MAPUA INSTITUTE OF TECHNOLOGY
School of Architecture, Industrial Design, and Built Environment
PROPOSED REDEVELOPMENT OF OSPITAL NG TAGAYTAY: CREATING THERAPEUTIC ENVIRONMENTS THROUGH INNOVATIVE HOSPITAL DESIGN _____________________________ ___________________________________________ ______________
In Partial Fulfillment Of the Requirements for the Bachelor of Science in Architecture
____________________________ ______________________________ __ Presented by:
JAN ALLEN S.J. GOMEZ
Arch. Junar Pakingan Tablan Adviser
CHAPTER I THE PROBLEM AND ITS BACKGROUND I.1.1 Introduction
Health is a fundamental right guaranteed by our constitution to all citizens. Health care, on the other hand, depends on what each citizen can pay. Health inequity is very evident in our society. The standard in health care for the rich in our country is far different from that for the poor, and this disparity is growing. The quality of public health is a major policy issue in every country, whether developed or developing. The international community, both public and private, also assigns high priority to improving health conditions in developing countries. Health facilities are important components of the health care system. The national government has been aiming for the provision of essential health services that are accessible, affordable and equitable. Despite the progress cited by the national government, the country’s public healthcare system is marred with problems. The lack of health personnel, the absence of adequate facilities, and the remaining barriers for the poor to access health care are just some of these problems. Hospitals play a very big role in society’s economic and social well -being. Their healing and rehabilitative functions empower them to bring back a person’s productivity in society. It is very important that the hospital carry out its mission of healing successfully. Hospitals are designed to not only support and aid safety of patients, advanced medicine and technology, and quality patient care, but also envelope the patient, family, and caregivers in a psycho-socially supportive therapeutic environment. The characteristic of the physical environment in which a patient receives care affects patient outcomes, patient satisfaction, patient safety, staff efficiency, staff satisfaction, and organizational outcomes. The effects can be positive or negative. No environment is neutral. Facility designers and health care providers are recognizing the effect of the physical environment on patient outcomes. Some studies have shown that a facility’s design can influence the rate of nosocomial infections, errors in patient care, and the cost associated with treating a given condition. Architects and interior designers who work with hospitals are becoming increasingly aware of this growing body of evidence and are taking it into account in their work.
I.1.2 Statement of the Problem:
The governments health agenda is to provide universal quality health care to the public. The purpose of this research is to provide a new health facility that can cater to upgraded services of the hospital with reference to the Department of Health (DOH) initiatives on regulation and classification of hospitals and other health facilities in the Philippines. The study aims to create innovations in the design of the new Ospital ng Tagaytay by incorporating therapeutic designs.
I.1.3 Project Goal:
•
Design and plan the facilities of the Ospital ng Tagaytay that will meet the new requirements of the Department of Health classification of hospitals in terms of services offered and capacity to handle patients
•
The research aims to explore new solutions in designing and planning architectural spaces with the therapeutic effects to the patients.
I.1.4 Objectives:
•
Determine the present and future needs and capacity of the hospital with regards to the population of the city
•
Design and plan the hospital that meets the DOH classification classificat ion by incorporating spaces to the services added by the hospital to meet the requirements.
•
Planning the hospital on the premise of new circulation due to the therapeutic based design of the facilities.
I.1.5 Significance of the Study
One of the functions of this research is to provide creative and technical assistance to public hospitals particularly to the Ospital ng Tagaytay. Determining the current status of the general hospital can help identify the facilities needed to increase
the service capability and improve the quality of health care of the hospital. The results of this study can be beneficial in providing recommendations for the redevelopment of the hospital as a primary health care provider in the city of Tagaytay. It will also serve as basis for future designs of public hospitals for innovative therapeutic designs.
I.1.6 Scope and limitation
The scope of the research shall be with the bounds of the design of the hospital and integrating therapeutic environments in the planning and designing of the facilities. The scope of the study shall also explore new architectural designs, planning of spaces and study of behavioral circulation of the users in the hospital. The assessment of the study was limited to 5 years of secondary data. The limitations of this research are the available applicable designs and technology available to aid in the healing process. The research is limited to architectural solutions of integrating therapeutic environments in the design of the hospital. It aims to create and enhance the design of spaces for therapeutic environments and not meddle with management and procedural processes in the hospital.
I.1.7 Assumptions
The assumption of this research would be the development of public hospitals complying with the new Department of Health classification requirements and would integrate designs for therapeutic environments.
I.1.8 Conceptual Framework
PROPOSED REDEVELOPMENT OF OSPITAL NG TAGAYTAY: CREATING THERAPEUTIC ENVIRONMENTS THROUGH INNOVATIVE HOSPITAL
PROBLEM ANALYSIS
METHODOLOGIES
RESEARCH &
CONDUCTING SURVEYS
CASE STUDIES
FORMULATION OF ARCHITECTURAL SOLUTION
CONCLUSION
GATHERING DESIGN GUIDE LINES AND RESTRICTIONS
I.1.9 Definition of terms
Accesible - is the degree to which a product, device, service, or
environment is
available to as many people as possible.
Healing- is the process of the restoration of health to an unbalanced, diseased or
damaged organism.
Health services- include all services dealing with the diagnosis and treatment of
disease, or the promotion, maintenance and restoration of health.
Hospitals- is a health care institution providing patient treatment with specialized
staff and equipment.
Incorporate - to include (something) as part of something else
Innovation - the act or process of introducing new ideas, devices, or methods
Integration - an act or instance of combining into an integral whole.
Patient- is any recipient of health care services.
Psycho-social- means it relates to one's psychological development in, and
interaction with, a social environment.
Rehabilitative- helping to restore to good condition; "reconstructive surgery";
"rehabilitative exercises"
Therapeutic- of or relating to the treatment of disease or disorders by remedial
agents or methods
Quality- the non-inferiority or superiority of something; it is also defined as
fitness for purpose.
CHAPTER 2 I.2.1 REVIEW OF RELATED LITERATURE AND STUDIES I.2.1.1 DOH gives hospitals 3 more years to comply with reclassification
The Department of Health and representatives from private hospitals have reached a compromise that will give healthcare facilities a maximum of 3 years to comply with the government's hospital reclassification scheme MANILA, Philippines The Department of Health (DOH) and representatives from private hospitals have reached a compromise that will give healthcare facilities a maximum of 3 years to comply with the government's hospital reclassification scheme. In a press briefing, Health Secretary Enrique T Ona told reporters the agreement allows hospitals to beef up their facilities and comply with the DOH's new rules on hospital classification based on Administrative Order No. 2012-0012."The AO will apply immediately to new hospitals. For those that are already existing, especially those without operating rooms, they will be given a maximum of 3 years, but I'm sure most of them will be able to do it in a year or a year and a half," Ona said. Ona said half of the estimated Level 1 hospitals under the old ruling need to spend some P10 to P15 million to put up a decent operating room. This would put them under Level 1 category in the new classification. He said that as of 2011, there are a total of 733 government hospitals and 1,088 private hospitals. Presently classified as Level 1 are 771 facilities composed of 372 public hospitals and 399 private hospitals. The health secretary said he's confident that after 3 years or earlier, more than half of these Level 1 hospitals would be able to retain their classifications under the new rules. Private Hospitals Association of the Philippines (PHAP) President Rustico Jimenez said they support the DOH's move. However, he said the DOH must help in fast-tracking PhilHealth payments, which are often delayed, and reaching out to other agencies on matters that currently hound hospitals.
