DESIGNING A HOSPITAL
Source:
LECTURE DELIVERED DURING THE UAPGA FORUM
UST College of Architecture & Fine Arts
May 2, 2007
HIERARCHY OF HOSPITAL PHYSICAL PARTS
WHOLE HOSPITAL
ZONES
DEPARTMENTS
ROOMS
SPACES
HOSPITAL ZONES
OUTER ZONE – departments which are the most public-oriented;
located closest to the entrance to the hospital premises.
Ex: Outpatient, Emergency, Admission, Rehabilitation
SECOND ZONE – departments which mostly receive their workload
from the Outer Zone; located in a site next to the Outer Zone
Ex: Laboratory, Radiology, Pharmacy, Diagnostic Sections
INNER ZONE – nursing units that requires peace and quiet, but
must be accessible to visitors and guests of patients
Ex: Patients’ Wards/Rooms
DEEP ZONE – departments that have strict aseptic requirements;
should not be readily accessible to the public
Ex: Operating Room, Intensive Care Unit, Delivery, Nursery
SERVICE ZONE – departments that comprise the “back of the house”
services; usually clustered around a delivery yard
Ex: Dietary, Linen & Laundry, Central Sterile, Bulk Storage
SPECIAL SERVICE ZONE – requires privacy and discreet routes
for entry and exit
Ex: Morgue
THE OUTER ZONE
OUTER ZONE – departments which are the most public-oriented; located
closest to the entrance to the hospital premises.
DEPARTMENT Particulars
Medical Arts Building (MAB) or Doctors’ offices where consultations by patients are
Outpatient Department (OPD) done on an outpatient basis
Admission, Discharge, Billing Counters or windows for admitting and discharging
patients; several positions are provided to service
patients simultaneously
Emergency (ER) Where patients are evaluated and treated on
emergency temporary basis; with curtained cubicles
for patients; 9sm/patient cubicle
Physical Therapy or Where patients with physical problems are treated,
Rehabilitation Department rehabilitated on an outpatient basis
Dialysis Where patients with kidney disease are treated on a
regular but outpatient basis
Pastoral Service / Chapel Where staff, relatives and patients may find solace
in prayer
THE SECOND ZONE
SECOND ZONE – departments which mostly receive their workload from the
Outer Zone; located in a site next to the Outer Zone
DEPARTMENT PARTICULARS
Laboratory Where specimens (blood, urine, feces, saliva,
tissues) are sent for analysis
Pharmacy Where drugs and other pharmaceutical products are
stored and dispensed; can deliver two types of
service: outpatient and in-patient
Radiology Where x-rays are taken – x-ray beams pass thru body
and structural densities are recorded on sensitive
films
Ultrasound Where parts of bodies are studied using high
frequency sounds that bounce off internal structures
Computed Tomography (CT-Scan) Where equipment gives pictures of cross sections of
internal body structures not seen thru X-ray; detect
tumors embedded in tissues; numerous images
collected by detector and reconstructed by computer
Magnetic Resonance Imaging (MRI) Where equipment record radiowave signals from the
body which are reconstructed by computer; more
details and higher resolution than CT-Scan
A COMPACT LAB LAYOUT
A COMPACT PHARMACY LAY-OUT
1.20M – 1.50M COUNTERTOP WORK
SPACE FOR COMPOUNDING
0.60M – 0.90M COUNTERTOP FOR
TYPING AND LABELING
SPACE REQUIRED FOR COMPUTER
PRINTER AND FAX MACHINE
FULL-SIZE REFRIGERATOR
BUILT-IN CABINET WITH DOUBLE SINK
ADJUSTABLE OPEN SHELVING
8” TO 10” DEEP
THE INNER ZONE
INNER ZONE – nursing units that requires peace and quiet, but must be
accessible to visitors and guests of patients
DEPARTMENT Particulars
