Research Tertiary Hospital

LA CONSOLACION COLLEGE BACOLOD - ARFIEN DEPARTMENT
INTRODUCTION
Incomplete:
-Cover page
-Table of contents
-Introduction
-Definition of terms
-School facilities
-Construction and specification materials
-Cite at least 3 examples of tertiary hospitals from every continent include

photos and description for each example.
-APA format references
Operational Characteristics of Philippine Hospitals
(Philippine Institute for Development Studies)
A. Medical Services
1. Department of Surgery
2. Department of Pediatrics
3. Out-Patient Department
4. Department of Gynecology
B. Ancillary Services
1. X-Ray Unit
2. The Pharmacy Service
3. The Dental Health Service
4. The Nursing Service
5. Laboratory Department
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6. Anesthesia Unit
C. Administrative Services
1. The Administrative Services
2. The Accounting Services
3. Budget Office
4. Admitting and Medical Records
Differentiation of classification of Hospitals
Tertiary-level hospital: highly specialized staff and

technical equipment— for example, cardiology, intensive care unit, and
specialized imaging units; clinical services highly differentiated by function;
could have teaching activities; size ranges from 300 to 1,500 beds.
(Definitions from Mulligan and others, 2003)
The size or bed capacity also determines the

classification of hospitals. Primary hospitals are those with less than 25
beds, secondary are those with 25 to 99 beds, while tertiary are those with
100 and more beds. (Avestruz F., 1995)
Different Level of Tertiary Hospitals in the Philippines
"Tertiary Level I hospital" refers to a hospital which has capabilities for

providing medical care to cases requiring sophisticated diagnostic and
therapeutic equipment and the expertise of trained specialists and
subspecialists.
"Tertiary Level II hospital" refers to a departmentalized hospital with

teaching and research capabilities and which have accredited Residency
Training Programs in the fields of surgery, pediatrics, medicine, OB-Gyne,
EENT, orthopedics, anesthesia and other ancillary disciplines. It likewise
offers dental services.
2
"Tertiary Level III hospital" refers to a hospital which has been particularly
selected to provide tertiary hospital services, with teaching, training and
research functions.
"Tertiary Level IV hospital" refers to a tertiary hospital with expensive and

