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Journal of the Academy of Hospital Administration

Hospital Architecture: Emerging Issues and Strategic Options

Author(s): Shakti Gupta*, Sunil Kant**

Vol. 16, No. 1 (2004-01 - 2004-06)

Key words: Hospital Architecture, Issues, Challenges, Strategic Options.

Messages: Host of emerging issues related to hospital architecture.

Present hospital buildings not ideally suited for the emerging trends in healthcare.

Essential to build renovate hospital buildings as per present / future requirements.

Introduction

Hospitals are amongst the largest and most complex of all modern institutions. Hospital architecture is a part of this complexity. Unlike other organizations, which may be built in various ways, hospital building has lesser choices. It differs from other building types in the complexity of functional relationship that must exist in the various parts of a hospital. Apart from providing the right environment for patients and care providers, it should also be sensitive to the needs of the visitors including patient’s families. A number of hospitals are ideally constructed to deliver the present/ future requirements of healthcare. It is an essential requirement to examine the emerging issues, analyse the challenges, appreciate the emerging trends and study the various strategic options available for designing, planning and constructing a hospital.

Emerging Issues

The emerging issues related to hospital architecture are mainly linked to the changing role of the hospitals. The main changes that have occurred in the healthcare delivery system are as follows.

  • Enhanced patients expectations: The patients have become more quality conscious as well as price sensitive. They expect clinical, administrative and supportive services as well as design of facilities to be contusive to their requirements.
  • Epidemiological and demographic changes: There has been a cascading pattern in the incidence of lifestyle diseases and geriatric related healthcare problems.
  • Emphasis on ambulatory / daycare: Hospital stay is gradually being programmed for high dependency impatient care and for other cases more emphasis is on shorter stay.
  • Enhanced standards: There has been an up gradation standards and norms in the delivery of healthcare in almost all aspects.
  • Changing function of hospitals: Hospitals are an evolving system. Hospitals apart from curing the sick have the added functions of maintenance and prevention of health, biomedical research and providing community outreach services. Focus has shifted from treating illness to creating wellness.
  • Health Insurance: Health insurance is gradually permeating as an important facet of healthcare delivery system. The providers of insurance and healthcare as well as the recipients view the hospital as an important hub for healthcare delivery.
  • Advancement in Medical Sciences: Advancement in medical sciences dictate/change the paradigm of healthcare delivery. Trends and dimensions in molecular biology, pharmaceuticals and surgical interventions have changed medical management outcomes. New diagnostic and therapeutic modalities require special controlled environment, energy requirements and other engineering services

Strategic Essentials

Hospitals inevitably are a combination of technologies, processes and human resources. Any structure may have many functions and any function may be fulfilled by alternative structure or process. Hospital architecture must facilitate technology adoption, implementation and also contribute to the efficiency and transparency of processes. It must provide a seamless integration of clinical requirements with building planning and designing issues. Strategies must be formulated to cope with differencing health needs, cultures, climates and budgets. Design responses must embrace all parts and aspects of the hospital.

Some of the strategic issues, which must be considered, are:

Design for flexibility and expandability: Due to the complexity of hospital organization and diversity in various factors such as operations, functions and development, alterations and expansion of buildings are varied and frequent. Buildings should be adaptable to changing requirements. Jhon Weeks, the British architect had remarked. “Functions change so rapidly that designers should no longer aim for an optimum fit between building and function. The real requirement is to design a building that will inhibit change of function least and not that will fit specific function best”. Some of the futuristic patterns for obtaining flexibility are 1.

Buildings designed to facilitate the docking of mobile and plug in modules. It is likely that specialized major diagnostic and diagnostic surgical equipment will be manufactured in self contained pre-constructed modules intended for docking at strategic points – ‘ports’ in the building.
Heat, ventilation and air conditioning (HVAC) will be modularized and zoned with vertical circulation, mechanical shafts and transport system moved form the core of the building to the perimeter in order to create free fields within the core floor plate that are easily adaptable to different layouts

As and when functions/equipment expand it should be possible to extent buildings as well as equipment and installation easily. It has to be acknowledged that building and function life span differs. The golden architectural principle of indeterminacy should be followed which enables a “building to grow with order and change with calm”. In order to combat obsolescence in hospital buildings universal space modules, modular design and interchangeable components which may be reinstalled / replaced should be utilized to keep space with changing needs.

Anticipate Change in Demand Functions: None of the varied elements are static for as technology develops, medical understanding progresses and their combined application expired so do social demand and expectation4.

Hospitals today are focusing on sick care rather than preventing illnesses. This is likely to change in the future. Demand will change due to increase in life expectancy, health becoming a norm and healthcare focusing on prevention and intervention rather than treatment 3.

The emphasis of care is also shifting from inpatient to day care. The healthcare facilities must plan for:

  • Daycare Facilities
  • Home care Facilities
  • Transmural care i.e. patient tailored care provided on basis of close collaboration and joint responsibilities between hospital and home care centers

Assisted living: Assisted living residences are an important concept in the continuum of care. The design should accommodate residents with a range of cognitive and physical abilities. The setting should be designed in a way that maximizes the quality of life, independence, autonomy, safety, dignity choice and privacy of residents

Healthcare hotels: These are places for convalescence and supervised care - a hybrid cross between hotel, spa and hospital.

The emphasis should be more on ambulatory facilities including specialized free standing clinics, medical office buildings and specialized freestanding diagnostic centers. There may also be an increased demand for healthcare facilities on the retail model medical malls possibly in a landscaped setting 1.

