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Journal of the Academy of Hospital Administration

Role of Architect in designing Health Care Facilities

Author(s): R. Chandrashekhar*

Vol. 15, No. 2 (2003-07 - 2003-12)

Hospital planning, a relative term, generally depends on the Standards or Norms being followed in various geographical locations. These norms could vary within the country or globally. In this era of professionalism where the marketing principle of "Consumer is King" has taken a broader definition, hospital planning is now shaping up to provide greater emphasis on patient satisfaction. As a result the entire health care system is undergoing major reform to prepare itself for challenges and opportunities for the future.

Traditional thinking has narrowed the definition of hospitals as a Doctor's workshop, as a consequence hospitals have been built for technology rather than for the patient.

A successful hospital rests itself on the bedrock of three sound principles - 1) good planning, 2) effective design and construction, and 3) efficient management. A hospital by its very nature is a complicated entity requiring that its design with all its intricacies and details be best left in the hands of an expert in the field. At any stage in the construction of a hospital there is a need for multiple consultants to function as a cohesive unit and the Architect being the leader of the design team has the responsibility of drawing out plans for maintaining the highest standards of patient care and overall efficiency. In this respect the Architect's experience, up to date knowledge and practical application of skill provide the foundation for rendering Architectural services to Health Care.

Standards versus Norms

Standards can provide a valuable means of integrating all aspects of medical and hospital care in government and private sectors in order to avoid major omissions as well as costly duplication. Health Norms are scientifically established indices of environmental conditions of the medical care requirement by the community of various groups of population and health facilities with utilization value. In contrast, the terms "Health Standards" covers indices related to resources required to meet the needs specified by the norms, i.e. indices related to public health facilities and the availability of medical care.

In situations where technical advice in hard to obtain or where professionals without the necessary expertise endeavor to design and construct the health care facilities, norms, standards and the technical requirement provide guidelines on fictional and economic needs. Architects, Engineers, Doctors and Heath workers entrusted with the planning and building process find in the standards, sources of information which help them to avoid costly improvisation.

The norms and standards are also of greater importance to developing countries like India where expenditure on hospital construction and operation rises enormously under the influence of foreign equipment manufacturers and foreign experts. Taking into account both human and economic constraints, physical planning standards or the spatial norms can be precious sources of reference for the judgment of projects to be provided by foreign country, e.g. specialized services for health facility on turnkey contracts.

The Present Scenario

The advancement in the scientific and technological research has taken the health care skills and facilities to a higher state-of-the-art level. In fact, improved efficiency in health care has risen the expectations of patients in the health facilities planning as well. Need-led planning, now must evidently go hand in hand with Resource-led planning. Beside the improvements in the qualitative aspects of health care the exponential in the cost of construction of hospitals and constraints of resources have thrown new challenges in effective utilization and conservation of the resources. The onus here is essentially to achieve both the qualitative as well as the quantitative aspects of health care facilities within the various participant expectations.

Presently, these three components of health care Delivery System do not operate in cohesive communication, resulting in highly underutilized physical facilities of excessive cost inputs. The win-win situation lies where the work culture is evolved at the stages of operational policy planning when the norms for physical facilities are decided. In fact, in 1983, the Indian Ministry of Health did feel an urgent need to establish up-to-date norms and strategies on comprehensive and contextual basis in the following three field of Health care and physical facilities planning: norms for staffing pattern; norms for architectural design for the hospitals at different hierarchical levels: norms for equipment at every level.

The available information on the subject, however, has become obsolete owing to the rapid technological changes in the health-care and its allied fields. On the obverse, such changes in technology have had far-reaching effects in form of changes in equipment usage, change in the concept of hospital administration and change in the expectation of the community at large which avails the services of these hospitals.

