Ateneo de Davao University Roxas Ave, Poblacion District, Davao City
AR 411 ARCHITECTURAL DESIGN 7 - COMMUNITY ARCHITECTURE AND URBAN DESIGN
MAJOR PLATE 3 - 200-BED LEVEL 1 COMMUNITY HOSPITAL (A Hospital Safe from Disasters)
Submitted by: MANIPON, Chelsea Jade A.
Project Study and Architectural Programming A.1
PROJECT STUDY
HOSPITAL
A hospital is a health care institution providing patient treatment with specialized staff and equipment (Jack, 2014). Hospital resilience is a comprehensive concept derived from existing disaster resilience frameworks. It has four key domains: hospital safety; disaster preparedness and resources; continuity of essential medical services; recovery and adaptation. These domains were categorised according to four criteria, namely, robustness, redundancy, resourcefulness and rapidity. A conceptual understanding of hospital resilience is essential for an intellectual basis for an integrated approach to system development. This article (1) defines hospital resilience; (2) constructs conceptual framework (including key domains); (3) proposes comprehensive measures for possible inclusion in an evaluation instrument; and (4) develops a matrix of critical issues to enhance hospital resilience to cope with future disasters ( FitzGerald and Zhong, 2014).
1. Project studies on hospital design
According to the Department of Health these are the GUIDELINES IN THE PLANNING AND DESIGN OF A HOSPITAL AND OTHER HEALTH FACILITIES
A hospital and other health facilities shall be planned and designed to observe appropriate architectural practices, to meet prescribed functional programs, and to conform to applicable codes as part of normal professional practice. References shall be made to the following: • P. D. 1096 – National Building Code of the Philippines and Its Implementing Rules and Regulations • P. D. 1185 – Fire Code of the Philippines and Its Implementing Rules and Regulations • P. D. 856 – Code on Sanitation of the Philippines and Its Implementing Rules and Regulations • B. P. 344 – Accessibility Law and Its Implementing Rules and Regulations • R. A. 1378 – National Plumbing Code of the Philippines and Its Implementing Rules and Regulations • R. A. 184 – Philippine Electrical Code • Manual on Technical Guidelines for Hospitals and Health Facilities Planning and Design. Department of Health, Manila. 1994 • Signage Systems Manual for Hospitals and Offices. Department of Health, Manila. 1994 • Health Facilities Maintenance Manual. Department of Health, Manila. 1995 • Manual on Hospital Waste Management. Department of Health, Manila. 1997 • District Hospitals: Guidelines for Development. World Health Organization Regional Publications, Western Pacific Series. 1992 • Guidelines for Construction and Equipment of Hospital and Medical Facil ities. American Institute of Architects, Committee on Architecture for Health. 1992 • De Chiara, Joseph. Time-Saver Standards for Building Types. McGraw-Hill Book Company. 1980
1 Envir onment: A
hospital and other health facilities shall be so located that it is readily accessible to the
community and reasonably free from undue noise, smoke, dust, foul odor, flood, and shall not be located adjacent to railroads, freight yards, children's playgrounds, airports, industrial plants, disposal plants. 2 Occupancy: A building designed for other purpose shall not be converted into a hospital. The location
of a hospital shall comply with all local zoning ordinances. 3 Safety: A hospital and other health facilities shall provide and maintain a safe environment for patients,
personnel and public. The building shall be of such construction so that no hazards to the life and safety of patients, personnel and public exist. It shall be capable of withstanding weight and elements to which they may be subjected. 3.1 Exits shall be restricted to the following types: door leading directly outside the building, interior stair, ramp, and exterior stair. 3.2 A minimum of two (2) exits, remote from each other, shall be provided for each floor of the building. 3.3 Exits shall terminate directly at an open space to the outside of the building. 4 Security: A hospital and other health facilities shall ensure the security of person and property within
the facility. 5 Patient Movement: Spaces shall be wide enough for free movement of patients, whether they are on
beds, stretchers, or wheelchairs. Circulation routes for transferring patients from one area to another shall be available and free at all times. 5.1 Corridors for access by patient and equipment shall have a minimum width of 2.44 meters. 5.2 Corridors in areas not commonly used for bed, stretcher and equipment transport may be reduced in width to 1.83 meters. 5.3 A ramp or elevator shall be provided for ancillary, clinical and nursing areas located on the upper floor. 5.4 A ramp shall be provided as access to the entrance of the hospital not on the same level of the site.