sophisticated diagnostic and therapeutic facilities for a specific medical
problem area.
A. FUNCTIONAL REQUIREMENTS
❖ Definition of Terms
⮚ Tertiary Hospital
⮚ …
⮚ …
❖ Occupancy Classification (National Building Code of the Philippines)
Rule VII – Section 701.
Group D – Institutional
Division 2 – Nurseries for full-time care of children under
kindergarten age, hospitals, sanitaria, nursing homes with
non-ambulatory patients, and similar buildings each
accommodating more than five persons.
3
❖ Zoning Classification (National Building Code of the Philippines)
GI (General Institutional) – a community to national level of
institutional use or occupancy, characterized mainly as a low-rise,
medium rise or high-rise building/ structure for medical,
government service administrative and related activities, e.g.,
hospitals and related health care facilities, government offices,
military, police and correctional buildings and the like.
❖ Development Controls
Development of a tertiary hospital/medical center.
The development of a tertiary hospital/medical center revolves around a
board of directors or board of trustees.
● First, the law requires them. When a corporate entity is established,
laws mandate that a board be established to assume responsibility of
its affairs.
● Second, boards represent the organization’s owners – be they
stakeholders in the case of nonprofits or shareholders in for-profits.
Boards are owners’ agents and provide the means of ensuring that
organizations act on the owners’ behalf.
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● Third, boards make sure that those “at interest” (e.g., management
and medical staff) function in ways that further organizational mission
and goals.
Only boards are empowered and able to perform these three functions.
They are ultimately accountable for their organizations – everything they do
and everything that goes on inside of them.
While they assume ultimate accountability, boards have no ability to perform
the actual work of their organizations. They must see to it that such work is
done by delegating tasks and authority to management and (in the case of
the hospitals) to the medical staff. Management and the medical staff are,
in turn, directly accountable to the board for their decisions and actions.
To be effective, the boards of health systems and hospitals must have a
clear, precise, and shared image of the type of work they should be doing to
really govern their organizations.
❖ General Design Requirements (Whole Building Design Guide)
Hospitals must serve and support a diverse spectrum of
users and stakeholders in addition to the large range of services that
must be accommodated. The design process should, in theory, include
direct input from the owner and important hospital staff early on.
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Patients, visitors, support workers, volunteers, and suppliers who do not
have direct participation in the design must also be represented by the
designer. The human needs of the hospital's various users are
integrated into good hospital design.
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.
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General Hospital Relationships
Major Clinical Relationships
The movement and communication of people, materials,
and trash are depicted in these flow diagrams. As a result, a hospital's
physical layout and its transportation and logistics systems are tightly
linked. The building configuration has an impact on the transportation
systems, and the configuration is strongly reliant on the transportation
systems. Site constraints and opportunities, climate, adjacent facilities,
budget, and available technology all impact hospital layout. New medical
requirements and technological advancements generate new options.
⮚ Building Attributes
Regardless of their location, size, or budget, all hospitals should have
certain common attributes.
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▪ 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
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● 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
● 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
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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. Some important
aspects of creating a therapeutic interior are:
● 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
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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
▪ Accessibility
All areas, both inside and out, should:
● 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.
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● 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
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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
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▪ 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.
❖ Classification of Hospitals by the Department of Health (DOH)
New DOH Hospital Classification 2015
Classification of hospitals shall be based on Administrative Order No.
2012–0012, dated July 18, 2012, "Rules and Regulations Governing the
New Classification of Hospitals and Other Health Facilities in the
Philippines"
They shall be classified according to the following:
⮚ According to Ownership
▪ Government
The Hospital is created by law.
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A government health facility may be under the National
Government, DOH, Local Government Unit (LGU),
Department of Justice (DOJ), State Universities and Colleges
(SUCs), Government-owned and controlled corporations
(GOCC) and others
▪ Private
Owned, established, and operated with funds from donation,
principal, investment, or other means by any individual,
corporation, association, or organization
⮚ According to Scope of Services
▪ General Hospital
● A hospital that provides services for all kinds of illnesses,
diseases, injuries or deformities
● It provides medical and surgical care to the sick and injured,
maternity, newborn and child care
It shall be equipped with the service capabilities needed to
support board certified/ eligible medical specialists and other
licensed physicians rendering services in, but not limited to the
following:
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● Clinical Services (Family Medicine, Pediatrics, Internal
Medicine, Obstetrics and Gynecology, Surgery)
● Emergency Services
● Outpatient Services
● Ancillary and Support Services (Clinical Laboratory, Imaging
Facility, Pharmacy)
▪ Specialty
● Specializes in a particular disease or condition or in one type
of patient
A specialized hospital may be devoted to the treatment of the
following:
● Treatment of a particular type of illness or for a particular
condition requiring a range of treatment
● Treatment of patients suffering from a particular diseases of a
particular organ or group of organs
● Treatment of patients belonging to a group such as children,
women, elderly or others
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⮚ According to Functional Capacity
▪ Level 1 General Hospital
A level 1 General Hospital shall have as minimum:
● A staff of qualified, medical, allied medical and administrative
personnel headed by a physician duly licensed by the PRC
● Bed space for its authorized bed capacity, in accordance with
DOH Guidelines in the Planning and Design of Hospitals
● An operating room with standard equipment and provisions for
