Hospital is a place for healthcare and

recovery as well as a battlefield

against diseases.
Different from other kinds of building,
hospital has three prominent features:
First, in order to
save lives, hospital needs to operate
24 hours a day, which leads to huge
energy consumption.
Second, the hospital has a
complicated function. Its function has
always been influenced by the
evolution of medical technology and
medical model. Third, hospital
provides services to patients,
healthy people in a specific
physiological state (e.g. pregnant
women, newborns) and people for
body check. Different people have
different demands for space and
feeling of comfort.
The features mentioned above
request the design of modern hospital
to consider not only a
reasonable and sustainable medical
process, but also an energy saving
construction and a
humanized rehabilitation environment.
1. Sustainable master planning
Hospital building is a kind of
important construction which protects
people's health, so its
lifespan usually reaches a hundred
years. It means hospital building can
hopefully be used for a
very long time. However, with the
constant update of medical treatments
and equipments, it is
inevitable to reconstruct or expand
hospital building throughout its life
cycle so as to meet
demands for new space usage.
Consequently, a reasonable master
planning for construction is
essential for green hospital buildings.
Both owners and architects are
requested to take a
long-term view before phase one
construction, and need to be aware
that it is impossible to
complete a hospital at once. Analysis
on hospital status and function has to
be done according to
the national healthcare policies. On
this basis, master planning makes its
future development
possible and flexible
Hospital is a place for healthcare and recovery as well as a battlefield against diseases.
Different from other kinds of building, hospital has three prominent features: First, in order to
save lives, hospital needs to operate 24 hours a day, which leads to huge energy consumption.
Second, the hospital has a complicated function. Its function has always been influenced by the
evolution of medical technology and medical model. Third, hospital provides services to patients,
healthy people in a specific physiological state (e.g. pregnant women, newborns) and people for
body check. Different people have different demands for space and feeling of comfort.
The features mentioned above request the design of modern hospital to consider not only a
reasonable and sustainable medical process, but also an energy saving construction and a
humanized rehabilitation environment.
1. Sustainable master planning
Hospital building is a kind of important construction which protects people’s health, so its
lifespan usually reaches a hundred years. It means hospital building can hopefully be used for a
very long time. However, with the constant update of medical treatments and equipment’s, it is
inevitable to reconstruct or expand hospital building throughout its life cycle so as to meet
demands for new space usage. Consequently, a reasonable master planning for construction is
essential for green hospital buildings. Both owners and architects are requested to take a
long-term view before phase one construction, and need to be aware that it is impossible to
complete a hospital at once. Analysis on hospital status and function has to be done according to
the national healthcare policies. On this basis, master planning makes its future development
possible and flexible.
Green hospital planning has to meet
the current needs of healthcare in the
region and
consider the future development at the
same time. A reasonable
arrangement of medical
functions provides flexibility for
hospital's development.
Green hospital planning has to meet the current needs of healthcare in the region and consider the future
development at the same time. A reasonable arrangement of medical functions provides flexibility for hospital’s
development.

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.

Furthermore, all hospitals must respond over their life cycles to changing demands imposed by shifting
demographics, increasingly sophisticated medical technologies, workforce capacity and capability
issues, pressured public and private sector health budgets and changing epidemiological patterns
(Carthey et al., 2011; Olsson and Hansen 2010).

In the above context, the concept of design flexibility as a means of responding to the uncertainty is no
stranger at all to the healthcare sector. Flexibility changes the goal from optimizing designs to a set of
deterministic point forecasts to finding designs that will affect favorably the entire distribution of possible
outcomes (Cardin, 2014). Besides, an optimal design is one that inhibits change of function least, rather
than one that fits a specific function best (Healy and McKee 2002). According to Olsson and Hansen
(2010), the three aspects of flexibility are adaptability, convertibility and expandability. Adaptability can
be defined as the ability of a building to meet shifting demands without physical changes. Convertibility
can be defined as the possibility for construction and technical changes with minimum cost and
disturbance. Finally, expandability can be defined as the ability to increase (or reduce) the size of a
building. Examples of flexible design in hospital buildings can include structural foundations that allow
additional floors to be added on top of existing buildings, or areas that are built but not fitted out with
medical equipment, or functional rooms that may be refitted for medical purposes other than their
original use (De Neufville and Scholtes, 2011).

Additionally, the recent experience confirms how efficient ventilation is of paramount importance along
with determining clean and dirty routes and specifying the permissible flows of equipment, medical staff
and patients through the ward’s clean and dirty areas.

