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To Design a Hospital

Hussain Varawalla“The art and science of designing a hospital anywhere is a complex affair. Public sector hospitals present a substantially different design approach than private healthcare facilities. I write here only of private sector hospitals to address pre-design programming and concept design which in India are a much neglected but essential part of the process of designing a good hospital,” says healthcare architect Hussain Varawalla.

Beyond technical requirements of modern medicine and rigid functional relationships between different medical departments, the designer also has to cope with a host of more subjective issues like the anxiety of the patient, the stressful work environment of the staff and the need to build a sustainable and healing building. In India, there are very few codes applicable to hospital design and scant attention paid to the myriad statutory requirements, that are otherwise specified for construction of healthcare facilities in western countries.

In privately financed hospitals, the horizontally aligned design offices mean that one person handles the beginning of all the projects from the pre-design programming, the concept design to schematic design. After approval from the client, another larger team of professionals takes over to produce the tender documents and then “good for construction” drawings. This addresses only the beginning of the design process.

Architects and the designers in general are eager to put pencil to paper and are impatient with reading through long briefs. Many times in my experience, I have received plans (or may be even semi-constructed buildings) where the architect has “jumped the gun” so to speak and then paid a heavy price for that impatience. It is very difficult to extricate the project from this mess, if it is semi-constructed and it invariably results in a compromised design.

Architectural Consulting

The facility mix is a list of the various components of the proposed hospital and is derived from the Detailed Project Report (DPR). It will give the number and types of inpatient rooms and wards, thrust areas for the proposed hospital and a list of other departments and support services necessary. This facility list forms the input for the functional and space program.

The method in which the functional and space programs are produced is very important to the healthcare facility design process. This is because, in larger projects the initial capital costs very often exceed the long term operational of the facility in four to five years in India and in two to three years in the West. Quality thought being given to the initial planning will go a long way towards decreasing long term operational costs. Care should be taken to develop realistic workload projections in the DPR and distinguishing between actual area requirements and the “wish lists” of departmental heads occupied in building their own sub-kingdoms. Often this kind of empire building will result inthe provision of extra, unnecessary space with which nothing can be done later.

Traditionally, the space program (or area program as it is also referred to in India) was the only programming document prepared before the start of the design process. As of today, the functional  program in combination with the space program is the way to go.The components of the functional and space program for each department of the proposed healthcare facility could read as follows:

  • An assessment of the situation on the ground (as existing)
  • The planning objectives and a vision for the future
  • Existing and proposed workloads
  • Proposed time of operation
  • Existing and proposed staffing
  • Operational and support systems assumptions
  • Equipment list for the proposed department
  • Functional adjacencies and access requirements of the various departments

The space program in square feet and meters provides a list of all rooms or areas required for each function and the total arearequired for the function. This approach flows from the functional requirements and initiates a dialogue with the client representatives / stakeholders on what eventually becomes the functional program. The functional requirements of the project in keeping with the facility & services mix brief provided by the clients are:

  • The services accommodated,
  • The potential workload,
  • The key operational premises.

The purpose of the document, apart from defining the functional content is to facilitate deliberation towards arriving at concurrence on the operational principles governing the delivery of clinical, diagnostic and support services, for these have an important bearing on the programming and hence on the design.

Room Data Sheets

The room data sheets are an extension of the space program containing a plan of the room, minimum dimension of the space, a list of major items of medical or other equipment to be housed within that space and any unique temperature, humidity and lighting conditions.

In this age of AutoCAD, one of the greatest problems I have found with young architects who have grown up working largely on this software is their inability to conceptualize scale, both of drawings and buildings. Model making skills too seem to have suffered because of the time taken and the easiness with which the building views can be prepared in 3-D.

At this stage, the room data sheets could only be generic to help the non-healthcare architect plan the furniture, fixture and equipment plan (FFE). For the room data sheets to be of optimal use, they would need to be prepared after the FFE is put inplace.

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