sterilization of equipment and supplies in accordance with:
● DOH Reference Plan in the Planning and Design of an
Operating Room or Theater
● DOH Guidelines on Cleaning, Disinfection, and Sterilization of
Reusable Medical Devices in Hospital Facilities in the
Philippines
● A post-operative Recovery Room
● Facilities consisting of Ward(s), Room(s), a Delivery Room,
exclusively for maternity patients and newborns
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● Isolation facilities with proper procedures for the care and
control of infection and communicable diseases as well as for
the prevention of cross infection
● A separate dental section/ clinic
● Provision for blood donation
● A DOH-licensed secondary clinical laboratory with the services
of a consulting pathologist
● A DOH licensed Level 1 imaging facility with the services of a
consulting radiologist
● A DOH licensed pharmacy
As minimum, all of Level 1 capacity, including but not limited to:
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 specialties
and other licensed physicians rendering services in the
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specialties of Medicine, Pediatrics, Obstetrics and Gynecology,
Surgery, their subspecialties, and other ancillary services
3. Provision for general ICU for critically ill patients
4. Provision for NICU
5. Provision for HRPU
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 examination
As minimum, all of Level 2, including but not limited to:
● Teaching and/or Training Hospital with accredited residency
training program for physicians in the four major specialties
namely: Medicine, Pediatrics, Obstetrics and Gynecology, and
Surgery
● Provision for physical medicine and rehabilitation unit
● Provision for ambulatory surgical clinic
● Provision for dialysis facility
● Provision for blood bank
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● A DOH licensed level 3 imaging facility with interventional
radiology
❖ DOH Guidelines on Hospital Planning and Design
Guidelines in the Planning and Design of a Hospital and other Health
Facilities (DOH, 2004)
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
● P. 344 – Accessibility Law and Its Implementing Rules and
Regulations
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● R. A. 1378 – National Plumbing Code of the Philippines and Its
● 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
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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 purposes 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.
a. Exits shall be restricted to the following types: door leading
directly outside the building, interior stair, ramp, and exterior
stair.
b. A minimum of two (2) exits, remote from each other, shall be
provided for each floor of the building.
c. 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.
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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.
a. Corridors for access by patient and equipment shall have a
minimum width of 2.44 meters.
b. Corridors in areas not commonly used for bed, stretcher and
equipment transport may be reduced in width to 1.83 meters.
c. A ramp or elevator shall be provided for ancillary, clinical and
nursing areas located on the upper floor.
d. 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.
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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 the 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.
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15. Segregation: Wards shall observe segregation of sexes. Separate
toilets 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:
a. 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.
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b. Second Zone – areas that receive workload from the outer
zone: laboratory, pharmacy, and radiology. They shall be
located near the outer zone.
c. Inner Zone – areas that provide nursing care and
management of patients: nursing service. They shall be
located in private areas but accessible to guests.
d. 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.
e. 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.
a. The emergency service shall be located on the ground floor to
ensure immediate access. A separate entrance to the
emergency room shall be provided.
b. 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.
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c. 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.
d. 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.
e. 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 workflow and patient
movement. Toilets shall be immediately accessible from
rooms and wards.
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f. The dietary service shall be away from the morgue with at
least 25-meter distance.
21. Space: Adequate area shall be provided for the people, activity,
furniture, equipment and utility.
❖ Factors to consider in the Design of a Hospital
Because hospitals provide a wide range of services and are
made up of many functional units, they are the most complex of building
types. Hospitals have diagnostic and treatment functions, such as clinical
laboratories, imaging, emergency rooms, and surgery; hospitality functions,
such as food service and housekeeping; and inpatient care or bed-related
functions. Good hospital design integrates functional requirements with the
human needs of its varied users. This need for diverse functions 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. Hospital design is also influenced by
site restraints and opportunities, climate, surrounding facilities, budget, and
available technology. All hospitals should have certain common attributes,
regardless of their location, size or budget.
● Efficiency and Cost-Effectiveness
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An efficient hospital layout should promote staff efficiency by
minimizing distance of necessary travel between frequently used
spaces; allow visual supervision of patients; provide an efficient
logistics system for supplies and food (and removal of waste); make
efficient use of multi-purpose spaces and consolidate spaces when
possible.
● Flexibility and Expandability
Medical needs and modes of treatment will continue to change.
Therefore, hospitals should follow modular concepts of space
planning and layout; use generic room sizes and plans as much as
possible; use modular, easily accessed, and easily modified
mechanical and electrical systems; and be open-ended, with well-
planned directions for future expansion.
● Therapeutic Environment
Patients and visitors should perceive a hospital as unthreatening,
comfortable, and stress-free. The interior designer plays a major role
in this effort to create a therapeutic environment. For example, this
can be accomplished by using cheerful and varied colors and
textures, by allowing ample natural light wherever feasible, by
providing views of the outdoors from every patient bed, and by
designing a “way-finding” process into every environment.
● Cleanliness and Sanitation
29
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; and adequate and appropriately located housekeeping spaces.
● Accessibility
● All areas, both inside and out, should comply with all standards and
minimum requirements of Americans with Disability Act, and ensure
grades are flat enough to allow easy movement and sidewalks and
corridors are wide enough for two wheelchairs to pass easily.
● Security and Safety