Apart from ventilation, the fundamental role of the venue’s mechanical systems is also evidenced by
the crucial need for reliable electrical infrastructure to support the function of ICU’s life-saving
ventilators and equipmentas well as the absolute requirement for an efficient network able to supply
medical gases (e.g. oxygen) to each of the beds. The medical gases system was located at a space
adjacent to the ward block to facilitate the installation of the gas circuits required to connect the oxygen
evaporators and the air compressors with the ward (BDP, 2020b).

Pwedeng intro
The COVID-19 pandemic has caused an unprecedented health and economic crisis with unpredictably
deep and multifaceted consequences, already felt around the globe. Securing the operation of health
facilities able to cope with the outbreak of such a highly contagious as well as lethal disease, has been
the top priority for many governments. Nowadays, many hospitals in some countries in the world
change their management process into better services and sustainable operational. It is in line with
vision of the society in the world to support the development of any aspects, including health.

At this moment, hospital is not only focusing on health but also becoming health services industry that
can give contribution for potential human resource, increases efficient services, uses friendly material,
lessens energy usage, and uses non-pollutant and toxic.

Green Hospital refers to a hospital that includes environment as part of quality services. It has
characteristic such as, strategic location, efficiently water usage, energy and good air pollution, using
good material and can be produced other product, keeps indoor environmental quality, provides good
food, provides green environment (green education), has orientation for green product, non-toxic
environment, green cleaning, waste reduction, and provides healing garden. The design must make
efforts to maximize the use of natural light and ventilation while considering the building orientation;
materials should be free from toxicity and be environmentally friendly; the landscape should be
strategically designed and the facilities should increase the sense of a healing environment, and water
efficient equipment should be installed.

AIMS OF DESIGN
1. Reducing energy use is a key focus for green designers, especially when considering ventilation
and lighting. Maximizing the use of natural lighting during the day can reduce energy costs and
improve the atmosphere for buildings’ users. The importance of access to natural light and the
impact this has on buildings’ users has been established, including the way it can significantly
change behaviors; e.g., use of natural lighting improves sales volume at retail outlets versus
artificial light (Heschong et al., 2002).

2. Improving water-use is achieved through various mechanisms of green design focused on efficient
water use; e.g., rainwater harvesting, use of fixtures that conserve water, waste water treatment
and recycling, green roofing, and control of storm water release. For example, harvesting rainwater
requires designs that raise the pH of collected water and the final treatment and elimination of
waste water. This reduces the burden on municipal infrastructure to supply clean water. Hospital
systems often operate for decades and therefore require well-constructed and efficient systems.

3. Integration of climatic- and site-features ensures that a green structure must not only be sustainable
itself but it must also ensure the design integrates important elements of sites’ climatic conditions.
Both location and design should encourage sustainable and healthy transport options (e.g., use of
mass transit, cycling, or walking).

4. Passive solar heating and cooling is supported by site design to select and use a site that
maximizes passive solar heating and cooling opportunities. The site must conserve natural
resources (e.g. trees and wildlife habitats) and minimize land interference and erosion.

REFERENCES
Agarwal, A, Nagi, N., Chatterjee, P., Sarkar,
S., Mourya, D., Sahay, R.R. and Bhatia, R.
(2020). Guidance for building a dedicated
health facility to contain the spread of the
2019 novel coronavirus outbreak. Indian
Journal of Medical Research, February &
March 2020, 177-183

World Health Organization (2020a). Strategic preparedness and response plan.

Carthey, J., Chow, V., Jung, Y.M., and Mills, S. (2011). Flexibility: Beyond the Buzzword—Practical
Findings from a Systematic Literature Review. Health Environments Research and Design Journal,4(4),
89-108.

Benefits of biophilic design in hospital settings

Extensive scientific research in various settings have confirmed the favorable impacts on human health
and performance in response to biophilic design of the built environment: healthcare facilities,
workplaces, children’s spaces, community spaces, etc. When it comes to healthcare buildings, thinking
about biophilic design concepts is particularly interesting. This is due not only to the high number of
critical and stress factors for patients, their families, and healthcare workers in hospitals, but also
because the hospital and the city are two independent but interconnected systems that are visited and
utilized by the same people. This relationship is characterized by a certain exceptionality that is
precisely due to the isolation of the hospital structure, which is essential to enable the medical practice.

