OVERVIEW OF HOSPITAL /
HEALTH FACILITY
BUILDING NEEDS
Contents
Introduction
Type of Health Facilities in MOH
General Hospital Set Up
Health Building Needs
EBD
Introduction
Health / Hospital Building is complex
Requires talents and expertise of many professionals
Complexity of practice = complexity of design
Need to understand hospital functions, operations which are
complex and evolving
Complex variation of needs of various department
Introduction
Interdependence of departments
Controlled environments
Compliance to Acts, standards, and other governmental
regulations
Need concerted and coordinated effort in design
Types of Health Facilities in MOH
Hospital
Specialised Hospitals/Institutions eg.
NCI, Rehabilitation Hospital, Women
& Children Hospital
Major Specialist Hospital hospital
with at least 14 specialties and 6
subspecialties eg. State Hospitals,
some District Hospitals
Minor Specialist Hospital hospital
with 10 specialties
Non-Specialist Hospital / Hospital with
visiting specialists no specialties
Standard MOH Hospital Scope / Size
Purpose : to expedite the project implementation
- standard MBOR
- standard costs
- standard plans?
Types :
76 beds
108 beds
268 beds
306 beds
500 beds
Types of Health Facilities in MOH
Health Clinics run by Doctor / Medical Assistant &
Nurses
KK
Type
Expected
Workload
(attendances)
Main Scope of Services
>800
OPD, MCH, Dental, Pharmacy, X-Ray, Lab,
Rehab, Home Nursing, Admin, FMS
500-800
OPD, MCH, Dental, Pharmacy, X-Ray, Lab,
Rehab, Home Nursing, Admin, FMS
300-500
OPD, MCH, Dental, Pharmacy, X-Ray, Lab,
Rehab, Home Nursing, Admin, FMS
150-300
OPD, MCH, Dental, Pharmacy, X-Ray, Lab,
Rehab, Home Nursing, Admin
100-150
OPD, MCH, Dental, Pharmacy, Lab, Home
Nursing, Admin
<100
OPD, MCH, Pharmacy, Lab, Home Nursing,
+/- ABC & Observation Bed
<50
OPD, MCH, Dental, Pharmacy, Lab,
+/- ABC & Observation Bed
Types of Health Facilities in MOH
Rural Health Clinics /
Klinik Desa (KD)
Run by Rural Health
Nurse
I Malaysia Clinic
Run by Medical Assistant
GENERAL HOSPITAL
Set-Up
General Hospital Set-Up
Will depend various factors:
Level of medical services
Operational policies
secondary, tertiary, specialised
primary care services
privatisation
outsourcing
Special needs
hospital
community
General Hospital Set-Up
Outpatient Services
Emergency Dept.
Clinic GOPD, Specialist Clinic
Day Care
Dialysis (Haemo-dialysis & PD)
General Hospital Set-Up
Inpatient Services
Wards
Standard ward for various discipline
2nd & 3rd Class
Paeds ward classless & with MAC facilities
Multidiscipline 1st Class & VIP, Royal
Intensive Care (ICU,CCU,HDW, NICU, SCN)
Special Ward ie isolation ward
General Hospital Set-Up
Diagnostic & Treatment
Operating Theatre Suites
Double corridor
Single corridor
Labour & Delivery Suites
Single room
General Hospital Set-Up
Diagnostic & Treatment
Imaging (XRay)
Pathology (Lab)
Forensic
(Mortuary)
Rehabilitation
(OT & PT)
General Hospital Set-Up
Medical Support Services
Pharmacy
Inpatient
Out-patient Pharmacy
Medical Store
General Hospital Set-Up
Medical Support Services
Central Sterile
Supply (CSSD)
Haemodynamic
Respiratory
General Hospital Set-Up
Medical Support Services cont
Medical Record
ITD
Medical Social Services
Infant Nutrition (Milk
Kitchen)
Dietatics
General Hospital Set-Up
Non-Medical Support Services
Catering/Kitchen
Linen holding
Waste disposal
General
Clinical/Biohazard
Chemical
General
Maintenance/Cleaning &
Housekeeping
Engineering
Porter/Transport
Helipad
General Hospital Set-Up
Training Education & Research
CME seminar room, auditorium
Library
Clinical Research
Quality Assurance
General Hospital Set-Up
Administration
General Administration
Nursing Administration
Admission & Revenue Collection
Telephone Operator & PABX
General Hospital Set-Up
Staff Facilities
Specialist & Doctors Offices
On-call complex
Staff change
Staff rest
Prayer rooms
Recreational facilities
Staff accommodation quarters, nurses
hostel & housemen quarters
General Hospital Set-Up
Public Amenities
Main entrance & hospital street
Shops & kiosks
Information counter
Cafeteria
Visitors lounge
Prayer rooms
Public Parking
Public Phones etc.