Hospitals have several particular security concerns, such as
protection of patients and staff, hospital property and assets
(including drugs), and also vulnerability to terrorism because of high
visibility. Security and safety must be built into the design with these
things in mind.
● Sustainability
Hospitals are large public buildings that have a significant impact on
the environment and economy of the surrounding community. They
are heavy users of energy and water and produce large amounts of
waste. Because of this, sustainable design must be considered when
designing and building hospitals.
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❖ Construction and Specification Materials
❖ General Hospital Spaces
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
Clinic Service
Emergency Room
Waiting Area 0.65 / person
Toilet 1.67
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Nurse Station 5.02 / staff

Examination and Treatment Area with Lavatory / Sink 7.43 / bed
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 Lavatory / Sink 7.43 / bed
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
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
Treatment and Medication Area with Lavatory/Sink 7.43
Central Sterilizing and Supply Room
Receiving and Releasing Area 5.02 / staff
Work Area 5.02 / staff
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Sterilizing Room 4.65

Sterile Supply Storage Area 4.65
Nursing Service
Office of the Chief Nurse 5.02
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 and Toilet 14.00
Dark Room 4.65
Film File and Storage Area 4.65
Radiologist Area 5.02 / staff
Pharmacy 15.00
Table n. Area Per Person
Note:
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
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❖ Principles of Hospital Planning (Mediance Consultancy, 2021)
Healthcare centers are classified as vital sevices and are
open 24 hours a day, seven days a week. As a result, hospital design and
planning play a critical role. Certain fundamental guiding principles should
be followed when planning and designing procedures. Following the guiding
principles for suitable planning and design is critical whether the hospital is
being created at the state or national level.
Note: These principles apply to all countries.
⮚ Equipment dictates design
Hospital planning experts sometimes overlook necessary
equipment because they are not suitable for architectural
design. Heavy equipment like MRIs shouldn’t be overlooked in
healthcare facilities. They should be installed smartly in the
outer structure without disturbing the entire design. While
doing the hospital planning, the priority should be equipping
the necessary equipment instead of prioritizing the
architectural design. By avoiding the common mistakes,
planning experts can install even the bulky equipment without
disturbing the hospital’s structure.
⮚ Provision for future expansion
34
Many planners are focusing on current problems and
overlooking the expansion plans. The population won’t be
decreasing; hence healthcare centers should have facilities to
equip endless patients. Subsequently, hospitals should have
additional departments, beds, and other essential facilities for
the growing population.
Most communities don’t shrink in population and a good
healthcare facility will grow a community around it.
⮚ Focus on the Core Facilities
The state or national level hospitals have four key units:
operation theaters, emergency rooms, ICUs, and radiology.
While designing the hospital, these facilities should be in close
proximity. Above all, providing privacy to the patients shouldn’t
be overlooked. Considering these factors in mind, the
hospitals’ overall structure will become more practical. Making
the keyspace of the healthcare center functional is more
necessary than making the structure appealing.
⮚ Solve the problems beforehand
While developing the architecture design, many construction
problems would arise that are often overlooked. Later these
problems result in costly repairs. As a result, none of the
35
issues should be ignored because they cost. Ignoring the
mistakes beforehand and afterward putting hefty money in the
renovation plans sounds a no-brainer. In simple words, just
evaluate and fix the problems ahead of time and focus on the
expansion plans.
⮚ Prioritize Hospital’s Staff
Ensure that all the departments are established in close
proximity because staff members have to rush round the
clock. The ultimate goal is to make the usable space practical
for the staff members instead of focusing on the design. If your
staff members have to take extra steps to navigate different
departments, it reduces their overall productivity. Everything
should be easy to navigate for the staff members because
they are the most hardworking ones in the facility.
❖ School Facilities
⮚ …
❖ Parking and Loading Space Requirements
⮚ Parking Requirements
36
Occupancy Required Parking
Public Hospitals 1 slot / 25 beds

Private Hospitals 1 slot / 12 beds
Office Building 1 slot / 125m² of gross area
Additional:
Table n. Parking Requirement
⮚ Loading Requirements
Occupancy Loading
1 standard truck loading slot for
every 5,000 m² gross floor area
1 passenger loading space
(can accommodate two (2) queued
Public & Public Hospitals jeepney / shuttle slot)
1 loading slot for articulated truck
*Provide truck maneuvering area
outside of the RROW (within
property or lot lines only)
Special Provision
1 accessible parking lot for 50–150 slots and an additional slot for every
100 thereafter.
Table n. Loading Requirements
⮚ Size of Parking Slot
Type of Parking Dimensions
Perpendicular & Diagonal 2.50m x 5.00m

