Case Study

Local Research

Redevelopment of Ospital ng Tagaytay

Introduction

Health facilities are important components of the health care system. The

national government has been aiming for the provision of essential health services that

are accessible, affordable and equitable. Despite the progress cited by the national

government, the country’s public healthcare system is marred with problems. The lack

of health personnel, the absence of adequate facilities, and the remaining barriers for

the poor to access health care are just some of these problems.

Ospital ng Tagaytay was inaugurated on April 25, 1997 by former President Fidel

V. Ramos and Atty. Francis N. Tolentino, former City Mayor. This was opened publicly

on May 4, 1997. It was dedicated to the people of Tagaytay as well as nearby

communities to provide primary care as well. The planned city health center and a lying

in clinic was converted into a hospital and is now the Ospital ng Tagayaty located at

Bacolod St. Kaybagal South, Tagaytay City, Cavite. The hospital has the old and new

wards, which houses different sections.

Figure 1.1. Front Elevation of Ospital ng Tagaytay.

Research Design

The Emergency room is located at the right side of the Hospital which is in the

minor road and at the back of the hospitals serves as parking spaces for their

ambulance and some hospital employees while being storage for their medical wastes

and other supplies.

Fig. 1.2 Side of the hospital Fig. 1.3 Rear view

We can see the lack of disposal and storage facility for their medical waste which is just

placed beside the wall without precautionary coverings or containment and this is

unsafe and can harm the air that is dangerous that can cause some disease.

In the public toilet in ground floor, the

cleaning materials and trash cans located

beside the toilets. There are no visible

storage compartments for these cleaning

materials and the risk of contamination is

evident in the area.

Fig. 1.4 Bins and Cleaning Equipment.

Fig. 1.5 Breastfeeding and Lactation room. Fig. 1.6 Corridor

A breast feeding and lactating station was near the toilet area and it was near the exit to

the back of the facility. The air tanks are situated only down the hallway and no suitable

area can be located to place the tanks safely. It is a danger since it is placed in the

breastfeeding and lactating area and its waiting area where these safety risks are

exposed to patients such as mothers and their newborn infants.

In spite of gathering samples from the

patient, the laboratory department can only

handle one patient at a time. You will suddenly

see the patient's chair with a table for

instruments and tools to collect samples from

patients as you open the door.

Fig. 1.7 Laboratory

entrance
Fig. 1.8 Laboratory.

The laboratory itself is quite small just enough for making tests that are within their

current capability and capacity.

Fig. 1.9 Emergency room Fig. 2.0 X-Ray room

The emergency room is located near the x-ray room but some of its facilities are

not up to the minimum hospital standards such as the current design and condition of
the doors. The access of patients to be confined from the emergency room is slightly

obstructed by the patients waiting along the Out-patient department clinics.

The counter for the hospital

pharmacy is located at the hospital

entrance. In this picture the counter

for the pharmacy is located right

beside the security guard manning

the entrance which looks

inconvenient to the patients.

Fig. 2.1 Pharmacy

Fig. 2.2 Hallway Fig. 2.3 Ramp to 2nd Floor

Some hallways appear to be dark and not very well lit with artificial lighting which

may discourage the people from entering the area because it appears unused. Since

the hospital is a 2-storey building they provided a big ramp for transporting the patients

to the second floor where the different wards are located. Only depending on natural

light, it appears to be insufficient for the area which makes it dark.

The single bed patient room was located at the

middle part of the floor of the building. It felt

stressful that the patient is surrounded by the walls

of the hospital without any external access to the

surroundings. The importance of having natural

environments at least to one side of a space can

enhance the therapeutic effects of the hospital.

Fig. 2.4 single bed patiemt room

Fig. 2.5 Small Outdoor Garden

The good thing about this space is that the hospital tried to blend some positive

space in the hospital where the patients can have pleasant views inside the hospitals

and where people can stay besides from the hospital areas. The bad thing about this

space is that they did not enhance the potential of this space In Emergency Laboratory

and other Tests Admission Private Room/Ward Cashier Out to help the patients and

people inside the hospital.