Nursing Wards Where patients receive treatment on an in-patient
1-bed Ward (Private) basis, from their admission to discharge
Multi-bed Wards
2-beds (Semi-Private)
4-beds
6-beds
8-beds
Nurses’ Station
Clean Utility
Dirty Utility
Medication Room
Staff Lounge and Toilets
Janitor’s Closet
Family Waiting
Public Toilets
THE DEEP ZONE
DEEP ZONE – departments that have strict aseptic requirements should not be
readily accessible to the public
DEPARTMENT Particulars
Operating Suite (OR) Where patients are brought to undergo surgery (go
under the knife) under anesthesia
Intensive Care Unit (ICU) Where patients requiring special nursing, special
equipment are brought for 24-hour intensive
monitoring and treatment
Delivery Suite Where pregnant women are brought for delivery of
babies
Nursery Where newly delivered babies are brought for
cleaning, evaluation and care
Neo-natal Intensive Care Unit (NICU) Where newly delivered babies who are not normal
and require special care and special equipment are
cared for and treated
Pediatric Intensive Care Unit (PICU) Where children (not adults yet) are brought for
special care with the use of special equipment
THE SERVICE ZONE
SERVICE ZONE – departments that comprise the “back of the house”
services; usually clustered around a delivery yard
DEPARTMENT Particulars
Dietary and Dining Where food for patients is prepared under the
supervision of a dietitian; also where food for staff
are prepared and served in the Dining Room or
Cafeteria
Linen and Laundry Where dirty linen are sorted, contracted out for
laundry or are laundered in-house; clean linen are
sorted, mended and stocked
Central Sterile Supply (CSS) Where instruments and other hospital materials and
equipment requiring sterile condition are cleaned
using high temperature and chemicals
Purchasing and Bulk Storage Where staff plan and implement purchase of
various supplies needed in the hospital; where
stocks are stored
Maintenance and Engineering Where carpentry work, mechanical repair are done
Waste Disposal Where various wastes are segregated for collection
THE SPECIAL SERVICE ZONE
SPECIAL SERVICE ZONE – requires privacy and discreet routes for
entry and exit
DEPARTMENT Particulars
Morgue Where bodies of dead persons are brought for
autopsy, preparation for transfer by funeral service
Zoning of Departments in a Hospital
Improper Zoning of Departments in a Hospital
ZONING AND TRAFFIC EXERCISE
IN A CASE STUDY HOSPITAL
EXISTING ZONING – Ground Floor
Outer zone Deep Zone Service Zone Twilight Zone
Second Zone Inner Zone
Medical Arts Radiology Security Morgue
HRD Lab Storage
Direct Patients Pharmacy
Credit/Collect Respiratory
Wellness Stone Ctr
Emergency President
Phys Med/Rehab Asst Med Dir
Chapel Nursing Serv
Dept Surgery
PABX
EXISTING ZONING – Basement
Outer zone Deep Zone Service Zone Twilight Zone
Second Zone Inner Zone
Medical Records Accounting Dietary
Medicare Conference Materials Mgmt
Medical Supplies Stock Room
Toilets
ZONING – Second Floor
Outer zone Deep Zone Service Zone Twilight Zone
Second Zone Inner Zone
OR CSS
Hemo-dialysis Wards ICU Elect Rm
ZONING – Third Floor
Outer zone Deep Zone Service Zone Twilight Zone
Public Toilets Second Zone Inner Zone Delivery Central Supply
Dept.Anesthesia Wards Nursery Storage
Staff Qtrs. Elect.Rm.
ZONING – Fourth Floor
Outer zone Deep Zone Service Zone Twilight Zone
Second Zone Inner Zone Housekeeping
Medical Lib Wards Storage
Elect.Rm.
ZONING – Fifth Floor
Outer zone Deep Zone Service Zone Twilight Zone
Second Zone Inner Zone Storage
Wards Elect.Rm.
