Comparative Analysis of Hospital Design Typologies

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UNIVERSITY OF NAIROBI COLLEGE OF ARCHITECTURE AND ENGINEERING SCHOOL OF THE BUILT ENVIRONMENT DEPARTMENT DEPARTMENT OF ARCHITECTURE & BUILDING SCIENCE

THE PLANNING AND DESIGN OF HOSPITALS: A comparative analysis of the hospital design typologies.

A Research Thesis Bachelor of Architecture Architecture Submitted by: MAIA !AR" #A$%&I B'()*+,*)(** (*,)(*,/

T"T'R: 0R &AM%1" &AM%1"

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DECLARATION This thesis is my my original 4or5 and and to the best of my 5no4ledge 5no4ledge has not been been presented presented for a degree degree in any other institution. Author: Maina !arun #anye5i Signature6666666666666666.

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This thesis is submitted submitted in part part ful7llment of the the e8amination e8amination re9uirements re9uirements for the the a4ard of the the Bachelor of Architecture degree 0epartment of Architecture and Building Science "niversity of airobi.

Tutor: Tutor: 0r. 0r. &amen;u &amen;u &imeu

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ACKNOWLEDGEMENTS To =od almighty for the gift of good To good health and mental composure composure that enabled enabled me to 4rite 4rite this thesis 4ith consistency. 66666666666666666666666666666666666666666666666666666666 6666666666666666666666666. To my loving 2arents Mr. and Mrs. Maina Than5 you for your continuous devotion to me through prayers moral and 7nancial support. To T o my siblings: Regina Regina Maina Monica Monica Maina and !ellen Maina Maina than5 you for your your moral support throughout throughout the 4riting of this thesis. To 0r.Muriithi than5 you for your career guidance and 7nancial support. I 4ould not have ;oined the 7eld of Architecture 4ere it not for your career guidance. To T o Tabitha Tabitha &iarie >department >department of architecture architecture?? than5 you for allaying allaying my fears in 7rst year 4hen 4hen I ;oined the department. department. $our encouragement encouragement has brought brought me this this far. far. 66666666666666666666666666666666666666666666666666666666 6666666666666666666666666. To my tutor 0r.&amen;u I am greatful for your valued insight support and encouragement throughout the 4riting of this thesis. th To T o Arch.Musau Arch.Musau >@ $ $ear ear 0ean >0ean school of the built %nvironment? %nvironment? and Arch.Samuel Arch.Samuel &igondu >1&"AT? than5 you for the initial guidance that helped shape this thesis. To all lecturers To lecturers 0epartment of Architectur Architecture e and building building science: 2rof 2rof.1.Magutu .1.Magutu 2rof 2rof.Anyamba .Anyamba Arch.Abonyo Arch.Abonyo Arch.Adnan M4a5ulomba Arch.i5u Arch Bulli ladu Arch.'yaro Arch.'yugi Arch.Allan 'tieno 0r.&a5umu Arch.Thatthi Arch.orna 5iamba Arch.&amau &arogi 0r.Shihembetsa Arch.&igara &am4eru 0es.&ahare Miano Arch.orbert Musyo5i Arch.Robert &ariu5i Arch.$usuf %brahim Arch.Mahinda Arch.'golla and inda 5atha I o4e you for the criti9ues during the design studios and for broadening my academic horion through the theory classes. 66666666666666666666666666666666666666666666666666666666 6666666666666666666666666. To Mr.Mundia >Administrator &enyatta ational !ospital? Mr. =ithaiga and Mr. Mungai >&enyatta ational !ospital dra4ings oCce? than5 you for ta5ing time from your busy schedule to orient me through &enyatta &enyatta ational !ospital during the 7eld4or5. 66666666666666666666666666666666666666666666666666666666 6666666666666666666666666. Special than5s to my friends 1edidah =itahi Mr. Matagaro

Rhoda &aguo and 2atric5 =itonga for their contribution in the data collection during the 7eld4or5. I 4ish to particularly than5 Mr.
DEDICATION

To To 0r.Muriithi

TABLE OF CONTENTS 0eclarati 0ecla ration on................................................................. ii ......................................................................................................................................... .................................................................................................................. ..................................................... ................... ........ Ac5no4ledgement ........................................................................................................................................................................................iii iii 0edica 0ed icatio tion n................................................................... iv ........................................................................................................................................... ................................................................................................................... ..................................................... ................. ....... Table T able of contents contents............................................................................................................................................................................................v ist of 7gures ................................................................... i8 ........................................................................................................................................... ............................................................................................................. ................................................ ................. ...... ist i st of ta tabl bles es ........................................................................ 8ii ................................................................................................................................................ ................................................................................................................. .................................................. ......... ......................................................................................................................................... ................................................................................................................... ..................................................... .................... .......... Abstr Abs tract act6 6................................................................. , Chapter : I!tr"#$%t"! ,.,......................... ,.,........ ................................... .................................... .................................... ................................... ................................... ........................................... .........................Bac Bac5gr 5groun ound d of study stud y ( ....................................................................................................................................... ....................................................................................... .......................... .................... .........+ ,.( 2ro 2roble blem m sta statem tement ent6 6............................................................... ,.+ Aims 3 'b;ections... 'b;ections..................... .................................... .................................... ................................... ................................... .................................... ................................... ............................. ............ ,. Research Duestions ......... .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. .................. ................. ........... ...   ,./ Scope 3 imitations.............................. imitations................................................ .................................... ................................... ................................... ..................................................... ................................... ,.@ 1usti7cation ,.@ 1usti7cation of Study6 Study6................ .................................. ................................... ................................... .................................... ............................................................... ............................................. / / ,.E Signi7cance of Study6........ ................. .................. .................. ................... ................... .................. .................. .................. .................. .................. .................. .................. .................. ............... ...... / / ,.F 0e7nition of Terms......... .................. .................. .................. .................. .................. .................. .................. .................. .................. ................... ................... .................. .............. ........... ............ ......... ... / / ,. Structure of the 2aper6.............................. 2aper6............................................... ................................... .................................... .................................... ...............................................@ .............................@ Chapter ': Lterat$re Re(e) (., Introduction............... ................................. .................................... .................................... ................................... ................................... .................................... ............................................. ........................... E E (.( !ist !istory ory of hosp hospita itall planning...................... ........................................ .................................... ................................... ................................... .................................... ................................ .............. E E (.(., %arly times........ ................. ................... ................... .................. .................. .................. .................. .................. .................. .................. .................. .................. ................. ............. .......... ........ ... E E (.(.( =reece................ .................................. .................................... .................................... ................................... ................................... ......................................................... ....................................... F F (.(.+
(. !ospital planning and design........ ................. .................. .................. .................. .................. .................. ................... ................... .................. .................. ................. ............. .......... ........ ... ,, ,, (.., ursing one......... .................. ................... ................... .................. .................. .................. .................. .................. .................. .................. .................. .................. .............. .......... .......... ..... ,, ,, (..(
(.,*./ Gertical monolith hospitals........ hospitals......................... ................................... .................................... .................................... ................................... ................................+ ...............+

Chapter *: Re+ear%h Meth"#","-. +.,....................... +.,......................................... ................................... ................................... .................................... .................................... ................................... ................................... ........................................ ......................Intr Intr oduct odu ction ion.................. ................................... ................................... .................................... .................................... ................................... ................................... .................................... ............................... ............. +/ +/ +.(....................... +.(......................................... ................................... ................................... .................................... .................................... ................................... ................................... ........................................ ......................Re Re search searc h purp purpose. ose................... .................................... .................................... ................................... ................................... .................................... ...................................................... .................................... +/ +/ +.+....................... +.+......................................... ................................... ................................... .................................... .................................... ................................... ................................... ........................................ ......................Re Re search sea rch des design ign and Str Strat ategy. egy.................. ................................... .................................... .................................... ....................................................................... ..................................................... +/ +/ +.+.,................ +.+.,.................................. .................................... .................................... ................................... ................................... .................................... .................................... .................................. ................sa >sampl mpling ing met method hod??................ .................................. .................................... ................................... ................................... .............................................. ............................ +E +E +./....................... +./......................................... ................................... ................................... .................................... .................................... ................................... ................................... ........................................ ......................0a 0a ta
.*.......................... .*........................................... ................................... .................................... .................................... ................................... ................................... .................................... .................................... ..................Intr Intr oduction................. .................................. ................................... .................................... .................................... ................................... ................................... ................................................. ...............................   .,.......................... .,........................................... ................................... .................................... .................................... ................................... ................................... .................................... .................................... ..................&e &e nyatta nyat ta ati ational onal !ospital ................ .................................. ................................... ................................... .................................... .................................... ................................... ......................... ........  .,.,........................... .,.,............................................. ................................... ................................... .................................... .................................... ..........................................................Intr ........................................Intr oduction....................... oduction......................................... .................................... ................................... ................................... .................................................................../ ................................................./ .,.(................. .,.(................................... ................................... ................................... .................................... .................................... ................................... .................................................. .................................
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Chapter 0(e: %"!%,$+"!+ a!# re%"11e!#at"!+ re%"11e!#at"!+ /.,.............................. /.,................................................ ................................... ................................... .................................... ................................... ....................................................Int ...................................Introduction roduction ,**

/.(.............................. /.(................................................ ................................... ................................... .................................... .....................................
LIST OF FIGURES

diagram sho4ing e8pansion and gro4th in a vertical hospital.pg,/

+@, feet?.pg/ igure ,-E: The south4est hospital surgery to4er in

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igure (-,: Massing diagram sho4ing e8pansion and gro4th in a vertical hospital.pg,/ igure (-(*: space for independent 4heelchair 3ambulant person.pg ,F igure (-(,: Space for 4heelchair user and semi-ambulant user 4ith clutches to pass.pg ,F igure (-((: space for t4o independent 4heelchairs users users to pass.p pass.pg g ,F igure igure (-(+ (-(+:: Space Space for indepen independen dentt 4heelch 4heelchair air user user and semi-amb semi-ambulan ulantt person 4ith 4al5ing frame to pass.pg ,F igure (-(: space for ( beds passing.pg, igure (-(/: corridor 4ith recess for turning bed * through ,F* . pg., igure(-(@: ift for bed movement.pg (* igure (-(E: =eneral Service lift.pg(* ig (-(F: Mattress evacuation do4n stair4ay.pg(, igure (-(: Ramp for the physically challenged.pg(( igure (-+*: vertical massing hospital model.pg( igure (-+,: horiontal massing hospital model.pg( igure (-+(: Independent lin5ed slab.pg(/

igure (-++: &hon &aen university hospital Thailand.pg(/ Thailand.pg(/ igure igure (-+: (-+: spine and pavilion.pg(@ igure (-+/: Samaritan hospital Ariona "SA.pg(@ igure (-+@: %8tended courtyard.pg(E igure (-+E: #e8ham par5 hospital slough "&.pg(E igure (-+F: !oriontal monolith hospitals.pg(F igure(-+: compact courtyard hospitals.pg(F igure (-*: Gertical hospital.pg( igure (-,: e4 $or5 2resbyterian !ospital.pg( igure (-(: simple to4er on podium.pg+* igure (-+: Dueen Mary !ospital !ong &ong.pg+* igure (-: comple8 to4er on podium.pg+, igure (-/: !ervey !ospital 0enmar5.pg+, igure (-@: Radial to4er on podium hospitals.pg+( igure (-E: Rush "niversity Medical
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unit for emergencies.pg// igure -,F: The hospital street as captured in the physical model of &!.pg/@ igure -,: Gie4 of the lifts lobby from the hospital street.pg/E igure -(*: #all 78ed signage plates along the secondary streets at &!.pg/E igure -(,: Mosaic arts along the corridors.pg/E igure -((: Internal circulation map at &enyatta ational hospital.pg/F igure -(+: The old hospital bloc5.pg/

igure -(: Image of the circulation spine in the old hospital.pg/ igure -(/: The old hospital as it e8isted before construction of the main hospital bloc5.pg@* igure -(@: detailed layout of the old hospital.pg@, igure -(E: ayout plan of the old hospital.pg@( igure -(F: Typical 4ard plan of the old hospital before relocation of the 4ards in the ursing to4er bloc5.pg@( igure -(:
igure -+@: =round Loor plan of A3% department at &!.pg@F igure -+E: irst Loor plan of A3 % department at &!.pg@ igure -+F: A model of the &! ursing to4er bloc5.pgE* igure -+: hard landscaped to4er bloc5 courtyard.pgE* igure -*: A typical Loor plan of the 4ard.pgE, igure -,: Aerial vie4 of the nursing to4er.pgE( igure -: A detailed analysis of the typical 4ards in at &enyatta ational !ospital.pgE( igure -(: Sectional analysis of the to4er bloc5 at &!.pgE+ igure -+: The four compartments of double 4ards in a typical Loor of the nursing to4er.pgE igure -: S5etch of a 7re resistant door along the +***mm 4ide corridors in the 4ards.pgE igure -/: Analysis of the architectural design emergency features in a typical Loor of the nursing to4er.pgE/ igure -@: The ramp serving the obstetrics 4ards in the 7rst Loor and the delivery suite in the =round Loor at &!.pgE@ igure -E: ire e8it sign at an emergency escape door at &!.pgE@ igure -F: ocation of the paediatric department at &!.pgE

igure -: Ma5e shift 4aiting area for paediatric outpatient unit donated by 2osta.pgE igure -/*: A child receiving emergency service at &! A3% unit.pgF* igure -/,: A child loo5ing for play activities at &!.pgF* igure -/(: location of china 4ithin Asia.pgF, igure -/+: ocation of an;ing 4ithin
th

th

igure -E(: Typical @ -,+ Loor of an;ing 0rum To4er th th !ospital.pg( igure -E: Honing plan of the typical @ -,+ nursing Loors of the an;ing 0rum To4er !ospital.pg+ th th igure -E/: Activity plan of the typical @ -,, Loors of the an;ing 0rum To4er !ospital.pg

igure -E@:

Articulated to4er on podium model.pg,*( igure /-,+: Gertical monolith model.pg,*( igure /-,: model of &enyatta national hospital.pg,*+ igure /-,/: model of an;ing 0rum To4er hospital.pg,*+ igure /-,@: "se of roof lights in deep plans.pg,* igure /-,E: "se of narro4 plans to achieve natural lighting 3 ventilation.pg,* igure /-,F:
LIST OF TABLES Table Table +-,: Table Table of study parameters parameters.................................................................................................................................................................... , Table Table -,: &enya? >&enya? 3 an;ing 0rum To4er To4er !ospital >

ABSTRACT !ospitals may be thought of as icons of pain sic5ness and distress but they are also icons of healing life family and hope. They are therefore important buildings for any community. The planning and design of hospitals has a great impact on the stress levels >to staK 3 visitors? and to the patientNs recovery period. The main factor 4hich diKerentiates hospitals from other buildings is that no other building type presents such a diverse diverse spectru spectrum m of occupants occupants 4ith 4ith varying varying physical physical and and emotional emotional needs. needs. The The hospital hospital is therefore a comple8 building type. A deep understanding of the inter-relationship of the parts and their relationship in-turn to the 4hole hospital is re9uired to ma5e a meticulous healing environment. !ospital planning can be grouped into t4o typesO the horiontal hospital and the vertical hospital. The success of these t4o types cannot be overstatedO ho4ever they are characteried by their o4n uni9ue challenges. ItNs precisely because of the limitations e8hibited in the t4o hospital types and their typologies that a conceptual frame4or5 is needed to clearly understand the creation of a proper healing environment. environment.

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CHAPTER ONE: INTRODUCTION 2 2 Ba Ba%3%3-r"$ r"$!# !# "/ +t$#. +t$#. There has has been 9uite 9uite a number of Bachelors Bachelors of architecture architecture theses in the "niversity of airobi dealing 4ith hospitals planning and design:-

Gersus

Shiv;i R. >,F/?.The >,F/?. The infuence o circulation and services to the unctional planning and design o hospitals 'chieng =. >,F? Curative Environment: Stress reduction in hospitals 'yaro %. >,(?. Architectural Architectural expressions expressions in hospital hospital orms Momanyi 1. >(**+?.!ospital >(**+?.!ospital design: A design: A search or fexibility fexibility in hospitals Muriithi  =.>(**/?. Architecture Architecture or spinal spinal injury hospital. hospital. ;uguna #. >(**@?.evelopme >(**@?.evelopment nt o paediatric hospital in !airobi MulangNa M. >(**E? "ealth care design: Creating a healing environment . &aseda %. >(*,+?.Environmen >(*,+?.Environmental tal strategies or hospital design in #arm humid climate. climate. #hereas the precedent theses are rich in aspects pertaining to hospital design none has carried out a comparative analysis of the typologies in hospital planning and design.

Therefore Therefore the author 7nds 7nds a gap of 5no4ledge 5no4ledge to 7ll in the planning and design of hospitals by analysing and comparing the typologies in hospital planning and design. This area has not been igure ,-,: A diagram illustrating the horiontal and vertical planning strategies in hospital design studied beforeO hence it 4ill contribute ne4 5no4ledge to the bul5 Source: AuthorNs s5etch 1une ,( th (*, of information available on hospitals planning and design. (

2' 2' Pr"4, Pr"4,e1 e1 +tate +tate1e 1e!t !t Most of human history has seen the vast ma;ority of people living in rural areas. !o4ever the urban population has risen steadily over the last t4o centuries. The ,F**s started 4ith ;ust a +P of the 4orld 4orldNs Ns popu popula lati tion on livi living ng in urba urban n area areas. s. By ,** ,** the the urba urban n population had increased to ,P and then doubled to almost +*P by ,/*.I ,/*.In n (**F (**F for the 7rst time time the 4orldN 4orldNs s popula populatio tion n 4as 4as evenly split bet4een bet4een the urban and rural rural areas. "rban gro4th gro4th is pro;ected to continue its increase 4ith e8pectations that E*P of the 4orld population 4ill be urban by (*/*. Thus urban gro4th trend igure ,-(: vertical planning strategy in hospital design Source: Author modi7ed s5etch 1uly ( nd (*, places places a particula particularr emphasis emphasis on developin developing g sound planning planning and design design strategie strategies s 4ithin 4ithin urban areas >#orld >#orld health health organisa organisation tion (*,*?.

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The hospital being a comple8 comple8 building type needs needs to respond to the urban urban gro4 gro4th th tren trend d by develo developin ping g sound sound planni planning ng and desig design n strate strategie gies. s. This This 4ould 4ould help help in addre addressi ssing ng the probl problems ems in the planning and design of hospitals 4hich range from site limitations in urban urban areas areas diC diCcul cultie ties s in achiev achieving ing gro4th gro4th and Le8ib Le8ibili ility ty challenges in achieving ma8imum natural lighting and ventilation challenge challenges s in carrying carrying out evacuatio evacuation n in times times of emerge emergencie ncies s circulation stress and mi8ing of incompatible traCc 4hich lead to cross-infections cross-infections among other problems. The horiontal hospital by nature utilies a great deal of land to fully accommodate accommodate its functiona functionall re9uir re9uiremen ements ts compared compared to the vertic vertical al hospi hospital tal.. The The susta sustaina inabil bility ity of the horio horionta ntall hospit hospital al especially in urban urban areas is therefore therefore 9uestionable 9uestionable since land is at a premium and the footprint is limited. 'n the other hand the

vertical hospitals are not 4ithout their problemsO it is argued that the usual vertical hospital is inLe8ible e8periences vertical traCc stress and heavily relies on lifts 4hich may present challenges in carryi carrying ng out evacu evacuati ation on in case case of emer emergen gencie cies s among among other other 2roblems.

igure ,-+: !oriontal planning strategy in hospital design Source: Author modi7ed s5etch 1uly ( nd (*,

Therefore Therefore there is is need to study study and analyse the t4o hospital hospital typologies and their models in order to help address the problems in hospitals planning and design.

2* 2* A1+ A1+ a! a!# # "45e "45e%t %t( (e+ e+ ,. To investigate the the typologies in the planning planning and design design of hospitals. (. To investigate the current current global trend trend in the planning planning and design of hospitals. +. To analyse and compare compare the typologies in the planning and design of hospitals in order to determine determine their levels of eCciency.

26 26 Re+e Re+ear ar%h %h 7$ 7$e+ e+t" t"!+ !+ igure ,-: Rush "niversity Medical
(. #hat is the current current global global trend in the the planning and and design of hospitalsQ +. #hich are the most eCcient typologies in the planning planning and design of hospitalsQ

28 28 S%"p S%"pe e a!# a!# ,1 ,1ta tat" t"!+ !+ !ospital planning and design is broad. 0ue to limitations of time and resources the study 4as limited to the analysis and comparison of the typologies in the planning and design of hospitals. The spatial analysis covered the three basic ones in a hospital and ho4 they have been manipulated to achieve a hospital organism. These are the clinical nursing nursing and support support ones.

igure ,-/: Aerial vie4 of Mbagathi 0istrict hospital

The 7eld 4or5 4or5 4as limited to &enyatta &enyatta national national hospital in airobi airobi as it provided an opportunity to investigate both the horiontal and vertical strategies in the same conte8t. In addition an;ing drum to4er hospital 4as selected as an international case study to provide a comparative base 4ith &enyatta national hospital.


29 29 $+t $+t0% 0%at at" "! ! "/ "/ +t$# +t$#. . The impetus impetus of the study arises due to the the need to address the challenges in hospital planning and design especially in urban areas 4here there are tight site constraints.

2; 2; S-! S-!0% 0%a! a!%e %e "/ +t$# +t$#. . This study 4ill 4ill bene7t Architects Architects and developers developers by by providing guidelines to achieve an appropriate eCcient and sustainable healing environment. environment. Additionally the study 4ill assist government institutions by implementing the 7ndings and recommendations in their pro;ects. igure ,-@: ational +@, feet? Source: -September , th (*, 2< 2<

De0! De0!t t"! "! "/ ter1+ ter1+

H"r="!ta, h"+pta,> This is a hospital model model that utilies utilies horiontal planning strategy. The ones are lin5ed together laterally so that the movement is mainly horiontal. They are limited to  Loors utilies Vert%a, h"+pta,> This is a hospital model that utilies vertical planning strategy. The ones are arranged one above the other so that the movement pattern is mainly vertical. They rise above  Loors provide access access Cr%$,at"! +pa%e+> These are spaces that provide 4ithin the hospital departments. They comprise of corridors internal lobbies etc. 4ithin a department for moving bet4een rooms)spaces 4ithin an individual department. C"11$!%at"! C"11$!%at"! +pa%e+> They are spaces spaces providing providing access bet4een departments. They comprise of hospital streets ifts Ramps staircases etc. that provide access bet4een igure ,-E: The south4est hospital surgery to4er in departments. + feet >,(* meters? 4ith ((** beds Source: -September , th (*, F,e?4,t.>Ability of a hospital to accommodate change and gro4th 4ithout destruction of e8isting systems. •

•

•

•

•


/


•

circulation corridor corridor from H"+pta, Street> The primary circulation 4hich all other secondary corridors branch.

2@ Str$%t$re Str$%t$re "/ the re+ear%h re+ear%h paper Chapter : I!tr"#$%t"! This chapter serves serves as the introduction of the topic of study study.. It highlights the bac5ground of the study problem statement aims and ob;ectives research 9uestions the scope and limitations de7nition of terms relevance of the study and the research methodology used to underta5e the investigation. Chapter': ,terat$re Re(e) The chapter begins 4ith the history of hospital hospital planning over over the igure ,-F: !ervey !ospital 0enmar5 Bed capacity-,@,@ beds centuries to give a clear understanding of the trend in hospital $ear $ear Built-,E@ Built-,E@ planning and design over time. The chapter further e8plores the Source: Source: August +rd (*, parameters in hospital planning and design and the typologies and models in hospital planning and design. Chapter *: Re+ear%h Meth"#","-. This chapter outlines outlines the process process of selection selection of the area area of study and the case studies that are a representative of the research by describing all the methods of data collection presentation and analysis. &enya? and an;ing 0rum To4er !ospital >

from the 7ndings of the study. This chapter concludes 4ith recommendations based on the 7ndings of the study.