Parallel 2.15m x 6.00m
Standard Truck 3.60m x 12.00m
Articulated Truck 3.60m x 18.00m
Jeepney / Shuttle 3.00m x 9.00m
37
Table n. Size of Parking Slot
❖ Requirement for Fixtures
1. Faucets
a. Lavatory Faucets:
Faucet for lavatory-type medical plumbing fixtures.
a. Maximum Flow Rate: 2.2 gpm

b. Body Material: Solid brass
c. Finish: Polished chrome plate
d. Type: Single-control mixing, two-handle mixing
e. Tempering System: Not required
f. Mounting: Deck; exposed, Deck; concealed
g. Handle(s): Single-lever, Wrist blade, 4 inches
h. Spout: Rigid, Swing, Rigid gooseneck, Swivel gooseneck
i. Spout Outlet: Laminar flow
j. Operation: Non Compression, manual
k. Drain: Grid Strainer
b. Shower Faucets:
Faucet for shower-type medical plumbing fixture.
38
c. Finish: Polished chrome plate
d. Type: Thermostatis, Pressure balance, Thermostatic and
pressure balance
e. Mounting: Concealed
f. Handle(s): Single-lever, touch pad
g. Diverter Valve: Integral with mixing valve
h. Backflow Protection Device for Hand-Held Shower:
Required
i. Operation: Non-compression, manual, Automatic, Hard-
wired electric senso
j. Anti-scald Device: Integral with mixing valve
k. Shower Head Material: Brass with chrome plated finish
l. Head Type: Ball joint, without ball joint, Hand held, slide-bar
mounted
m. Integral Volume Control: Required
n. Shower-Arm, Flow- Control Fitting: 1.5 gpm
c. Sink Faucets:
Faucet for sink-type medical plumbing fixture.
39
c. Finish: Polished chrome plate or Anti-Bacterial plating
d. Type: Sink faucet, Clinical-sink faucet, vacuum breaker,
hose-thread outlet, and pail hook
e. Tempering Device: Not required
f. Mixing Valve: Single control, Two-lever handle
g. Backflow Protection Device for Hose Outlet: Required
h. Mounting: Deck, exposed; Deck, concealed; Back/wall,
exposed; Back/wall, concealed
i. Handles: Lever, Wrist blade, 4 inches
j. Spout: Rigid, solid; Swing tubular; Rigid, gooseneck, solid;
Swivel, gooseneck solid; Brass with wall brace
k. Spout Outlet: Swivel aerator/spray; Spray; Laminar flow;
Hose thread; Plain end
l. Vacuum Breaker: Required
m. Operation: Non Compression, manual; Automatic, hard-
wired electric sensor
2. Flushometers
40
Flushometer for clinical-sink and water-closet-type medical plumbing
fixtures.
a. Internal Design: Diaphragm operation.
b. Style: Exposed
c. Trip Mechanism: Oscillating, lever-handle actuator, Mechanical,
push-button actuator with stainless-steel access plate; Hard-wired,
electric-sensor actuator
d. Consumption: 1.6 gal/ flush
3. Toilet Seats
Plastic toilet seat for water-closet-type medical plumbing fixture.
a. Material: Molded, solid plastic with antimicrobial agent
b. Configuration: Open front without cover
c. Size: Elongated
d. Class: Heavy-duty commercial.
e. Hinge Type: SC, self-sustaining check
f. Color: White
4. Protective Shielding Guards
Protective Shielding Pipe Covers:
41
1. Manufactured plastic wraps for covering medical plumbing fixture
hot- and cold-water supplies.
B. Protective Shielding Piping Enclosures:
Manufactured plastic enclosure for covering medical plumbing fixture
hot- and cold water
5. Fixture supports
A. Water-Closet Supports:
1. Combination carrier designed for accessible, standard
mounting height of wall-mounting, water-closet-type medical
plumbing fixture.
B. Lavatory Supports:
1. Type II, lavatory carrier with concealed arms and tie rod for
wall-mounting, lavatory-type medical planning fixture.
C. Sink Supports:
1. Type I, sink carrier with exposed arms and tie rods; Type II
sink carrier with hanger plate, bearing studs, and tie rod for
sink type medical plumbing fixture.
6. Bedpan Washers
Bedpan Washer:
42
1. Flushometer valve operation.
7. Water Closets
A. Wall-Mounting Water Closets:
1. Accessible, wall and wall-mounting, back-outlet, vitreous-china
medical plumbing fixture designed for bedpan washing and
flushometer valve operation.
a. Style: Flushometer valve.
1) Bowl Type: Elongated with siphon-jet design and bedpan lugs.
2) Design Consumption: 1.6 gal/flush.
B. Floor-Mounting Water Closets:
1. Accessible, floor and floor-mounting, floor-outlet, vitreous-china
medical plumbing
fixture designed for bedpan washing and flush meter valve operation.
a. Style: Flush meter valve
1) Bowl Type: Elongated with siphon-jet design and bedpan lugs or
slots. Include bolt caps matching fixtures.
2) Height: Accessible
3) Design Consumption: 1.6 gal./flush .
43
4) Color: White
8. Patient’s Combination Toilets
A. Swing-Away, Patients' Combination Toilets:
1. Factory-fabricated, combination water closet and lavatory medical
plumbing fixture.
a. Cabinet: Fixed installation with storage space and toilet paper
holder.
1) Material: Stainless steel, plastic laminate, or fiberglass with
laminated-wood or plastic top surface.
b. Water Closet: Swivel, floor-mounting, back outlet, flush meter
valve design.
1) Material: Stainless steel.
2) Orientation: left and/or right hand.
3) Toilet Seat: White, solid plastic.
4) Flush meter: Concealed flush meter valve.
c. Lavatory: Counter mounting.
1) Material: Stainless steel
2) Faucet: Gooseneck type with wrist-blade handles
44
d. Bedpan Washer: On flush meter valve tailpiece or separate
attachment affixed to unit
9. Clinical Sinks
A. Wall-Mounting Clinical Sinks:
1. Wall-mounting, back-outlet, vitreous-china, flushing-rim, service-
sink-type medical plumbing fixture.
10. Lavatories
11. Plaster Sinks
1. Wall-mounting, vitreous-china medical plumbing fixture.
