movement into the suite

2.3.6.6 Scrub-up area recessed into an alcove or other open

space out of the main traffic

2.3.6.7 Sub-sterilizing area separate from the operating room

and accessible to the clean-up area

2.3.7 Separate toilets and rooms for male and female patients

2.3.8 Nursing Service

2.3.8.1 Nurse station located and designed to allow visual

observation of patient and movement into the nursing unit

2.3.8.2 Nurse station provided in all nursing units of the hospital

with a ratio of at least one (1) nurse station for every thirty-five
(35) beds

2.3.8.3 Toilet immediately accessible from each room in a

nursing unit
2.3.9 Dietary, maintenance and other non-patient contact services
located in areas away from normal traffic within the hospital, or located
in separate buildings within the hospital premises

2.3.9.1 The dietary service shall be away from morgue with at

least 25-meter distance.