In particular, when it comes to biophilic design, it is possible to convey or promote different types of
experiences within hospital spaces. According to Browning et al. the 14 biophilic design patterns can be
organized into three categories to illustrate the enhancement of user experience and its biological
responses, and potential impacts in different care levels: nature in the space, natural analogues and
nature of the space. First, the direct experience of nature (nature in the space) that refers to real
contact with nature in the built environment, such as the presence of natural light (positively impacted
circadian system functioning, Figueiro et al. 2011; Beckett and Roden 2009), thermal and airflow
variability (positively impacted comfort and well-being, Heerwagen 2006; Tam and Willem 2005;

Moreover, extensive research that is supported by rigorous empirical data has shown that the beneficial
effects of biophilic design are not only found through architectural solutions that encourage direct
contact with the external natural environment, but are also obtainable by inserting green or elements of
biophilic design within the interior spaces. Such interventions, especially if integrated, allow patients to
better manage their emotions, fears and anxieties related to disease. Positive effects have also been
verified from the physical standpoint.

DESIGNING FOR SOCIAL DISTANCING

CATEGORY WHAT HAS CHANGED WHAT IT MEANS

ROUTE PLANNING The extra spacing requires for One-way movement should be
 safe distancing severely limits consider in most situations and
door-traffic capacity and incorporate partitions to
requires rethinking ways to facilitate safer routes within the
measure one-way flow. The building
design must minimize instances
of people crossing in front of
each other.
RISK CIRCULATION Focus on “life safety”
specifically fire protection and
evacuation, expands to Covid
19 infection and transmission.
SPEED AND FLOW Although assumptions about It takes longer for people to
walking speeds with or will enter, exit, and move around
likely stay the same, enforced buildings and built
extra spacing between people environments.
will result in lower traffic-flow
rates.

DESIGN PARAMETER
The first step in designing for social distancing is to define the relevant parameters that describe the
environment. The building blocks of designing for social distancing are:
 LEVEL OF SOCIAL DISTANCE IN PLACE. Recommended social distance varies based on the
type of infectious agent and the local jurisdiction.
 RELATIVE OCCUPANT DENSITY. The number of people allowed to occupy a particular space
will vary based on how they occupy that space: Standing, sitting, walking, or queuing.
 TRAFFIC FLOW RATE. The speed at which people are able to move in aggregate.
 TRAFFIC SPEED. How quickly people move. This varies based on activity, environment, and
other factors.
 DIRECTION. The direction in which people typically move: One direction, Two Direction, or
Bidirectionally.

FACTORS THAT INFLUENCE THOSE PARAMETERS INCLUDE:

 OCCUPANCY ACTIVITY AND BEHAVIOR. The activities that occupants are performing and
the way occupants behave have a significant impact on design parameters.
 SOCIAL DISTANCE THRESHOLD. Recommended social distance is defined by the local
authority that has jurisdiction over the building. In the case of Covid 19, the general distance
recommendation is 2 meters, or 6 feet, but different transmission pattern and severities may
require different threshold.
 SPATIAL CONFIGURATION. This can include attributes such as walkways, furnitures,
partitions and so on.

SPACE PER PERSON

The function of a hospital is more than a body treatment

The built environments, planning, and the type of wards or other spaces have been changed in
healthcare facilities over time, but the spatial quality and characteristics in these facilities are given the
slightest preference and priority.

The aim of this concept is to established a design concerning human-nature relationships. To increase
the connection to nature and enhance places of wellbeing within healthcare environments.

Research on changing the healthcare and its environment toward more comfort of the user connected
with natural aspects provides an opportunity to identify the missing elements in prevailing system.
Toward the changing intellectual process of communities about feeling a lack of linkage with nature and
naturalness more than before and demanding a patient-oriented and holistic environment.
Newborn Intensive Care Units
Each newborn intensive care unit (NICU) shall
include or comply with the following:
i. The NICU shall have a clearly identified entrance and reception area for families. The area
shall permit visual observation and contact with all traffic entering the unit.
ii. In a multiple-bed room, every bed position shall be within 20 feet (6 meters) of a hands-free
handwashing station. Where an individual room concept is used, a hands-free handwashing station
shall be provided within each infant care room. All sinks shall be hands-free operable and large enough
to contain splashing.
iii. At least one door to each room in the unit
must be large enough to accommodate
portable
X-ray equipment. A door 44 inches (1117.6
millimeters) wide should accommodate most X-
ray
equipment. Both width and height must be
considered.
iv. There should be efficient and controlled
access to the unit from the labor and
delivery area,
the emergency department, or other referral entry
points.
v. When viewing windows are provided,
provision shall be made to control casual
viewing of
infants.