Ground floor Facilities: • Delivery room

• Outpatient section • Eye clinic
• Laboratory Second floor facilities:
• X-ray • Private rooms
• Drug-room/Pharmacy • Semi-private rooms
• Records room • Ward Rooms
• Emergency Room • Authorized bed capacity of 12 beds
• Labor but total inventory of 20 beds

Application of the Project

Noise Reduction

Research suggests that environmental interventions may be effective in reducing the

noise levels in hospitals and improving the acoustical environment. Key interventions include
installing high-performance sound-absorbing ceiling tiles, eliminating or reducing noise sources,

and providing single-bed rather than multi-bed rooms

Sound-absorbing ceiling tiles

At least three studies have shown that installing high-performance sound- absorbing ceiling tiles

and panels results in reduced noise levels and perceptions of noise and impacts other

outcomes such as improved speech intelligibility and reduced perceived work pressure among

staff. Though decibel levels were not greatly reduced as a result of the ceiling-tile intervention in

these studies (reduction of 3 to 6 dB(A)), reverberation times and sound propagation were

significantly reduced. This impacted the perception of the unit being less noisy and also

improved speech intelligibility, which has implications for staff communication

Fig. 2.8 Ceiling

Sound proofing

Reducing noises from floors

Fig 2.9 Carpet Fig 3.0 Padding

By far the most effective way to reduce impact noise from above is to lay carpet
with thick padding underneath — the thicker, the better. This dissipates the impact
energy before it has a chance to enter the building structure as sound. Carpeting gives
superb results and often resolves the problem of impact noise.

Resilient Underlayment with Damping Compound If you have impact noise but
carpeting is not feasible in your case, or is something you'd prefer to avoid, then you'll
want to put down layers of flooring that include resilient underlayment and damping
compound. The resilient underlay introduces a decoupling effect, and the damping
compound further dissipates the sound energy, and is especially important at lower
frequencies where underlayment does not help.

Resilient Underlayment: There are several varieties of resilient underlayment

material available, including foam, fiber, cork, and rubber. A shredded rubber mat is an
excellent choice because it is heavier than foam or cork, so it gives you the extra
soundproofing benefit of added mass.

Damping Compound: The damping compound (typically Green Glue Noise

Proofing Compound) can often be applied directly onto the existing subfloor layer, if the
subfloor is not thick and massive, and it is of a material that can be screwed into. Since
the damping compound needs to be between two stiff surfaces to do its job, a rigid layer
needs to be placed above it. You can use cement board, or if total thickness is not a
concern and you want the extra mass for more sound isolation, you can use thicker
sheets of medium-density fiberboard (MDF) or oriented strand board (OSB). Any sheets
that have damping compound between them should then be screwed together.

Flooring: Install your choice of finished flooring (such as hardwood, wood

laminate, or tile) on top of the underlayment as a floating raft — in other words, do not
attach it to the layer beneath with nails, screws, or adhesive. Also, leave a gap between
the edge of the flooring and each wall, and fill the gap with acoustic sealant. This gap
allows for expansion of the flooring, and also acts as a decoupler, helping reduce the
sound energy that is transmitted through the walls into the building structure (the
"flanking noise" problem).

Artificial Lighting System

Reception Area – fixed downlights are used for general lighting. To guide

visitors to the reception area, accent lighting is used to illuminate the back wall, whilst

suspended luminaires are used for task lighting above the reception desk. In daylight

areas, daylight regulation is used to save energy by using a daylight sensor.

 Corridors – A space where patients often meet each other and talk

while navigating their way through different parts of the hospital, this

solution for corridors in hospitality areas features LED lighting. It ensures

that lighting brings high efficiency in terms of guidance, safety and comfort,

while at the same time having diffused lighting without glare.

Fig. 3.2 Distance of Lighting

Fig. 3.3 LEDs

Waiting Room – In this standard lighting solution, contrasts are created to stimulate

interaction between people and to give the waiting area a friendly dynamic. This has

been achieved by the use of downlights. Where the luminaires are placed near the wall,

a pleasing play of light beams is visible.

Lighting plan
Examination Room – In an examination room accurate color rendering in the lighting is

of vital importance. This standard lighting system can be adjusted to suit the activity –

whether calming, to assist with patient conversations or brighter task lighting for

examinations. Different presets for different lighting levels can be pre – programmed

and this scheme includes an additional LED examination light, featuring high color

rendering with no heat output.

Lighting plan
Imaging room – this room uses LED downlights that provide effective general white

light with very low energy consumption. In additions the system is fully dimmable using

DALI controls and this solution provides a very comfortable feeling in the imaging room

Lighting plan
Patient Room – to create a comfortable and warm ambience, a luminaire with a gentle

light and soft appearance has been selected to meet the needs of patients and comply

with requirements for patient rooms. In addition, there is a wall – mounted reading light

which can be controlled by the patient. In the evening, a downlight above the table

makes the space more open and inviting for visitors, plus an additional task light is

provided above the table.