Jimenez said one of these agencies is the Department on Environment and Natural Resources. It has imposed a fine of P200,000 per day for improper hospital waste management, which, Jimenez said, is difficult for some hospitals that don't own a waste facility. "As I said, we are agreeable to those terms because before, our request to Secretary Ona was that only new hospitals [ought to] be covered by the AO. If you read the AO, there was no mention of 3 years. After that, Secretary Ona released the 3 years so I think we are agreeable to that," Jimenez said. He also expressed the hope that DOH help the PHAP and the Philippine Hospital Association Association (PHA) stay as members of the board of PhilHealth. PhilHealth. Some lawmakers lawmakers are pushing for the removal of the two organizations from the board of PhilHealth on grounds that their membership creates a conflict-of-interest situation. New classifications under the new DOH reclassification order: Level 1 hospitals should should have the following facilities: surgery room isolation surgical and maternity facilities dental clinics secondary clinical laboratory blood station first level X-ray a pharmacy Level 2 hospitals require additional departmentalized clinical services including: a respiratory unit
high pregnancy risk unit second level X-ray with mobile unit Level 3 hospitals should have: DOH-accredited teaching and training on 4 major clinical services, ambulatory surgical and dialysis clinics and a blood bank
I.2.1.2 The Healing Environment: A Therapeutic Landscape
There remains so much more to consider in bringing the outdoors inside, specifically for acute care and other hospital settings.Potted plants became a greater part of modern life indoors when it was easier to transport them greater distances, and this also allowed the enjoyment to cross class lines. “Passive and active engagement with
nature
outdoors
can,
for
example,
increase
positive
affect,
reduce
psychophysiological arousal, and renew an ability to perform tasks that require concentration. This positive affect has transferred itself indoors to the degree that the access is appropriate and to the extent that the individual is in need of restoration or stress reduction” (Bringslimark, Hartig, & Patil, 2009). In the late 1960’s, when John Portman designed the first Hyatt Regency in Atlanta, hotels could no longer just landscape their porches and walkways. walkways. The outdoors has been invited indoors almost five decades, with inside offices having windows and skylights that offer daylight and the hour-to-hour changes in natural light. By virtue of market pressures to mimic the hospitality industry, and with the emergence of models of care such as the Eden Alternative for elders, attention to the natural environment has become a standard of design for care environments. Newer facilities have gardens, some designed to be actively therapeutic while others to be only aesthetically pleasing. Some have walkways and security for those residents who may wander. Other gardens are only to be viewed from outside. What is meaningful and functional for a long-term care resident who is living in a building is quite different from an overnight visitor of the acute care patient.
Questions to consider: 1. How does landscape architecture serve the clinical objectives that drive a healthcare organization? 2. How can natural landscapes be integrated seamlessly between the inside of a hospital, which represents illness, confinement, challenge, and fear, and the outside, which offers health, hope, and freedom? 3. What kind of research would bring to the fore the greater depth offered by landscape architects to better inform budgetary decisions regarding nature and recovery? This is the time to tackle these issues, as the values of healthcare organizations and the inherent stresses placed on patients and staff demand more attention to humane care. The beauty of nature, by its very character, is therapeutic. Human pain and suffering can be eased with views that are inherently hopeful, are readily accessible, offer enough complexity to engage the mind and spirit, and are appropriate to the needs of the moment. Bringing clarity and skill to how this can be accomplished is the challenge in front of each of us who works in this field.
I.2.1.3 Patient comfort
Not surprisingly, noise reduction in hospitals is top of mind in hospital facility design. Some 71 percent of respondents said that over the next five years noisereducing construction materials would be incorporated into design features. And 60 percent of respondents said they are incorporating noise-reducing materials into patient room design. Noise reduction is an area of focus because of the increased emphasis on patient satisfaction and Facility Guidelines Institute (FGI) Guidelines for Design and Construction of Hospitals and Outpatient Facilities issued earlier this year that has a new section on acoustics, including the use of noise-absorbing materials and reducing the amount of hard surfaces in facilities, which can create unnecessary noise, Sprague says.The FGI is a volunteer-run organization and its guidelines, published every four years, are used by 40 states as a hospital licensure requirement. “It’s amazing how
noisy hospitals hospit als have become,” Sprague says. To that point, 71 percent of survey respondents said that regulatory requirements are a major influence in driving change to health care facility design. Another FGI guideline involves medication safety zones to reduce medication errors. This can include guidelines on lighting, security and access, Sprague says. Nearly half of survey respondents (48 percent) said they would put more emphasis on medication safety zones over the next five years.Top features in room design include wireless technology for staff (71 percent), conversion of semiprivate to private rooms (69 percent), technology integration (65 percent) and bar coding for medication administration (63 percent).Other items that could influence patient satisfaction include individual temperature control (59 percent) and patient control of room lighting and shades (57 percent). “That’s a lot,” Hamilton says of the results. “The research shows these are helpful in terms of patient satisfaction.” An satisfaction.” An important important aspect of of facility design these days is energy efficiency because it can reduce overhead costs, some experts said. For instance, 68 percent said better energy usage and efficiencies were a major influence in driving changes in facility design. However, just 37 percent of respondents said that selecting environmentally friendly materials was a major influence in design.“Energy design. “Energy is the biggest opportunity to make an effect on the financial well -being of a hospital,” says Quirk. “It gives you better control over swings in commodities like gas, water and electricity. Hospitals and health care organizations need to push the industry and, on the client side, clients need to be willing to take professional recommendations and step up and take a little bit of a risk.”
CHAPTER 3 I.3 RESEARCH METHODOLOGY I.3.1 RESEARCH METHODOLOGY DESIGN
In using different methods in the research we can gather different types of data that can give multiple views of analyzing the research better. Case studies as a method of obtaining data from the existing site are used by making a detailed study of the facilities. Different methods of obtaining information like observation and interviews and consulting with knowledgeable people are used to gain insights on the problems. I.3.2 RESEARCH DESIGN: CASE STUDY EXAMPLES E XAMPLES I.3.2.1
Children’s Hospital
at Montefiore (CHAM) - INTERNATIONAL
The Children’s Hospital at Montefiore CHAM was specifically designed to provide a healing and aesthetic setting for pediatric care. “Reflects both the philosophies of ‘family -centered care’ and the teachings of C arl Sagan, stressing our connection to the larger whole of the universe and making the hospital a place where the journey is not only towards healing, but also knowledge. Throughout the hospital, the child is the centerpiece and driving force behind the design. The concepts of journey and connection are explored on each floor using different themes and depicted through numerous numerous art installations. Local and nationally known artists were handpicked to develop each floor’s pieces around a specific idea geared geare d either to the developmental level or illness treated on that floor.” These initiatives at The Children’s Hospital at Montefiore (CHAM) and, help promote well-being among patients, family members and associates by reducing stressors such as noise, glare and clutter; connecting
patients and associates to nature; offering beauty and positive distraction through visual art; and providing space and seating layouts that encourage visitation by family and friends.
I.3.2.2 St. Luke's Medical Center Global City LOCAL
St. Luke's Medical Center - Global City's wellness-centered infrastructure, state-of-the-art medical technology and hotel-like ambiance - all combined to help deliver an exceptional patient experience. The exterior of the hospital projects a modern building with its strong linear elements and bold horizontal and vertical features. The materials and color schemes gives us an impression of a state of the art treatment facility. The hospital tries to inject landscape greeneries to soften the design and blend well with the surroundings. The hospital’s lobby is very generous in terms of space that it can accommodate large traffic of people going in and out of the hospital.
The combination of artificial lighting, natural lighting, and light colored materials gives the interiors the necessary brightness inside the hospital to add to a more spacious feel. The hospital’s hospital ’s interior design includes warm woods and nature-inspired elements and soft color schemes. The width of the hallways of the hospital are wide enough to accommodate patient traffic and not cause stress due to congestion inside. Spaces are located along the corridors to serve as breaks to the otherwise long pathways. These spaces tend to serve as lounging areas for people attending to their hospital needs and services.
The hospital keeps their clinical departments patients very relaxed as lounge areas outside of the departments have been created for the people to use while doing their business with the clinics. There is ample lighting in the area to give it a bright spacious feel for the patients and clients.
The hallways for the doctors offices are also wide which does not compromise the patient traffic in the area where consultations are ongoing. The hallways have one side for waiting areas of the patients for consultations.
The hallways have vistas overlooking a pocket sky garden outside so as to give the passersby visual breaks inside the building. The hallway uses glass walls as alternative to let natural light in to brighten up the area where people can lounge when waiting.
Aside from from the vistas vistas provided provided by the the gardens outside the hospital also utilizes artworks to serve as visual stimulations for the patients and people doing their business inside the hospital. These are one of few strategies of the hospital to redirect their attention to more pleasant stimulations of the patients rather than being stressed with their medical procedures and businesses.