12. Surgeons' Scrubs Sinks
A. Stainless-Steel Surgeons' Scrub Sinks:
1. Wall-mounting, sink-type medical plumbing fixture.
13. Surgeon’s Instrument Sinks
A. Surgeons' Instrument Sinks: autoclave pre-wash sink
1. Wall-mounting, stainless-steel, sink-type medical plumbing fixture.
Include an instrument tray on each side.
45
a. Size: 28 by 20 inches (710 by 510 mm) with 8” center set holes for
deck mounting faucet.
b. Faucet: Chrome-plated-brass, gooseneck type matching fixture
with wrist blade knee and foot pedal control for mixing hot and cold
water supplies.
Bathing Units:
1. Plastic-tub, institutional side-entry whirlpool bath fixture with
integral controls.
a. Tub Size: 60 by 30 inches (1525 by 765 mm).
b. Controls: Vacuum breakers on supplies, thermostatic mixing valve,
tub-fill spout, and hand-held shower head.
c. Unit Electrical Characteristics:
1) Volts: 120V.
2) Phase(s): One. C. Bathing Units:
1. Plastic-tub, institutional side, transfer-lift entry, adjustable, fixed-
height bath fixture with integral controls.
a. Tub Size: 60 by 30 inches (1525 by 765 mm)
tub fill spout, and hand-held shower head.
46
c. Lift System:
d. Unit Electrical Characteristics:
1) Volts: 120V.
2) Phase(s): One
D. Bathing Units:
1. Plastic-tub, institutional front-entry shower fixture with integral
controls.
a. Cabinet Size: 35 by 41 inches (889 by 1041 mm).
tub fill spout, and hand-held shower head.
c. Unit Electrical Characteristics:
1) Volts: 120V.
2) Phase(s): One.
14. Hydrotherapy Whirlpools
A. Podiatry Whirlpools:
1. Stationary, stainless-steel tank for feet and ankles.
a. Water Capacity: 15 gal. (57 L).
47
b. Thermometer: Control panel or tank mounted.
c. One electric turbine ejector.
1) Volts: 120, 240, 277, 480 V.
2) Phase(s): One, Three B. Upper-Extremity Whirlpools:
1. Stationary, pedestal-mounted, stainless-steel tank for arms, hands,
and elbows.
1) Volts: 120, 240, 277, 480 V.
2) Phase(s): One, Three
C. High-Tank Body Whirlpools:
1. Stationary, stainless-steel tank for legs, hip, and back.
48
1) Volts: 120, 240, 277, 480 V
D. Low-Tank Body Whirlpools:
1. Stationary, extended-length stainless-steel tank for legs, hip, and
lower back.
1) Volts: 120, 240, 277, 480 V
E. Small, Hubbard Immersion Tanks:
1. Stationary, butterfly-shaped tank, for full-body massage.
a. Tank Dimensions: 93 by 64 by 22 inches (2362 by 1626 by 560
mm).
b. Overall Height: 34 to 38 inches (864 to 965 mm).
c. Water Capacity: 268 gal. (1014 L)
49
d. Material: Stainless steel.
e. Thermometer: Control panel or tank rim mounted.
f. Electric Turbine Ejectors: Two; one rail mounted on each side.
g. Thermostatic, mixing-valve assembly.
h. Unit Electrical Characteristics:
1) Volts: 120, 240, 277, 480 V
i. Hose and hand-held shower.
j. Wash-out-hose assembly.
k. Stretcher lift.
l. Overhead electric hoist.
F. Medium, Hubbard Immersion Tanks:
mm).
b. Overall Height: 34 to 38 inches (864 to 965 mm)
50
f. Electric Turbine Ejector: One, panel mounted.
1) Volts: 120, 240, 277, 480 V
k. Stretcher lift.
G. Large, Hubbard Immersion Tanks:
1) Volts: 120, 240, 277, 480 V
51
E. Small, Hubbard Immersion Tanks:
mm).
b. Overall Height: 34 to 38 inches (864 to 965 mm).
1) Volts: 120, 240, 277, 480 V
k. Stretcher lift.
52
F. Medium, Hubbard Immersion Tanks:
mm).
b. Overall Height: 34 to 38 inches (864 to 965 mm)
f. Electric Turbine Ejector: One, panel mounted.
1) Volts: 120, 240, 277, 480 V
k. Stretcher lift.
G. Large, Hubbard Immersion Tanks:
53
mm).
b. Overall Height: 34 inches (864 mm)
1) Volts: 120, 240, 277, 480 V
k. Stretcher lift.
H. Full-Body Immersion Tanks:
1. Stationary, rectangular tank, for full-body massage.
54
mm), 95 by 41 by 22 inches (2413 by 1041 by 560 mm).
b. Overall Height: 32 or 34 inches (813 or 860 mm).
c. Water Capacity: 195 gal. (738 L), 260 gal. (984 L)
f. Electric Turbine Ejector: One, tank mounted at end, on rail, and on
side.
h. Unit Electrical Characteristics: 1) Volts: 120, 240, 277, 480 V. 2)
Phase(s): One, Three
k. Stretcher lift.
15. Outlet Boxes
A. Dialysis Equipment Outlet Boxes:
55
1. Recessed-mounting outlet box with water supply and drain
connections.
a. Box and Faceplate: Stainless steel.
b. Supply Fitting(s): 1 NPS 1/2 (DN 15) PVC ball valve(s) and
adapter with male hose-thread outlet.
16. Morgue Equipment
A. Autopsy Tables:
1. Pedestal stainless-steel table with sink; designed for downdraft
ventilation.
a. Material: Stainless steel.
b. Overall Size: Approximately 88 by 30 inches (2250 by 760 mm)
with deck faucet holes.
c. Faucet: Deck mounted with wrist- or elbow-blade handles.
d. Aspirator: Deck mounted.
e. Rinse Assembly: Deck-mounted faucet with hose.
f. Disposer: Required.
g. Receptacle: Duplex, hospital grade with ground-fault interruption.
1) Volts: 120, 240, 277, 480 V.
56
2) Phase(s): One, Three.
B. Dissecting Sinks:
1. Wall-mounting sink with backsplash.
a. Material: Stainless steel.
b. Overall Size: 84 by 28 inches (2134 by 711 mm) with back faucet
holes.
c. Sink Size: Approximately 30 inches (763 mm) wide.
d. Equipment drawer.
e. Faucet: Back mounted with wrist- or elbow-blade handles.
f. Aspirator: Back mounted.
g. Rinse Assembly: One back-mounted faucet with hose.
h. Disposer: Required
i. Back-mounted, hand-held-type eye wash.
j. Unit Electrical Characteristics:
1) Volts: 120, 240, 277, 480 V.
2) Phase(s): One, Three.
57
❖ Other Pertinent Topics
⮚ Site Allocation Percentage Requirements
& of Total Lot Area (TLA)