Health Facility Planning
Most complex building
Wide range of
services & functional
units
Governed by various
regulations, codes,
guidelines etc.
Health Facility Planning
Requires specialised knowledge
& expertise
Competing needs & priorities
among various functional units
Ideal & strong individual
preference VS mandatory
requirements, functional needs
& financial status
Health Facility Planning
Serve & support many
different users &
stakeholders
Design process to
incorporated direct input
from owner & key
hospital staff
Good hospital design
integrates functional
requirements with the
human needs of its varied
users
Hospital/Health Facility Building
Needs
Regardless of their site,
size, budget,
hospital/health facility
have certain common
needs :
Efficiency & Cost
Effectiveness
Flexibility &
Expandability
Therapeutic Environment
Cleanliness & Sanitation
Hospital/Health Facility Building
Needs
Accessibility
Controlled circulation
Redundancy
Aesthetic
Security & Safety
Sustainability
Efficiency & Cost-Effectiveness
Promote staff efficiency
eg. reduce walking
distance
Easy visual supervision of
patients by limited staff
Efficient logistics systemlifts, pneumatic tube,
conveyors
Efficient use of space &
prudent use of
multipurpose space
Efficiency & Cost-Effectiveness
Group functional
areas with similar
system requirements
Encourage sharing of
resources & avoid
duplication
Provide optimal
functional adjacencies
eg. ICU next to OT
Flexibility & Expandability
Follow modular concepts
of space planning &
layout
Use generic room sizes
and plans as much as
possible
Be open ended, well
planned directions for
future expansion eg. soft
space next to hard space
Therapeutic Environment
Unthreatening,
comfortable and stress
free
Using familiar & culturally
relevant materials
Using cheerful and varied
colours & texture (note:
some colours are
inappropriate)
Therapeutic Environment
Ample natural light
External views for
patient bed
Designing a way
finding process
making spaces easy
to find, identify and
use
Cleanliness & Sanitation
Easy to clean &
maintain
Appropriate & durable
finishes
Careful details to
avoid dirt-catching
and hard to clean
surfaces
Cleanliness & Sanitation
Adequate &
appropriately located
housekeeping spaces
Special materials,
finishes, and detail of
spaces for sterile
areas
Accessibility
Disable friendly facilities
Does not hinder trolley
movements
Corridors are wide
enough
Marking glass walls &
doors to make their
presence obvious
Direct Vehicular access to
eg. A&E, L&D, Mortuary
Controlled Circulation
Typical outpatient route
simple & well defined
Avoid unnecessary
movement through
inpatient functional areas
Visitors have simple &
direct route to each
patient nursing unit
without penetrating other
functional areas
Separate patients &
visitors from support
services & engineering
areas
Controlled Circulation
Dirty material flows
separated from
movement of food &
clean supplies
Transfer of cadavers
to & from Morgue
should be out of sight
of patients & visitors
Redundancy/Back-up Plan
Able to
service/maintain
systems without greatly
affecting service
Able to tolerate certain
degree of system
failure
Medical gas zonings
Water supply
Electrical supply
Air-condition system
Aesthetics
Use natural light,
materials & textures
Use artworks
Attention to proportions,
colour, scale & details
Bright, open, generouslyscaled public spaces
Homelike & intimate scale
in patient rooms, day
rooms etc.
