“A functional design can promote skill, economy, conveniences, and comforts; a non-functional design can impede activities of all types, detract from quality of care, and raise costs to intolerable levels” …. Hardy and Lammers
In terms of design, healthcare facilities are among the most complex objects. When designing hospitals, the location of diagnostic and treatment units, emergency rooms, clinical laboratories, surgical units, admission rooms, the separation of ambulatory care and inpatient care areas, comfort maintenance, food services, and household tasks should be taken into account. Many regulations address requirements for healthcare facilities, the proper interpretation of which requires professional knowledge and expertise.
This diversity of functions is presented in different regulations governing the construction and operation of hospitals. Every major and constantly changing function of a hospital, including complex electrical, mechanical, and telecommunications systems, demands specialized knowledge and experience. It is quite difficult to possess such extensive knowledge. That is why consultants have a significant role in designing and planning health care facilities. The functional department in the hospital can have competing needs and intercrossing priorities. Idealized scenarios and clearly defined individual preferences should be well balanced against obligatory requirements, actual functional needs (internal traffic and relationships with other departments), and the organization's financial position.
Healthcare facilities must serve and support a large number of employees and the parties involved, along with the full service range that should be provided. In an ideal scenario, the design process involves direct contribution from the owner and key hospital personnel at the initial stage of the process. Besides, the designer should ensure the safety of patients, auxiliary personnel, visitors, volunteers, and suppliers who are not usually directly involved in the design. Proper healthcare facility design incorporates functional requirements with the human needs of different users.
In the ideal case, healthcare facilities involve functions related to:
- inpatient care;
- outpatient care;
- diagnostic and treatment;
- administration;
- services (food and supply);
- research and teaching.
The future configuration of a healthcare facility is defined by physical relationships between these functions. The established relationships demonstrate the flow and communication of people, materials, and waste. Therefore, the physical configuration of a hospital, its transport and logistics systems are inextricably linked. The transportation systems are under the influence of the building configuration, and the configuration largely depends on transportation systems. Site limitations and opportunities, surrounding environment, climate, budget, and available technologies also have an impact on the hospital`s configuration. New medical needs and new technologies create new alternatives.
In a large healthcare facility, the form of a typical treatment unit is a major component of the general configuration since it may be repeated many times. Nowadays, the form and size of treatment units have a tendency towards minimization. To decrease the distance between the patient's bed and the nurse station compact rectangles, modified triangles, or even circles are used. The selected decision significantly depends on program issues such as the organization of the nursing program, the number of beds in a treatment unit, and the number of beds in a patient's room (a tendency, which has been recently intensified by HIPAA, extends to all private rooms).
BUILDING ATTRIBUTES
All healthcare facilities must possess certain common characteristics, apart from their size, location, or budget.
Efficiency and Cost-Effectiveness
Healthcare facility efficient layout has to:
- Improve personnel efficiency by reducing the distance required for its movement between commonly used premises to a minimum;
- Allow easy visual monitoring of patients by limited number of personnel;
- Embrace all essential premises, but not redundant premises, which require thorough preliminary design planning;
- Provide an efficient logistics system that may include elevators, box-type conveyors, pneumatic tubes, gravity or pneumatic chutes, manual or automated wagons to ensure efficient handling of food and clean materials, as well as disposal of waste, recyclable materials, and contaminated materials;
- Efficiently use space by locating support spaces to be shared by adjacent functional areas, as well as by rational use of multi-purpose spaces;
- Consolidate outpatient functions for more efficient operation. For instance, on the first floor, where possible, for direct outpatient access;
- Group or unify functional areas with similar system requirements;
- Ensure optimal functional adjacencies. For example, locate the surgical intensive care unit near the operating suite. These adjacencies must be found on a detailed functional program describing the hospital's intended operations from the perspectives of patients, personnel, and expendable materials.