TRAFFIC FLOW and HIERARCHY OF CORRIDORS
Secondary
Secondary
Tertiary
MAIN SPINE CORRIDOR
EXTERIOR and GROUND FLOOR TRAFFIC FLOW
Sub-corridors
T-shaped main corridor
Driveway used by various
types of crisscrossing traffic
INTERIOR TRAFFIC FLOW
Basement Floor
•Short straight main corridor
•Different types of users
INTERIOR TRAFFIC FLOW
Second Floor
F-shaped Main corridor
INTERIOR TRAFFIC FLOW
Third Floor
L-shaped main corridor
INTERIOR TRAFFIC FLOW
Fourth Floor
T-shaped main corridor
INTERIOR TRAFFIC FLOW
Fifth Floor
T-shaped main corridor
Hospital Form: The Village Concept
Like a village
Buildings of different forms
Easy to phase
Easy to expand
Nature-permeated ambience
Requires a large site
Corridor system lengthy
Hospital Form:
The Modified Village Concept
Like a village
Buildings with pre-determined forms
Easy to modularize
Fast construction
Forced planning
Hospital Form: The Block
A high-rise form
Hospital developed vertically
Ideal for sites that are tight
Requires a very small site
Visibility of a tall building
Can be difficult to design
Difficult to expand
Hospital Form:
The Tower and Podium
Fast-growing departments in Podium
Slow-growing departments in Tower
Replicable departments in Tower
Easy to design and construct Tower
Fast-growing departments are at
lower floors
Hospital Form: The Finger Plan
Developed from the train corridor Single-loaded corridor – natural light
Spine corridor linking various fingers and ventilation
Might be difficult for staff if corridors
are too long
Hospital Form: The Court Plan
Natural ventilation an lighting from
exterior and from the court
Form closes on itself Nature into inner spaces
With an open court at center Court is a spill-over area
Easier to secure
Open court used as expansion area
The Compact Plan
Like a box
A solid, deep plan
Relies on engineering for
internal environment
Ideal for cold countries
Compact spaces
Less building footprint
Consumes a lot of energy
Artificial ventilation and light
in inner spaces
The Ward
SIZE
Comprises largest % in total area of a hospital
PRIME FUNCTION
To provide accommodation for patients when
dependence is highest
MAIN ACTIVITIES
Normal body activities – eating, sleeping, toilet activities
Treatment – examination, drug administration, therapy
Preparation for return to domestic life – rehabilitation, retraining
FORM
Developed thru time
The Nightingale Plan
Usually 30-32 beds
Beds arranged on either side of center corridor
Center corridor used as staff base and as day space
Administrative offices and support on right side of the ward
Toilets, baths and other utilities on left side of the ward
Variation: Nightingale Ward
Ward is converted into a cruciform, reducing length
Sinks at center
Toilets, bath and utilities, administrative support
at one end of ward
The L-Shaped Plan
•Bi-nuclear, with 2 nursing stations
•Entrance is at center of gravity
•Administrative support at center
•Bed spaces overlook the garden
•Toilets for each group of beds
The T-Shaped Plan
•Entry point at center at leg at T-form
•Administration at center
•Toilets, baths and utilities at center
•Wards at “cross” of the T-form
•Flexible arrangement for ward –
can be 1-, 2-, or 4-bed
The Race Track Plan
•Entry at one end only
•Wards at periphery in a ring
•Corridor follows the ward in
a ring like a race track
•Toilets, baths and utilities are
at the core/center spaces
•Administrative support also at
center/core space
The Cruciform Plan
•Entry from end of one arm of cross
•Administrative support and visitors’
area at one arm where entry is
located
•Toilets, baths, other utilities at core
area
•Wards on the other three arms of
the cross
Peripheral Banding
•Wards occupy the periphery
•Wards may be a mix of single
or multiple occupancy
•Provision of internal corridor
within the ward area
•Separate external corridor or
hospital street
•Wards in the inner layer against
the windows
•Toilets, baths, other utilities,
administrative offices at
outer layer adjacent to street
corridor
Considerations: Privacy vs. Support
Considerations: Progress Patient Care
Each nursing section cares for patients in low, intermediate
and high dependency categories; those in high dependency
being alloted to a bed close to the staff base.
THE OPERATING SUITE (OR)
MINIMUM REQUIREMENTS FOR
SURGERY
ESSENTIALS to carry out operation
a. A place in which to work
min 36sm, no obstruction, strong table, easily cleaned
a. Basic services
water, light, gases
a. Instruments
about 50pcs
CONDITIONS for carrying out the operation
a. Wound must heal – aseptic technique
b. Blood loss must be replaced – intravenous infusion
c. Incident must be painless - anaesthesia
GENERAL CONDITIONS FOR DESIGN
A. Concentration of operating and sterilizing facilities
B. Location of the department within the hospital
C. Relationship with other departments
D.Functions within the department which affect design
A. Concentration of operating and sterilizing
facilities
1. Economy in the provision of engineering lines
2. Ease in segregating department from general traffic
3. Simplification of supply and disposal procedures
4. Space economy
B. Location of the department within the
hospital
1. Whole department on only ONE floor
2. Higher floor vs lower floor location
B. Location of the department within the
hospital (continuation)
Surgical Ward
OR Suite
3. Direct and easy communication with Surgical Ward
4. Department must be located in a cul-de-sac, with no thru-traffic
C. Relationship with other departments
WARDS – OR function mostly for in-patients; CSSD
transport routes must be simple
EMERGENCY – easy route for patients requiring
major operation is important
X-RAY – mobile x-ray available if necessary; ICU
processing can be done in X-ray department
LABORATORY – specimens must be easy to be WARDS
sent to Laboratory by staff/attendants;
Laboratory should not be remote OR
ICU – located near, in fact adjacent; with
direct access from Recovery Room so that
Staff and equipment may serve both
LAB
CSSD – OR and CSSD relationship important
especially if no department sterile supply unit
is provided; close physical relationship is
important.