@


CHAPTER TWO: LITERATURE REVIEW '2 I!tr"#$%t %t"! The study of man from his beginnings beginnings sho4s that the desire for health along 4ith food shelter and clothing ran5s high among the fundamen fundamental tal basic needs. needs. The hospital has develope developed d over the centuries to serve this basic urge >American institute of hospitals consultants ,@?. 2eopleN eopleNs s e8pe e8pecta ctatio tions ns from from hospit hospitals als have have chang changed ed over over the centuries. In the middle ages they they 4ere primarily primarily associated 4ith death. Some of the 7nest hospitals 4ere built for pilgrims far from igure (-,: basic human needs Source:en.m.4i5ipedia.org) human needs Sep (nd (*, home since they had no4here to go 4hen they fell sic5. They 4ere oKered care in cruciform halls 4ith the nunsN nursing station at the centre and the altar at the end. The aim 4as to protect the healthy pilgrims from infection and to prepare the sic5 for the death. The idea that hospitals 4ere about life rather than death began to da4n gradually >1ames 3 Tatton-Bro4n ,F@?.

'2' '2' H+t H+t"r. "r. "/ h"+p h"+pta ta,, p,a! p,a!! !!!'2'2

Ear,. T1e+ rd

In the early + century B.< medicine and healing 4ere lin5ed to the gods. gods. Rosen7eld 3 Rosen7eld ,@?.

The 2lanning 2lanning 3 0esign of igure (-(: Maslo4 hierarchy of needs Source: en.m.4i5ipedia.org)Maslo4 Sep ( nd (*,

E


'2'2'

Gree%e th By the end of @ century B.< medical clinics had developed in =reece to complement the temples that acted as healing centres. The =ree5 =ree5 physicians physicians 4ho 4ere 4ere free citiens citiens held consultations consultations and treated their private patients. These clinics 4ere eventually eventually private institutions but the state funded similar institutions to provide health care to the citiens.

'2'2*

C,a++%a, A!t7$t. According to Rosen7eld 3 Rosen7eld >,@? ater in ,@? !ospital architecture and beyond 4ere delineated delineated and attention paid to functional groupings. groupings. 1uly /th (*,

igure (-: =reco-Roman atreia

'2'26

Me#e(a, Chr+ta! Per"# The clarity in the the classical anti9uity anti9uity 4as lost during during the medieval medieval Rosen7eld 3 Rosen7eld ,E,?.

'2'28

Re!a++a!%e In Italy Renaissance brought brought bac5 a certain rational clarity to the plan form. 'rderliness and careful attention to circulation 4as demonstrated but the Alter 4as still the focal point.


F


'2'29

th


th

the late ,F and , centuries forerun by lorence ightingale. The pavilion type type 4hich segregate segregated d patients into small groups and ensured there 4as natural light and ventilation evolved. There 4as orderliness orderliness and clarityO patterns of circulation 4ere delineated functional groupings 4ere assembled and a greator respect 4as sho4n to human dignity >@  isterNs use of carbolic sprays for antiseptic surgery 4hich reduced the number of post-operative fatalities. This increased the range of surgery and surgical theatres <<9 - Introduction of aseptic techni9ues techni9ues  the igure (-/: Romano-,@? !ospital architecture and beyond 1ulysteriliing ,(th (*, of e9uipment. e9uipment. This e8tended e8tended the area of ancillary accommodation <@8- Roentgen used 8-rays as an aid to diagnosis hence the need for 8-ray rooms arose. aboratories similarly added a ne4 dimension to medicine and e8tended the use of pharmaceuticals. The primary function of hospitals turned slo4ly from custodial care to active intervention. They became places to save and improve the 9uality of life >1ames 3 Tatton-Bro4n ,F@?.

'2'2;

igure (-@: lorence ightingale 4ard

th

' Ce!t$r. As from the (*th century to the present day the architectural form of the hospital has changed from the lo4 horiontal pavilions to a vertical hospital. The vertical




hospital superseded the pavilion plan and became the accepted architectural architectural form for hospitals during the t4enties >!udenberg ,@?.

'2* THE ORGA ORGANI NIA ATION TION OF HEAL HEALTH CARE CARE FACILITIES All systems of healthcare delivery comprise of a range of institutions 4hich are graded according to their degree of sophistication and specialiation as 4ell as the level of care they can provide >Ministry of health (*,*?.
igure(-E: The !ealth pyramid Source: ministry of health (*,*

Based on this criterion the health facilities are then classi7ed into @ distinctive levels. The

level-/ hospitals. The national referral hospitals are classi7ed as level @ hospitals.

,*


The central governmen governmentt through the the relevant relevant ministry used this classi7cation to come up 4ith standard model architectural dra4ings upon 4hich the design of any public health facility 4ithin the country by the government 4as based. The ne4 constitution (*,* has since devolved health services to the county governmentsN.

'26 HOSPI HOSPIT TAL PLA PLANN NNIN ING G AND DESI DESIGN GN It has been argued that a study of traCc re9uirements suggests a

igure (-F: Relationship of the + ones in a hospital and hosp ital operatin operating g more li5 e a number number of villages villages than a single heir appro8imate proportions in a general hospital. Source: Source:hospital Author modi7ed s5etch 1uly ,* li5e th (*,

organism organism.. !ospitals !ospitals should be assembled assembled in a 4ay that it 4ill be more than a mere collection of functions and departments needed in the practice of medicine. The avenues of circulation should be organised to create order in the movement of persons supplies and services. services. %veryone %veryone should be able to arrive arrive at move around around and leave the hospital building 4ithout unnecessary eKort an8iety embarrassment or confusion >Rosen7eld 3 Rosen7eld ,@?. Activities 4ithin the hospital building are grouped into three distinct ones. These are: igure(-: 0iagram sho4ing the distribution of the + ones in a vertical hospital ,.
(. urs ursin ing g one one +. Supp Suppor ortt one one

The 5ey 5ey to hospital planning planning is the manipulation manipulation of these these ones and their relationships to produce a fully functional integrated hospital >1ames 3 Tatton- Bro4n ,F@?.

262distribution  N$r+!igure(-,*: 0iagram sho4ing'the of

="!e


The nursing one can generally generally be referred referred to as the patient patient 4ards. Its purpose is to foster patients throughout throughout their stay in hospital. 1ames and Tatton-Bro4n atton-Bro4n >,F@? assert assert that: 





igure (-,,: Relationship and oning diagram for a healthcare facility Source: Metric handboo5 planning and design 

'262'

Maternity beds should be suCciently separated from the rest of the hospital to avoid contamination but still be part of the hospital 4ith reasonably ready access to the clinical and support ones. The beds of the mothers should con;oin the delivery suite. Recovery beds should be ad;acent to the operating suite since the patients are under constant supervision. Intensive care beds should be ad;acent to the recovery beds since acutely ill patients re9uire re9uire the same 5ind of e8pert nursing as recovery patients 2aediatric beds may be part of an intermediate care nursing unit in a very small hospital or occupy the space of a full typical intermediate nursing unit 4ith pertinent modi7cations or comprise a separate building con;oined 4ith clinical division.

C,!%a, ="!e This is the 4or5ing 4or5ing area for medical treatment treatment and observation. observation. The clinical one one should be located on the most accessible Loor from the street or road from the inpatients 9uarters and from the outpatient clinics. It comprises of various departments needed for medical treatment and observation. observation. 'f importance to note in the clinical one is: 

aboratories serve both inpatients and outpatients. ItNs therefore preferable that this department be so situated that it is accessible to both. The labs should also be accessible by radiotherapy and the surgical


,( igure (-,(: %8panded relationship diagram for a healthcare facility Source: metric handboo5 planning design


Radia adiati tion on serv servic ices es serv serve e both both inpa inpati tien ents ts and and outpatients. In modern medicine there are situations in 4hich 4hich the 4or5 4or5 of the departme departments nts of labs labs and radiation intermingle. intermingle. Surgical theatres should be contiguous to labs and reontology. This is due to the necessity of consultation bet4een surgeons and lab scientists 4hich is often done 1uly 4hen patient is on the operation table. Most igure (-,+: support services on a vertical model Source: Author modi7ed s5etch , ththe (*, surgery operations are done on inpatients rather than outpatients. %mergency service should be accessible from the main road 4ith a separate entrance shielded from sight of the main hospital entrance. %mergency %mergency patients may need immediate laboratory tests 8-rays and even surgical intervention. ollo4ing emergency treatment a patient may need intensive care thus intensive care unit and surgical theatres and recovery beds should be provided in the accident and emergency department. 





igure (-,: support services on a mi8ed horiontal- ' vertical 262* strategy S$pp"rt Source: Author modi7ed s5etch 1uly , th (*,

igure (-,/: support services oK site Source: Author modi7ed s5etch 1uly , th (*,

The support support one is the third third main section section of the hospital. hospital. Its purpose is to satisfy all the physical and material needs of the nursing and clinical ones. Such needs include: food energy goods and services. It has to provide for the reception handling distribution storage and disposal of everything that comes into and goes out of the hospital >#heeler ,@?.

'26 '2626

igure (-,@: support services on a horiontal

="!e

L"%at"! "/ "/ th the +$ +$pp"rt =" ="!e

"ntil recently most buildings have been planned 4ith comprehensive support ones 4ithin the building either in the basement >vertical scheme? scheme? or in a separate bloc5 >horiontal


,+


developments developments in catering steriliing and laundry e9uipment it is more eCcient to provide these services on an area or regional basis. This 4ith the increasing use of commercially supplied disposals has resulted in the reduction of the support one 4ithin the hospital.

'28 '28 PLAN PLANNI NING NG GUI GUIDE DELI LINE NES S In his boo5 "ospital planning handboo$ Re8 #hita5er >,E@? outlines the general principles of planning that may apply to any comple8 building and particularly medical facilities. The principles provide some guidance to architects interested interested in hospital design .They are outlined as follo4s: ,

'282Ste P,a!!!-E?ter!a, Cr%$,at"! including morgue? from patient areas. Ambulances shouldnNt pass through par5ing areas 4here they may be sub;ect to delay. The location of par5ing places can have a great great impact on internal hospital circulation. 2eople al4ays see5 4ay out of the shorter route and no number of signs indicating 4here the outpatient entry is 4ill force people to use that entry if there is an entry close to 4here they left their cars. 'bstetric patients should be provided 4ith drive-up and par5ing space close to the entrance. !ealthy staK members and visitors can be as5ed to 4al5 some distance from their cars.


2hysicians should be assured space by designating a speci7c area. It seems self- evident but it is sometimes forgotten that patients to clinics and emergency ,


rooms are often old and in7rm that they may re9uire assistance in 4al5ing and that par5ing spaces for these people should be as close as possible to the entrance.

'2 8 2 '

PROVISION FOR GROWTH '282'2 The !$%,e$+ %"!%ept The rate of increase increase both in comple8ity comple8ity and the sie of hospital is unprecedented. The nucleus concept arose due to the need for Le8ibility. It aims to build a hospital in phases. It is a highly versatile and economical ans4er to the problem of gro4th and change. The sie of the the nucleus is is designed to to be fully operational

igure (-,E: Bloc5 schematic plan of Maidstone general hospital th Source: Author modi7ed s5etch 1uly , (*,

in its o4n right


igure (-,F: Stac5 diagram sho4ing e8pansion and gro4th in a vertical hospital Source: AuthorNs s5etch

igure (-,: Massing diagram sho4ing e8pansion and gro4th in a vertical hospital Source: AuthorNs s5etch-September (*,

'282*Separat"! "/ #++1,ar tra% The 7ve classes classes of people people 4ho create create hospital traCc traCc are: Inpatients outpatients hospital employees staK physicians and visitors. In the horiontal hospital there are three avenues of horiontal traCcO one for supplies one for staK and patients and another for visitors. To To reduce the the mi8ing of incompatible incompatible 5inds 5inds of traCc 4hich the vertical hospital implies one set of elevators should be provided for ancillary and professional transactions and another for transporting visitors. !o4ever this system is inLe8ible .To relive the elevators of the ancillary load and also to obtain 9uic5 unscheduled deliveries various conveyors and dumb4aiters are employed. An average vertical hospital should have three SystemsO dumb4aiters dumb4aiters and conveyors for ancillary services service lifts for staK and patients and 7nally visitorsN elevators. #hether the hospital is vertical horiontal or a combination of both itNs not possible to route these three avenues separately into every part of the hospital. evertheless 5eeping categories of traCc separated should be follo4ed as far as possible. The more separation is achieved the less chance of infecting the patients. Separation also cuts do4n e8posure of those patients 4hose condition and appearance might upset passerby and 4ho 4ould in turn prefer not to be seen by passerby.