To configure the all important norms, the service delivery of the entire hospital has been divided into three sections, viz. Out patient Department OPD (where the patient is mobile while the doctors paramedics and the equipment are fixed), Wards (where the patient is fixed while the rest of the attendant facilities including physicians are mobile) Operation Theatre and Laboratory (where the equipment is fixed while the patients, paramedics and surgeons are mobile).

The discourse has further, identified a broad division of an extreme type and a coastal type of climate to address the objectives comprehensively. It also sums up the total populated and desert / mountain (thinly populated). The variable and fixed components within the broad realms of spatial utilization and functional suitability which have direct bearing on normative planning.

Questionnaires can be employed as investigative tools to collect information for activity data sheet after taking into account the service delivery and the operational policy. These sheets can then aid in identifying two levels of activity possibilities viz Activity unit and Activity sequence. Inputs from User Identification and Workload Tendencies will underline the Staffing Needs thereby producing a numerical requirement of Spatial Units.

Data thus accumulated will help in formulating a Design Brief which will accommodate the Norms for Spatial Design of the particular Health Care Facility.

The Design Brief provides impetus to the process of Hospital Planning in the sense of being a highly technical compilation requiring the services of an expert in the field of Medical Architecture. Besides providing an Architect with a stepping stone for initializing his services, a Design Brief holds the key to the achievement of the goal of effective health care delivery.

High quality of health care can be achieved only if the hospital design is efficient , functional and economical. A minor defect in design can hamper efficient operation of the hospital resulting in operational difficulty of the staff gradually leading to a compromise with the delivery of proper health care to the patient. IN this context a point in contention is the economy in construction. Quality of care provided to the patient depends on the effective planning of the hospital premises and issues like the capital cost of the building become secondary to the cost running and maintenance.

Specifications, Environment and Socio-cultural aspects

Environment plays a dominant role in the healing process of a patient and selection of aesthetically pleasing building material which is also sustainable and patient friendly will go a long way in complementing patient healing.

It is often thought that medicine is curative process, but contrary to popular belief that "Medicine is the surgery of function, as surgery proper is that of limbs and organs. Neither does anything but remove obstructions, but remove obstructions, neither can cure, only nature cures".

Architects, Interior Designers and Health Care Administrators have realized natures influence on patients and their need to nurse their soul. Their approach now combines this inherited wisdom with modern technology by applying a "Holistic" approach in designing health care environment.

The Holistic approach recognizes that each patient has a unique character, physical and psychological needs and the built environment should accommodate these needs. This new approach also identifies the fact that illness has the potential to transform an individual as it provides the person with an opportunity for introspection and time to evaluate life's goals and values. The process of healing is helped a great deal by partnerships between patients and family members.

There is a greater need to be cognizant of the blend of technology and human behaviour by promoting development of landscapes, gardens which are proportionate to the scale of the building and the population it serves. In short a more humane environment should be provided that is in harmony with the body, mind and soul.

It is a common feeling that hospitals encroach on a persons privacy and individuality thus affecting human dignity. It is easy to break out from this straitjacket through efficient layouts and a barrier free environment that helps patient mobility and wellness, by providing lounges, worship places, gardens, kitchen activity rooms. Many of these details and facilities can be incorporated into the plan at little or no extra cost.

Studies show that utilization of natural light, good illumination and better appearance have a theoretical healing potential. Building ventilation, external and internal appearance, landscape and internal and external traffic patterns are very important points to be kept in mind while designing an effective health care environment.

Basic planning aspects like equipment planning, functional circulation, critical areas of hospital services are the most important planning tools that deserve special attention.

Conclusion

Professionals in the health care sector have come to ground with the fact that there is a need to transform today's fragmented health care delivery system into an organised and reformed system to gear up for the future. There is an urgent need to integrate sophisticated equipment, new services and the potential for expansion to survive in competition. Design of Health Care buildings requires considerable foresight and functional insight to accommodate future structural expansions and at the same time providing state of the art medical facilities.


* Senior Architect, Directorate General of Health Services, Ministry of Health and Family Welfare, Govt. of India, New Delhi

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