RE100: Research on Hospital / Chua, Kirsteen Nichole P.

Introduction

Ever since the olden times, humans have injured themselves severely due to hunting, wars, accidents due to
forces of nature, and sicknesses from bacteria and deadly deceases. There was a need for people to treat their
wounds and various illnesses in the form of herbal and traditional medicine. However, as time went on there was
a need for housing patients to further enhance their abilities in treating them effectively. As humans evolved,
hospitals were the served as sanctuaries for the sick and rehabilitation of the injured. Various versions of the
hospital included general hospitals, public hospitals, and a plethora of specialized hospitals (including acute and
long term, for profit and non profit, community and non community, urban and rural, independent, system, and
network, teaching and non teaching, federal and state/local) (Nelson, 2017). Smaller ones also existed such as
community hospitals and clinics. Its origin can be traced back in the early Christian age and even during
Mesopotamia where people assisted the sick and the poor by establishing centers. At the time, hospitals were any
worship place able to withhold people and aid them. It started off as houses of bishops, monasteries and the
contemporary hospitals. Economically, hospitals were able to thrive through the generous donations of wealthy
philanthropists. Since the 19th century hospitals have revolutionized their organization, function, and structure
while continuing to foster charity and care (Riva & Cesana, 2012).

Hospital Spaces and Design Considerations

Hospitals are buildings wherein medical care and attention are given to people. Thus, when dealing with a lot
of illnesses and various injuries, there should be enough space for each medical practitioner and patient to achieve
their tasks well. Hospitals are one of the most complex of building types. Each hospital is comprised of a wide
range of services and functional units able to house practices such as diagnostic and treatment functions, clinical
laboratories, imaging, emergency rooms, surgery and operation rooms, hospitality functions, food service,
housekeeping, inpatient care and bed-related function. Constructing and planning a hospital required diversity in
spaces and function as well free flowing circulation. There are a set of specific regulations, codes and various
laws that are in place to ensure the optimal construction and operations in a hospital. Spaces should be able to
maintain and operate highly complicated mechanical, electrical, and telecommunications systems. In order to
fully design and plan effectively, we must also take into consideration the needs and practices of medical experts
in order to satisfy their required functionality. Internal traffic should also be analyzed as there are various hallways
that will be utilized by different people with different needs. The financial status of the organization should also
be considered as to identify the necessary spaces that can be created.

In addition, the wide range of medical services must also be maintained properly through the addition of support
and maintenance facilities. Ideally, when designing hospitals there should be input from the stakeholders up until
the hospital staff. The designer should also be able to experience how patients move about from one place to
another as well as the circulation of visitors, support staff, volunteers, and suppliers. In order to be considered as
a good hospital, there should be a seamless integration between functional requirements and the human needs of
its varied users. In simple terms, an ideal hospital should be based on function, giving emphasis to the following
(1) bed-related inpatient functions, (2) outpatient-related functions, (3)diagnostic and treatment functions, (4)
administrartive functions, (5)service functions (food; supplies), (6)research and teaching functions. The
relationship between these spaces considering their function are illustrated as:
RE100: Research on Hospital / Chua, Kirsteen Nichole P.

As observed from the flow diagrams above, the movement and communication of people as well as materials,
and waste are interrelated, therefore transportation and logistic systems are inextricably intertwined. The
building’s form is crucial in influencing the circulation of the users, however, the form and configuration of the
structure is also influenced by site restrains and opportunities, climate, surrounding facilities, budget, available
technology, roads and linkages. In considering a large hospital, typical nursing units may be reoccurring per floor
as patients are present on each level. Nursing units today are observed as compact and usually takes the form of
an elongated rectangle, modified triangles, and circles to minimize the travelled distance of nurses’ navigation
towards the patient’s bed. This solution is mostly 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, as followed through the
regulation enforced by HIPAA for its private rooms (Carr, 2017).