6 Lighting: All areas in a hospital and other health facilities shall be provided with sufficient illumination
to promote comfort, healing and recovery of patients and to enable personnel in the performance of work. 7 Ventilation: Adequate ventilation shall be provided to ensure comfort of patients, personnel and public. 8 Auditory and Visual Privacy: A hospital and other health facilities shall observe acceptable sound
level and adequate visual seclusion to achieve the acoustical and privacy requirements in designated areas allowing the unhampered conduct of activities. 9 Water Supply: A hospital and other health facilities shall use an approved public water supply system
whenever available. The water supply shall be potable, safe for drinking and adequate, and shall be brought into the building free of cross connections. 10 Waste Disposal: Liquid waste shall be discharged into an approved public sewerage system whenever
available, and solid waste shall be collected, treated and disposed of in accordance with applicable codes, laws or ordinances. 11 Sanitation: Utilities for the maintenance of sanitary system, including approved water supply and
sewerage system, shall be provided through the buildings and premises to ensure a clean and healthy environment. 12 Housekeeping: A hospital and other health facilities shall provide and maintain a healthy and
aesthetic environment for patients, personnel and public. 13 Maintenance: There shall be an effective building maintenance program in place. The buildings and
equipment shall be kept in a state of good repair. Proper maintenance shall be provided to prevent untimely breakdown of buildings and equipment. 14 Material Specification: Floors, walls and ceilings shall be of sturdy materials that shall allow
durability, ease of cleaning and fire resistance. 15 Segregation: Wards shall observe segregation of sexes. Separate toilet shall be maintained for patients
and personnel, male and female, with a ratio of one (1) toilet for every eight (8) patients or personnel. 16 Fire Protection: There shall be measures for detecting fire such as fire alarms in walls, peepholes in
doors or smoke detectors in ceilings. There shall be devices for quenching fire such as fire extinguishers or fire hoses that are easily visible and accessible in strategic areas.
17 Signage. There shall be an effective graphic system composed of a number of individual visual aids
and devices arranged to provide information, orientation, direction, identification, prohibition, warning and official notice considered essential to the optimum operation of a hospital and other health facilities. 18 Parking. A hospital and other health facilities shall provide a minimum of one (1)
parking space for every twenty-five (25) beds. 19 Zoning: The different areas of a hospital shall be grouped according to zones as follows:
19.1 Outer Zone – areas that are immediately accessible to the public: emergency service, outpatient service, and administrative service. They shall be located near the entrance of the hospital. 19.2 Second Zone – areas that receive workload from the outer zone: laboratory, pharmacy, and radiology. They shall be located near the outer zone. 19.3 Inner Zone – areas that provide nursing care and management of patients: nursing service. They shall be located in private areas but accessible to guests. 19.4 Deep Zone – areas that require asepsis to perform the prescribed services: surgical service, delivery service, nursery, and intensive care. They shall be segregated from the public areas but accessible to the outer, second and inner zones. 19.5 Service Zone – areas that provide support to hospital activities: dietary service, housekeeping service, maintenance and motor pool service, and mortuary. They shall be located in areas away from normal traffic. 20 Function: The different areas of a hospital shall be functionally related with each other.
20.1 The emergency service shall be located in the ground floor to ensure immediate access. A separate entrance to the emergency room shall be provided. 20.2 The administrative service, particularly admitting office and business office, shall be located near the main entrance of the hospital. Offices for hospital management can be located in private areas. 20.3 The surgical service shall be located and arranged to prevent non-related traffic. The operating room shall be as remote as practicable from the entrance to provide asepsis. The
dressing room shall be located to avoid exposure to dirty areas after changing to surgical garments. The nurse station shall be located to permit visual observation of patient movement. 20.4 The delivery service shall be located and arranged to prevent non-related traffic. The delivery room shall be as remote as practicable from the entrance to provide asepsis. The dressing room shall be located to avoid exposure to dirty areas after changing to surgical garments. The nurse station shall be located to permit visual observation of patient movement. The nursery shall be separate but immediately accessible from the delivery room. 20.5 The nursing service shall be segregated from public areas. The nurse station shall be located to permit visual observation of patients. Nurse stations shall be provided in all inpatient units of the hospital with a ratio of at least one (1) nurse station for every thirty-five (35) beds. Rooms and wards shall be of sufficient size to allow for work flow and patient movement. Toilets shall be immediately accessible from rooms and wards. 20.6 The dietary service shall be away from morgue with at least 25-meter distance. 21 Space: Adequate area shall be provided for the people, activity, furniture, equipment and utility.