Compatible exterior
design with physical
surroundings
Security & Safety
Protection of
hospital property &
assets
Protection of
patients & staff
Safe control of
violent or unstable
patients
Sustainability
Operational Costs
Maintenance Costs
Energy saving features
Basic Principle
Small vs Bigger Hospitals / Non Specialist vs Specialist
Hospitals
Small Hospital
(<150 beds)
Bigger Hospital
(>300 beds)
Combine out-patient &
inpatient pharmacy
-May be separated
-May have satellite
pharmacy
Combine L&D with Obstetric -May be separated
Ward on GF
-PAC if L&D located on
higher floor
Centralised OT Complex
-May separate main OT,
Daycare OT and Maternity
OT
Multidisciplinary Ward eg
Obst + Pediatric Ward;
Female Ward
- May be dedicated eg. Male
Medical, Pediatric, Female
Obstetric etc.
Centralised Pathology / Lab
-May have satellite lab
Basic Principle
Doctors examine
patient on the right
side; hence it shall be
the basis for the
orientation of patient
bed, examination
couches and procedure
table within a room etc.
Lessons Learned (Architecture)
No wet areas above
clean/sterile areas eg OT, CSSD
packing & sterile stores, clean
rooms
Corridors where there are patient
/trolley movement shall be wide
enough and with no hindrance
eg fire doors.
All room doors where patient
enters shall be wide enough for
wheelchair and able to be hold
opened.
Lessons Learned (Architecture)
Doors into rooms where patients are
being examined shall have no
glazing.
All patients toilet with shower
facilities shall have textured non
slipped floor tiles.
ALL sinks (clinical/non clinical/builtin) shall have sufficient backsplash.
Provide seamless finishes to floor
and wall in clinical areas.
Lessons Learned (Architecture)
Use washable paint in all clinical
areas.
ALL windows shall be lockable.
Avoid ledges (surface) especially
in clean rooms.
Avoid grey colored flooring in
Operating Rooms.
Lessons Learned (M&E)
Filtered water supply for autoclaves,
haemodialysis, kitchen.
Dedicated water tank for
haemodialysis.
Special treatment for laboratory
sewer i.e dilution tanks.
Task light at nurses counter/station
Sufficient & appropriately located
floor traps.
Easy to maintain materials.
Avoid sprinkler at clean/sterile areas
and areas with expensive equipment eg
ICU, CCU, Burns etc.
Digital Calling system shall be provided
for ALL rooms where patient need to
queue eg. CE rooms, Treatment,
Procedure, Assessment, ECG etc.
Lessons Learned (M&E)
Room air flow shall be from the
doctor/medical staff to the
patient before being exhausted
out.
Provide dedicated plug point for
electric beds in 1st class.
Provide sufficient & appropriate
power supply:
eg. essential supply for all
medical fridges
eg. UPS for life supporting
equipment ie. ventilators,
angiography etc
EVIDENCE BASED DESIGN (EBD)
Dr Maarof Sudin
Planning & Development Division
Ministry of Health Malaysia
Introduction
Healthcare business is about
selling care experiences
An aesthetically pleasing facility
is a key aspect of the perceived
quality of care
Does health facility design really
have impact on patients and staff
outcome?
Growing evidence - design can
produce positive impact on the
desired outcomes
Introduction
Impact of building on
people/occupants
Second to fresh air, I should be inclined to
rank light in importance for the sick. Direct
sunlight, not only light is necessary for speedy
recovery. I mention from experience, as quite
perceptible in promoting recovery, the being
able to see out of a window, instead of looking
against a dead wall
- Florence Nightingale on Light, 1860
First we shape the building; thereafter, they
shape us
- Sir Winston Churchill, May 10, 1941
Well Designed Hospitals
Create a built environment
that take into consideration
patient and staff requirements
that can have positive impact
on patient outcome, staff
performance and staff and
patient safety
No Environment is Neutral
The design of facilities,
organizations, work
processes, and
equipment impact one
another as well as patient
outcomes, safety and
staff satisfaction
Either positively or
negatively, the design will
exert its impact
Connecting Environmental Design to
Quality Improvement
Hospital Built Environment
Safety and Quality
Of Patients Care
Patients Perception
Of Care Given / Care
Experiences
Staffs Job Satisfaction
And Stress
How supportive healthcare design
improve outcomes?
