Wilson Churchill has once remarked First we shape

Wilson Churchill has once remarked “First we shape our buildings, thereafter they shape us”. This is certainly true for hospital buildings. "A functional design can promote skill, economy, conveniences, and comforts; a nonfunctional design can impede activities of all types, detract from quality of care, and raise costs to intolerable levels. "

TRENDS AND DIMENSIONS IN HOSPITAL ARCHITECTURE A HOSPITAL ADMINISTRATOR’S PERSPECTIVE Presented by DR. ANU GUPTA KALPANA VERMA IIHMR JAIPUR

BUILDING ATTRIBUTES 1. Efficiency and Cost-Effectiveness 2. Flexibility and Expandability 3. Therapeutic Environment 4. Cleanliness and Sanitation 5. Accessibility 6. Controlled Circulation 7. Aesthetics 8. Security and Safety 9. Green Architecture 10. Energy Savings 11. Water and Waste Management 12. Materials

EFFICIENCY AND COST-EFFECTIVENESS

An efficient hospital layout should: Promote staff efficiency by minimizing distance of necessary travel between frequently used spaces Allow easy visual supervision of patients by limited staff Provide an efficient logistics system, which might include elevators, pneumatic tubes, box conveyors, manual or automated carts, gravity or pneumatic chutes for efficient handling of food and clean supplies and removal of waste, recyclables, and soiled material

Make efficient use of space by locating support spaces so that they may be shared by adjacent functional areas Consolidate outpatient functions for more efficient operation —on first floor, for direct access by outpatients Group functional areas with similar system requirements Follow modular concepts of space planning Use generic room sizes and plans , than highly specific ones

Provide optimal functional adjacencies, such as locating the surgical intensive care unit adjacent to the operating suite. These adjacencies should be based on the hospital's intended operations , from the standpoint of patients, staff, and supplies. Be served by modular, easily accessed, and modified mechanical and electrical systems Be open-ended, with well planned directions for future expansion

THERAPEUTIC ENVIRONMENT

Using familiar and culturally relevant materials consistent with sanitation and other functional needs Using cheerful and varied colors and textures, keeping in mind that some colors can interfere with provider assessments of patients' pallor and skin tones, disorient older or impaired patients, or agitate patients and staff, particularly some psychiatric patients. Admitting ample natural light

Providing views of the outdoors from every patient bed, photo murals of nature scenes are helpful where outdoor views are not available Designing a "way-finding" process into every project. Building elements, color, texture, and pattern should all give cues, as well as artwork and signage.

CLEANLINESS AND SANITATION

durable finishes for each functional space Careful detailing of such features as doorframes, casework, and finish transitions to avoid dirt-catching and hard-to-clean crevices and joint Special materials, finishes, and details for spaces which are to be kept sterile, such as integral cove base. The new antimicrobial surfaces might be considered for appropriate locations.

ACCESSIBILITY

All areas, both inside and out, should: be easy to use by patients with handicaps grades are flat enough to allow easy movement sidewalks and corridors are wide enough for two wheelchairs to pass easily entrance areas are designed to accommodate patients with slower adaptation rates to dark and light; marking glass walls and doors to make their presence obvious

CONTROLLED CIRCULATION

Outpatients visiting diagnostic and treatment areas , not travel through inpatient functional areas nor encounter severely ill inpatients Visitors have a simple and direct route to each patient nursing unit without penetrating other functional areas Outflow of trash, recyclables, and soiled materials separated from movement of food and clean supplies, and both separated from routes of patients and visitors Transfer of cadavers to and from the morgue , be out of the sight of patients and visitors Dedicated service elevators for deliveries, food and building maintenance services

AESTHETICS

Increased use of natural light, natural materials, and textures • Use of artwork • Attention to proportions, color, scale, and detail • Bright, open, generously-scaled public spaces

SECURITY AND SAFETY

Protection of hospital property and assets, including drugs Protection of patients and staff Safe control of violent or unstable patients Vulnerability to damage from terrorism

GREEN ARCHITECTURE

Minimize the use of carpets and other such materials that have the potential to absorb and release indoor pollutants. Use high-reflectant roofing. Use high-performance windows (double-glazed, argon, etc. ). Use rapidly renewable building materials, such as bamboo flooring, wool carpet, strawboard, linoleum, sunflower seed board, wheatgrass cabinetry, hemp fabrics, etc

Install and maintain a temperature/humidity monitoring system to automatically adjust to building conditions and link system to building automation system. Evaluate safe strategies to recycle wastewater/gray water for other purposes on the site. Use low-flow taps, nozzles, and toilets.