I.3.3 RESEARCH DESIGN: CASE STUDY OSPITAL
NG
TAGAYTAY
Ospital ng Tagaytay was inaugurated on April 25, 1997 and was opened publicly on May 4, 1997. It was dedicated to the people of Tagaytay as well as nearby communities to provide primary care as well. The planned city health center and a lying in clinic was converted into a hospital and is now the Ospital ng Tagayaty located at Bacolod St. Kaybagal South, Tagaytay City, Cavite. The first time the researcher saw the hospital from the other side he
didn’t
immediately think it was a hospital because of its exterior facade. If not for its signage that tell you its a hospital you might think it’s just another another government government or private private building. building.
The back of hospitals serves as parking spaces for their ambulance and some
hospital
employees
while
being
storage for their medical wastes and other supplies. I immediately noticed the lack of disposal and storage facility for their medical waste which is just placed beside the wall without
precautionary
containment.
coverings
or
When the researcher looked for the public toilet in the ground floor the first thing he saw was the cleaning materials and trash cans located beside the toilets. There is no visible storage
compartments
for
these
cleaning
materials and the risk of contamination is evident in the area.
Near the toilet area was a breast feeding and lactating station and it was near the exit to the back of the hospital. The air tanks are just located along the corridor and there is no storage area than can be located to safely store the tanks. This is a hazard considering it is located near the breastfeeding and lactating area and its waiting area where patients
like
mothers
and
their
newborn
children are exposed to these safety hazards. The hall ways is lit by natural light but can be only appreciated nearing the exit of the hallway. The width of the hallway is enough to accommodate the human traffic of waiting patients, passersby and some equipments but on a busy day in the hospital this area could be crowded and become a source of stress especiall to the patients like the mothers and their new born babies.
The
laboratory
department
can
only
accommodate one patient at a time in terms of collecting samples from the patient. When you open the door you can immediately see the patients chair with a table for the equipment and materials for extracting samples from the patients. It is a bit of the problem for employees and patient traffics since it is the only door for both laboratory employees and patients to pass through. A secondary door leading to the laboratory itself is seen near the patients chair that could be a hindrance for passersby when there is an ongoing collection of samples being done.
The laboratory itself is quite small just enough for making tests that are within their current capability and capacity.
The other side of the laboratory is a make shift storage and equipment area. The space allocated for the laboratory services is not enough if ever they decide to upgrade their equipments. The spaces and furnitures needed to house different equipments and materials are already utilized.
The internal medicine consultation room and ob-gyne consultation rooms are housed in one area where they separated by cubicles inside. The spaces allocated for these services are limited that the doctors/ consultant consul tant doctors don’t have enough room to conduct proper consultations. The rooms for these services are not confortable and inconvenient for the physicians and patients because of the lack of space and privacy needed for the consultations. Because consultation rooms are made as cubicles sound insulation is very poor inside.
The central sterilizing and supply room is the storage room for the supplies needed in the hospitals such as fluids, personal protective equipment and other hospital supplies. It is tha main sourcing facility for the hospitals materials. Unfortunately the space for the supplies are almost full and inadequate for
inventories of certain duration. There is littlee room to operate for two staff members working inside. Due to the inability of the central sterilizing and supply room to accommodate other materials, the space beside the main stairs has been converted to a storage facility of Intravenous fluids (IV fluids) These is located across the supply room which is a few meters away.
The emergency room is located near the xray room but some of its facilities are not up to the minimum hospital standards such as the current design and condition of the doors. The access of patients to be confined from the emergency room is slightly obstructed by the patients waiting along the Out-patient department clinics. The people waiting along the corridors is mixed with patients from the Out-patient Department, patients coming out of the emergency room and even the company of the patients.
The X-ray room has a very cramped office space that the desk of the technician and attending staff is almost obstructing the way where a patient will pass through. Patient on wheelchairs can have a stressful time navigating inside the narrow space going through the room.
Some of the nurse stations are unmanned and not well lit so whenever patients within the area are in need of the attention of nurses they would have to go to other nurse stations to seek assistance.
The
emergency
room
is
capable
of
accommodating from 4-5 patient in its area. But the problems I noticed is the lack of space for the equipment.
Equipments
not
used
inside
the
emergency room are only stored at the sides of in corners within the emergency room.
Inside the pharmacy office there is no clear separation for the staff working inside and the storage areas for the medicines. The spaces for the storage of medicines are almost full and there is a need to expand more space to accommodate other inventory of medicines.
The counter for the hospital pharmacy is located at the hospital entrance. In this picture the counter for the pharmacy is located right beside the security guard manning the entrance which looks inconvenient to the patients especially when there is build up of lines.
People may have a hard time looking for location of departments inside the hospital because of lack of centralized maps. They have to depend on signages on the walls and assistance of available hospital staff for their way finding inside the hospital.
Some hallways appear to be dark and not very well lit with artificial lighting which may discourage the people from entering the area because it appears unused.
Since the hospital is a 2-storey building they provided a big ramp for transporting the patients to the second floor where the different wards are located. Only depending on natural light it appears to be insufficient for the area which makes it dark. The
hospital
administrator
says
that
in
an
occurrence of death in the wards there is no other way to bring down the dead body but to pass through the ramp which is adjacent to the front entrance
of
the
hospital
and
Out-patient
departments. A dead body being taken out of the hospital
passing
through
these
areas
is
an
unpleasant sight for the patients whenever they are seeking medical attention in the hospital.
The
unused
counter
was
used
as
a
temporary storage facility for oxygen tanks which is very dangerous. There should be proper and safe storage for oxygen tanks and other equipments that can pose a risk to safety.
The childrens ward offered a playful and friendly ambiance for the young patients by painting the walls with recognizable and fun characters to serve as pleasant vistas.
The hallways along the wards are dark when they only depend on the natural light. The colors are plain and comply with the minimal required clean image of the facility without thinking further of enhancing it to make it more therapeutic.
The single bed patient room was located at the middle part of the floor of the building. It felt stressful that the patient is surrounded by the walls of the hospital
without
any
external
access
to
the
surroundings. The importance of having natural environments at least to one side of a space can enhance the therapeutic effects of the hospital.
The government building does not satisfy the minimum
requirements
of
the
Fire
code
of
the
Philippines in terms of fire exits. From the door used to the signage’s there could be more improvement in the safety of the patients if the codes are followed.
The children’s pediatric department is just near the entrance and adjacent to the main ramp where inpatients are brought to the second floor wards. This poses a risk to the young patients in terms of possible infections since they are the most vulnerable to infectious diseases.
The good thing about this space is that the hospital tried to blend some positive space in the hospital where the patients can have pleasant views inside the hospitals and where people can stay besides from the hospital areas. The bad thing about this space is that they did not enhance the potential of this space
to help the patients and people inside the hospital. The front grounds of the hospital also serve as the areas for parking for the visitors. Other parking areas are on the perimeter side of the compound which is not safe for parked cars.Other parking areas are located on the sideIn emergency cases in the hospital need to have clear and free from obstruction emergency bays.
I.3.4 Behavioral Analysis:
IN-PATIENT:
In
Emergency
Laboratory and other Tests
Admission
Private Room/Ward
Cashier
Out
Laboratory and other Tests
Admission
Private Room/Ward
Cashier
Out
IN-PATIENT:
In
Doctors Clinic
OUT-PATIENT:
In
Out patient department/ Doctors Clinic
Laboratory and other Tests
Cashier
Pharmacy
Out
PATIENTS COMPANY:
In
Patients Room/ Ward
Nurse Station
Pharmacy
Out
Doctors Clinic
Patients Room/ Ward
Nurse Station
Out
Staff Area
Nurse Station
Patients Room/ Ward
Out
Authorized Station areas
Patients Room/ Ward
Out
DOCTOR/CONSULTANTS:
In
NURSE:
In
OTHER HOSPITAL STAFF:
In
Staff Area
I.3.5 Research Instrument: Observation
This technique is used when the data is not adequate through the use of interview and some other method. Observation used direct means of identifying the current facility of the hospital, the direct means of observation means of studied the flow, movement of the people in the facility, the use of the spaces and identifying what is in the facility. To complete this instrument a Site visit is performed to the potential research area. We identified the interesting and problematic areas and document the problem for analysis, and taking it to account, the users and proponents of the area which is the government and the public.
