Integrating Vision into Hospital Design
By Sumandeep Singh
Every healthcare organization has a promoter’s vision built into it which is generally unique. Sumandeep Singh explains the process of translating that vision into design.
A healthcare facility is a sanctuary of hope for a populace in case of a medical emergency, which throws the patient and his/her dear ones into a state of panic, wherein all instruments of their brain’s cognitive understanding are put to test. In such situations, also put to test is the ability of the hospital designers to bridge the gap between care seekers and care providers. The care providers in this case are not just the doctors, nurses and other staff in the medical profession. It is also the facility, the building and its essential services, which act as care givers. The healthcare organization thus needs to pay significant attention to the design of their facility as a responsibility and, in turn, it becomes the responsibility of the healthcare facility designers to translate the vision of the organization into functional design.
Healthcare organizations in the country are primarily divided into three categories: public, private and charitable. Public organizations are funded and maintained by the state or central governments. This category may also include hospitals run by the defense services (i.e. army hospitals). Private organizations are for-profit organizations which are in the business of care giving. The third category is the charitable/religious organizations providing free care to their community or general public at large. All of these different types of care-giving organizations have different visions for the design of their facilities, which depends on various factors like budget constraints, user groups and long-term goals. For instance, public hospitals are open and free to the general public, in most cases, and hence witness a mass of people arriving from nearby areas on a daily basis. Therefore, they need to have large waiting areas, crowd-control mechanisms and disaster management mechanisms, among other factors. Private hospitals, on the other hand, will target a certain group of users based on their business model financial targets, while keeping in mind the government regulatory controls which govern the design of healthcare facilities. The charitable facilities will have a different set of goals with respect to the founder’s vision and financial constraints.
Talking to the right people at the right stage of the project
Every healthcare facility is unique and there is no such thing as a general or typical design as it is often understood. Each facility has the promoter’s vision built into it and it is generally unique. The designer’s responsibility is to engage key personnel from the client’s side at the right stage, so as to maintain a smooth design process flow. An example of this could be user-group meetings. The designers engage with the exact users of the spaces they are going to design for. This could mean heads of departments for the future facility. In cases where the future users are still not on board, the reference user groups could be engaged from the organization’s existing facility. These meetings help set standards for the designers to follow with respect to services like medical gases, door sizes and the most important thing – layout of the preferred process flow. An example of this could be how an endoscopy procedure works. The clean scopes (the long tubes with cameras at the ends used to insert in the digestive tract, stomach and colon area) are maintained in HEPA-filtered, air-supplied scope cabinets and are supposed to be provided to the procedure site within minutes of them being removed from the cabinets. Hence the flow needs to be designed such that the distance of travel is minimized and unobstructed. The minute details of clinical processes are important and very often unique to the staff and doctors of a facility. The designers need to understand the processes and keep the design team in loop for the same.
Where it is important to inform/educate clients about emerging technologies, equipment and practice, it is equally crucial to inform them what cannot happen or cannot fit into their larger vision. As designers have a more holistic view of the design, sometimes clients might ask for a design change that might not fit their overall vision. It is then that the designer should communicate this in a timely manner, to avoid assumptions and expectations that might sour the designer-client relationship in the future.
Healthcare is expensive. Where on one hand man has made tremendous progress in medical science and technology, developing cure for almost all ailments known to its species, the same technology has translated to highly expensive equipment and practices that require mammoth initial capital expenditure and a considerably high running and maintaining cost. There are certain equipments and procedures that require controlled environment at all times. A highly sterile environment is needed to be maintained for almost all major surgical procedures. This incurs a high cost with respect to the mechanical/air conditioning and filtering systems. Hospitals are also a major guzzler of water. Clean water consumption is significantly high in hospitals as compared to, let’s say, an office building or school. The electricity consumed by highly specialized equipment and the constantly running air conditioners and water purifiers only add to the electrical consumption. This is without mentioning the cost of the machines themselves which runs into millions. The organization aims to be lean when it comes to spending their bucks, hence they make sure they can provide the basic minimum first and then only selectively provide luxury in their facility. And at times this special category is designated only for the economically effluent customers (patients). Yes, as designers, we constantly encounter the organizations referring to the patients as customer or users. The designers often mock up certain rooms in advance for the clients to give their suggestions so as to make financial, aesthetic and functional decisions for certain repetitive standard rooms in advance.
The Time Factor
Based on who is the promoter of the facility, there are time constraints governing the project process. The designers must adhere to the same and promise only realistic milestones to the organization, not considering this crucial factor could prove highly detrimental to the designer’s reputation. The factor of time is directly related to the budget aspect of the project and also to the future patients. The designers must stick to the timelines at all times. They must secure certain key decisions from the organization to ensure smooth one way flow of information to the design team and avoid too many changes at a later stage. Doing too much at the wrong time is equally dangerous as doing too little at the right time; hence the design process must only proceed when decisions from the client are secured for that particular stage. Often times, this makes or breaks the client-designer relationship. Project managers play a key role in managing the various consultants on the projects, weekly conference calls between various consultants ensure that everybody is on the same page, and is using the most updated drawings/documents while moving forward.