Ability to alleviate STRESS
Promoting stress reduction, buffering
and coping
Patient can use their limited energy
to get better, instead of having to
fight the environment
Stress in itself is a negative health
outcome
AND
detrimental to psychological,
physical, and behavioral effects that
worsened other outcomes
EVOLUTION OF HOSPITAL DESIGN
Traditional
Approach
Hospital
Outlook
New
Narrow wellness perspective
Holistic wellness perspective
Emphasis on functional efficiencies
Also include:
-psychological needs
-social needs
-spiritual needs
Pathogenic conception
-reduction of infection and disease
risk exposure
-prevent illness and physical harm
of patient, staff and improve
medical outcomes
Institutional
Patient and Family Centred
Stressful
Healing Environment
Detrimental to care quality
Friendly
Quality Care
Traditional Hospitals
Institutional & Stressful
New Hospitals
Patient Centred & Promote Healing
Reasons For Change In Design Approach
High
demand
satisfaction
Growing stress,
healthcare staffs
to
increase
work
patient
demands
for
Declining staff / patient ratios
Need to attract and retain quality employees
Advances in mind/body medicine
Stress and psychological factors impact on
health
Increase adoption of patient centred and
family centred care philosophies
Mounting scientific researches linking welldesigned healthcare environments to
improved outcomes
New Health Facility Design Approach
Evidence Based Design /
EBD
Design is less of an art BUT
more of a SCIENCE
- Empirical Approach /
Engineering-style Approach
Measure first then fix
Architects / designers and
informed clients make decisions
guided by credible evidence
Evidence Based Design (EBD) Definition
General :
Evidence based design is the conscientious, explicit and
judicious use of current best evidence from research and
practice in making critical decisions, about the design of
each individual and unique project
Hamilton, DK & DH Watkins 2009
A process of basing decision about the built environment on
credible research to achieve the best possible outcome
The Centre for Health Design, 2008
EBD in Healthcare Setting
In Healthcare Buildings,
Built environment = Healing environment
A Healing Environment
is the result of a design that has
demonstrated measurable improvements
in the physical and/or psychological ,
social and spiritual states of patients
and/or staff, physicians, and visitors
- complementary treatment modality
- makes a therapeutic contribution to the
course of care
EBD Research Initiatives
1. Centre for Health Design
& Robert Wood Johnson
Foundation, Chicago
2. Georgia Institute of
Technology
3. Rubensi & Golden metaanalysis on 84 studies
(1998)
4. Ulrich & Zimring metaanalysis on 600+ studies
(2004)
Centre for Health Design
Literature Search 2004
by Ulrich & Zimring
Organizes the substantial research knowledge
base on the effects of the environment to various
outcomes.