I.3.6 Research Instrument: Interpritative-Historical
I.3.7 History:
Ospital ng Tagaytay was inaugurated on April 25, 1997 by former President Fidel V. Ramos and Atty. Francis N. Tolentino, former City Mayor. This was opened publicly on May 4, 1997. It was dedicated to the people of Tagaytay as well as nearby communities to provide primary care as well. The planned city health center and a lying in clinic was converted into a hospital and is now the Ospital ng Tagayaty located at Bacolod St. Kaybagal South, Tagaytay City, Cavite. The hospital has the old and new wards, which houses different sections. Open for 24 hours, it has the strength of 99 competent and well trained staff and consultants. The hospitals commitment is to deliver affordable, accessible and informative quality health care to their patients, regardless of sex, nationality, religion, political, affiliation and economic status. They have a vision of commited patient-oriented comprehensive health care program through pro-active, effective and humane hospital services.
Ground floor Facilities:
Second floor facilities:
Outpatient section
•
Private rooms
Laboratory
•
Semi-private rooms
X-ray
•
Ward Rooms
•
Drug-room/Pharmacy
•
Authorized bed capacity of 12 beds
•
Records room
•
•
•
but total inventory of 20 beds
•
Emergency Room
•
Labor
•
Delivery room
•
Eye clinic
The Local Government Code of the Philippines:
I.3.8 Research Instrument: Qualitative POPULATION:
HOSPITALS:
Local Government Unit- Tagaytay City
CHAPTER 4 I.4 SUMMARY OF FINDINGS AND ANALYSIS
In this chapter we summarize and analyze the gathered information during the research methodology phase of the paper. In using the different methodologies to gather different information about the site and its facilities we are able to systematize the datas for better anlysis. This chapter will tackles these datas and presentation them in order to get a picture and further understand the collected information. I.4.1 PRESENTATION OF COLLECTED DATA
The presentations of data through graphical methods and figures are done in this study so that the proponent can understand the problem and easily understand the problem in this study so that the proponent can easily discuss the gathered information.
Hospital Unmet Bed Need
Projected primary and secondary catchment area (P) – 201,659 – 201,659
Total Inventory of Hospital beds (IHB) – 140 – 140 beds Bed to Population Ratio (BPR) = (IHB / P) * 1,000 = (140/ 201,659) * 1,000 = 0.69
*The standard bed to population ratio is 1:1000 BPR= 0.69 < 1:1000 Projected Bed Need (PBN) = P * (1/1000) = 201,659 * (1/1000) = 201.65 or 202 beds Unmet Bed Need (UBN)
= PBN – PBN – IHB IHB = 202 – 202 – 140 140 = 62 Beds
*Based on 2010 Census the projected unmet beds based on the population is 62 beds In computing for the possible increase of bed capacity of the Ospital ng Tagaytay we shall base it through the Department of Health ratio of bed to population which is 1:1000. Using the 2010 census we computed for the primary catchment area in which the hospital is located and the secondary catchment area which have access or is contiguous to the primary catchment area. Following the computation process stipulated by the Department of Health we were able to come up of the projected unmet beds for future expansion of bed capacity which is 62 beds. If the Ospital ng Tagaytay shall increase its bed capacity based on the data they are allowed to add up to 62 beds.
I.4.2 RESLUTS: INTERVIEW
Ospital ng Tagaytay was originally a city health center and lying in clinic but was converted to an infirmary hospital. In 2012 the Department of Health (DOH) and representatives from private hospitals have reached a compromise that will give healthcare facilities a maximum of 3 years to comply with the government's hospital reclassification scheme. This agreement allows hospitals to beef up their facilities and comply with the DOH's new rules on hospital classification based on Administrative Order No. 2012-0012. The Ospital ng Tagaytay is currently classified under the General to Level 1 Hospital needing only a Dental Clinic and Blood Station services. 2013 was a good year for them because of the following achievements that they have done:
With their achievements, the hospital administrator stressed that their hospital could have done more for patient care and that if their facilities were upgraded to offer more services they could not provide. Due to their lack of services they had to refer other patients to other hospitals that offer services outside of their capabilities. Transferred Patients
76
Referred indigents to other hospitals
34
Total
110
These 2013 statistics show the different cases leading up to the morbidity and mortality of patients in the Ospital ng Tagaytay and the Tagaytay City Health office. The cases in terms of morbidity and mortality show that the limitations to what the current level of service the hospital can provide in terms of the treating these cases. Some diseases need other types of services and facilities that clearly with the present line up of services and facilities the hospital does not have.
I.4.3 Presentation of the Collected Data: Strengths, Weaknesses, Opportunities and Threats (SWOT) I.4.3.1 Analysis of strength of the facilities:
Very accessible to roads either by public and private vehicles The site of the hospital is located along the Crisanto M. Delos Reyes avenue
traversing
the
Mahogany
avenue
and
Tagaytay-Nasugbu
highway.
The hospital have some positive spaces The current design of the hospital incorporated some positive spaces like the interior garden to boost vistas and lounging areas.
The hospital takes advantage of the natural climate As part of their savings programs some areas in the hospital takes advantage of the natural light instead of using artificial ones. The location of the hospital presents a great opportunity for therapeutic environments
Child friendly ward The rooms for the children’s ward children’s ward were painted with cartoon characters to make it a fun and kid friendly ward.
The 2nd floor access ramp The ramp that accesses the second floor is very useful in transporting patients to their respective wards with its wide pathways and non-slippery surface.
I.4.3.2 Analysis of weakness of the facilities:
Exterior design The problem with the building’s design building’s design is that it doesn’t give an impression that it’s it’s a hospital facility. Other than the sign that says it’s it’s a hospital it doesn’t convey its purpose to the patients that it’s a building of therapeutic design.
Interior design Although the hospital meets the minimum requirements requirements for hospital facilities, the hospital could have exerted an effort in making the interior design more therapeutic environment for the patients.
Toilet facilities The number of toilet facilities are not suitable to the amount of users in the building. Some of the toilets are already dilapidated and in need of replacement.
The hospital is not friendly to persons with disabilities The facilities of the hospital lack appropriations for persons with disabilities such as ramps and toilet facilit ies for PWD’s
No other ramps The main ramp to the second floor is the only access for transporting patients. The problem is it crosses paths with the out patient department and the main lobby that when an unfortunate death of a patient occurs other patients and visitors will be able to see the body being taken out.
Fire safety code violations
There are a number of violations in the fire safety code that the design of the hospital didn’t follow and poses a risk in the lives of the people inside the building
Space allocation and planning The spaces of the building are not designed for expansion and that when the administrators plan to add other services to the hospital their only option is to make a makeshift facility outside of the building.
Lack of landscapes The exterior of the building lack is landscapes which can help in the appearance of the building. The only positive space in the hospital which is the interior garden is not properly landscape.
Lack of lighting Some areas of the hospital are very dark when natural lighting does not reach those areas.
Unnecessary noise The sound minimization or sound proofing in the hospital is not evident in the areas and it contributes to the unnecessary noise especially when there are many patients especially children.
In adequate storage spaces There is a need for more storage spaces especially in hospital materials and equipment. In some pictures the hospital equipment’s such as oxygen tanks are stored along corridor which can pose a risk to the visitors.
Hazardous waste storage facility The hospital doesn’t have any space in the compound for hazardous waste materials. The wastes were only stored on an open area at the back of the hospital without any coverings to prevent contamination.
I.4.3.3 Analysis of opportunities for the facilities:
Due to the growing population in the city of Tagaytay and the adjacent municipalities there is a foreseen growth in terms of patients in the future.
The Ospital ng Tagaytay is the only public hospital in Tagaytay city and nearby municipalities which gives it a potential for accepting indigent up to middle class citizens.
There is a good potential for introducing new facilities adapting with with technology for their convenience.
The hospital is located in Tagaytay city which very well known for its good climate all year round.
The hospital has a potential to add more beds with the current inventory of beds of all hospitals there is still an opportunity of growth to increase the bed to population ratio.
Given the climate and environment of the area there is an opportunity to make the hospital a more therapeutic environment for the patients.
I.4.3.4 Analysis of potential threat for the facilities:
The age of the hospital is very vulnerable to damages when typhoon Glenda battered the hospital the roof was damaged and the hospital shut down and did not accept new patients for almost 2 months. Some patients were transferred.
