Design Development Stage

Presented by:Aparajita Hishikar MBA(HA) I Sem

Transitional phase of an architect/engineer (A/E) services in which the design moves from the schematic phase to the contract document phase. In this phase, the A/E prepares drawings and other presentation documents to crystallize the design concept and describe it in terms of architectural, electrical, mechanical, and structural systems. In addition, the A/E also prepares a statement of the probable project cost

The design stage is initiated after the Hospital board, Hospital Administrator, Architect, Consultant & Building contractor have reached a definite understanding to the Hospitals requirements. After deciding upon What to build, how to build & where to build? the decision for external & internal design is made.

Internal Design Development

It consists of the following:
      

Working drawings & specifications Space requirement Conceptual design Bed distribution Types of bed accommodation Identifying & designing traffic routes within the hospital Planning for elevators

Working drawings & Specifications

The working drawings convey to the contractor & his workmen details pertaining to the construction of the building. A complete set of working drawings consists of the following: Architectural Drawings: this shows plan of site, location of building, utility connections, existing & finished grades, floor & roof plans, sections &elevation, finishes of all rooms, etc. Structural Drawings: these show the location & size of foundation, footing, columns, beams, girders & slabs.

Mechanical Drawings: these depict diagrams of all piping, details of plumbing, ventilation & airconditioning work. Electrical Drawings: show diagrams of electrical feeders, location of electric panels, fixtures & other electrical feeders. License Drawings: these are the architectural drawings showing plan of all floors, heights, details of rooms, exits, etc. that need an NOC from the authorities before commencing the actual construction. Tender Drawings: these are the architectural, structural & drawings of other utilities explaining the building & the engineering scheme.

Space Requirements

A simple way to calculate the space requirements for a hospital is:(100 sq.ft X no.of beds)X 10 = Total Hospital Area in sq.ft The fundamental principle that the planners & designers should bear in mind is that the hospitals should be planned for at least 10 years ahead. The aim is always to design smart Hospitals that respond to present need while anticipating future change

Laboratory tests & space requirements double in every 10 years, i.e there is 100% increase in lab space every 10 years. y The Hospital design should be so flexible so as not to disrupt the daily activities & without much construction cost during further expansion. y The space needs of a modern day Hospital maybe anywhere between 900 to 1200 sq. ft
y

Schematic Design
It is one of the most important phases of design process during which 90% of the functional design is frozen y The Architects, Consultants & Hospital Management team prepare the outline specifications of the various materials to be used in construction, in this phase
y

Room-by-room departmental layouts y Regulatory compliance conformation y Selection of appropriate structural system y General arrangement of structural grid y Major equipment & furniture layouts y Preliminary structural design y MEP identification & preliminary design y Outline specifications y Cost estimate updates
y

Bed Distribution
A hospital bed is one that is installed for regular 24-hour use by inpatients during their period of hospitalization y Certain beds are necessary for hospital purpose though they may not be used while counting the bet compliment as the are not available full time for care of patients
y

Examples of such beds:

beds

 Labour  Beds  Beds

in out patient & emergency departments in diagnostic or therapeutic departments recovery beds

 Anesthesia  Beds

in infirmary

Bed Distribution by Service

y

The rule of thumb for distribution of beds in a specialty or super specialty service Hospital is:

 30-40%

beds for surgical & medical patients  10-15% for obstetrics  7-10% for paediatrics  9-15% for other patients including eye, ear, nose & throat

Designing Proper Traffic Routes

The traffic routes are designed concidering the four basic rules:

Protection of the patient Plan for the shortest traffic routes Separation of dissimilar activities Control

The general features of planning hospital traffic are: Separate public corridors from patient& staff corridors, so as to reduce staff & patients transit time Visitors route should be controlled Corridors of 8 ft width & finished ceiling height of 8 ft is the most widely accepted pattern where ramps are used the gradient must not exceed 1:10

There should at least be two stairways (apart from elevators) leading from top floor to ground level y The ramps should have a minimum width of 38 for handling stretchers in an emergency y The floors should be sound proof & fall proof to an optimum level. y the numerous hospital departments should be properly integrated so that the traffic routes are kept short & important functions are protected from prying eyes
y

Planning for Elevators

They should be located where there is minimum concentration of traffic y The elevator doors should open in an alcove rather than the main lobby y Any multi-storied hospital should have at least 2 elevators y In hospitals having more than 250-300 beds minimum 3 & maximum 6 elevators are required
y