'2826A!t%pate %ha!-e ,

!ospitals are sub;ect to the demands of ne4 developments in function and technology. ItNs reasonable to eliminate as many 78ed vertical elements as possible. This 4ould mean reducing the number of columns consolidating mechanical mechanical shafts and 5eeping 5eeping elevator shafts stairs and other vertical circulation from dividing Loor space into small compartments. All of these elements are practically impossible to move once built and therefore inhibit change.

'2828De(e,"p1e!t "/ 1"#$,ar +pa%e+ Modular spaces provide Le8ibility. Room sies are seldom critical that a variation of ,*P-(*P 4ill not ma5e any diKerence in their usefulness. usefulness. If a module can be developed that is acceptable for a variety of occupancies change in use 4ill re9uire minimum alteration

'2829E!er-. %"!+er(at"!+$+ta!a4,t. Studies have concluded that a natural environment is essential to creating a genuine state of the art-healing environment >A%<'M (*,(?. Spending time in outdoor places of respite has been sho4n to reduce stress >important for staK and visitors? and vie4s to nature have been credited 4ith reduced pain levels and a shorter stay in hospitals. This 4ould entail: BuildingsN orientation-The orientation-The hospital bloc5s should be designed such that the long a8is is along the %ast-#est a8is. arro4 plan-This helps to achieve ma8imum natural lighting penetration and cross-ventilation into the 4ards. 







Sun shading all glaed areas-This should be realied by use of vertical and horiontal sun-shading elements deep roof overhangs balconies etc. "se of !igh thermal mass on 4alls >thic5 4alls?-all e8ternal 4alls should be at least (**mm thic5.






2lacing 4indo4 openings openings on the orth and South facing 4alls. andscaping J use of 4ell-chosen native trees in the courtyards and roof gardens 4ithin the hospital to create spaces of respite.

'29 %r%$,at"! a!# %"11$!%at"! +pa%e+ ! h"+pta,+ The form of a hospital building building is strongly inLuenced by the choice of access and circulation routes. Rosen7eld 3 Rosen7eld ,@?. including those using crutches stic5s and 4al5ing frames and 4heelchair 4heelchair users?. They should also allo4 for bed and trolley movement.

access bet4een departments. They comprise of hospital streets lifts ramps and staircases etc. that provide access bet4een departments 2 igure igure (-((: (-(+: space Space for for t4o independent independent 4heelchair 4heelchairs user and users semi-ambulant to pass person 4ith 4al5ing frame to pass Source: !ospital building notes (*,+ Source: !ospital building notes (*,+

,F


The entrance entrance to the hospital hospital buildings and and the circulation circulation 4ithin it should be designed 4ith due consideration for 4heelchair users people 4ith visual ambulatory disabilities and the physically frail 4ho constitute a large proportion of the hospital users.
'292 igure (-(: space for ( bed s passing Source: hospital es (*,+ building not

A%%e++

'ne of the primary success factors for proper healthcare design is convenient and easy access to and from the facility. This includes simple 4ay 7nding 7nding safe and and 4eather protected protected vehicular drop-oKs and convenient access to par5ing. The e8ternal access points have their location around the hospital street. A modern healthcare facility re9uires multiple entrances: Main patient entrance for inpatients and visitors. %mergency department entrance for emergency cases and Ambulances. 'utpatient %ntrance. Service %ntrance usually at the rear of the site. All traCc including outpatient admission staK and visitors  

 


one of the hubs of hospital

activities and may contain other facilities such as shops ban5s cafeteria etc. The ,

igure (-(/: corridor 4ith recess for turning bed through ,F* Source: hospital building notes (*,+

*


main entrance probably leading directly to the outpatient department department should have an easy access from the public high4ay and some par5ing for cars. uCeld 2rovincial !ospitals Trust ,//?. Internal traCc is the most important single determinant of the location of departments 4ithin a hospital. TraCc bet4een hospital departments consists of inpatient outpatients hospital employees employees staK physicians and visitors. The smooth running of the hospital re9uires re9uires that traCc be allo4ed to move as directly and conveniently bet4een bet4een origin and destination. The location of outpatient rooms is of particular importance .separation of routes ta5en by outpatient emergencies and inpatient should be given consideration early in the planning process. 2atient 2atient travel distances should be reduced reduced to a minimum. The simplest 4ay of reducing interdepartmental interdepartmental distances is by lin5ing the ends of the corridors to form a ring to achieve gro4th igure(-(@: ift for bed movement

Source: !ospital building notes (*,+

The accident accident and %mergency %mergency >A3%? >A3%? department department 4ill need its o4n entrance because It is open (hours and since there are clinical and aesthetics reasons reasons for not allo4ing accident traCc to mi8 4ith outpatient and visitors. The entrance to the emergency service should be shielded from sight of the main hospital entrance. It should have space for unloading about + vehicles simultaneously and there should be par5ing space 4here 4aiting cars can be par5ed 4ithout obstructing access and maneuverability in front of the entrance. The door opening to the Accident and %mergency department should be 4ide enough >,F** min? to permit a stretcher 4ith attendants and even transfusion apparatus to pass through 4ith ease and dispatch. 2rovision space for 4heelchairs and 4heel stretchers should be made at the entrance.


(*

'292*

L/t+

All lifts in healthcare healthcare buildings should have minimum internal dimensions of ,,**mm 4ide 8 ,**mmm deep that is capable of accommodating a minimum of F people @+* 5g. At least one 4heelchair-accessible lift should be in operation bet4een each ig (-(F: Mattress evacuation do4n stair4ay Source: hospital building notes (*,+ Loor of a healthcare facility. %ach lift should open onto a landing of ade9uate depth in order not to restrict traCc Lo4 in front of the lift entrance or onto a protected lobby. ifts should not open directly onto corridors.

'2926

Pr(a%.

2rivacy and con7dentiality are important aspects of the relationship bet4een a patient and staK members. T4o places 4here these aspects suKer from poor design are: The reception reception des5 4here one one side of a telephone telephone call can can be overheard by people 4aiting. 

( igure (-(: Ramp for the physically challenged. Source: Metric planning handboo5



(

seen or overheardO there should be no 4aiting outside doors or along corridors.

'2; EMERGENCY DESIGN FEATURES FEATURES IN HOSPITALS !ospitals are not e8empt from devastation of a disaster. In hospitals patients have diKering physical physical abilities and a range of psychological characteristics characteristics 4hich all impact on the degree of assistance that they 4ill re9uire to evacuate from a building safely. In the case of 7re for instance a bed-ridden patient though noticing 7re 4ould not be in a position to escape unless other4ise assisted. Ade9uate Ade9uate facilities for safe evacuation of patients and even for combating the haard should therefore be in place. less Lash>less than / hert? 4hen a 7re alarm sounds. These signs should be connected to the emergency po4er systems. The colour of the e8it door should contrast 4ith the surrounding surface so as to ma5e it distinguishable by the people 4ith sight problems >eufert (**+?. These e8it signs should be visible and should be placed on the doorframes and not on the doorleaves.This 4ill enable an individual to identify an escape route at all times even 4hen the door is open. The e8it signs should have

contrasting colours that are conspicuous to the visually impaired. (. 0oors-An accessible door should have the the follo4ing features: A sign door handle glaing and a 5ic5ing plate. These ma5e ma5e the building building more accessible accessible to 4heel 4heel chair con7ned persons. Revolving doors are not suitable for use by patients and people 4ith prams. The emergency doors

should be 7re resistant and are normally located in stair4ells corridors and other areas as re9uired by 7re codes. +. %8it)%scape routes-A minimum of t4o t4o accessible accessible e8its e8its or horiontal e8its for all accessible areas of the building should be provided >0a4son , 2Incase of 7re one e8it can be used as an escape route. . Ramps JThey JThey are are used for ease of of movement for the mobility impaired 4here there is a level diKerence and ease of manouvre for semi- ambulant is re9uired. The ramps are particularly helpful in evacuating semiambulant persons 4ith ease and speed from Loor to Loor. /. %mergency %mergency staircases staircases J%very J%very multileveled multileveled building should have a set of emergency staircases to aid in evacuation of ambulant people. In hospitals the emergency staircases should be 4ide enough to a llo4 for mattress evacuation >min ,/**?.The emergency stairs should neither have open risers nor protruding nosing. The emergency staircases should preferably preferably open to the courtyard and not 4ithin the hospital building. #hereas #hereas emergency evacuation in horiontal hospitals is fairly achievable due to horiontal contiguity evacuation is vertical hospitals is challenging due to vertical contiguity. Gertical hospitals heavily rely on lifts 4hich are unsafe to use in case of emergencies such as 7re. This re9uires additional genius design features by the architect to ease in evacuation such as:

,. !elipad- A helipad helipad is a typical designated designated helicopter landing and ta5e-oK area. ItNs useful for high-rise buildings and it forms a good area for attending evacuees. (. Roof Roof gardensgardens- The roof-gard roof-garden en itself is a 5ey 5ey sustainable sustainable design design element element in that it minimies minimies the building buildingNs Ns heat island island eKect eKect reduces reduces demand on storm storm 4ater 4ater systems systems improves surrounding air 9uality and reduces noise


pollution. As such it not only provides an amenity for the buildingNs occupants occupants but and it forms a good area for attending evacuees.

'2< TYPES OF HOSPIT HOSPITAL AL PLANNI PLANNING NG th

Since the beginning of , century various strategies have been devised in the planning of the modern hospital. The hospital planning can be grouped into t4o primary types: ,. !orio !orionta ntall hospital hospitals s (. Gertical ertical hospitals hospitals.. In the vertical planning strategy the ones are arranged one above the other such that the movement pattern is mainly vertical. In the horiontal planning strategy the ones are lin5ed together (*th (*, s5etch 1uly igure (-+*: vertical massing hospital model Source: Author modi7edlaterally so that the movement is mainly horiontal >1ames 3

Tatton-Br Tatton-Bro4n o4n ,F@?.

'2@ The h"r= h"r="!t "!ta, a, h"+pta h"+pta,, Gersus

!oriontal hospitals planning go as far as the =ree5 civiliation period. The horiontal hospital can be bro5en do4n into several categories. These are: a? Independ Independent ent lin5ed lin5ed slabs hospitals hospitals b? Spine Spine and 2avilio 2avilion n hospitals. hospitals. c? %8tended %8tended courtyar courtyard d hospitals hospitals !oriontal monolith hospitals e?
c

igure (-+,: horiontal massing hospital model Source: Author modi7ed s5etch-1uly (* th planning (*, !oriontal hospital re9uires large sites to fully

accommodate their functional re9uirements.


(

'2@2 '2@2

I!#e I!#epe pe!# !#e! e!tt ,!3 ,!3e# e# +,a4 +,a4+ + h"+p h"+pta ta,+ ,+

In this type of hospital planning allocation is done for three basic onesO nursing clinical and ancillary. The three ones are lin5ed horiontally usually at ground level by means of a 4ide corridor. They are usually lo4 rise. rise. igure (-+(: Independent lin5ed slab st Source: Author modi7ed s5etch 1uly (, (*,

igure (-++: &hon &aen university hospital Thailand Source: Author modi7ed s5etch st 1uly (, (*,.

(

E?a1p,e: Kh"! Kae! $!(er+t. h"+pta, Tha,a!#

It utilies Independent parallel lin5ed slabs 4ith varying storey heights. This type

(

of planning strategy re9uires large site to allo4 independent e8pansion of buildings >1ames 3 Tatton-Bro4n ,F@?.

'2@2' Sp!e a!# pa(,"! pa(,"! h"+pta,+ h"+pta,+ These hospitals have a strong central spine usually 4ith clinical clinical and support support ones to one side of the spine and the nursing one to the other side of the spine. The nursing unit is high-rise usually up to four levels.

E?a1p,e: Sa1arta! h"+pta, Ar="!a USA igure (-+: spine and pavilion Source: Author modi7ed s5etch 1uly (, st (*,

igure (-+/: Samaritan hospital Ariona "SA. Source: Author modi7ed s5etch 1uly (, st (*,

2hase 2hase-, -, of Samar Samarita itan n !ospit !ospital al Arion Ariona a "SA comple completed ted in ,EE.It has a capacity for (E/beds and provides for e8pansion of up to ,,**beds.It uses the spine and pavilion strategy to provide for open ended incremental gro4th.