SPACE
AREA IN SQUARE METERS
Administrative Service
Lobby Waiting Area Information and Reception Area Toilet
0.65/person 5.02/staff 1.67
Business Office
5.02/staff
Medical Records
5.02/staff
Office of the Chief of Hospital
5.02/staff
Laundry and Linen Area
5.02/staff
Maintenance and Housekeeping Area
5.02/staff
Parking Area for Transport Vehicle Supply Room Waste Holding Room
9.29 5.02/staff 4.65
Dietary Dietician Area
5.02/staff
Supply Receiving Area
4.65
Cold and Dry Storage Area
4.65
Food Preparation Area
4.65
Cooking and Baking Area
4.65
Serving and Food Assembly Area
4.65
Washing Area
4.65
Garbage Disposal Area
1.67
Dining Area Toilet Cadaver Holding Room
1.40/person 1.67 7.43/bed
Clinical Service
Emergency Room Waiting Area Toilet
0.65/person 1.67
Nurse Station
5.02/staff
Examination and Treatment Area with Lavatory/Sink
7.43/bed
Observation Area
7.43/bed
Equipment and Supply Storage Area Wheeled Stretcher Area
4.65 1.08/stretcher
Outpatient Department Waiting Area Toilet
0.65/person 1.67
Admitting and Records Area
5.02/staff
Examination and Treatment Area with Lavatory/Sink
7.43/bed
Consultation Area
5.02/staff
Surgical and Obstetrical Service
Major Operating Room
33.45
Delivery Room
33.45
Sub-sterilizing Area
4.65
Sterile Instrument, Supply and Storage Area
4.65
Scrub-up Area
4.65
Clean-up Area
4.65
Dressing Room
2.32
Toilet
1.67
Nurse Station
5.02/staff
Wheeled Stretcher Area
1.08/stretcher
Janitor’s Closet
3.90
Nursing Unit Semi-Private Room with Toilet
7.43/bed
Patient Room
7.43/bed
Toilet
1.67
Isolation Room with Toilet
9.29
Nurse Station
5.02/staff
Treatment and Medication Area with Lavatory/Sink
7.43/bed
Central Sterilizing and Supply Room Receiving and Releasing Area
5.02/staff
Work Area
5.02/staff
Sterilizing Room
4.65
Sterile Supply Storage Area
4.65
Nursing Service
Office of the Chief Nurse
5.02/staff
Ancillary Service
Primary Clinical Laboratory Clinical Work Area with Lavatory/Sink Pathologist Area Toilet Radiology
10.00 5.02/staff 1.67
X – Ray Room with Control Booth, Dressing Area andToilet
14.00
Dark Room
4.65
Film File and Storage Area
4.65
Radiologist Area
5.02/staff
Pharmacy
15.00
Notes: 1. 0.65/person – Unit area per person occupying the space at one time 2. 5.02/staff – Work area per staff that includes space for one (1) desk and one (1) chair, space for occasional visitor, and space for aisle 3. 1.40/person – Unit area per person occupying the space at one time 4. 7.43/bed – Clear floor area per bed that includes space for one (1) bed, space for occasional visitor, and space for passage of equipment 5. 1.08/stretcher – Clear floor area per stretcher that includes space for one (1) stretcher.