Building/
Maximum Minimum
Structure Use
Maximum Allowable ISA USA
or Occupancy TOSL d
Allowable c
(or Land Use) (Unpaved
(ISA+USA)
a PSO c,d (Paved Open Open
Spaces) Space)
50 e 20 30 50
Institutional
60 f 20 20 40
Table n. Reference Table of Maximum Allowable PSO, Maximum Allowable
ISA, the MACA, the Minimum USA and the TOSL by Type of Land Use
Zoning per Lot
Note: e. Without a firewall , f. With firewall
Design Considerations:
● Function and Efficiency
● Vertical and Horizontal Circulation Patterns
● Architectural Characteristics and Form
● Aesthetic and Landmark Quality
● Natural Lighting and Ventilations
● Solar, Wind, Noise and View Considerations
● Amenities, Facilities, Services and Utilities
● Security and Safety Features
58
● Ecological (Environmental or Green Architecture)
● Site Potential and Limitations including User’s Need
References:
https://www.acmehospitalprojects.com/healthcare-facility-planning-and-
design.html
https://www.who.int/management/facility/ReferralDefinitions.pdf
http://legacy.senate.gov.ph/lisdata/85807134!.pdf
https://doh.gov.ph/sites/default/files/publications/
planning_and_design_hospitals_other_facilities.pdf
https://dirp4.pids.gov.ph/ris/dps/pidsdps9516.pdf
https://pdfcoffee.com/design-8-proposed-tertiary-hospital-pdf-free.html
https://www.foi.gov.ph/requests/
aglzfmVmb2ktcGhyHQsSB0NvbnRlbnQiEERPSC05MTMyMjE3OTQ5NzAM
https://www.linkedin.com/pulse/hospital-design-considerations-dr-salil-
choudhary
https://www.slideshare.net/surajbarma/report-on-hospital-design
https://publichealthresources.blogspot.com/2015/04/new-doh-hospital-
classifications-2015.html
https://www.wbdg.org/building-types/health-care-facilities/hospital
https://blog.medianceconsultancy.com/the-five-key-guiding-principles-of-
hospital-planning-and-designing-you-should-know/
https://insights.omnia-health.com/hospital-management/guiding-principles-
hospital-design-and-planning
https://www.facilities.rochester.edu/ppm/designstandards/
division22/224300-HEALTHCAREPLUMBINGFIXTURES.pdf
59