The simple spine corridor)street corridor)street allo4s allo4s for unlimited gro4th gro4th at almost any point either of the street itself or of individual departments. departments. 'n the other hand


such streets can be up to ** m long in a completed development creating boredom >!udenberg ,@?.

'2@2* '2@2*

E?te! E?te!#e #e# # %"$r %"$rt. t.ar ar# # h"+p h"+pta ta,+ ,+

This type of a hospital is planned around open courtyards. The ones ones are lin5ed lin5ed horio horionta ntally lly at upper upper levels levels as 4ell 4ell as the ground ground Loor via a central central spine corridor corridor system 4hich 4hich aKords aKords easy access for patients visitors and goods to all departments. !eig !eight ht is usua usuall lly y limi limite ted d to four four stor storey eys s but but neve neverr usua usuall lly y e8ceeds t4o stories >'yaro ,(?. igure (-+@: %8tended courtyard Source: Author modi7ed s5etch 1uly (, st (*,

E?a1p,e: We?ha1 par3 h"+pta, +,"$-h UK2 The hospital is is a single storey storey layout utiliing utiliing the e8tended e8tended courtyard strategy. It is a +** bed general hospital completed in ,@@. It fully e8ploits advantages presented by the e8tended courtyard strategy: •

-atural light

•

-Gentilation from roof lights •

-andscaped courtyards •

-0omestic scale •

-%ase of evacuation in case of 7re •

-2rovision for future e8tension -Simple load bearing structure •

igure (-+E: #e8ham par5 hospital slough "& Source: Author modi7ed s5etch 1uly (,st (*,


(E


'2@26 '2@26 H"r=" H"r="!ta !ta,, 1"!", 1"!",th th h"+pta h"+pta,+ ,+ These 5ind of hospitals 4ere and are built in the "SA and "& mostly during the period of ,@/-E/.They incorporate interstitial Loors 4hich permit easy installation of engineering services and e9uip e9uipmen ment.T t.The he hospit hospitals als 4ere 4ere mainly mainly e8pe e8perim rimen ental tal and are are limited to science research centres >'yaro ,(?. The advantages advantages presented presented by this this type of a hospital hospital include •

atural lighting

andscaped andscaped courtyard providing places places of rest and natural ventilation igure (-+F: !oriontal monolith hospitals. Source: Author modi7ed s5etch 1ulyof (,st (*, %ase evacuation in case of emergency •

• •

Simple load bearing

!o4ever !o4ever this hospital hospital type is inLe8ibl inLe8ible e to future future e8tension e8tension and gro4th

'2@28 '2@28 C"1pa% C"1pa%tt %"$r %"$rt.a t.ar# r# h"+pt h"+pta,+ a,+ These 5inds 5inds of hospitals 4ere 4ere 7rst built built in the "& in the mid ,@*Ns.The main aim 4as to reduce the contentsie and cost of hospitals in the "&.The resulting design concept 4as called Best-Buy.In this strategyplanning is centralised around a courtyard)s and nursing ones occupy the periphery and usually rise up to four levels.The greatest limitation of this hospital is e8pansion 4hen completed >'yaro ,(?. !o4ever this hospital type presents several advantages 4hich include: %conomic utiliation of the site landscaped courtyard


evacuation in case of emergency they are of domestic scale ventilation from roof lights and natural lighting. (F


'2 '2

igure (-*: Gertical hospital Source: AuthorNs s5etch 1uly (( nd (*,

THE THE VER VERTICA TICAL L HOSP HOSPIITAL

To4ards To4ards the end end of the,th the,th century technology technology 4as improvingO Industrial methods of transportation and handling of supplies 4ere successfully adapted to hospital needs. The vertical hospital emerged and 4ith a rare dissent became the accepted form of the hospital. In the vertical planning strategy the hospital ones are arranged one above the other such that the movement pattern is mainly vertical. The steel s5eleton frame and the elevator made it possible to 7t the scattered elements in the horiontal hospital to a single mass >'yaro ,(?. In the vertical planning strategy the clinical one is placed in the podium at street level 4ith the supporting one in the basement and the nursing one in the to4er. The vertical hospital achieves economy in use of land since it occupies relatively relatively little space on site and lends itself 4ell to the vertical stac5ing of communications communications and services. The vertical hospital may be the only practicable solution 4here the ground space is at a premium. It uni7es circulation patterns through the use of vertical communication by elevators. The 4ard may be naturally ventilated if it is narro4 enough as may be the podium if it spreads 4idely around courtyards 1ames 3 Tatton-Bro4n ,F@?. The vertical hospital hospital has three three systems systems of services: ,. dumb4aiters dumb4aiters and conveyors for ancillary ancillary services services (. Gisit Gisitors orsNN elevat elevators ors.. +. Service Service lifts lifts for staK staK and patient patients s The vertical hospital hospital can be bro5en bro5en do4n into several several categories. categories. These are: are: ,. Simple Simple to4er to4er on podium podium hospital hospitals s (. comple8 comple8 to4er to4er on on podium podium hospitals hospitals


+. Radial Radial to4er to4er on podium podium hospita hospitals ls (


. articulated slab on podium hospitals hospitals /. vertical monolith hospital type type

'22 '22 S1p,e S1p,e t")er t")er "! "! p"#$ p"#$1 1 h"+pt h"+pta,+ a,+ This is the simplest simplest high-rise high-rise hospital strategy strategy.. It consists of a to4er on a podium. The nursing one is contained in the to4er 4hile the clinical and support one are contained in the podium. The to4er-on to4er-on podium design design enables a precisely precisely de7ned de7ned programme to be realied in one complete building operation on a restricted site. !o4ever it is argued that this can result in buildings 4hich do not readily respond to the need for gro4th and change during their lifespan >'yaro ,(?.

igure (-(: simple to4er on podium Source: Author modi7ed s5etch 1uly (,st (*,

E?a1p,e: $ee! Mar. h"+pta, Bed capacity-,** capacity-,** beds $ear Built,, Dueen Mary hospital is situated in 2o5 u am on !ong &ong Island. It is  feet >,+E meters? tall and 4as completed in ,,.The facility provides surgical general medical and emergency services to !ong &ong and the surrounding region. The hospital has has ,** beds beds and is also a teaching teaching hospital for the "niversity of !ong &ongNs medical and dentistry faculties.


+*


'22' '22' C"1p C"1p,e ,e? ? t")er t")er "! p"# p"#$1 $1 h"+p h"+pta ta,+ ,+ These types types of hospitals are are similar in many aspects aspects to the simple to4er Jon podium type but the to4er faade are protruded or recessed to create aesthetic interest variety and environmental response. 1ust li5e the simple to4er-on J podium the nursing one is contained in the to4er 4hile the clinical and support ones occupy the podium.

E?a1p,e: Her(e. h"+pta, Bed capacity-,@,@ beds

igure (-: comple8 to4er on podium Source: Author modi7ed s5etch 1uly ( th (*,

!ervey hospital is located in !erlev ,(* meters? high. !ervey hospital is also a teaching hospital for the "niversity of
igure (-/: !ervey !ospital 0enmar5 Source: Source: 1uly (th (*,


'22* '22* Ra#a, Ra#a, t")er t")er "! "! p"#$1 p"#$1 h"+p h"+pta,+ ta,+ This type of hospital hospital has a podium podium 4ith a circular circular to4er. to4er. The nursing one is contained in the to4er 4hereas the clinical and support one are in the podium.
E?a1p,e: R$+h $!(er+t. 1e#%a, %e!tre Ar%hte%t+ : 2er5ins  #ill igure igure (-@: Radial to4er on podium hospitals Source: Author modi7ed s5etch  1uly (/th (*, L"%at"!: Rush "niversity Medical Arch0aily (*,+?. The podium connects to e8isting diagnostic treatment treatment facilities to create a ne4 continuous interventional platform. 2art of the ground level of this base contains an emergency department 4hich has been designed to be an advanced emergency response centre. The geometry of the bed to4er ma8imies vie4s and natural light for patient rooms 4hile also creating an environment environment for eCcient and safe health care.


igure (-E: Rush "niversity Medical
Source: Source: 1uly (/th (*,

+(


'2 '226 26

Art Art%$ %$,a ,ate te# # +,a +,a4 4 "! "! p"# p"#$1 $1 h"+p h"+pt ta, a,+ +

This type of hospital hospital has more more than one to4er to4er rising from from the podium but these to4ers are lin5ed and share one central vertical circulation. %ach to4er houses one particular one of activity either nursing or clinical onlyO usually the nursing to4er rises highest.

E?a1p,e: The 4$!t!- %e!tre Architects: A%<'M

igure igure (-F: Articulated slabs on podium Source: Author modi7ed s5etch 1uly (/th (*,

ocation: Baltimore "nited States. Bed capacity-(@* beds Site area-,./ acres >par5ing ( oKsite? Building area-E***** ft $ear $ear built-(*,* The bunting bunting centre is primarily an inpatient inpatient hospital consisting consisting of nursing units and diagnostic and treatment spaces. #ithin the surrounding bloc5s are e8isting related facilities namely an outpatient clinic the original hospital >currently >currently being regenerated regenerated into outpatient and administrative functions? as 4ell as associated par5ing structures >A%<'M (*,(?.


igure (-: The bunting centre Source: Source: 1uly (/th (*,

++

'228 Vert%a, 1"!",th 1"!",th h"+pta, h"+pta, These are are usually small hospitals put up at restricted areas for e8ample in to4n. Most of such hospitals are special hospitals. 'ne set of elevators is used for ancillary and professional transactions and another for transporting visitors. !o4ever this system is inLe8ible .To relive the elevators of the ancillary load and also to obtain 9uic5 unscheduled deliveries various conveyors and dumb4aiters are employed. An average vertical hospital

igure igure (-/*: vertical monolith Source: Author modi7ed s5etch

E?a1p,e: Ke!.atta !at"!a, h"+pta, !$r+!t")er 4,"%3 The ,*-storey nursing to4er bloc5 houses all the 4ards and theatres in the hospital. ,@ specialised?.

igure /,: &enyatta national hospital nursing to4er bloc5 Source: Author (( nd August (*,

+

CHAPTER THREE: RESEARCH METHODOLOGY *22 *22 I!tr I!tr"# "#$% $%t t"! "!22 This chapter see5s to outline outline the various means through through 4hich the author 4ill underta5e to achieve the aims and ob;ectives of the research outlined in chapter one. To understand the research problem detailed case study research 4ill be used to investigate selected local hospitals in airobi as 4ell as international case studies .

*2'2 *2'2 Re+e Re+ear ar%h %h p$ p$rp rp"+ "+e2 e2 The study is an e8ploratory e8ploratory research. research. The purpose purpose of this research research is to compare the planning and design of the horiontal and the vertical urban hospitals. This is due to the urban gro4th trend and the resultant limited footprint available for development development in urban areas. This places a particular emphasis on developing sound planning and design strategies 4ithin the urban areas to achieve a sustainable and eCcient hospital organism.

*2*2 *2*2 Re+ear Re+ear%h %h #e+-! #e+-! a!# Stra Stratete-. .2 The main research research ob;ectives outlined outlined in chapter chapter one 4ere: 4ere: ,. To investigate the the typologies in in the planning planning and design of hospitals. (. To investigate the current current global trend trend in hospital planning and design. +. To compare and contrast the horiontal horiontal and the vertical hospital models.

*2*2Ca+e +t$#. 1eth"# The case study study method 4as 4as chosen for this this study since it is a 9ualitative analysis 4here careful and complete observation of an individual)a situation)an institution is done. %Korts are made to study each and every

aspect of the concerning unit in minute details and then from case data generaliations inferences are dra4n >%othari& '(()?. '(()?. =roat 3 #ang >(**(? identify several characteristics in the case study method should be outlined in order order to ans4er ans4er the researc research h 9uestion 9uestions s appropria appropriately tely. These These characteristics are: ,? ocus on the cases in their conte8t-2henomen conte8t-2henomena a should be studied in their conte8t especially 4hen the boundaries bet4een conte8t and phenomena are not clearly de7ned. In this case the hospitals 4ere studied in their planning and design conte8t as this determines determines 4hether a hospital 4ill be horiontal or vertical. ,? The capacity to e8plain e8plain casual lin5s-$in ,?.The selection of hospitals to be analysed for the case study 4as important in e8plaining the sub;ect matter of the thesis by analysing the planning and design of the vertical and the horiontal hospital. (? The role of theory theory developmentdevelopment-This This is guided by theoretical development 4hether the case studyNs purpose is to develop or to test theory. It should be a suCcient blueprint blueprint for the study that 4ill suggest 4hat data must be collected and 4hat criteria should be used for analysing it. An important part of the research research 4as through theoretical theoretical analysis of the planning and design of both the vertical and the horiontal hospitals. It 4as possible to carry out the study 4ith clear goals in mind.