Avoid ozone-depleting chemicals in mechanical equipment and insulation (zero tolerance for CFC-based refrigerant). Avoid materials that will offgass pollutants, such as solventbased finishes and adhesives, carpeting, and particleboards that release formaldehyde Audit existing building systems using refrigerant and fire suppression chemicals and remove HCFCs and halons. Identify opportunities to incorporate recycled materials into the building, such as beams and posts, flooring, paneling, bricks, doors, frames, cabinetry, furniture, trim, etc

Specify materials free from toxic chemicals and that do not release toxic byproducts throughout their life cycle, and avoid those toxins that are carcinogenic or bioaccumulative. Key materials to avoid include mercury (switching equipment), arsenic (pressure-treated wood), urea formaldehyde (engineered wood), PVC (floors, wall coverings, furniture, roof membranes, plumbing pipe, electrical wire), and asbestos. Place air intakes away from vehicles and other such sources of pollution to prevent indoor air contamination.

ENERGY SAVINGS

Maximum use of natural light, solar energy and green power can lead to plenty of energy being saved. Solar energy can also be used to produce thermal energy which can further be used to produce electrical energy. construction of the building aligned at an angle to the sun. The major orientation of the building to face north and south maximises use of natural light. Shades on the south side block unwanted direct sunlight while reflecting light onto the ceiling of the interior. This in turn will lead to proper lighting, heating-cooling and ventilation process of a hospital. .

• Courtyards increase access to air movement and daylight. Windows must be located in such a manner so as to ensure ventilation, and increase access to natural light, which will reduce heat. • Green power like bio-gases, bio fuel and renewable sources of energy should be used.

WATER AND WASTE MANAGEMENT

Rainwater harvesting and storm-water management , to conserve water efficiently. This method requires rain water to run across terraces through clean pipes to storage tanks where they are purified and then used. Sewage water is recycled for further use. Minimise wastewater by using ultra-low flush toilets, lowflow showerheads, and other water conserving fixtures

Waste can be effectively disposed through vermicomposting or simple composting, . During construction, waste materials and debris can be further re-used to built inland roads, pavements and gardens. . In the same manner, paramedical waste should be reused, recycled and then disposed

MATERIALS

Hospitals should use PVC, VOC and arsenic-free material Digitalised devices , instead of mercury counterparts. When disposing acids they should be diluted in alkaline High Density Poly Ethylene (HDPE) products , for plumbing and roofing purposes. Concrete, the de-facto building material be mixed with industrial by-products like Flyash, cinder, stone dust, is an acceptable substitute.

• Powdered well-burnt brick , for water proofing roofs and in outdoor pathways. • Biodegradable materials, especially for syringes, as they are cheap and can be easily disposed. • In a country like India, minimum glass should be put in the east and west side since the maximum amount of heating and cooling happens there leading to abnormal heating of the building.

EXAMPLES

Thank you

COST ANALYSIS AFTER IMPLEMENTATION OF GREEN ARCHITECTURE

Green architecture promotes good environment and health. It has also been found to aid in early recovery and shorter hospital stays. Since the average stay of patients is reduced, hospitals can expect an influx of patients, thus increasing profits An upfront investment of two per cent in green building design, on an average, results in lifecycle savings of 20 per cent of the construction costs — more than ten times the initial investment. The US Environmental Protection Agency (USEPA) estimates that —a $4 investment (per square foot) in green buildings nets a $58 benefit (per square feet) over 20 years

Jehangir Hospital saved Rs 46. 25 lakh with an investment of mere Rs 27. 95 lakh. The hospital through its innovative strategies reduced electrical energy consumption by 12. 66%, water energy consumption by 53. 9%, specific energy consumption for air conditioning by 17. 9% and lighting by 5. 99%. . • Banner Health in Phoenix, saved nearly $1. 5 million in 12 months from reprocessing operating room supplies such as compression sleeves, open but unused devices, pulse oximeters and more

According to the survey, hospitals with a high dependence on artificial lighting spent more than 3 times as compared to hospitals depending on natural lighting systems. Hospitals which have higher level of technology spend four times more than those with basic technology infrastructure. Indian hospitals have also documented evidences on energy conservation, reducing electricity utilization by 27 per cent and saving up to Rs 40 lakh rupees per annum.

The medical centres including the six All India Institute of Medical Sciences (AIIMS) facilities coming up in the country will implement ‘Green Architecture’ and ‘Green Engineering’ as an option to save the rising electricity consumption. Some of the other hospitals which are now taking on the Green Design route are Breach Candy, Jaslok and Hinduja in Mumbai; Batra Hospital in New Delhi. , Kovai Medical Centre and Hospital, Coimbatore, Fortis and Apollo