X-RAY ER
BUBBLE DIAGRAM
D. Functions in the department that affect
design
1. Those that affect lay-out of spaces and facilities
DIRTY
CLEAN
OR independent of general traffic of the rest Clean and dirty stream of traffic
of the hospital: the CUL-DE-SAC principle segregated as much as possible
Rooms arranged from entrance to OR on the Direction of airflow must always be from
principle of PROGRESSIVE ASEPTICISM cleaner to less clean areas
D. Functions in the department that affect
design (continuation)
1. Those that affect lay-out of spaces and facilities
EXAMPLE TO BE SHOWN
IN LATER SLIDES
Staff working within the department moves from one Dirty materials removed from department
clean area to another without having to pass through Without passing through clean areas
a dirty/unclean area
D. Functions in the department that affect
design (continuation)
2. Entrance to the department
A. Patients, staff and other service personnel should have ONLY ONE ENTRY POINT to discourage
unauthorized entry.
B. If service entrance/supplies entrance is provided, prevent from becoming a “back door” for
the department
3. Circulation within the department
Main traffic flows generated by: PATIENTS, STAFF and EQUIPMENT/SUPPLIES
D. Functions in the department that affect
design (continuation)
4. Transport of patients
from OR clean area
Lung Center of the Philippines Makati Medical Center Transfer Area
From hospital public corridor
a. Number of times of transfer of patient must be limited
b. Contamination of the clean zones when bed from wards is wheeled in must be avoided
c. No build-up of infection in transfer zone and recovery areas
D. Functions in the department that affect
design (continuation)
5. Pre-Operative Care of Patients
Lung Center of the Philippines Makati Medical Center British hospital
a. In the Philippines, patients pre-medicated in the wards, anesthesia given on operating table.
b. In Britain, patients are brought to an anesthesia where anesthesia is administered while
OR is being cleaned and prepared in between 2 successive operations
D. Functions in the department that affect
design (continuation)
5. Post-Operative Care
a. Recovery Area located accessible from outside hospital corridor without passing clean
zones, but also accessible directly from clean zones to permit access by a surgeon or
anesthesiologist
b. Provide 1-1/2 beds per Operating Room
D. Functions in the department that affect
design (continuation)
6. Use of Staff Rooms
a. Changing Rooms accessible from both clean and outer corridor.
b. Lounge close to Changing Rooms but accessible from clean corridor only
D. Functions in the department that affect
design (continuation)
7. Engineering Services
Air movement within the air ducts should be from sterile zones to less sterile zones
Preferred temperature by surgeons:
65-70 degrees F or 18-21 degrees C
Relative humidity:
60% is desirable to prevent/reduce build-up of electro-static charges
Ventilation: provide comfortable environment so that there is less fatigue for staff
There should be no re-circulated air from other parts of the hospital
Provide hot and cold water services
Provide suction, medical gases services
Electric power source: distribute around walls of OR rather than concentrate.