The current capacity of facilities of the hospital may be inadequate when the surge of patients come in the near future.
Infections and contaminations of the patients is possible without proper segregation and protection of their facilities.
Services not found on the current capacity of the hospital may affect its image to the public as a provider of quality healthcare services.
I.4.4 Needs analysis:
The facts and figures given in the study is analyzed and gives the necessary recommendations to what is needed by the facility to satisfy the goals and objectives of this The following are the needs of the hospital:
Propose more spaces to add to the current capacity of handling services and patients.
Propose new spaces for the new services of the hospital to make it a Level 2 hospital
Propose a new exterior and interior design of the hospital that can promote therapeutic environments to the patients.
Propose new materials that can help further in the goals of the hospitals and adapt better in the surrounding environment.
A better design of the facilities that is friendly to persons with with disabilities.
Injects strategies in the appearance of of the hospital to promote a therapeutic environment.
Design the hospital to make it more adaptive to the current and future climate of the area.
I.5 CONCLUSION AND RECOMMENDATION:
In this part of the study the proponent clearly identifies the problems of the Ospital ng Tagaytay to give solutions and recommendations needed to the ailing problems of the facility. Based on the analysis of the gathered data, we determined the strength and weaknesses of the hospital’s facilities. We identified the po tential risks and opportunities of the hospital to decide on what the hospital needs. The hospital needs to increase its capacity to cater to more patients today and in the future. It
needs more capabilities in handling current cases of illnesses and be prepared for the future. In its vision of providing committed patient oriented healthcare services the proponents for the hospital is recommended to subject the Ospital ng Tagaytay for redevelopment. In designing of the new Ospital ng Tagaytay strategies must be put in place in order to make the hospital a therapeutic environment for the patients. In redevelopment of the new hospital the new facilities must reduce or eliminate causes of stress in the patients. The new hospital must provide positive distractions and enable social support to the patient and its immediate families. There is a good potential for adding more spaces for accommodation of bed capacities for the growing number of patients in Tagaytay and the nearby areas. Complying with the Department of Health standards of computing unmet bed requirements there is still quite a number of beds still needed to suffice the needs of the primary and secondary catchment populations. The design of the new hospital must be based on the Level 2 hospital classification of the Department of health to further enhance its capabilities for current and potential diseases inherent in the area.
Part II. Research Focus
In this chapter the emphasis on the main focus of the research is stated and explored to the redevelopment of the Ospital ng Tagaytay. Principles will be slated on what is the best approach to the design and how its relevance to the target market would affect the building.
II.1 Rationale
Proposed redevelopment of Ospital ng Tagaytay : Creating therapeutic environments through innovative hospital design. In this part of the research we shall focus on innovative approaches in design to create a therapeutic environment for the users of the hospital. Many studies are linking the hospital environment to healthcare outcomes, buildings can either make a people sick or help them heal. The Ospital ng Tagaytay is committed in providing affordable, accessible, and quality healthcare to their patients. Their mission and vision is to providing quality healthcare services through
patient-oriented
facilities
and
services.
By
adapting
national
and
international standards of hospital design and injecting new innovations, the new Ospital ng Tagaytay aims to promote a reliable, modern and therapeutic environment for their users. This research aims to show the potential of the hospital of reaching more patients in the city and neighboring municipalities but also also expand it capabilities of providing healthcare services to their patients.
II.2 Principles and Relevance to the Project
Therapeutic Environment theory stems from the fields of environmental psychology (the psycho-social effects of environment), psychoneuroimmunology (the effects of environment on the immune system), and neuroscience (how the brain perceives architecture). Patients in a healthcare facility are often fearful and uncertain about their health, their safety, and their isolation from normal social relationships. The large, complex environment of a typical hospital further
contributes to the stressful situation. Stress can cause a person's immune system to be suppressed, and can dampen a person's emotional and spiritual resources, impeding recovery and healing. Healthcare architects, interior designers, and researchers have identified four key factors which, if applied in the design of a healthcare environment, can measurably improve patient outcomes:
Reduce or eliminate environmental stressors
Provide positive distractions
Enable social support
Give a sense of control
II.2.1 Principles: Noise Reduction
There are two main reasons why hospitals are noisy. First, there are many noise sources present, and, second, environmental surfaces in hospitals —walls, floor, and ceiling— ceiling —tend to be sound-reflecting rather than sound-absorbing. Sounds contributing to the loud noise levels in hospitals come from mechanical equipment in use— use —alarms, paging systems, telephones, computer printers, ice machines, staff conversations, and noises generated by roommates and visitors. Many studies have found that staff conversation in particular is a major source of loud noises on the hospital unit. The presence of hard sound-reflecting surfaces in the hospital tends to aggravate the noise problem in hospitals. Soundreflecting surfaces cause noise to propagate considerable distances, traveling down corridors and into patient rooms, and adversely affecting patients and staff over larger areas. Sound-reflecting surfaces typical of hospitals cause sounds to echo, overlap, and linger or have long reverberation times Reverberation is the persistence of sound in an enclosed space, resulting from multiple reflections after a sound source has stopped. Extensive use of sound-absorbing material will mean that the sound is absorbed and, thus, prevented from “building up”. When acoustic conditions are characterized by long reverberation times, echoes will
cause blending and overlapping of sounds, resulting in reduced speech intelligibility. To make themselves heard staff members then need to raise their voices, thereby compounding the noise problem even further.
II.2.2 Principles : Access to Daylight
At least 11 strong studies suggest that bright light is effective in reducing depression among patients with bipolar disorder or seasonal affective disorder (SAD). A majority of the studies have examined the impact of artificial bright light in reducing depression. Artificial light treatments usually range between 2,500 lux and 10,000 lux. The treatment is believed to be effective by suppressing the onset of melatonin. Two studies have shown that exposure to natural bright light is similarly effective in reducing depression. Benedetti and colleagues (2001) found that bipolar depressed inpatients in east-facing rooms (exposed to bright light in the morning) stayed an average of 3.67 days less in the hospital compared with similar patients who stayed in west-facing rooms. Exposure to daylight reduces depression among patients with seasonal affective disorder and bipolar depression. It helps decreases length of stay of patients in hospitals. It also improves sleep and circadian rhythms and lessens agitation among dementia patients, ease pain. Lighting in healthcare settings • Provide windows for access to natural daylight in patient rooms, along with provisions for controlling glare and temperature. • Orient patient rooms to maximize early -morning sun exposure. • Assess adequacy of lighting levels in staff work areas. • Provide high lighting levels for complex visual tasks. • Provide windows in staff break staff break rooms so staff has access to natural light.
II.2.3 Principles: Artificial Lighting
The lighting of hospital tasks is important as is the lit appearance of the interior. There can be a conflict of requirements. On the one hand, there are high technology and critical tasks, some of which can have life or death implications. This suggests a crisp high-tech appearance, which will stimulate staff to a high level of performance. But on the other hand, the patients, particularly as they recover, may require a softer approach bordering on a domestic impression. This same sort of conflict is shown in entrance and reception areas. The patient or visitor arrives wanting reassurance about the quality and care level of the hospital. This can be demonstrated by the quality of the interior design, which includes the way the space is lit. But they also need to have clear direction to the reception desk, perhaps by making it the brightest part of the scene; here they are welcomed and directed to where they need to go next. If the lighting scheme is well designed, some of the apprehensions will be alleviated. Also if they have to wait in an unappealing space where the lighting has a functional appearance, they may become agitated and restless – – a state unhelpful for a medical consultation or examination.