LEAN: IPD (Integrated Project Development)
A lean process is a novel concept in the healthcare design field. This concept involves dedicated work sessions where the various consultants for the project meet and work at the same facility for intense work sessions, which could stretch up to a week to ten days. Some key aspects of this kind of strategy are as follows:
Smooth flow of information between consultants: this happens because all consultants are in the same room for all practical purposes for a week to ten days of work sessions.
Correct information is sought, attained and disbursed to the correct individuals with no time gap. Normally, simple communications could take days to go through because of the medium of email.
Saving of resources for the design consultants and the client as well: The clients provide the work space and participate as one with the consultants all working together toward a common goal of the organization. These work sessions foster great working relationships among the consultants and they get to know each other’s working processes and styles. If the consultants have a good working relationship, the project and the healthcare organization, which is the promoter, stands to benefit.
Strategically Cutting Down on Redundant Services
Each healthcare organization is bound by duty and regulations of the government, due to the criticality of this profession/business. Hence it aims at providing the basic minimum standards and adding on their so called USPs to promote their facility. The designers have to make sure they consider this while laying out the facility and assigning spaces to processes. With the rapidly advancing science and technology in medical profession, certain machines and services become redundant, hence designers need to constantly evolve and engage in research. It is imperative that designers inform the client of such advances in cases where it’s not already known to them. This helps the design stay ahead of time and provide long-term validity. There are certain procedures where sizes of equipment have drastically reduced and become more and more compact, hence designers may utilize the extra space for other essential services. A simple example of this could be the sizes of servers. Server sizes have reduced over the years and the sizes of server/IT rooms could be minimized and given to other essential functions.
The Importance of Accreditations
Globally, there are numerous ratings which credit the facility based on the design and medical processes followed in the facility. There are guidelines that govern the design of the facility if it is aiming to achieve that particular rating. Joint Commission International is one such agency which is globally renowned to provide a rating known simply by the acronym ‘JCI’. Now a JCI rated hospital might hold more credibility simply because an international organization has endorsed its design and medical processes. Then there are certain mandatory ratings which a facility needs to hold in order to provide certain key medical procedures. The designers often need to keep up to date with the rating standards so that the client is always protected for these. These codes/guidelines keep changing every year with major or minor changes here and there. The designers are often encouraged to maintain the latest versions of these in order to remain up to speed with them. A small flaw could lead to cancellation of a healthcare organization’s rating and hence bring down the client’s reputation.
Phasing of Projects
Some organizations aim to grow their facilities in phases or stages. These stages are based on their visions of introducing new facilities or expanding existing ones in a time bound manner. The designers then come in and devise a strategy to allow for the expansion and addition of facilities, without causing any disturbance to the existing. This incorporates providing additional space in advance for the future expansion and considering the same while designing services such as plumbing, electricity and mechanical services, structural design (e.g., in cases where additional upper floors need to be added). In most cases, expansion is a key concern for healthcare organizations and forms part of their key business model. In some cases, hospitals look to add surgical facilities, like more operating theaters.
Making it environmentally sustainable
Due to the scare of climate change in recent years, governments across the globe have responded to the situation by encouraging energy saving mechanisms in buildings. Since the construction industry has been a major consumer of energy and resources, there are various governmental organizations which rate the buildings based on their energy saving strategy. This helps the organizations gain credibility for doing their bit for the environment. There are various ratings that rank the building based on the same. LEED ratings are by far the most popular among them. A LEED gold rating could earn the organization credits for being environmentally conscious. There are various practices related to construction, the general building design as a whole, and certain products which have these ratings. If the organization is looking for a rating, the designers need to work out a strategy to achieve that kind of rating.
Health facility designers carry an important responsibility toward society and the organizations they are working with. If they take care of the points mentioned above, they are certain to secure the trust of their client and the end users. Health facility design is more than just architectural design; it is an essential service that must be provided and carried out with the highest standards of professional ethics, since it affects the health of its users in a direct manner.
The healthcare organizations prefer to work with designers who understand their vision and are able to translate the same into a facility/building. There are barriers of nomenclature that distinguish designers from the organization’s key decision-making personnel. The designer must bridge this gap by innovating techniques of design communication that get the correct message across and equip the organization to make a timely and correct decision.
About Author :
Sumandeep Singh is an Architectural Designer working in HKS New Delhi. He has been an important part of design teams for various prestigious hospital projects and is currently actively exploring parametric design tools, not just for healthcare but also other project