+? "se of multiple sources sources of evidence-The evidence-The strength strength of the case study method is incorporation of data from multiple sources. There 4as sourcing of secondary data from several authors in literature revie4. Similarly several methods of data collection 4ere used to ensure all

relevant data 4as collected. These 4ere observation intervie4s surveys and use of instruments.

*262 *262 Se,e%t Se,e%t"! "! Crte Crtera ra +a1p +a1p,! ,!- 1eth"# 1eth"# A sample design is a de7nite plan for obtaining a sample from a given population. It refers to the techni9ue or the procedure the researcher 4ould adopt in selecting items for sample. According to &othari >(**? the researcher must consider the follo4ing points 4hile developing sampling design. Type Type of universeuniverse-This This is the set set of ob;ect to be studied and they they should be clearly de7ned. They can be 7nite or in7nite. In this study the type of universe is the horiontal and the vertical hospitals. Sampling unit-The sampling unit should be decided before selecting a sample it may be a geographical one such as a to4n a city or a village. In this study airobi 4as selected because of its diverse composition of hospitals of all levels. Sampling frame- This is 4here the samples shall be dra4n from. It contains the names of all items of a universe >in this case of 7nite universe only?.It shall be comprehensive correct reliable appropriate and as a representative of the population as possible. Based on the literature revie4 horiontal hospitals are limited to four Loors. This implies that any hospital above 7ve Loors shall be considered vertical. Sie of sample-This refers to the number of items to be selected from the universe to constitute a sample. It should be optimum not too large and not too small. The parameters of interest in a

research study must be 5ept in vie4 4hile deciding the sie of the sample. ThereNs only one level @ hospital in airobi 4hich has applied both the horiontal and vertical planning strategy and therefore 9uali7es as a case study to ful7ll the research ob;ectives.

2arameters of interest-In determining the sample design one must consider the 9uestion of the speci7c population parameters 4hich are of interest. As mentioned earlier the study is a comparison of the planning and design of the vertical versus the horiontal hospital model. This 4ill be analysed against the 7ndings in the literature revie4. Budgetary constraint-random sampling?-%very item of the universe has an e9ual chance of inclusion in the sample. on-probability on-probability >purposive sampling?-Items for the sample are selected deliberately by the researcher and his choice concerning the items remains supreme. or this study purposive sampling 4as used to select the case studies and this is ho4 it 4as done: Area selection- airobi 4ill be used as the case study area. airobi provides provides a mi8 of public and private hospitals in large

numbers. The area is also at close pro8imity to the "niversity of airobi 4hich shall be used as the centre for data analysis.

C",,e%t"! Meth"#+

The methods methods used to collect collect primary data 4ere: 4ere:

*282 Pr1a 1ar. #a #ata ,. 'bservation 'bservatio n >structured? The authorNs interest interest shall shall be to observe observe the planning planning functional organisation oning and space utiliation in the !ospitals under investigation. investigation. This shall be done by recording observation in 4riting using annotated diagrams s5etches and through photographic recording. (. Intervie4s >non-structured? >non-str uctured? igure igure +-(:/m measuring tape used for data collection Source:

The author shall shall see5 to intervie4 intervie4 various categories categories of hospital hospital users to get their reaction on the functioning and organisation of the hospitals under investigation. The respondents shall comprise of the hospital management staK and visitors

+.

2hysica l measurements The author shall shall use physical physical measurements measurements to determine determine certain certain measurable aspects such as corridor sies inter-departmental distances and 4ard sies. This shall be done using /M and /* M measuring tapes.

*282 *282' ' Se%" Se%"!# !#ar ar. . #a #ata ta igure igure +-+: canon digital camera used for data collection ,. Archi Archite tectu ctural ral dra4ings Source:

%8isting master plans and architectural dra4ings of the hospitals under investigation shall be collected from the relevant authorities authorities to aid in data collection and analysis.

igure igure +-: blac5 pen used for data collection in intervie4s notes and s5etches Source: Author

*292

(. Bac5ground information Bac5ground Bac5ground Information such as the establishment catchment population bed capacity and bed occupancy levels shall be collected from the hospital administration. This shall help in analysing and determining 4hether the facilities are overstretched overstretched underutilied or optimied.

Data C",,e%t"! T"",+2 The follo4ing tools shall be used used to collect data: data:

igure igure +-/: s5etch pad used in data collection in form of notes and s5etches Source: Author

a? b? c? d? e?

/* metres metres long measurin measuring g tape tape / metres metres long measuri measuring ng tapes. tapes. ,(., megapi megapi8el 8els s
f? Blac lac5 2en 2en..



*2; Data A!a,.++ 1eth"#+2 The research research focused focused on the planning planning and design design of hospitals 4ith a vie4 of comparing the vertical versus the horiontal hospital models.

St$#. para1eter

Repre+e!tat"!

A!a,.

Sie of site

Master plan =oogle maps

Sie of developed 3 undeveloped and Typology Typology

Master plan site plan

Honing

Master plan site plan

!ori !orio ont ntal al plan planni ning ng stra strate tegy gy

Site Site plan plan sec secti tion onal al dra4 dra4in ings gs

Gertical pl planning st strategy

Site pl plan sectional dr dra4ings

Availability of land Availability Availability of and ban5 for future gro4th pro;ection for vertical)horiontal future Gertical typology typology horiontal
Master plan images images

Loor Loor plans plans secti sectiona onall dra4i dra4ing ngs s %ase of evacuation le le8ib 8ibilit ility y and and gro gro4th %ase of 4ay 7nding

Mast Maste er pl plan Loo Loorr pla plan ns se sec ctio tions Site plan Loor plans

Separat aratio ion n of traC raCc

Mast Maste er plan plan Loo Loorr plan lans se sectio tions



2atient admission travel

Site plan Loor plans

Trac5 patient admission travel from entry to e8it.



'ccupancy levels in 4ards

Loor plans

Scale

sections Images

Access

site plan sections Images

0rop-oKs 3 par5ing

Site plan Images

Site plan Lo Loor pl plans s section ions Images

Loor plans sections Images

Sensiti sitivi vity ty to sem semi-am i-ambu bula lan nt Services andscaping

Loor plan lans se sectio tions Imag Image es Site plan Loor plans sections Master plan sections Images

Gentilation)air Lo4


ighting


2laces of rest

site plan sections Images

eighbourhood
=oogle maps Master plan !ospital records

Materials

loor plans %levations sections

umber of beds per 4ards chec5 for bed utiliation levels total bed capacity of all 4ards 0ominance le levels si sie of of buildings in relation to surr surrou ound ndin ing g envi enviro ronm nmen ent t 0iKerent access routes for outpatient inpatient support facilities accident and 0esignated drop-oK points for !ospital street ifts Staircases Ramps main lobbies Atriums
Table Table +-,: Table Table of study parameters parameters Source: Source: Author (

*2;2Data A!a,.++ T"",+2 0ue to the e8plorative nature of this study comprehensive analysis of the selected hospitals 4ill involve analysis soft4are sho4n in 7gure+-F.These are: ,. =raphisoft Archicad version version ,@>%ducational ,@>%ducational version?version?-This This is both a (0 and +0 drafting soft4are for drafting and dra4ing models. (. =oogle s5etch s5etch up version version F-This F-This is purely purely a +0 tool that is useful in 9uic5 modeling of building.

*2;2'Data Pre+e!tat"! M"#e+ Research 7ndings 4ere represented using: ,? Tables-These ables-These are used to convey convey columns of te8ts for ease of comparison of the 7ndings. Tables have been used to carry the comparison of the vertical versus the horiontal models. (? igures-These igures-These are divided divided into t4o as follo4s: 2hotography-Image 2hotography-Image representations of hospitals are used to illustrate e8isting conditions of diKerent components components in hospitals. Illustrations-These are the most essential in this research to compare and analyse the planning and design of hospitals 4ith the aim of comparing the vertical and the horiontal hospital models. 



*2<2 T1e H"r="! 

The time horion horion shall be cross-sectional cross-sectional as it studies a certain certain phenomenon phenomenon at a particular given time. th The research research shall be carried out out in 4ee5s 4ee5s as from  August th -+* August (*,



CHAPTER TER FOU FOUR: ANALYSIS 622 I!tr"#$%t"!

DATA

PRE PRESEN SENTATIO TION

AND

The main aim of this research research is to compare the planning and design of hospitals 4ith an emphasis on typologies .This 4ill help in addressi addressing ng the challeng challenges es in hospital hospital planning planning and design design 4hich range from site limitations in urban areas provision for gro4th gro4th and Le8ibili Le8ibility ty challeng challenges es in achieving achieving natural natural lighting lighting and ventilation ease of evacuation separation of incompatible traCc among other challenges. The research research is e8ploratory in nature and therefore therefore the case stud study y appr approa oach ch has has been been iden identi ti7e 7ed d as the the main main rese resear arch ch strategy. The case study approach provides the best opportunity for analysing and comparing the models and their typologies in the selected case studies. The selected selected case hospitals are: ,? Ke!.atta Nat"!a, H"+pta,-both horiontal and vertical planning strategies (? Na!5!- Dr$1 T")er h"+pta,>%h!a -Gertical planning strategy

62 KENYA KENYATTA NATIONAL NATIONAL HOSPITAL HOSPITAL 622 Ba%3-r"$!#

igure igure -,: map sho4ing the location of airobi in &enya 4ithin Africa Source: 444.unep.comO *E),,)(*,

&enyatta ational !ospital is located along !ospital Road oK gong Road in airobi &enya. &enyat enyatta ta ation ational al !ospit !ospital al 4as 4as estab establis lishe hed d in ,*, ,*, as the ative I<" >I<"? ? radiology radiology Medical Medical #ards ards and Medical Medical school school teaching teaching bloc5s bloc5s hostels and maintenance department 4as completed. 2hase II comprisin comprising g of Sterile Sterile 2roces 2rocessing sing "nit >S2"? >S2"? 2harmacy 2harmacy o.* o.* ,( J ,F? ,F? funded funded by the #orld Ban5 The 0octorsN 0octorsN 2laa private 4ing 4ing faci facili liti ties es ne4 ne4 mort mortua uary ry and and an o8yg o8ygen en plan plantt 4ere 4ere established.

The !ospital operated operated as 0epartment 0epartment of the Ministry of !ealth !ealth up to ,FE 4hen it became a State "niversity of airobi? &enya Medical Research Institute ational Source: goggle maps: *E),,)(*,

laboratory laboratory =overnme =overnment nt M' and the &enya Medical Training Training
622'

C$rre!t +t +tat$+

,@ specia specialis lised? ed? and an accide accident nt and emerg emergen ency cy department. 'ut of the total bed capacity of ,F**((/ beds are for the 2rivate #ing. 0ata from the hospitalNs records reveal that the annual average bed occupancy rate is ,,/P but goes up to (,* P in medical orthopaedic and paediatric 4ards. In addition on any given day the hospital hosts in its 4ards bet4een (/** and and +*** +*** patien patients. ts. 'n averag average e the hospital hospital caters caters for over over F**** in-patients and over /***** outpatients annually.

igure -+: A monument of the nursing to4er at &! Source: Author >, th August (*,?

622*

H"+pta, Ser(%e+

The hospital is the biggest referral referral facility in the region oKering a 4ide range of specialised services including diagnostic services such such as labora laborator tories ies radiol radiologi ogical cal interve interventi ntions ons)im )imagi aging ng endoscopy and radiation)oncology. In addition the hospital receives referral cases from provincial hospit hospitals als in the countr country y and and 4ithin 4ithin the %aster %astern n "niversity >"niversity of airobi? &enya &enya Medical Medical Training raining
igure -: An Image of &enyatta ational !ospital ta5en from gong road Source: Author >, th August (*,?