II.2.4 Principles: Postive Distractions in Hospitals
When people refer to their “healthcare experience,” they typically (and correctly) note their experiences in the examination, treatment, and recovery rooms as well as interactions with the caregivers and support staff. However, it is common knowledge that a sizable proportion of a patient's and the accompanying family members' time are spent waiting. Today's planners are paying considerable attention to waiting time as well as waiting spaces. After allfrom a lean process perspective-any waiting time is a waste that should be purged from the system. While a wait-free healthcare model does not exist, the
time people spend waiting is increasingly being acknowledged as a crucial aspect of the overall healthcare experience, with a general appreciation that the waiting period is not the best part of the healthcare experience for patients and families. Studies are providing more information on the waiting experience. A 1996 article, published in the Annals of Emergency Medicine, reported that it is not the actual wait time, but the perception of wait time that is the determining factor in patient satisfaction. The International Journal of Research in Marketing subsequently reported that the attractiveness of the waiting environment has a greater role in contributing positively to the waiting experience, as compared to reducing the objective waiting time. A 2008 report from Cornell University further articulated the potential association between the quality of the waiting environment, the perceived waiting experience, and the overall healthcare experience. Sets of independently collected data on environmental attractiveness and a host of perception measures from actual patients in six clinic waiting areas demonstrated significant correlations between the attractiveness of the physical environment and perceived waiting time, perceived care quality, level of anxiety, and quality of interaction with staff.
II.2.5 Principles: Enable Social Support
Patients and visitors often perceive hospitals as scary, intimidating, and isolating places. Aside from uncertainties associated with illness, aspects of the hospital environment itself may generate feelings of uneasiness and heighten stress levels. Providing patients with social support can lessen stress, reduce fear/anxiety, improve outcomes, and s timulate healing. Specifically, “Social support may reduce the amount of medication required, accelerate recovery, and facilitate compliance with prescribed medical regimes”. Providing patients with social support may also help patients take their mind off of their serious medical
conditions and promote feelings of usefulness. Plus, family-centered spaces are associated with decreased length of stay, fewer medication errors, and fewer falls. In conclusion, the presence of family and friends during hospitalization is beneficial to the patient’s physical, social, emotional, social, emotional, and mental well-being.
II.2.6 Principles: Colors
It has been suggested that color has a therapeutic effect, although few empirical observations exist. From daytime to night-time and through all seasons, the colour of theinterior needs to be attractive and relaxing without being too stark. The selection of colours for this area is not easy, as all colours will have to be tested under the light sources installed or planned to be used in this sector of the building. Some beige or neutral tones can take on very unattractive green or orange hues under different types of lighting. What appears to be a very soft and neutral decor by day can turn into an unpleasant colour at night. II.2.7 Principles: Landscaping
Findings from several studies of non-patient groups suggest that even brief visual encounters with real or simulated natural settings can elicit significant psycho-physiologic restoration within as little as 3 - 5 min. This restoration is manifested as reduced negative effects, and heightened positive effects and changes in physiology systems that are indicative of reduced arousal or stress mobilization
(electrocortical,
cardiovascular,
neuroendocrineand
musculoskeletal). Accordingly, Sherman et al. focused on the activities of the users in the hospital, and found that 66% of staff garden usage was in the form of “walk“walk-throughs” from one place to another. Although this activity does not fully exploit the gardens to their full capacity, research such as Kaplan’s on micro restorative experiences suggests that even these brief encounters may enhance staff’s well-being well -being and job satisfaction, both of which are predictors of patient healthcare satisfaction.
II.2.7 Relevance Therapeutic environments in the hospital: Ospital ng Tagaytay
The relevance of applying therapeutic environments in the design of hospitals is to create environments where the patients experience an wholistic care of mind and body. Aiding the pschiatrical therapy with physical treatment of the patients increases the effectivity of hospital treatments. The Ospital ng Tagaytay is committed to a patient-oriented healthcare by providing a comprehensive approach through innovative, pro-active, effective and humane hospital services. The hospital aims is to further expand its capabilities and capacities in providing healthcare to its users. This is a perfect avenue to introduce new strategies in trying to connect the link of the physical environments to the patients welfare. In trying to achieve a therapeutic environment for the patients the design of the hospital focuses on the factors that give stress to the mental and emotional state of the patient. Designing the external and internal environments of the hospital to promote therapeutic effects to the patient can increase ones success of getting well from an ailment.
II.3 APPLICATION OF THE PROJECT . II.3.1 Exterior Design
Hospitals designs are not commonly known for pleasure mostly because people visiting this type of building are seeking for medical treatment. Normally, hospitals are very simple and minimalist in design, either: we think of over-lit and sterile environments, with visual stimulation limited to small, wall-mounted televisions.
However, a new generation of medical facilities is changing the face of the hospital design. These places take a more holistic approach to healthcare – one – one that takes the therapeutic environment into consideration. As a result, hospitals are becoming more welcoming and diverse than those with which many are familiar.
The design of the Ospital ng Tagaytay tries to be a contemporary building for its medical facilities when it was first built by the proponent. However in todays changing design of hospitals it cannot keep up with the new trends in therapeutic environments. The facade of the building is probably the most important part of the hospitals appearance as it immediately gives the impression of what kind of services a hospital can give. By applying new trends in hospital design and materials they can already set the tone to the prospective patients that the hospital is state of the art with patient-oriented facilities offering therapeutic environments to the people. The design of the hospital must work with the environment that it is in. Tagaytay is situated in a high area and the climate is appeling almost all year long. Applying modern tropical architecture to take advantage of the climate in the area could help both the hospital administrators and the patients in reaping the benefits of the good weather in the area. Modern materials such as glass and wall panels/cladding are a welcome addition to the exterior design of the hospital
as it offers a fresh look to the building. Using stainless or rust resistant materials are recommended in the buildings materials because of Tagaytay’s cold climate.
II.3.2 Noise Reduction
Research suggests that environmental interventions may be effective in reducing the noise levels in hospitals and improving the acoustical environment. Key interventions include installing high-performance sound-absorbing ceiling tiles, eliminating or reducing noise sources, and providing single-bed rather than multi-bed rooms Sound-absorbing ceiling tiles At least three studies have shown that installing installing high-performance soundabsorbing ceiling tiles and panels results in reduced noise levels and perceptions of noise and impacts other outcomes such as improved speech intelligibility and reduced perceived work pressure among staff. Though decibel levels were not greatly reduced as a result of the ceiling-tile intervention in these studies (reduction of 3 to 6 dB(A)), reverberation times and sound propagation were significantly reduced. This impacted the perception of the unit being less noisy and also improved speech intelligibility, which has implications for staff communication.
Reducing noises from floors By far the most effective way to reduce impact noise from above is to lay carpet with thick padding underneath — the thicker, the better. This dissipates the impact energy before it has a chance to enter the building structure as sound. Carpeting gives superb results and often resolves the problem of impact noise. Resilient Underlayment with Damping Compound If you have impact noise but carpeting is not feasible in your case, or is something you'd prefer to avoid, then you'll want to put down layers of flooring that include resilient underlayment and damping compound. The resilient underlay introduces a decoupling effect, and the damping compound further dissipates the sound energy, and is especially important at lower frequencies where underlayment does not help. You will also have the opportunity to choose materials that provide additional mass, introducing a third soundproofing element that is especially important if airborne noise (such as voices or music) is also a concern. (If your existing subfloor is already substantially massive, such as a concrete slab, adding additional mass will not accomplish much and won't be necessary.) Resilient
Underlayment:
There
are
several
varieties
of
resilient
underlayment material available, including foam, fiber, cork, and rubber. A shredded rubber mat is an excellent choice because it is heavier than foam or cork, so it gives you the extra soundproofing benefit of added mass. Damping Compound: The damping compound (typically Green Glue Noise proofing Compound) can often be applied directly onto the existing subfloor layer, if the subfloor is not thick and massive, and it is of a material that can be screwed
into. Since the damping compound needs to be between two stiff surfaces to do its job, a rigid layer needs to be placed above it. You can use cement board, or if total thickness is not a concern and you want the extra mass for more sound isolation, you can use thicker sheets of medium-density fiberboard (MDF) or oriented strand board (OSB). Any sheets that have damping compound between them should then be screwed together. Flooring: Install your choice of finished flooring (such as hardwood, wood laminate, or tile) on top of the underlayment as a floating raft — in other words, do not attach it to the layer beneath with nails, screws, or adhesive. Also, leave a gap between the edge of the flooring and each wall, and fill the gap with acoustic sealant. This gap allows for expansion of the flooring, and also acts as a decoupler, helping reduce the sound energy that is transmitted through the walls into the building structure (the "flanking noise" problem).