Findings :
Rigorous studies link the environment to
outcome in 4 areas :
1. Reduce patient stress & improve outcome
2. Reduce staff stress & fatigue
3. Improve safety
4. Improve quality
Literature Search 2004
by Ulrich & Zimring
Research Conclusion / Recommendations
Provide single bed room
Hospital should be much more quieter to reduce
stress and improve sleep
Provides stress reducing views of nature
Develop efficient way finding systems
Improve ventilation
Improve lighting
Design to reduce staff walking and fatigue
Saint Alphonsus
Centre for Advanced Healing
Identify evidence based design elements with
positive outcomes (in order of the strength of evidence):
1. Single patient rooms
2. Installing HEPA filters
3. Providing access to nature
4. Installing ceiling lifts
5. Installing sound-absorbing ceiling tiles
6. Family areas within patient care spaces
7. Providing access to sunlight
8. Promoting the use of visible and accessible
hand washing facilities/dispensers
9. Promote visual access and accessibility to patient
10.Providing areas of respite for staff
Single Patient Rooms
-High HAI
-More medical error
-Increase patient transfers
-Privacy violation
-Lack family involvement
-Stress
-Reduced quality of care
-Reduced satisfaction
-Reduced staff productivity
-Faster recovery
-Lower HAI & medical error
-Better privacy
-Less noise
-Better communication
between staff and patient
-High satisfaction
Installing HEPA filters
-Control indoor air pollution
-Filter harmful pathogens
-Reduce impact of infections
-Isolation of patient
-During construction and renovation
(portable HEPA) to filter m. organism
eg. aspergillus from soil
Providing access to nature
View to Nature
-large window
Healing Garden
-visibility, accessibility, familiarity, quiet
environment
Positive Distraction
-ARTS, music etc
-Increase satisfaction
-Positive escape & recuperation from stress
-Opportunity for patient-visitors interactions
-Positive mood change
Artwork - Example
Comforting/Healing
Stress Induced
Installing Patient Lifters
- 44% of injuries to nurses that
result in lost workdays
- patients becoming heavier & nurses
ageing( 40% US nurses aged >50 by 2020 )
- integrated with staff education,
ergonomic program,
& no manual-lifting policy
- reduce staff injuries
-reduce staff MCs
-reduce medical claims
Installing sound absorbing ceiling tiles
- Acoustic environments
-High ambient noise levels
- Reduced sound reverberation
times & sound propagation
- Staff emotional exhaustion
and burnout
-Reduce noise
- Reduce stress
-Threat to patient confidentiality
and safety
- Improve sleep
- Improve communication
- Impeding effective communication
- Reduces perceived work pressure
Family areas within patient care spaces
-Unfriendly facilities for family
- Space within patients room
- Family lounge &
-Family counseling room
-Intermittent contact with patient
-Unable to participate actively in
patient care
-Reduce family involvement &
satisfaction in care
-Encourage active family participation
-Patient-family interaction privacy
Providing access to sunlight
-Reduce depression & stress
-Patient & staff rooms, family lounge
-Large windows
-No glare
- pain
- Less
-Decrease LOS
-Improve sleep & circadian rhythm
-Less agitation among dementia patients
-Able to control light level
-Vitamin D intake
Visible and accessible hand washing facilities
Scrub troughs, clinical sinks or hand sanitizers
-Easy access
-Good visibility
-Within easy reach
-Unobstructed access
-Placed at comfortable height
-Minimal effort to use
-All patient rooms
Hand washing frequency among healthcare staffs generally still low
Promote visual access and accessible to patient
-Centralized nurse base
-1/3 nurse time walking
-Decentralized nurse stations
-Alcoves outside patient rooms
-Locating frequent used supplies
in / near patient room
-Walks 6 miles/shift
-No direct visibility of patients
-Time wasted in hunting &
gathering supplies
-Reduce staff walking distance
-More time on direct patient care
-Reduce staff fatigue
-Reduce patient fall rate
Providing area for respite for staff
-non revenue generating space
-very cramp/compact
-contribute to staff stress
-poor staff satisfaction
-poor staff retention
-Large staff lounge
-Windows with view
-Respite area
-Staff toilets and shower
-Staff satisfaction & retention
-Increase staff effectiveness
Nowhere to Rest
Conclusion
Environmentally preventable hospital
acquired conditions can no longer be tolerated
eg.
-infections and falls
-injuries to staff,
-unnecessary intra hospital transfers
that can increase errors,
-increase patient and family anxiety,
stress,
-LOS caused by noisy, confusing care
environments
Clear connections between constructing well-
designed healing environment and improved
health care safety and quality for patients,
families and staff as well as long run cost
saving
Conclusion
Cost-effective, evidence based
environmental design
interventions should be included
in all hospital improvement
programs
Evidence-based environmental
design intervention should be
implemented together with other
process improvements for them
to be effective
We can show empathy through EBD..
THANK
YOU