2. Hospital design and planning characteristics.
According to the Department of Health, these are checklist for review of floor plans - LEVEL 1 HOSPITAL
1 PHYSICAL PLANT 1.1 Administrative Service 1.1.1 Waiting Area 1.1.2 Admitting and Records Area 1.1.3 Administrative and Business Office 1.1.4 Staff Toilet
1.1.5 Parking Area for Transport Vehicle 1.2 Clinical Service 1.2.1 Emergency and Outpatient 1.2.1.1 Waiting Area 1.2.1.2 Toilet 1.2.1.3 Nurse Station 1.2.1.4 Consultation Area 1.2.1.5 Examination and Treatment Area with Lavatory/Sink 1.2.1.6 Equipment and Supply Storage Area 1.2.1.7 Wheeled Stretcher Area 1.2.2 Birthing Room 1.2.2.1 Birthing Area 1.2.2.2 Scrub-up Area 1.2.2.3 Newborn Area with Lavatory/Sink 1.2.2.4 Equipment and Supply Storage Area 1.3 Nursing Service 1.3.1 Nurse Station 1.3.2 Patient Room 1.3.3 Toilet 2 PLANNING AND DESIGN 2.1 Floor plans properly identified and completely labeled 2.2 Conforms to applicable codes as part of normal professional service: 2.2.1 Exits restricted to the following types: door leading directly outside the building, interior stair, ramp, and exterior stair 2.2.2 Minimum of two (2) exits, remote from each other, for each floor of the building 2.2.3 Exits terminate directly at an open space to the outside of the building 2.2.4 Minimum of one (1) toilet on each floor accessible to the disabled
2.3 Meets prescribed functional programs: 2.3.1 Main entrance of the infirmary directly accessible from public road 2.3.2 Ramp for clinical, nursing and ancillary services located on the upper floor 2.3.3 Administrative Service 2.3.3.1 Administrative and business office located near the main entrance of the infirmary 2.3.4 Emergency and Outpatient 2.3.4.1 Located in the ground floor to ensure easy access for patients 2.3.4.2 Ramp for wheelchair access 2.3.4.3 Nurse station located to permit observation of patient and control of access to entrance, waiting area, and treatment area 2.3.4.4 Separate toilets for patients and staff 2.3.5 Birthing Room 2.3.5.1 Located and arranged to prevent non-related traffic through the room 2.3.5.2 Scrub-up area recessed into an alcove or other open space out of the main traffic 2.3.6 Separate toilets and wards for male and female patients 2.3.7 Nursing Service 2.3.7.1 Nurse station located and designed to allow visual observation of patient and movement into the nursing unit 2.3.7.2 Toilet immediately accessible from each room in a nursing unit
3. Resilient design approaches
According to the UNISDR (United Nations Office for Risk Reduction), The following are 10 basic facts to know about keeping hospitals and health facilities safe from disasters: Many factors put hospitals and health facilities at risk:
1
Buildings: The location, design specifications, and resilience of the materials used, all contribute to a hospital’s ability to withstand natural hazards.
Patients: In normal times, health facilities are occupied 24 hours a day by highly vulnerable people, and are often full to capacity. In disaster situations, damage to hospital components compounds patient vulnerability, as well as increasing the number of patients.
Hospital beds: Disasters often cause the loss of hospital beds, frequently just as the demand for emergency care increases.
Health workforce: The loss or unavailability of health workers compromises care for the injured. Hiring outside personnel to sustain response capacity adds to the overall economic burden.
Equipment: Damage to non-structural elements often surpasses the cost of damage to the building. Even less costly damage can still force a hospital to halt operations.
Basic lifelines and services: A hospital’s ability to function relies on lifelines and other basic services such as electrical power, water and sanitation, and waste management and disposal. The loss of even some services can affect the entire health facility.
2
Components of a hospital or health facility are typically divided into two categories:
Structural elements: those essential elements that determine the overall safety of the system, such as beams, columns, slabs, load-bearing walls, braces or foundations.
Non-structural elements: all other elements that enable the facility to operate. They include elements such as water heaters or storage tanks, mechanical equipment, shelving and cabinets and lifelines. In the case of hospitals, 80 per cent or more of the total cost of the facility can be the price of non-structural components.