'0 !'S2ITA !'S2ITA

MAI

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"RSI= T'#%R

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0%IG%R$ S"IT% A0MI  B'< & !%I2A0 A3 % '"T2ATI% T <II
A0S

%TRA<% -A '"T2ATI% T 2AR&I= igure -/: An image of the model of &enyatta th ational !ospital Source: Author >,/ August (*,?

B"S ST'2

MAI 2AR&I=

%TRA<%B T' A3 % '$ E

622 6226 6

P,a! P,a!! !!!- "/ Ke!.a e!.att tta a Nat Nat" "!a !a,, H"+ H"+p pta ta,,

&enyat &enyatta ta national national hospital hospital has adopted adopted both the vertical and horiontal planning strategies in its master plan. This is clearly evident from the construction phases through 4hich the hospital has undergone through to its current state. The old hospital and the clinical areas have purely utilied horiontal planning strategy 4hereas the nursing areas have adopted adopted vertical vertical planning planning strategy strategy in the ,*-store ,*-storey y nursing nursing to4er. 'n its entirety &enyatta national hospital reads as a simple to4er on podium hospital. !o4ever it cannot be classi7ed as such since the nursing to4er doesnNt have a podium. ,,+ acres?.!o4ever acres?.!o4ever the main hospital comple8 4hich is the primary area of study in this research utilies appro8imately ,FP of the site >(*acres?.@*P of the site >@F acres? has been utilied by the staK housing Mary =riCn !ostels "niversity of airobi medical school StudentsN hostels &enya Medical Training &.M.T.(/ acres? of the site is available for future e8pansion of the hospital. Among the proposed developments in this land are: The proposed 2aediatric emergency centre >2.%.
environment environment a4ay from the mi8 4ith adult patients the proposed burns unit the proposed construction of a bun5er and th August igure igure -@: A model of &enyatta ational hospital comple8 Source: author e9uipment of >,/ cancer unit (*,? and the envisaged e8pansion of the nursing to4er to cater for the rapidly increasing need for medical services.



igure -E: Master plan of &enyatta th ational !ospital Source: Author >,E August (*,?

6228

"!!-

&enyatta national hospital has been oned into three distinct ones. These ones are: ,.
62282

C,!%a, =" ="!e

The clinical one is the 4or5ing area for administration medical treatment and observation. The one has been located on the most acces accessib sible le areas areas from from the access access routes routes and !ospital Street. It comprises of: igure igure -F: ,* storied nursing to4er boc5 home to the entire nursing one at &! The administration administration bloc5

Source: Author



The old hospital hospital





Accident 3 %mergency 4ing)casualty

The old 3 the ne4 mortuary



The doctors plaa plaa





'bservation



'utpatient clinics



Medical records



Main pharmacy



%mergency lab



Medical clinic



2aediatrics unit



Surgical unit



=ynecology unit

igure igure -:
/

62282'

N$r+!- =" ="!e

The nursing nursing one is the patient patient 9uarters)4ards. 9uarters)4ards. It fosters fosters patients throughout throughout their stay in hospital. It comprises of: The nursing nursing to4er bloc5 'bstetrics 4ards





62282*

S$pp"rt =" ="!e

The support support one satis7es satis7es all the physical physical and material needs needs of the nursing and clinical ones. It comprises of: &itchen 3 dining '8ygen plant =eneral stores Boiler house 0rug stores Incinerator igure igure -,*: The support services bloc5 at &! housing the<.S.S.0? Theatre Sterile Supplies "nit>T.S.S."? The three three ones have have been intrinsically intrinsically tied together together to act as one homogenous unit. Garying typologies have been used to assemble the three basic hospital ones. The nursing one has adopted the vertical model and it is the most outstanding and dominating element in the &enyatta &enyatta national hospital comple8. The clinical one one has adopted adopted single storied storied horiontal planning planning strategy e8cept the Accident and emergency )casualty 4ing 4hich is double storied. !o4ever the ground Loor is used by patients 4hereas the 7rst Loor is oCce space for the hospital management. management. The support one adopts the horiontal planning. nd Interestingly Interestingly the 5itchen is located in the ( Loor of the support one and 







  







rd

th

directly lin5s to the 4ards located in the + to ,* Loors. The o8ygen plant is purely an engineering adventure igure igure -,,: '8ygen plant at &! Source: Author



igure igure -,(: oning map of &enyatta national hospital Source: Author

/(


6229 CIRCULA CIRCULATION The e8ternal e8ternal circulation circulation has greatly greatly inLuenced inLuenced the functional functional organisation of the interdepartmental relations at &enyatta ational !ospital.

62292

A%%e++

The main vehicular vehicular and pedestrian pedestrian entrance entrance to the hospital hospital is from the hospital road .The Bus drop-oK point is also located along the hospital road 4hich lin5s to gong road. gong road is used to access Mortuary igure -,+: main entrance to the #ards and clinics at &!.ma;orly This entrance forms the the !ospital Street.academic institutions 4ithin Source: Author the hospital as 4ell as servicing the hospital. The e8ternal e8ternal circulation circulation is a primary success success factor in the planning and design of &enyatta ational !ospital. It provides a convenient and easy access to and from the facility. This has been achieved throughO simple 4ay 7nding safe public vehicular drop-oKs convenie convenient nt access to par5ing and separation of vehicular and pedestrian traCc. A3%? department has its o4n entrance >=ate-B? 4hich is speci7cally designated for emergency cases. The location of par5ing places has desirably inLuenced inLuenced the the location of the hospital street >labeled no.+E in the circulation diagram?

igure -,: 2edestrian 4al54ays have been used to avoid vehicular and pedestrian conLict. Source: Author


/+



ig -,/: Master plan of &enyatta ational !ospital Source: Author

/

622 62292 92' '

Sepa Separa rat t"! "! "/ "/ #++ #++1 1, ,ar ar tra tra% %

At planning level &enyatta ational !ospital has achieved to separate dissimilar traCc through provision of multiple entrances to the hospital. These include: Main entrance for inpatients and visitors >=ate A? A3% entrance for emergency cases and Ambulances>=ate-B? 2edestrian entrance at the bus drop-oK point Service %ntrance at the rear of the site








Source: Author



The separation separation of dissimilar traCc has helped in in minimiing the pedestrian and vehicular traCc as 4ell as minimiing collision of dissimilar vehicular traCc e.g. ambulances and visitorsN vehicles. It has also helped in avoiding collision of Air and road traCc during emergencies at the Accident and %mergency unit. The separation separation of the academic academic institutions from from the main hospital has greatly helped in controlling and managing the human traCc 4ithin the hospital. The academic institutions occupy a designated one 4ithin the site. 0espite the separation they are still able to lin5 seamlessly 4ith the main hospital 4hile still maintaining the privacy of the patients and the visitors. These institutions are: The "niversity of airobi >".o.? medical school 4hich lin5s 4ith the Mortuary &enya Medical Training &.M.T.'ld Mbagathi road? 4hich branches from gong Road. This helps in /

igure igure -,E: 0irect vehicular access at the A3 % unit for emergencies Source: Author.

separating the traCc from the hospital and the academic one 4hile the t4o still acting as one homogenous unit.

/

!ospital Street

622 62292 92* *

I!ter !ter! !a, Cr Cr%$ %$,a ,at t"! "!

The internal internal circulation has contributed contributed ma;orly to the functional functional organisation of intradepartmental intradepartmental relations 4ithin &enyatta ational hospital. The hospital street street 4hich 4hich is the primary primary circulation spine spine in the hospital runs through the hospital from the par5ing lots through the nursing To4er bloc5 to the service road 4hich branches from gong road.

igure igure -,F: The hospital street as captured in the physical model of &! Source: Author

The strategic location of the hospital hospital street street enables patients patients and visitors to access the hospital both from the gong road and from !ospital road 4ith ease. These t4o roads are the ma;or matatus drop-oK points for users of public transport. The hospital street >labeled +E? has the most human traCc since itNs the principal internal circulation channel in the hospital. There is conLict of dissimilar traCc such as the patients visitors trolley bays 4heeled beds and staK since they all converge at the hospital street. Secondary circulation streets branch from the hospital street to the various departments hence tying the various components of the hospital together.

62292 2926 6

Ea+e "/ "/ )a )a. 0! 0!#!!-

#ay 7nding at &enyatta ational hospital is convenient and easy. igure igure -,: Gie4 of the lifts lobby from the hospital Signage has been used as the ma;or tool to direct the patients and street Source: Author

visitors to and from the hospital.

622 62292 928 8

Cr% Cr%$, $,at at" "! ! +pa +pa%e+ %e+

The circulation circulation spaces at &enyatta &enyatta ational ational !ospital comprise of the tertiary corridors internal lobbies internal staircases and the internal ramp at the A3 % department. The circulation spaces have been used to facilitate movement bet4een rooms)spaces 4ithin the individual departments. The internal corridors range from ,.Fm 4ide to +m 4ide depending on their location 4ithin the departments.

622 62292 929 9

igure -(*: #all 78ed signage plates along the secondary streets at &! Source: Author

igure igure -(,: Mosaic arts along the corridors Source: Author

C"11 C"11$! $!% %at at" "! ! +pa +pa%e+ %e+

The communication communication spaces at &enyatta &enyatta ational hospital hospital comprise of the hospital street the secondary streets a set of ,* lifts in the nursing to4er( service lifts,-public staircase in the nursing to4er - %mergency staircases in the nursing to4er a ramp from the delivery suite to obstetric 4ards in the st

, Loor and Series of courtyards. These circulation spaces have been used to provide access bet4een departments at &enyatta ational hospital. The hospital street 4hich is the primary circulation route in the hospital is appro8imately @m 4ide. It has been designed for the ma8i ma8imu mum m e8pe e8pect cted ed circ circul ulat atio ion n Lo4 Lo4 to cate caterr for for trol trolle leys ys 4heelchairs 4heelchairs 4heeled-beds patients and the traCc from visitors. 0uring the visiting hours there is heavy traCc and long 9ueues since the ,* lifts are not ade9uate to serve the patients visitors staK and food items. The only available alternative is the public staircase at the lift lobby. This staircase is inade9uate given the high traCc of visitorNs accessing the 4ards in the nursing to4er bloc5.

The 4idths of the secondary secondary streets streets vary from (.m (.m to +.* m depending depending on their location 4ithin the hospital.


igure igure -((: Internal circulation map at &enyatta ational hospital Source: Author

/F


622;

FLEJIBILITY & GROWTH

le8ibility and gro4th at &enyatta ational !ospital is e8hibited through the development of the hospital in phases. These are: are:

The ",# h"+pta, M"#e,:

622;2

!oriontal hospital model. T.p","-.: Spine and 2avilion The old hospital is a +-storied spine and pavilion typology. It has a strong spine 4ith clinical and nursing ones on either sides of the spine. In this typology the circulation has been used as the principle organising element. A#(a!ta-e+ Along the central spine are emergency 7re escape doors that open to the landscaped courtyards. This is convenient for emergency evacuation. The narro4 narro4 plan characteristic characteristic of this typology typology ma8imies on natural lighting and ventilation in the building. This is a sustainable approach to hospital design as it alleviates the need for arti7cial lighting The narro4 narro4 plan ma8imies ma8imies on natural ventilation. ventilation. 2atients have vie4s to the landscaped gardens hence oKering therapeutic bene7ts 4hich create a conducive healing environment. The simple spine corridor corridor )street allo4s allo4s for unlimited gro4th at almost any point either of the street itself or of individual departments. departments. This is clearly evident at the node 4here the old hospital intersects 4ith the main hospital to forming a uni7ed composition •

igure igure -(+: The old hospital bloc5 Source: Author

•

• •

•


D+a#(a!t a-e+ The central corridor corridor is too long and monotonous. monotonous. This creates boredom and increases the intra-departmental distances. This typology re9uires re9uires a big piece of land to develop develop hence igure igure -(: Image of the circulation spine in the old hospital Source: Author not suitable in small and congested congested sites •

•

/


igure -(/: The old hospital as it e8isted before construction of the main hospital bloc5 Source: Author @*