II.3.3 Artificial Lighting System
– fixed downlights are used for general lighting. To guide Reception Area – fixed visitors to the reception area, accent lighting is used to illuminate the back wall, whilst suspended luminaires are used for task lighting above the reception desk. In daylight areas, daylight regulation is used to save energy by using a daylight sensor.
– A space where patients often meet each other and talk while Corridors – A navigating their way through different parts of the hospital, this solution for corridors in hospitality areas features LED lighting. It ensures that lighting brings high efficiency in terms of guidance, safety and comfort, while at the same time having diffused lighting without glare. Lighting plan
– In this standard lighting solution, contrasts are creared to Waiting Room – In stimulate interaction between people and to give the waiting area a friendly dynamic. This has been achieved by the use of downlights. Where the luminaires are placed near the wall, a pleasing play of light beams is visible. Lighting plan
Examination Room – In – In an examination room accurate color rendering in the lighting is of vital importance. This standard lighting system can be adjusted to suit the activity – – whether calming, to assist with patient conversations or brighter task lighting for examinations. examinations. Different presets for different
lighting
levels can be pre – – programmed and this scheme includes an additional LED examination light, featuring high color rendering with no heat output. Lighting Plan
– this room uses LED downlights that provide effective Imaging room – general white light with very low energy consumption. In additions the system is fully dimmable using DALI controls and this solution provides a very comfortable feeling in the imaging room Lighting plan:
– to create a comfortable and warm ambience, a luminaire Patient Room – to with a gentle light and soft appearance has been selected to meet the needs of patients and comply with requirments for patient rooms. In addition, there is a wall – – mounted reading light which can be controlled by the patient. In the evening, a downlight above the table makes the space more open and inviting for visitors, plus an additional task light is provided above the table. Lighting plan:
II.3.4 Accessing Daylight:
Access to
sunlight sunlight
will depend on
window orientation orientation
and
on
overshadowing by obstructions. In general, spaces lit solely by windows facing within 45 degrees of due north will be perceived as poorly sunlit. Windows within 90 degrees of due north are also likely to give little sun if there are significant obstructions to the south. For many low-dependency hospital spaces, curtains are the common shading option. Metallized fabrics are available which can reflect extra solar heat to the exterior and provide some extra insulation at night. For maximum daylight, it should be possible to pull the curtains fully back so they do not obstruct the glazing. Louvered blinds give better control of sunlight; often the blind can be adjusted to block sun but permit some view out. They are harder to keep clean, but provide good glare control, especially in non-clinical areas. The most hygienic option is to use mid-pane blinds in a sealed double-glazing unit. Mid-pane shading also rejects more solar gain than an equivalent interior blind. In spaces with significant window area, extra shading may be required to prevent overheating in summer. Horizontal shading above the window, such as awnings, overhangs or canopies, can block high-angle summer sun while allowing winter sun and a view out. High performance glazing is now available which can give reduced solar transmittance with a higher daylight transmittance. Sunlight in outdoor spaces around the hospital is also valued, both for sitting out and to give pleasant views from inside. Asked if they would prefer a pleasant sun-lit view with no indoor sun rather than indoor sunshine with an unpleasant view, 50% of patients opted for the view. Courtyards, particularly deep ones, are generally poorly sun-lit unless they are opened out to the south. Lighting in healthcare settings • Provide windows for access to natural daylight in patient rooms, along with provisions for controlling glare and temperature. • Orient patient rooms to maximize early -morning sun exposure.
• Assess adequacy of lighting levels in staff work areas. • Provide high lighting levels for complex visual tasks. • Provide windows in staff break rooms so staff has access to natural lig ht.
II.3.5 Positive distraction’s inside the hospital
Positive distractions refer to a small set of environmental features or conditions that have been found by research to effectively reduce stress. Distractions can include certain types of music, companion animals such as dogs or cats, laughter or comedy, certain art, and especially nature. The focus here is on the last, nature. Design strategies in providing positive distractions inside the hospital are the ff: •
Views of nature, from patient rooms, and wherever possible in lobby, waiting, and other 'high stress' areas
•
Access to nature, healing gardens Chapel, meditation room, and meditation gardens
•
Artwork depicting nature, including back-lighted photographs of nature
•
Mild physical exercise; corridors, public spaces, and gardens that invite walking when appropriate
II.3.6 Enabling social support:
Many studies have demonstrated how social support can improve health related outcomes. Studies have shown “a general positive association betwe en the overall number of social ties or contacts people ha ve and their health status”. Research has shown that in a range of healthcare and non-healthcare settings, people who receive higher levels of social support, tend to be less stressed and have better health status than more socially isolated people. Design strategies that promote social support are the ff: •
Spaces should be flexible and easily controlled by patients and families in order to adjust to situational needs.
•
Provide patients with single rooms, with designated family areas
•
Provide family lounges and waiting areas near patients
•
Create a confortable environment by incorporating “soft” finishes, furnishings and materials into the design.
•
Use technology to foster social support
•
Provide natural gardens for patients and families to use
II.3.7 Therapeutic effects of Colors
A perfectly perfectly crafted crafted color palette can can do wonders wonders for a healthcare healthcare facility, facility, whether it’s the product of a new -build project, renovation, or just a bit of rejuvenation.
But determining what shades of paint are best suited for a specific space should be done with plenty of consideration for not only facility type, but also the area/department being painted and the individuals who will be using it. •
White walls are often associated with a clinical appearance and institutional settings. Adding color and an interesting ceiling design, as in this procedure room, can make the environment seem less intimidating.
•
Color may be tied to the institutions instituti ons logo or corporate brand
•
Art can create an analogous color scheme in hospitals
•
Here several colors of various hues, but similar in value,combine to create a warm environment and visually “shorten” a long corridor.
•
Signage is sometimes overused in healthcare.Small accents of color may play a role in “attention grabbing” assisting as a wayfinding cue.
II.3.8 Landscaping
Landscaped grounds - Green areas between buildings, primarily used for waiting and eating in, link the architecture with walking paths; however, they may be expensive to maintain.
Landscaped setbacks - These are usually planted areas in front of the main entrance, which are visually pleasant and serve to separate the hospital building from the street.
Courtyards - Courtyards are the central and most often used spaces in a hospital building complex, because of their proximity to the dining area; they tend to be used more by visitors and patients if they are easily visible, and should be sufficiently large to prevent overcrowding. Courtyard features may include landscaped tree-shaded areas, water features, flowerbeds and moveable seats; for reasons of privacy and security as well as aesthetics, they may be fenced around (especially if designed for care of the mentally ill) up to a height of 4.27m.
Roof gardens - Gardens located on roofs are visually attractive, enabling patients to look out from their rooms and have a comforting view of grass, paving stones, benches and people, rather than roofing material or medical equipment. Depending on how much planting material is used and to what depth, green roofs generally weigh between 6.82kg and 22.73kg per square foot. They are a practical and sustainable way of regulating the quantity and speed of runoff, as they retain 70-90% of the rainwater that falls on them in the summer, and 35-40% of the precipitation in winter [18]. Roof gardens enable major energy savings that will more than compensate, in time, for the costs of building, structure, waterproofing, and landscape maintenance; and they also minimize the environmental impact of a health care facility.
Viewing gardens - Some health care facilities with limited space and budgets feature a small, enclosed garden that can be seen but not entered. Such gardens cost little to maintain, provide some green space, flowers, perhaps a water feature, and they can be seen from sheltered indoor seating areas; however, the elements of nature they provide are removed from the senses, as they cannot be approached smelled, heard or touched.
Part III
Site
Identification and Analysis Chapter III.1 Site Evaluation and Analysis III.1 Criteria for site selection
In this chapter, the site of the Ospital ng Tagaytay is being analysed and identified, the characters of the site based on the progression and undesirable characters are being identified in terms of the macro setting and micro setting. Specific laws and ordinances are stated according to the particular area. III.1.1 The Macro Setting
Location of Site
Tagaytay, officially the City of Tagaytay is a component city in the province of Cavite, in the Philippines. It is one of the country's most popular tourist destinations because of its outstanding scenery and cooler climate provided by its high altitude. Tagaytay overlooks Taal Lake in Batangas and provides one of the iconic views of the t he Philippines, the view of Taal Volcano Island in the middle mi ddle of the th e lake, viewable from several vantage points in the city.
