Wilson Churchill has once remarked

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• 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 non-functional
  design can impede activities of all types,
  detract from quality of care, and raise costs to
  intolerable levels."

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TRENDS AND DIMENSIONS IN HOSPITAL
ARCHITECTURE A HOSPITAL ADMINISTRATORS
PERSPECTIVE

• Presented by
• DR. ANU GUPTA KALPANA VERMA

IIHMR JAIPUR
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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

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• EFFICIENCY AND COST-EFFECTIVENESS

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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

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• 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 operationon 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

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• 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

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• THERAPEUTIC ENVIRONMENT

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• 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

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• 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.

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• CLEANLINESS AND SANITATION

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• 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.

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• ACCESSIBILITY

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• 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

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• CONTROLLED CIRCULATION

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• 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

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• AESTHETICS

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• 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

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• SECURITY AND SAFETY

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• 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

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• GREEN ARCHITECTURE

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• 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

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• 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.

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• Avoid ozone-depleting chemicals in mechanical
  equipment and insulation (zero tolerance for
  CFC-based refrigerant).
• Avoid materials that will offgass pollutants,
  such as solvent-based 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

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• 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.

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• ENERGY SAVINGS

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• 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..

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• 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.

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• WATER AND WASTE MANAGEMENT

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• 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, low-flow showerheads, and other water
  conserving fixtures

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• 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

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• MATERIALS

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• 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.

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• 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.

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• EXAMPLES

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• Thank you

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• COST ANALYSIS AFTER IMPLEMENTATION OF GREEN
  ARCHITECTURE

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• 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

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• 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

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• 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.

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• 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