Lighting plan:
Accessing Daylight:

Access to sunlight will depend on window orientation and on overshadowing by

obstructions. In general, spaces lit solely by windows facing within 45 degrees of due
north will be perceived as poorly sunlit. Windows within 90 degrees of due north are
also likely to give little sun if there are significant obstructions to the south. For many
low-dependency hospital spaces, curtains are the common shading option. Metallized
fabrics are available which can reflect extra solar heat to the exterior and provide some
extra insulation at night. For maximum daylight, it should be possible to pull the curtains
fully back so they do not obstruct the glazing. Louvered blinds give better control of
sunlight; often the blind can be adjusted to block sun but permit some view out. They
are harder to keep clean, but provide good glare control, especially in non-clinical areas.
The most hygienic option is to use mid-pane blinds in a sealed double-glazing unit. Mid-
pane shading also rejects more solar gain than an equivalent interior blind. In spaces
with significant window area, extra shading may be required to prevent overheating in
summer. Horizontal shading above the window, such as awnings, overhangs or
canopies, can block high-angle summer sun while allowing winter sun and a view out.
High performance glazing is now available which can give reduced solar transmittance
with a higher daylight transmittance.

Sunlight in outdoor spaces around the hospital is also valued, both for sitting out
and to give pleasant views from inside. Asked if they would prefer a pleasant sun-lit
view with no indoor sun rather than indoor sunshine with an unpleasant view, 50% of
patients opted for the view. Courtyards, particularly deep ones, are generally poorly
sun-lit unless they are opened out to the south.

Lighting in healthcare settings

• Provide windows for access to natural daylight in patient rooms, along with
provisions for controlling glare and temperature.
• Orient patient rooms to maximize early-morning sun exposure.
• Assess adequacy of lighting levels in staff work areas.
• Provide high lighting levels for complex visual tasks.
• Provide windows in staff break rooms so staff has access to natural light.

Fig. 3.8 Patient Rooms

Fig. 3.9 Work Areas and Corridor

Positive distraction’s inside the hospital

Positive distractions refer to a small set of environmental features or conditions

that have been found by research to effectively reduce stress. Distractions can include

certain types of music, companion animals such as dogs or cats, laughter or comedy,

certain art, and especially nature. The focus here is on the last, nature.

Design strategies in providing positive distractions inside the hospital are the ff:

• Views of nature, from patient rooms, and wherever possible in lobby,

waiting, and other 'high stress' areas

• Access to nature, healing gardens Chapel, meditation room, and

meditation gardens

• Artwork depicting nature, including back-lighted photographs of nature

• Mild physical exercise; corridors, public spaces, and gardens that invite

walking when appropriate

Enabling Social Support

Many studies have demonstrated how social support can improve health related

outcomes. Studies have shown “a general positive association between the overall

number of social ties or contacts people have and their health status”. Research has

shown that in a range of healthcare and non-healthcare settings, people who receive
higher levels of social support, tend to be less stressed and have better health status

than more socially isolated people.

Design strategies that promote social support are the ff:

• Spaces should be flexible and easily controlled by patients and families in

order to adjust to situational needs.

 Provide patients with single rooms, with designated family areas.

 • Provide family lounges and waiting areas near patients .

• Create a comfortable environment by incorporating “soft” finishes,

furnishings and materials into the design.

• Use technology to foster social support.

• Provide natural gardens for patients and families to use.

Therapeutic effects of Colors

A perfectly crafted color palette can do wonders for a healthcare facility,

whether it’s the product of a new-build project, renovation, or just a bit of

rejuvenation.

But determining what shades of paint are best suited for a specific space

should be done with plenty of consideration for not only facility type, but also the

area/department being painted and the individuals who will be using it.

• White walls are often associated with a clinical appearance and

institutional settings. Adding color and an interesting ceiling design,

as in this procedure room, can make the environment seem less

intimidating.
• Color may be tied to the institution’s logo or corporate brand

• Art can create an analogous color scheme in hospitals

 • Several colors of various hues, but similar in value, combine to create a

warm environment and visually “shorten” a long corridor.

• Signage is sometimes overused in healthcare. Small accents of

color may play a role in “attention grabbing” assisting as a wayfinding cue.

Landscaping

Landscaped grounds - Green areas between buildings, primarily used for waiting and

eating in, link the architecture with walking paths; however, they may be expensive to

maintain.

Landscaped setbacks - These are usually planted areas in front of the main entrance,

which are visually pleasant and serve to separate the hospital building from the street.
Courtyards - Courtyards are the central and most often used spaces in a hospital

building complex, because of their proximity to the dining area; they tend to be used

more by visitors and patients if they are easily visible, and should be sufficiently large to

prevent overcrowding. Courtyard features may include landscaped tree-shaded areas,

water features, flowerbeds and moveable seats; for reasons of privacy and security as

well as aesthetics, they may be fenced around (especially if designed for care of the

mentally ill) up to a height of 4.27m.