Separate passenger & service elevators are recommended y The elevator for hospital purpose should preferably be 5 X 7 feet with the door at least 4 feet wide y The elevators should preferably have dual controls to obviate the need for an operator y All safety devices including self-levelling feature, telephone, alarm & ventilation are necessary
y

External Design Development

The external design development begins with planning of the site with reference to: Parking facility Availability of public utilities (water, electricity back-up, waste management, etc) Proper elevation for good drainage & general sanitary measures Accessibility to transportation

Conceptual Design
y y y y y y

Preliminary departmental block diagrams Conceptual site master plan Regulatory framework review & analysis Study model for building mass Landscaping Preliminary cost estimates

The area needed for hospital construction including the construction area with external design as per the bed strength is as under:
Hospital Beds Area in Acres

750 beds 250 beds 100 beds 76 beds

30-75 18-45 12-30 10-28

Designing Hospital Entrances

The smaller hospitals may use two entrances  Main entrance for patients, visitors & staff  Other entrance for utilities & supplies
y

For the larger hospitals four entrances are prescribed; main hospital entrance, outpatient entrance, emergency entrance & service entrance

Designing Main Entrance & Front Lobby

y

The main entrance & lobby should be designed attractively Hospitals having targeted the upper income strata of the society should have their main entrance & lobby furnished elaborately & elegantly

Recent Trends in Hospital Designing

The New
The very latest concepts in hospital designing are:

Green architecture Evidence Based Design (EBD) Spiritual Architecture Healing Architecture Signages

Green Architecture
Green architecture, also referred to as eco-design is a term used to describe economical, energy-saving, environmentalfriendly, sustainable development. It includes:Energy saving environment Use of biodegradable material in construction & designing Water & waste management

Space utilization by landscaping

Natural light saves energy

Large windows help in proper ventilation

Evidence Based Design

Evidence-based design stems from the recognition that the physical environment can have a measurable influence on our well-being, especially in health care. y Evidence-based design is the critical thinking of the architect, working together with an informed client, to make design interpretations on the basis of reliable evidence from research.
y

Evidence Based Design is considered parallel to Evidence Based Medicine & includes:Single patient room Sound absorbing tiles Adequate ventilation Easy navigation Natural light Operating rooms &ICU

Identical OTs help reducing stress & error

Extra wide hallways help reduce patient fall

Similar rooms reduce staff medical error

Single rooms score over multi-patient rooms

Spiritual Architecture
It is very well said that man is closest to God when he is sick, thus, the concept of Spiritual Architecture y If the mind of the patient is at peace with his surroundings whether it is through Vaastu or Feng-shui, they will surely heal faster. y The concept also encourages space for Meditation & Prayer rooms in the hospital

Healing Architecture
Healing architecture can be defined as creating environments that make you feel good. y Healthy-hospital design is a harmonious blend of nature and architecture, that promotes health and aids early recovery in those who are sick.
y

Friendly ICUs with pleasant view to heal faster

Piped music & Plush environment at Columbia Asia, Bangaluru

Healing Architecture also refers to aesthetics in hospital design & includes: y Friendly ICUs to reduce the cases of ICU psychosis y Proper space allocation for courtyards & rooms with view y Feng-shui paintings to balance yin & yang y Color, environment, happiness & efficiency y Provision for piped music as de-stressors y Ventilation through HEPA filters & laminar air flows to reduce risk of infection

Huge atrium to optimizi light & better patient flow at Dr. LH Hiranandani Hospital, Mumbai

Feng-Shui paintings at Columbia Asia, Bangaluru

Canal Water ambulance service at Lakeshore Hospitals, Kochi. Most rooms have a view of the same

Signage
Danger signs y Showing the way y Points of reference y Setting an image y Color coding
y

Illuminated Signage Boards at Dr. LH Hiranandani Hospital, Mumbai

Informative signages at Yashoda Hospitals, Hydrabad

Use of different languages at Apollo Hospitals, Hydrabad

All signages at Max Healthcare use consistent color coding

Other Design Concepts

New conditioning ways- use of recycled water for cooling in summers & heating in winters & thus, saving power as compared to the traditional air conditioning y Holistic Engineering concepts
y
 Proper

insulation of building  Planning all the aspects of hospital designing from electricals & plumbing to specialized medical facility  Adequate project management with fixed dates & workflows

Conclusion
Though the design concepts may not be seen directly applied, but their increased acceptance can be seen in many green field projects in India. The fundamentals of designing a hospital lie in increasing its efficiency & healing effect, as it is rightly saidLooks Matter