Hospital Architecture and Design Planning

In the architectural perspective of hospitals, regardless of their location, size, or budget, all hospitals should
have the following common attributes such as (1) Efficiency and Cost-Effectiveness, (2)Flexibility and
Expandability, (3)Cleanliness and Sanitation, (4)Accessibility, (5)Controlled Circulation, (6)Aesthetics,
(7)Security and Safety, and (8)Sustainability. (1) To be considered as efficient, there should be minimized
distance between frequently used spaces. There should also be no visual barriers for staff to supervise their
patients. The spaces established should all be needed; avoid redundancy of spaces; carefully plan pre-design
programming. Logistic systems should also be provided such as elevators, pneumatic tubes, box conveyors,
manual or automated carts, and gravity or pneumatic chutes for food, supplies, waste, recyclables, and souled
materials. Strategic locating of support spaces should also be considered as they may be shared by adjacent
functional areas through the use of multi-purpose spaces. There should be consolidate outpatient functions for
effective operation mostly located in the first floor for direct access. There should be group or combined functional
areas with similar system requirements for space optimization. There should also be optimal functional
adjacencies, such as locating surgical intensive care units adjacent to operating rooms; they should be based on a
detailed functional program regarding the hospital’s intended operations from the perspective of patients, staff,
and supplies. (2) Modular concepts should be considered for the space planning and layout. Consider using
generic room sizes and plans rather than specific ones. Be served by modular, easily accessed, and easily modified
mechanical and electrical systems; VA Hospital Building System (the use of walk-through interstitial space
between occupied floors for mechanical, electrical, and plumbing distribution), mostly it is recommended for
RE100: Research on Hospital / Chua, Kirsteen Nichole P.

large projects to provide continuous adaptability to changing programs and needs. The structure needs to be open
ended having soft spaces adjacent to hard spaces; such as relocating administrative departments adjacent to clinics.
(3)There should be implication of familiar and culturally relevant materials, consistent with sanitation and various
functional needs. There should be use of cheerful and varied colors and textures to ensure the calm and relaxing
environment for the patients (colors used should be not agitate the patients or overwhelm them.) There should be
admission of ample natural light and the use of color-corrected lighting in interior spaces which mimic the natural
daylight. There should be provided views of the outdoors form every patient bed whenever possible. Photo murals
representing nature or natural scenes are helpful whenever outdoor views are not feasible. Way finding should be
integrated in order for patients, visitors, and staff to know where they are located and how to reach their destination
and return. Textures and colors as well as patterns may be utilized to achieve this goal. (4) Hospitals should
observe an appropriate and durable finishes for every functional space. There should be careful detailing of
features such as doorframes, casework, and finish transitions to avoid dirt-catching and hard to clean crevices and
joints. There should also be adequate and appropriately located housekeeping to ensure cleanliness. (5) Designers
should comply to their respective accessibility laws to provide efficiency and promote safety for persons with
disability. Grades should be ensured that they are flat for easy movement; sidewalks and corridors should be wide
enough to accommodate two wheelchairs passing by. The entrance should also be designed to accommodate
patients with slower adaptation rates from dark and light; glasses should be marked as well as doors to make their
presence obvious in case a patient has problem with eyesight. (6)Constant movement is always observed,
therefore there should be areas where outpatients visiting diagnostic and treatment areas should not travel through
inpatient functional areas nor encounter severely ill inpatients. Routes for outpatients should be clearly defined
and easily navigated. Visitors should also have a simple and direct route to each patient nursing unit without the
need to penetrate through functional areas. Separation between patients and visitors from industrial and logistical
areas should be observed. The outflow of trash, recyclables, and soul materials should be separated from
movement of food and clean supplies; they should also be separated from routes of patients and visitors. The
transfer of cadavers to and from the morgue should be out of sight for patients and visitors. There should be
dedicated service elevators for deliveries food, and building maintenance services. (7) There should be increased
use of natural light, natural material, and textures. If possible calming nature centered artworks and painting can
be integrated to increase aesthetic as well as relaxation of patients. There should be attention to proportions, color,
scale, and details. Bright, open, and generously scaled public areas should be observed. There should be homelike
and intimate scale in patient rooms, day rooms, consultation rooms, and offices. (8) There should be proper areas
dedicated for storing hospital property and assets as well as drugs. There should be protection of patients,
including incapacitated patients and staff. There should also be safe control of violent or unstable patients. (9)
Sustainability should also be considered as hospitals are complex structures that utilize a high significant amount
of energy and water. They are also responsible for the exposal of human waste and various harmful chemicals
used for medicinal purposes. Sustainable principles should be used to enhance and maintain function and services
of the care facility (Carr, 2017).