Research Tertiary Hospital

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LA CONSOLACION COLLEGE BACOLOD - ARFIEN DEPARTMENT

-Construction and specification materials

-Cite at least 3 examples of tertiary hospitals from every continent include

-APA format references

Operational Characteristics of Philippine Hospitals

(Philippine Institute for Development Studies)

Differentiation of classification of Hospitals

Tertiary-level hospital: highly specialized staff and

The size or bed capacity also determines the

Different Level of Tertiary Hospitals in the Philippines

"Tertiary Level I hospital" refers to a hospital which has capabilities for

"Tertiary Level II hospital" refers to a departmentalized hospital with

"Tertiary Level IV hospital" refers to a tertiary hospital with expensive and

❖ Occupancy Classification (National Building Code of the Philippines)

Rule VII – Section 701.

Division 2 – Nurseries for full-time care of children under

kindergarten age, hospitals, sanitaria, nursing homes with

non-ambulatory patients, and similar buildings each

accommodating more than five persons.

❖ Zoning Classification (National Building Code of the Philippines)

GI (General Institutional) – a community to national level of

institutional use or occupancy, characterized mainly as a low-rise,

medium rise or high-rise building/ structure for medical,

government service administrative and related activities, e.g.,

hospitals and related health care facilities, government offices,

military, police and correctional buildings and the like.

Development of a tertiary hospital/medical center.

The development of a tertiary hospital/medical center revolves around a

board of directors or board of trustees.

● First, the law requires them. When a corporate entity is established,

laws mandate that a board be established to assume responsibility of

● Second, boards represent the organization’s owners – be they

stakeholders in the case of nonprofits or shareholders in for-profits.

organizations act on the owners’ behalf.

and medical staff) function in ways that further organizational mission

They are ultimately accountable for their organizations – everything they do

and everything that goes on inside of them.

While they assume ultimate accountability, boards have no ability to perform

To be effective, the boards of health systems and hospitals must have a

really govern their organizations.

❖ General Design Requirements (Whole Building Design Guide)

Hospitals must serve and support a diverse spectrum of

users and stakeholders in addition to the large range of services that

must be accommodated. The design process should, in theory, include

Patients, visitors, support workers, volunteers, and suppliers who do not

have direct participation in the design must also be represented by the

designer. The human needs of the hospital's various users are

integrated into good hospital design.

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

● bed-related inpatient functions

● diagnostic and treatment 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.

General Hospital Relationships