Roof gardens - Gardens located on roofs are visually attractive, enabling patients to

look out from their rooms and have a comforting view of grass, paving stones, benches

and people, rather than roofing material or medical equipment. Depending on how much

planting material is used and to what depth, green roofs generally weigh between

6.82kg and 22.73kg per square foot. They are a practical and sustainable way of

regulating the quantity and speed of run- off, as they retain 70-90% of the rainwater that

falls on them in the summer, and 35-40% of the precipitation in winter [18]. Roof

gardens enable major energy savings that will more than compensate, in time, for the
costs of building, structure, waterproofing, and landscape maintenance; and they also

minimize the environmental impact of a health care facility.

Viewing gardens - Some health care facilities with limited space and budgets feature a

small, enclosed garden that can be seen but not entered. Such gardens cost little to

maintain, provide some green space, flowers, perhaps a water feature, and they can be

seen from sheltered indoor seating areas; however, the elements of nature they provide

are removed from the senses, as they cannot be approached smelled, heard or

touched.
SWOT Analysis

Strengths

 Very accessible to roads either by public and private vehicles

o The site of the hospital is located along the Crisanto M. Delos Reyes

avenue traversing the Mahogany avenue and Tagaytay-Nasugbu

highway.

 The hospital has some positive spaces

o The current design of the hospital incorporated some positive spaces

like the interior garden to boost vistas and lounging areas.

 The hospital takes advantage of the natural climate

o As part of their savings programs some areas in the hospital takes

advantage of the natural light instead of using artificial ones. The

location of the hospital presents a great opportunity for therapeutic

environments

Weaknesses

 Exterior design

o The problem with the building’s design is that it doesn’t give an impression

that it’s a hospital facility. Other than the sign that says it’s a hospital it

doesn’t convey its purpose to the patients that it’s a building of therapeutic

design.

 Interior design
 o Although the hospital meets the minimum requirements for hospital

facilities, the hospital could have exerted an effort in making the interior

design more therapeutic environment for the patients.

 Toilet facilities

o The number of toilet facilities are not suitable to the number of users in the

building. Some of the toilets are already dilapidated and in need of

replacement.

 The hospital is not friendly to persons with disabilities

o The facilities of the hospital lack appropriations for persons with disabilities

such as ramps and toilet facilities for PWD’s

 No other ramps

o The main ramp to the second floor is the only access for transporting

patients. The problem is it crosses paths with the outpatient department

and the main lobby that when an unfortunate death of a patient occurs

other patients and visitors will be able to see the body being taken out.

 Fire safety code violations

o There are a number of violations in the fire safety code that the design of

the hospital didn’t follow and poses a risk in the lives of the people inside

the building.
 Space allocation and planning

o The spaces of the building are not designed for expansion and that when

the administrators plan to add other services to the hospital their only

option is to make a makeshift facility outside of the building.

 Lack of landscapes

o The exterior of the building lack is landscapes which can help in the

appearance of the building. The only positive space in the hospital which

is the interior garden is not properly landscape.

 Lack of lighting

o Some areas of the hospital are very dark when natural lighting does not

reach those areas.

 Unnecessary noise

o The sound minimization or sound proofing in the hospital is not evident in

the areas and it contributes to the unnecessary noise especially when

there are many patients especially children.

 Inadequate storage spaces

o There is a need for more storage spaces especially in hospital materials

and equipment. In some pictures the hospital equipment’s such as oxygen

tanks are stored along corridor which can pose a risk to the visitors.

 Hazardous waste storage facility

o The hospital doesn’t have any space in the compound for hazardous

waste materials. The wastes were only stored on an open area at the back

of the hospital without any coverings to prevent contamination.

Opportunities

 Due to the growing population in the city of Tagaytay and the adjacent

municipalities there is a foreseen growth in terms of patients in the future.

 The Ospital ng Tagaytay is the only public hospital in Tagaytay city and nearby

municipalities which gives it a potential for accepting indigent up to middle class

citizens.

 There is a good potential for introducing new facilities adapting with technology

for their convenience.

 The hospital is located in Tagaytay city which very well known for its good

climate all year round.

 The hospital has a potential to add more beds with the current inventory of beds

of all hospitals there is still an opportunity of growth to increase the bed to

population ratio.

 Given the climate and environment of the area there is an opportunity to make

the hospital a more therapeutic environment for the patients.

Threats

 The age of the hospital is very vulnerable to damages when typhoon Glenda

battered the hospital the roof was damaged and the hospital shut down and did

not accept new patients for almost 2 months. Some patients were transferred.

 The current capacity of facilities of the hospital may be inadequate when the

surge of patients come in the near future.

 Infections and contaminations of the patients is possible without proper

segregation and protection of their facilities.

 Services not found on the current capacity of the hospital may affect its image to

the public as a provider of quality healthcare services.