3
Functional collapse, not structural damage, is the usual reason for hospitals being put out of service during emergencies:
Functional collapse occurs when the elements that allow a hospital to operate on a day-today basis are unable to perform because the disaster has overloaded the system. These include: architectural spaces such as laboratories or operating theatres; medical records; medical and support services; and administrative processes (such as contracting, procurement, and maintenance routines). Although the measures necessary to prevent a functional collapse (such as contingency planning, improved organization and staff training) require a significantly smaller financial investment, they nonetheless remain a major challenge
4
Hospitals and health facilities can be built to different levels of protection:
Life safety is the minimum level of protection and is the most common approach to protection in the construction of health facilities;
Investment protection is designed to protect all or part of the infrastructure and equipment, although the facility itself may stop functioning. This level of protection ensures that the facility resumes operations within a reasonable timeframe and cost;
Operations protection, which is the most costly level, includes life and investment protection but also seeks to ensure the facility continues to function after a disaster.
5
Making new hospitals and health facilities safe from disasters is not costly
Building a hospital is a significant capital investment. In calculating the cost, one must include both the structure itself and the non-structural elements (non-structural elements account for about 80 percent of the total cost). It has been estimated that the incorporation of mitigation measures into the design and construction of a new hospital will account for less than 4 percent of the total initial investment.
6
Field hospitals are not necessarily the best solution to compensate for the loss of a hospital or health facility
Field hospitals have been used successfully in complex disasters (civil conflicts and wars), but experience in the aftermath of disasters caused by natural hazards in developing countries has shown these extremely expensive solutions to be not satisfactorily cost-effective.
7
Seeking the right expertise: a check consultant A “check consultant” is an independent consultant who, on behalf of a client, ensures that norms and building standards are in place. Check consultants can be contracted to oversee the construction of any building, but their thorough knowledge of building codes and natural hazard mitigation measures are particularly important to ensuring the disaster safety of critical facilities such as hospitals.
Building codes are of utmost importance
8
One of the earliest mentions of the importance of building codes is found in Hammurabi’s Code 2 :
232: “… he [the builder] shall make compensation for all that has been ruined, and inasmuch as he did not construct properly this house which he built and it fell, he shall reerect the house from his own means.”
Creating safe hospitals is as much about having vision and commitment as it is about actual
9
resources
The responsibility of creating safe hospitals must be shared among many sectors: planning, finance, public works, urban and land-use planning, together with the health sector. The political will to make this happen must match the knowledge that already exists.
10
The most costly hospital is the one that fails!
4. Situational analysis and visual survey of the proposed site. Location: Carlos P. Garcia Highway, Davao City Zone: The area near the road is on the Major Commercial Zone (C-2) while the lot in its back portion in
on the Low density residential zone (R-1)
⦁
Neighborhood Context: Its neighborhood context in the front area are commercial buildings while on
its rear and side areas are residential buildings.
ACTUAL PICTURES:
( view from the other side of the street - from phoenix gasoline station and City Hardware)
(view from the overpass)
(the lot on the left site is the site – this is the road is going to the Bangoy international airport)
(sidewalk area)
A.2
ARCHITECTURAL PROGRAMMING
1. Statement of Goals and Objectives To design a sense of place
⦁
To apply sustainable design & environmental conservation
⦁
To create a lay out that suits its environment and its users
⦁
To build a cost saving, efficient and resilient place
⦁
To give accessibility, comfort and relaxation to all of its users
⦁
To build a structure that could protect and function well during disaster.
⦁
2. Design Considerations 1. Resilient design structure 2. Architectural relationships with the environment and ecology. 3. Design for communities in public design with an understanding of site development and planning. 4.Various human behaviors (socio-cultural factors) related to the project 5. Energy efficiency in the buildings 6. The efficient use of materials and the nature of site for energy conservation and a sustainable built environment.
3. Design Concept and Philosophy Hospitals are structure built to give care to the people who need medical attention. Yet unlike its meaning, the design concept of this project is to go beyond further the usual care a hospital could provide. Using the latest resilient design methods, the structure could provide both state-of-the-art design and medical facilities. The facade is water and mountain inspired. Water because it symbolizes cleansing. On the other hand, mountain because it symbolizes the obstacles that a patient is experiencing. Furthermore, it aims to inspire everyone to hope that a person has a chance to conquer its obstacle if he or she would really want to. Lastly, its circulation or floor plan is inspired by an image of a mother carrying a baby. Its design concept is based on resilient design and modern architecture. It also aims to boost the connection between the user and the environment through the use of elements in order to give a dynamic impact to its users through aesthetic design and efficient space planning. Its concept is to create an active and livelier environment, a significant aura and a sense of place to everyone.