Boundaries of Tagaytay
Tagaytay is relatively rel atively close to the capital city of Manila, only 55 km (34 mi) away via Aguinaldo Highway, providing an easy escape for the locals from the heat of the big city. Tagaytay City has a total to tal land area of 66.1 km 2 (26 sq mi) which represents about 4.37% of the total area of the Province of Cavite. It lies within 120° 56' longitude and 14° 6' latitude and overlooks Manila Bay to the North, Taal Volcano and Lake to the south and Laguna de Bay to the east. III.1.2 Land Area
Land Capability Map
The southern and eastern portions of Tagaytay City are covered by hills and mountains which is generally forests and open grasslands. The city lies along Tagaytay Ridge, a ridge stretching about 32 kilometres (20 mi) from Mount Batulao in the west to Mount Sungay (now People's Park in the Sky) in the east with elevations averaging about 610 metres (2,000 ft) above sea level. Mount Sungay, in Tagaytay, is the highest point of the province of Cavite at 709 metres (2,326 ft). III.1.3 Topography
Soil Suitability Map
The ridge, which overlooks Taal Lake in Batangas province, is actually the edge of Taal Caldera. The 25-by-30-kilometre (16 mi × 19 mi) wide cavity is partially filled by Taal Lake..[6] Tagaytay's built-up areas including the urban center is situated in the relatively Lake level top of the caldera rim but beyond the edge are deep ravines that drop straight down to Taal Lake. The portions adjoining the municipalitie municipalities s of Mendez, Indang, Amadeo and Silang are level to nearly level areas interspersed with very gently sloping surface. Across the southern edge of the lake on the opposite side of the city is Mount Macolod, the highest point of the Taal Caldera rim.
Amended Amende d Land Use Plan
Access Road Road Map
III.1.4 The Micro Setting
Site Location
The site of the current Ospital ng Tagaytay is located on Tagaytay City, near the Tagaytay City Hall. The site is along Crisanto M. Delos Reyes Street which jeepneys pass through.
Property Identification Map
Referring to the figureThe site of the Ospital ng Tagaytay is located on Lot 011 which has an area of 1000 Sqm is adjacent lot 013 having an area of 3722 Sqm. The redevelopment of the Ospital ng Tagaytay will involve the construction of a new building which will be erected on lot 013.
Traffic and Noise Analysis
Traffic Analysis
Jeepneys pass along road Delos Reyes (Yellow Line) and so the main traffic is along this road only. Private vehicles barely pass through this part unless their purpose is to go to the hospital or to the city hall. The main traffic passes through TagaytayNasugbu Highway which is connected to Delos Reyes Street. Since the hospital and the site is along a road that is passed by jeepneys, it can be expected that the site is exposed to a lot of noise from the eastern side. The immediate vicinity of the site is clear and of open spaces and so there is not much activity around. Foot traffic therefore is also to a minimum unlike the vehicular traffic on Delos Reyes Street.
Sun Path Diagram
Wind Path Diagram
III.1.5 Related laws and ordinances
ZONING ORDINANCE for TAGAYTAY CITY CITY ORDINANCE NO. 97-93 Series of 1997 AN ORDINANCE ORDINANCE REVISING REVISING THE ZONING ZONING REGULATI REGULATIONS ONS FOR FOR THE CITY OF TAGAYTAY, PROVIDING FOR THE ADMINISTRATION, ENFORCEMENT AND AMENDMENT AMENDMENT THEREOF THEREOF AND AND FOR THE THE REPEAL REPEAL OF ALL ALL ORDINANC ORDINANCES ES IN CONFLICT THEREWITH. Be it ordained enacted by the Sangguniang Panlungsod of Tagaytay that: WHEREAS, the implementation of the Comprehensive Land Use Plan would require the enactment of regulatory measures to translate its planning goals and objectives into reality; and a Zoning Ordinance is one such regulatory measures which is an important tool for the implementation of the Comprehensive Land Use Plan; WHEREAS, Republic Act No. 7160, otherwise known as the Local Government Code of 1991 authorizes local government units to enact zoning ordinances subject to and in accordance with existing laws; WHEREAS, the Housing and Land Use Regulatory Board (HLRB) has spearheaded and now assists in and coordinates the activities of local governments in comprehensive land use planning; NOW THEREFORE, the Sangguniang Panlungsod of Tagaytay, in a session assembled, hereby adopts the following Zoning Ordinance. ARTICLE IV ZONE CLASSIFICATIONS Section 5. Division into Zones or Areas. To effectively carry out the provisions of this Ordinance, the city is hereby divided into the following zones or areas as shown in the Official Land Use ad Zoning Map. 1. Tourism Strip
2. Primary Urban Core 3. Secondary Urban Core 4. General Development Area 5. Agricultural Development Area 6. Ecological Development Area 7. High Density Area 8. Special Conservation Area 9. Ecological-Tourism Area 10. Greenbelt Zone 11. Special Institutional Area
Section 6. Zoning Map. The official zoning map for the entire city, wherein the designation, location and boundaries of the districts/zones herein established are shown, are hereby adopted as an integral part of this Ordinance. Such official zoning maps shall be signed by the local chief executive and duly authenticated by the Sangguniang Panlalawigan. Section 7. Zone/Area Boundaries. The locations and boundaries of the zones or areas into which the city has been divided are hereby identified and specified as follows: ZONE LOCATION 1) Tourism Strip 2) Primary Urban Core 3) Secondary Urban Core Roads;
Section 8. Interpretation of the Zone Boundary. In the interpretation of the boundaries for any of the zones indicated in the zoning map, the following rules shall apply: 1) Where zone boundaries indicate that they approximately follow the center of the street or highway, the street or highway right-of-way lines shall be construed to be the boundaries; 2) Where zone boundaries indicate that they approximately follow the lot lines, such lot shall be construed to be the boundaries. 3) Where zone boundaries indicate that they are approximately parallel to the center lines or right-of-way lines of streets and highways, such zone boundaries shall be construed as being parallel thereto and at such distance therefrom as indicated in the zoning map. If no distance is given, such dimension shall be determined by the use of the scale shown in said zoning map. 4) Where the boundary of a zone follows approximately a railroad line, such boundary shall be deemed to be the railroad right-of-way. 5) Where the boundary of a zone follows a stream, lake or other bodies of water, said boundary line should deemed to be at the limit of the political jurisdiction of the community unless otherwise indicated. Boundaries indicated, as following the shorelines shall be construed to follow such shorelines. In the event of change in the shorelines, the boundaries shall be construed as moving with the actual shorelines. 6) Where the lot of one owner on record at the effective date of this Ordinance is divided by a zone boundary line, the lot shall be construed to be within the zone where the major portion of the lot is located. In case the lot is bisected by the boundary line, it shall fall within the zone where the principal structure falls. 7) Where the zone boundary is indicated as one-lot-deep, said depth shall be construed to be the average lot depth of the lots involved within each particular city block. Where, however, any lot has a depth greater than said average, the remaining portion of said lot
shall be construed as covered by the one-lot-deep zoning district. Provided, that the remaining portion has an area less than fifty percent (50%) of the total area of the entire lot. If the remaining portion has an area equivalent to fifty percent (50%) or more of the total area of the lot, then the average lot depth shall apply to the lot which shall become a lot divided and covered by two or more different zoning districts, as the case may be. In case of any remaining doubt as to the location of any property along zone boundary lines, such property shall be considered as falling within the less restrictive zone. 8) The textual description of the zone boundaries shall prevail over that of the official zoning maps. ARTICLE V ZONE REGULATIONS Section 9. General Provision. The uses enumerated in the succeeding sections are not exhaustive nor all-inclusive. The Local Zoning Board of Adjudication and Appeals (LZBAA) shall, subject to the requirements of this Article, allow other uses not enumerated hereunder provided that they are compatible with the uses expressly allowed. Allowance of further uses shall be based on the intrinsic qualities of the land and the socio-economic potential of the locality with due regards to the appropriate sustainable development principles and the maintenance of the essential qualities of the zone. Specific uses/activities of lesser density within a particular zone may be allowed within the zone of higher density but not vice versa, nor in another zone and its subdivisions except for uses expressly allowed in said zones, such that the cumulative effect of zoning shall be intra-zonal and non inter-zonal.