Hospital Architecture in the Contemporary

Through the evolution of various bacteria and sicknesses, there is a need for new hospitals to adjust their design
regarding a more contemporary approach to rehabilitation and fostering of care to patients. Such solutions
includes promoting patient safety. In order to achieved this, there should be the proper design for patient safety
through infection control. Solutions include the use of bacteria resistant finishes (coated or impregnated with
copper reduces infection rates). Using indigo LED lighting to aid in disinfecting the air and surfaces (applicable
RE100: Research on Hospital / Chua, Kirsteen Nichole P.

in treatment and operating rooms). Integration of handwashing and disinfectant stations as well as clear way
finding towards them. There should also be establishing IDs to high risk patients to ensure safety and less
contamination. Proper ventilation is important; provide clean, contaminant free air through proper ventilation. To
further help in promoting patient safety there should be (1) inclusion of handrails, smooth flooring finishes, and
supportive furniture, (2)Using technology and security checkpoints to track patients, (3)Design hallways and
corridors regarding mobile work stations, (4) Addition of Patient lifts.

Conclusion

There are various way to design hospitals, the vital elements to consider are (1) having a welcoming design
aesthetic to further gain the trust of the patients in admitting themselves for medical care. (2) Having an accessible
drop off and parking applicable for doctors, service, visitors, and hospital staff. (3) Internal wayfinding is
important and achievable through the use of lighting variation as well as play between colors and textures. (4)
there should be a spacious waiting area equipped with expansive views, windows for daylight, art, and
comfortable furniture to ease the worry of relatives, friends, and, family of the patient. Through this, the stress of
the patient and their visitors are mitigated. (5) there should be a pleasant clinical environment through the
manipulation of colors and proper circulation between hallways. (6) There should be separation of circulation
between goods, service staff, medical staff, patients ,visitors, and waste disposal to ensure that everything would
be in order and can happen seamlessly throughout the operation of the hospital. (7) There should be areas
accessible by the cleaning staff for the proper maintenance of the structure as well as each and every room,
including the patients, nurses quarters, clinics, medical supplies, operation room, and various machinery heavy
areas. (8) integration of accessibility principles through the addition of ramps, railings, emergency stairs,
emergency exits, elevators and the like to properly assist people with disability to freely navigate as well as to
keep the patients and its staff safe in the event of a disaster.
Vital considerations are (1) consideration of the environment (proper waste disposal, proper integration of
natural light and ventilation into the structure. (2) Occupancy (hospital should comply with the local zoning
ordinances and local government laws and regulations. (3)Safety (there should be a safe environment for patients,
personnel and public that are away from hazards. Emergency exits should be strategically located and reached by
the staff, patients, and medical professionals). (4)Security (there should be strategic placement of entrance and
exit as well as ensuring security equipment and professionals are present in the structure). (5)Patient movement
(there should be way finding as well as corridors and hallways wide enough to be utilized by patients- avoiding
bumping from one another). (6)Lighting (integration of natural lighting). (7)Ventilation (8)Auditory and Visual
Privacy (9) Water supply (potable water should be sourced from approved public water supply and should be
brought into the building free of cross connections). (10) proper waste disposal (segregation of liquid waste and
solid waste treatment and disposal). (11)Sanitation ( there should be approved water supply and sewage system
to ensure cleanliness and health of the patients and staff). (12) Housekeeping (there should be spaces allocated
for housekeeping in order to maintain rooms). (13) maintenance (there should be spaces allocated for the
maintenance and performance of equipment). (14) there should be material specification (for floors, walls,
ceilings all should be of sturdy materials). (15)segregation (16)Fire protection (17)Signages (18)Parking
(19)Zoning (outer zone for emergency, outpatient, public and should be at entrance; second zone for workload
such as laboratory, pharmacy, and radiology located near outer zone; inner zone for nursing care and management
of patients located in private areas but accessible to guests; deep zone areas for surgeries, delivery services,
nursery, intensive care and should be segregated from public areas but accessible to outer, second and inner zones;
service zones which provide support to hospital activities, dietary, housekeeping, maintenance.