" Resilient Design is the best medicine."
Being in a world that is affected by climate change, especially to our country, Philippines, which is known to be vulnerable in terms of disasters, it is already the right time to use resilient design. This design philosophy aims to be a source of strength and hope. A structure that could provide more than being a dwelling place. It aims to make people and nature be more connected through visual, audible and physical elements that urban design could give. It aims to change our unhealthy surrounding with a more warm and cozy atmosphere.
4. Project Requirements -According to Philhealth, these are the requirements to be accredited as a Level 1 Hospital
– Emergency hospital – initial treatment for cases that require immediate treatment and that provides primary care for prevalent diseases in the area – general medicine, pediatrics, minor surgeries, and non-surgical gynecology – primary clinical laboratory, pharmacy and first level radiology – nursing care for patients needing minimal supervised car -Ample Parking space - Administration, Service Facilities (toilet, solid waste mgt, security etc.)
- Flora and fauna/ Landscaping/ Promenade (Park Area) - Common Community Area (Activity Ground) - Others deemed necessary 5. Site Analysis Plan/s (Lot Details/ Bearings, Utilities, Topography and Climate)
Location: Carlos P. Garcia Highway, Davao City Zone: The area near the road is on the Major Commercial Zone (C-2) while the lot in its back portion in
on the Low density residential zone (R-1)
Vicinity Map:
____________________________________________________________________________________ POINTS
DISTANCE MEASUREMENT
BEARING
A
162.00 m
N 42.9° E
B
131.00 m
N 57.3°W
C D
138.75 m 129.00 m
S 42.9°W S 47.1°E
⦁
Topography: The site is not a flood prone area. It is located on the highland part of the city.
⦁
Type of Soil: Loam soil ( It is good for agriculture)
⦁
Hydrology: There are no bodies of water near the site
⦁
Climate: Davao City enjoys a mild tropical climate
⦁
Vegetation: The site is filled with different plants and trees specifically grass and grains.
⦁
Man-made Features: Billboards
This site was chosen for the proposed project for its accessibility and ample space. Aside from it, the site in the Buhangin Area does not still have an existing hospital that could cater to a lot of people. Thus, this would be good for it could contribute great to the community.
6. Site Land Use Distribution Plan (Matrixes & Bubble Diagrams)
This project aims to provide the following:
-medical/health facilities - state of the art -holistic care - coffee shop or food establishments - oasis; praying area - great views of the setting -welcoming environment -Rooftop garden
SOURCES:
Department of Health. (2007). Checklist for review of floor plans level 1 hospital. Retrieved September 11, 2015 from: http://www.doh.gov.ph/system/files/review_level1hospital.pdf Department of Health. (2004). Guideline in the planning and design of a hospital. Retrieved September 11, 2015 from: http://www.doh.gov.ph/system/files/planning_and_design_0.pdf Department of Health, Philippines and the World Health Organization. (2015, September 10). Hospitals Should be safe from Disasters. Retrieved September 11, 2015 from: http://www.eird.org/publicaci ones/safe_hospi tals_manual.pdf FitzGerald, G. and Zhong, S. (2014). Validation of a framework for measuring hospital disaster resilience using factor analysis. Retrieved September 11, 2015 from: http://www.ncbi.nlm.nih.gov/pmc/articl es/PMC4078582/ Jack, C. (2014). Care Institution Providing Patient Treatment. Retrieved September 11, 2015 from: http://sinhalacartoonworld.blogspot.com/2014/10/care-institution-providing-patient.html Phil health. (2011).What are hospital levels, as used by philhealth. Retrieved from: http://www.healthphilippines.net/2011/08/hospital-levels-philhealth/ UNISDR - United Nations Office for Risk Reduction. (2008). 10 basic facts to know. Retrieved from: http://www.unisdr.org/2009/campaign/pdf/wdrc-2007-2008-10-basic-facts.pdf