Emphasize on Patient focused hospitals: Patients till the recent past had become more an object on the scene than the focus of design 4. Hospitals are service organization which are essentially facilitating systems that enable users to achieve their gorals in direct interaction with the providers. In a major paradigm shift, sensitivity to peoples feelings and their need for sensory input have entered the lexicon of facility planning and design. Lindheim 5 emphasized that the design of healthcare setting should:

  • Welcome the patient’s family and friends
  • Value human beings over technology
  • Enable patients to fully participate as partners in their care.
  • Provide flexibility to personalize the care of each patient.
  • Encourage care givers to be responsive to patients.
  • Foster a connection to nature and beauty.

The objective is to create a patient focused, patient centered architecture by offering an atmosphere of safety, security, cleanliness and physical comfort.

Focus on Energy conservation: Emergency conservation must be planned and implemented some of the measures are:

  • Use of high efficiency light sources.
  • Natural light utilization.
  • Effective ventilation.
  • Easy maintainability.
  • Energy recycling.

Create a Healing Architecture: A hospital needs to be the most wonderful place in the world. It needs to heal. The hospital must have a humanizing architecture that can positively contribute to the healing process.

Studies have linked poor healthcare facility design to elevated blood pressure, anxiety and longer hospital stays following surgery6. The physical environments of the hospital should fulfill the following two conditions:-

  • It should do no harm
  • It should facilitate the healing process

Exposure to nature through interaction or access to view has a positive healing effect.

Hospitals should provide a cheerful and inviting ambience and a caring and healing environment.

Life enhancing designs are architecture that facilitate:

  • High quality of care and access in a setting that is supportive of human relationship during times of great anxiety and fear.
  • “Our stop shopping” that caters to the diagnostic and therapeutic needs.
  • Facilitates ease of maintenance.
  • Provides patients sense of safety
  • Provision of pleasant space for patient’s families and friends.
  • Natural light.
  • Facilitates care.

Aesthetics – An Essential Requisite : Though patients give the highest priority to obtaining the best treatment, it has to be considered that they are people with eyes, ears and other senses and deserve to receive pleasure from the environment 7.

Aesthetics is now considered an essential ingredient of hospital design and planning. Aesthetics, which is the quality of the total experience our surroundings give us as, perceived by our senses and intellect, should be planned for all its dimensions as follows2.

  • Psychological aesthetics which includes happiness, joy and pleasure.
  • Spiritual aesthetics, which suggests hope, contentment and peace
  • Physical aesthetics implies well being, ease and convenience
  • Intellectual aesthetics inspires humour, interest and contemplative delight

Go for Green Hospitals: The emphasis of healthcare architecture must be on improving the quality of the environment for patients and health care providers. The hospitals should be environment friendly. Some of the parameters which may be considered are:

  • Designed to make best use of passive solar energy.
  • Utilization of renewable sources of energy such as solar, wind and biogas
  • Proper waste disposal
  • Go organize.
  • Use materials utilized in hospital building should be noon toxic and non allergic
  • Use of natural light by construction of a truism
  • Ventilators.

Visualize the Hospital of the Future: In the future that more common hospital functions will move close to patients and only a few specific specialized functions will be concentrated at other places. The concentration of specialized facilities and dispersal of other hospital function will influence the building design and planning as well as facilities to support the continually changing hospital function. A number of smaller facilities will be required at several locations to accommodate the dispersed functions and larger facilities at an early accessible location to accommodate the concentrated functions. When the amount of intervention becomes higher or the impact of the intervention becomes lower, request for dispersion function grows. Since function will be continually be transferred to the decentralized health facilities as new function are introduced in the specialized centers, flexibility and expandability in the building design at both centers in a necessity3.

The vertical differentiation of hospital care leading to the specialist oriented building archetype was suitable in cases in which patients are treated by specialists very individually. With the increasing specialization and advances of medical technology hospitals are being designed around distinctly different function.

The different hospital function may be accommodated in different buildings. The different buildings may be a diagnostic buildings, a building for pre-clinical services, a building for daycare including surgery, a building for special medical treatment and intensive care, a logistic center, an office building and an education / scientific building3.

The hospitals of the future will have architecture plan and design facilitating continuous improvements in healthcare, improved technologies monious convergence of the clinical, administrativeof diagnostics and therapeutics. There will be har and hospitality dimensions of healthcare delivery. The hospital of the future will successfully be reformed into organ based centres that have a building of the their own. The patients would only be moved around in the hospital in exceptional cases of when there is a need for highly specialized diagnostic equipment or treatment. In the specific buildings for such a centre there will be beds and equipment as well as possibilities for diagnostics, treatmentlized radiology and so forth will be able to link up with smaller hospitals and local care centres. Thus the hospital o and relief. The center will through the aid of telemedicine, digitaf the future will not just be a hospital as a decentralized network, serving patiwe recognize it today, it will be a hub inents not only in the hospital but also in local hospitals and their homes3.

Diagram

Conclusion

A number of existing hospitals do not have the architecture to effectively deliver patient care. They were mainly designed when patients were considered more an object on the scene rather than focus of design and thus were death rioted from the hospital architectural planning4.

Hospital architecture must focus on improving the quality of environment for the consumers and the care givers. All aspects including interior designing, spaces, exteriors, landscaping should receive due care. Hospitals must be designed to support the processes that have to take place within the building to treat the patients in an efficient manner. The hospital building must evoke positive responses. State of the art technology and human sentiment can be juxtaposed, adopted, adapted and implemented to create an unrivaled architecture.

The nature of a hospital building determines to a certain extent the effectiveness of healthcare and other processes that take place. Wilson Churchill had said “First we shape our buildings, thereafter they shape us”3. This is certainly true of the hospital building. Architects and hospital planners have to keep pace with the advancement in modern medicine, nursing techniques and community clientele expectation.

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