D. Functions in the department that affect
design (continuation)
8. Anti-static / anti-explosive precautions
• TSSU at one end
Linear Plan 1 • Clean supplies to TSSU without passing thru
the clean corridor
• ORs flanked by clean corridor on one side and
disposal corridor on the other side
• Long walking distance from some ORs to TSSU
disposal to CSSD and Laundry
Disposal Corridor
TSSU OR 1 OR 2 OR 3 OR 4 OR 5
Clean Corridor
clean supplies
patients and staff
STAFF CHANGING PATIENTS
patients & staff
ROOMS AND RECEPTION/
REST ROOMS TRANFER AND clean sterile supplies
RECOVERY AREA used dirty supplies
• TSSU placed centrally
Linear Plan 2 • Clean supplies to TSSU cross clean corridor
• ORs and TSSU flanked by a clean corridor on
one side and disposal corridor on the other side
• Shorter walking distance between TSSU and
farthest OR
disposal to CSSD and Laundry
Disposal Corridor
OR 1 OR 2 TSSU OR 3 OR 4
Clean Corridor
patients and staff clean supplies
PATIENTS patients & staff
RECEPTION/ STAFF CHANGE
TRANSFER AND ROOMS AND
REST ROOMS clean/sterile supplies
RECOVERY AREA
used/dirty supplies
patients & staff
Double Bank Plan 1 clean sterile supplies
• Two lines of ORs – ideal if many ORs are required
• Central clean corridor, two external disposal corridor used dirty supplies
• Two lines of ORs share clean corridor but have
separate disposal corridors
Disposal Corridor
Laundry, CSSD
PATIENTS RECEPTION/
TRANSFER AREA AND
Disposal,
RECOVERY AREA
OR 1 OR 2 OR 3 OR 4
Clean supplies in
TSSU Clean Corridor
OR 5 OR 6 OR 7 OR 8
STAFF CHANGING
Laundry, CSSD
ROOMS AND
REST ROOMS
Disposal,
Disposal Corridor
patients & staff
clean sterile supplies
Double Bank Plan 2
• Double line of ORs
used dirty supplies
• Peripheral / double clean corridors
Clean Corridor • Central disposal corridor
• Central TSSU
OR 1 OR 2 PATIENTS RECEPTION/
TRANSFER AREA AND
OR 3 RECOVERY AREA
Clean supplies in
Disposal, Laundry, CSSD
TSSU
OR 6 STAFF CHANGING ROOMS
OR 4 OR 5 AND RESTROOMS
Clean Corridor
WORLD TRENDS IN HOSPITAL DESIGN
Non-institutional environment
Facilities as tool and healer
People-centered, humanized hospital
Developments in surgery
Developments in diagnostic imaging
Film-less and paperless hospital
Robotics
Green hospital
The Patient as an Ally in His Own Healing
Centers for Excellence: the Specialty Hospitals
Current World Trends
Non-institutional environment
Exterior Architectural Character
Current World Trends
Non-institutional environment
Interior design
& atmosphere
Current World Trends
Facilities as tool and healer
Sensual stimulation
Current World Trends
Facilities as tool and healer
Positive distractions
Current World Trends
People-centered hospitals
The Home Model
Current World Trends
People-centered hospitals
The Mall Model
Current World Trends
People-centered hospitals
The Hotel Model
Current World Trends
Developments in surgery
Minimally-invasive surgery
Short-acting drugs
Day surgeries
Downsizing of hospital wards
Delineation between acute and ambulatory care
Current World Trends
Developments in diagnostic imaging
Emergence of the
multi-section Imaging
Center
Use of interventional
radiology
Increase in space
standards
Need for design
flexibility
MRI (Magnetic Resonance Imaging)
Current World Trends
Film-less and paperless hospital
Film-based to digitalized processes
Reduction of storage spaces
More dispersed spaces for work stations
Networking of computers within hospital and
community
Paper files to electronic files
Current World Trends
Robotics
Robot food and supplies trolley
Current World Trends
Green hospital
Energy conservation
Symbiosis: nature and man
Use of local materials
Current World Trends
The patient as an ally in his own healing
Patients’ Library
Patients’ Dining Room Patients’ Lounge
Current World Trends
Centers of excellence: specialty hospitals
Women’s Center
Current World Trends
Centers of excellence: specialty hospitals
Hospitals for Children
DESIGN 6 – LEVEL 4 TERTIART HOSPITAL
(200 beds)
DESIGN REQUIREMENTS:
§ 20 X 30 SNOW WHITE PAPER; INKED. RENDERED
§ MANUAL DRAWING FOR FLOOR PLANS, ELEVATIONS, SECTIONS
§ PERSPECTIVES: COMPUTER GENERATED (OPTIONAL)
§ MASTER DEVELOPMENT PLAN
- SCALED MODEL
- 20 X 30 BASE BOARD
- PROVISION FOR MEDICAL SCHOOL
DESIGN 6 – LEVEL 4 TERTIART HOSPITAL
(200 beds)
DESIGN REQUIREMENTS:
Design Concept
Design Philosophy
Design Considerations
Bubble Diagram:
- Per department
DESIGN 6 – LEVEL 4 TERTIART HOSPITAL
(200 beds)
DESIGN REQUIREMENTS:
FLOOR PLANS =1:200 / 1:300 (use KEY PLAN is necessary)
SWEEPING ELEVATIONS = 1:200 / 1:300
(north-side, east-side, south-side, west side OR if 3 or more buildings, 2
elevations per building)
SECTIONS (atleast 2) = 1:200 / 1:300
Detailed floor plan & section (1:20) :
- SUITE WARD
- EMERGENCY ROOM or OPERATING ROOM
PERSPECTIVES
- Aerial View
- Man’s eye view of: 1. Building entrance façade
2. Lobby
3. Suite Ward