- Meet modular concepts of space planning and layout;
- Use, as much as possible, general room sizes and plans;
- Be served by modular, easily modified, and easily accessed mechanical and electrical systems;
- Be designed on a modular system, where size and program allow. Also, such systems use walk-through space between floors for utility distribution. This provides constant adaptation to changing programs and needs for
- large-scale projects, without increasing the cost, if properly planned, designed, and bid. Such construction systems also allow vertical expansion without disruptions to the floors below;
- Be open to future expansion; for example, the positioning of administrative departments, next to clinical laboratories.
Therapeutic Environment
Patients often feel scared and confused and these feelings may hinder their recovery. Every effort should be exerted to make your stay at the hospital safe, comfortable, and stress-free. Interior design is an essential component in establishing and maintaining a proper therapeutic environment. A hospital's interior design must be centered on a deep understanding of the facility's tasks and objectives, and its patient profile. Patient profile characteristics will define the degree to which the interior design should consider different physical and mental disabilities, such as loss of visual acuity, aging, rudeness, and abusiveness. Some significant aspects relating to therapeutic interior creation are given below:
- Using familiar and culturally relevant materials whenever this complies with sanitation needs and other functional needs;
- Using bright and different color and texture schemes. However, it should be taken into consideration that some colors are inappropriate. They may interfere with paleness and skin tone assessments, or disorient older or impaired patients, or agitate patients, especially some psychiatric patients;
- Where possible, using natural light and lighting in interior areas that closely resembles natural daylight;
- Providing exterior views from every patient bed, and where possible; wall murals of nature scenes are useful where outdoor views are not available;
- Developing a navigation process within buildings for each project. Patients, visitors, and personnel need to know what their destination is, where they are, and how to get there and return. The sense of competence in patients is enhanced by making spaces easy to find, identify, and use without asking for help. Building elements, texture, color, and pattern should give clues.
Cleanliness and Sanitation
Health care facilities should be easy to clean and maintain. It is ensured by:
- Appropriate and durable finishes for each functional space;
- Thorough detailing of such elements as casework, doorframes, and finish transitions to avoid dirty and hard-to-clean cracks and joints;
- Adequate and properly located service facilities;
- Specific materials, finishes, and details for premises, which should be sterile.
Accessibility
All areas, inside and outside, have to:
- Meet the minimum requirements of the legal provisions relating to persons with disabilities;
- In addition to the abovementioned requirements, be designed to be easy to use by other patients with temporary or permanent handicaps;
- Ensure that grades are flat enough to allow their easy movement; and corridors and sidewalks are wide to allow two wheelchairs to pass easily;
- Ensure the entrance areas allow accommodating patients with slower adaptation rates to light and dark; glass walls and doors are marked to make them visible.
Controlled Circulation
A health care facility is a complex system of intertwined functions that requires the constant movement of people and materials. The vast majority of this circulation must be controlled.
- Outpatients visiting diagnostic and treatment areas should not walk through inpatient functional areas nor come into contact with severely ill patients;
- Main outpatient routes must be easy and clearly established;
- Visitors should have a simple and direct route to each patient nursing unit without entering other functional areas;
- Separation of patients and visitors from logistical/ industrial zones or floors;
- Disposal of waste, recyclable materials, and contaminated materials has to be separated from the movement of food and clean materials, and both should be separated from patients and visitors routes;
- Transport of cadavers to and from the morgue has to be out of the sight of patients and visitors;
- Special service elevators for deliveries, food, and building maintenance services.
Aesthetics
Aesthetics is closely connected with creating a therapeutic environment (homelike and attractive). It is essential for improving the image of the hospital and serves as a valuable marketing tool. Environmental improvement also contributes to better personnel morale and patient care. Aesthetic considerations include:
- Ample use of natural light, natural materials, and textures;
- Use of artwork;
- Attention to proportions, scale, color, and details;
The Validation Center company provides services for the design of medical institutions with the development of all necessary documentation.