,./ metres 4ide #indo4s lighting the central spine

+.@ metres 4ide central spine

Staircase to upper Loors

The node lin5ing the old hospital 4ith the main hospital comple8 %mergency 7re escape door

igure igure -(@: detailed l ayout of the old hospital Source: Author


@,


The narro4 narro4 plan allo4s for natural natural ventilation and and lighting to the 4ards. The poc5et poc5et landscaped landscaped courtyards oKer oKer therapeutic therapeutic bene7ts bene7ts to the patients in the 4ards The central aisle aisle allo4s for emergency emergency evacuation evacuation to the poc5et courtyards through doors located along the circulation spine. ighting to the central aisle is achieved through 4indo4s 4indo4s located strategically along the spine

igure igure -(E: ayout plan of the old hospital Source: Author


@(

igure -(F: Typical 4ard plan of the old hospital before relocation of the 4ards in the ursing to4er bloc5 Source: Author


622;2'

Pha+e 

M"#e,: !oriontal hospital model. T.p","-.: %8tended courtyard. The hospital has has e8panded e8panded through+ through+ ma;or phases under under the funding of the British =overnment.2hase-, =overnment.2hase-, comprising of outpatient clinics casualty central sterile and supplies department department ><.S.S.0? intensive care unit >I<"? radiology medical 4ards medical school teaching bloc5s hostels and maintenance department 4ere completed in,E(.

igure igure -(:
2hase , development employs the use of the e8tended courtyards typology. In this typology poc5ets of courtyards are used as the principle organising elements. This typology presents several advantages 

   

 

igure igure -+*: Roof lights used to light the single storied deep planned bloc5s Source: Author

ma8imum utiliation of natural light Gentilation from roof lights andscaped courtyards 0omestic scale %ase of evacuation in case of 7re 2rovision for future e8tension Simple load bearing structure

!o4ever the typology still has its o4n limitations e.g. In areas 4here deep plans have been used it becomes hard to achieve natural lighting and ventilation. This necessitates the use of roof lights 4hich are only functional in single storied buildings unless an atrium has been provided


@+



igure igure -+,: ayout of the phase -, development at &enyatta ational !ospital Source: Author

@


62 ;2* Pha+e II 2hase II comprising of Sterile 2rocessing "nit >S2"? 2harmacy o.*
in,E(.

igure igure -+(: ayout of the phase development at &enyatta ational !ospital Source: Author

@/


622;26

Pha+e III

2hase III 4as completed in ,F,.This included the ,* storey To4er Bloc5. "nder the !ealth Rehabilitation programme >,( - ,F? funded by the #orld Ban5 The 0octor 2laa and private 4ing facilities ne4 mortuary and an o8ygen plant 4ere established.

igure igure -++: ayout of the phase-III development at &enyatta ational hospital. Source: Author

@@


622<

A&E W!-

M"#e,: !oriontal hospital model. T.p","-.: %8tended courtyard The A3% 4ing 4ing adopts the e8tended e8tended courtyard typology in its planning and design. This brings several advantages that are crucial in an accident and emergency 4ing. These are: 



igure igure -+: Gie4 of the A3 % unit from the par5ing Source: Author

  

Reduction Reduction of intradepartmental intradepartmental distances
The department department is strategically strategically located 4ithin 4ithin the &enyatta &enyatta ational !ospital master plan and is easily serviced by vehicles pedestrian and choppers. The department is at close pro8imity to the helipad 4hich ma5es it eCcient to attend emergency cases via air transport. Gehicular access to the department is via a dedicated emergency entrance >=ate-B?. This aids in avoiding the mi8ing of incompatible traCc 4hich may cause delay 4hile accessing the emergency department. The department department has a deep deep plan 4hich 4hich creates challenges in achieving natural lighting throughout the building. This problem is mainly due to the double storied nature of the building 4hich ma5es it hard to light the ground Loor using roof lights. The lac5


of ade9uate atriums ma5es it hard to light the interiors of the building using natural light. igure igure -+/: ocation of the A3% unit at &! Source: Author @E


LEGE

ND igure igure -+@: =round Loor plan of A3% department at &! Source: Author

@F


LEGE ND


igure igure -+E: irst Loor plan of A3 % department at &! Source: Author

@


Interstitial Loor

622@

The !$r+!- t")er

M"#e,: Gertical hospital model. T.p","-.: Gertical monolith The ,*-storey nursing to4er bloc5 houses all the 4ards and theatres in the hospital. ,@ specialised?. 'ut of the total bed capacity of ,F**((/ beds are for the 2rivate #ing. The annual average bed occupancy rate is ,,/P but goes up to (,* P in medical orthopaedic and paediatric 4ards. Based on the hospital records on any given day the hospital hosts in its 4ards bet4een (/** and +*** patients. 'n average the hospital caters for over F**** in-patients and igure igure -+F: A model of the &! ursing to4er bloc5 Source: Author over /***** outpatients annually. %ach of the typical Loors in the to4er bloc5 has F 4ards. A set of ( 4ardsO, male and , female. A set of ( 4ards share facilities such as the service lift nurseNs station emergency 7re escape and the reception. The #ards #ards are grouped grouped into into clusters of ,* beds each. The to4er bloc5 is serviced by a set of ,* lifts and one public staircase. !o4ever !o4ever due to the high number of patients accessing the 4ards during visiting hours one can barely get a lift ride. This results to long 9ueuing lines and many visitors opt to use the only staircase available. The lifts are for use by all classes of people ranging from staK patients and visitors. This results to mi8ing of incompatible traCc in the vertical circulation. Based on the authorNs observation the vertical circulation is the biggest challenge being faced by the hospital. At some instances the hospital has reported suicide cases 4hereby patients ;ump igure -+: hard landscaped to4er bloc5 courtyard Source: Author from from the ,(**mm ,(**mm high high balco balcony ny rails rails to the hard landsc landscape aped d courtyard. According to the hospital %ngineer the challenge is ho4 to balance safety and security of patients in the 4ards.


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igure -*: A typical Loor plan of the 4ard Source: Author

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igure igure -,: Aerial vie4 of the nursing to4er Source: Author

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igure igure -: A detailed analysis of the typical 4ards in at &enyatta ational !ospital Source: Author

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igure igure -(: Sectional analysis of the to4er bloc5 at &! Source: Author

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622 622  E1er E1er-e -e!% !%. . #e+ #e+-! -! /ea /eat$ t$re re+ + ! the the !$r+!- t")er2 2atients 2atients have diKering physical abilities and a range of psychological characteristics characteristics 4hich all impact on the degree of assistance that they 4ill re9uire to evacuate from a building safely. &enyatta ational !ospital has incorporated architectural design emergency emergency features for safe evacuation of patients in case of disasters li5e 7re. These include:

igure igure -+: The four compartments of double 4ards in a typical Loor of the nursing to4er Source: Author

,? %mergency %mergency staircases staircases JThe ,* storied storied nursing to4er to4er has a set of  emergency emergency staircases to aid in evacuation of ambulant people. The emergency stairs are appro8imately ,/**mm 4ide. This 4idth is good enough to allo4 for mattress evacuation. The emergency stairs are accessed via 7re escape doors. !o4ever the emergency stairs open 4ithin the hospital in the =round Loor. #hereas it is preferable preferable for the emergency emergency stair to open to a courtyard and not 4ithin the hospital building the emergency stairs open to the latter due to security reasons. (? ire 0oors-The 0oors-The typical Loor of the nursing nursing to4er is divided into  sets of double 4ards. %ach of these sets is accessed via a 7re resistant door that has the follo4ing features: an e8it sign door handle glaing a 5ic5ing plate. This ma5es the building more accessible to all including the 4heel chair con7ned persons. +?

combating the spread of 7re to the other 4ards in the same Loor.

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igure igure -: S5etch of a 7re resistant door along the +***mm 4ide corridors in the 4ards. Source: Author


igure -/: Analysis of the architectural design emergency features in a typical Loor of the nursing to4er Source: Author

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? %8it)%scape routes-%ach routes-%ach set of the double double 4ards in the the typical Loor plan of the nursing nursing to4er has ( accessible e8its for horiontal evacuation)escape route and an internal emergency escape staircase for vertical evacuation. /? %8it signs-All doors doors along the corridors in the nursing nursing to4er and emergency emergency staircases staircases have visible e8it signs 78ed on door frames. This enables an individual to identify the escape routes at all times even 4hen the door is open. @? Ramps J The 'bstetrics 'bstetrics 4ards in the 7rst 7rst Loor of the nursing to4er to4er have access to a ramp that .This ramp creates ease of movement for the patients from the 4ards to the delivery suite in the ground. The ramp can be be particularly helpful helpful in evacuating evacuating semi-ambulant semi-ambulant persons 4ith 4ith ease and speed from from the 7rst Loor to the courtyard in the ground Loor. !o4ever this ramp is only limited to the 7rst Loor. igure igure -@: The ramp serving the obstetrics 4ards in the 7rst Loor and the lifts delivery suite in the =round at &!. Source: E? #ide corridorsJ The main circulation circulation corridor at the lobby is appro8imately appro8i matelyLoor @metres 4id 4ide. e. TheAuthor interior circulation aisle in the 4ards is appro8imately + metres 4ide. The 4ide corridors can be particularly helpful in emergency evacuation. 2atients 2atients and visitors can be evacuated into the @metres 4ide corridor as they a4ait transfer to safer areas.

igure -E: ire e8it sign at an emergency escape door at &! Source: Author

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622 622  C"1p C"1par ar+ +"! "! "/ "/ the the H"r H"r= ="! "!ta ta,, t.p","-. 1"#e,+ at KNH PARAMETER

EJTENDED COURTYARD

SPINE & PAVILLION

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arro4 plan

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!oriontal hospital model- mi8ture of single double and +Re9uires a relatively smaller site compared to the spine and pavilion

!oriontal hospital model- + storied building. Re9uires a relatively larger site compared to the e8tended

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2atients can easily be evacuated directly from the building bloc5s into the landscaped courtyards.

2atients can be evacuated out of the building through the 7re escape doors situated along the central circulation corridor.

%UIBIIT$ A0 =R'#T! S%2ARATI' S%2ARATI' ' ' 0ISSIMIAR TRAI< TRAI< 2ATI%T A0MISSI' TRAG%)0%2 TRAG%)0%2AR ARTM% TM% TA TA 0ISTA<%S 0ISTA<%S S
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The typology allo4s for both The typology allo4s for unlimited vertical and horiontal gro4th gro4th at almost any point either 4ith ease. lat roofs can be of the street itself or of individual particularly helpful in attaining departments. The multiple secondary secondary streets streets ItNs diCcult to separate allo4s for separation of dissimilar traCc since thereNs dissimilar traCc. only one central circulation The arrangement arrangement of departments departments The departments departments are arranged arranged around courtyards reduces the laterally along the central spine. departmental distances since This result to longer departmental departmental closely related departments can distances compared to the 0omestic scale. !as a ma8imum of 0omestic scale. !as a ma8imum of + Loors in the 5itchen and + Loors in the old 4ards. The typology has deep plans. plans. This The typology has a narro4 narro4 plan ma5es it diCcult to achieve throughout. throughout. This is particularly ma8imum natural air ventilation helpful in achieving ma8imum through cross ventilation via the natural air ventilation through courtyards. The roof vents have cross-ventilation. been used to provide natural air ventilation in the single storied bloc5s .!o4ever they are The deep plans ma5e ma5e it The narro4 narro4 plans helps helps in achieving achieving challenging to achieve ma8imum ma8imum natural lighting to all naturally to all spaces in the spaces in the building as 4ell as building. The roof lights have been providing therapeutic therapeutic vie4s to the used to provide natural lighting but landscape from the 4ards

Table -,:
622' 622' p,a! p,a!!! !!! !- & #e+ #e+-! -! %h %ha, a,,e! ,e!-e -e+ + at at Ke!.atta !at"!a, h"+pta, To To a great e8tent e8tent &enyatta &enyatta national hospital hospital is successful successful in its planning and design. !o4ever !o4ever the author 4as able to identify a fe4 challenges through observation and intervie4s from the hospital administrators. These are: ,? There is high high vertical circulation circulation stress stress in the nursing nursing to4er bloc5 due to overdependence on lifts and lac5 of ade9uate public staircases to complement the lifts.

Comparative Analysis of Hospital Design Typologies

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