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Home > Design Guidance > Building Types > Health Care Facilities > Hospital
Hospital
by Robert F. Carr NIKA Technologies, Inc. for VA Office of Construction & Facility Management (CFM) Revised by the WBDG Health Care Subcommittee Last updated: 04-21-2011
Achieving Sustainable Site Design through Low Impact Development Practices Aesthetic Challenges
OVERVIEW
"A functional design can promote skill, economy, conveniences, and comforts; a non-functional design can impede activities of all types, detract from quality of care, and raise costs to intolerab le levels." ... Hardy and Lammers
Within This Page Overview Building Attributes Emerging Issues Relevant Codes and Standards
Hospitals are the most complex of building types. Each hospital is comprised of a wide range of services and functional units. These Major Resources include diagnostic and treatment functions, such as clinical laboratories, imaging, emergency rooms, and surgery; hospitality functions, such as food service and housekeeping; and the fundamental inpatient care or bedrelated function. This diversity is reflected in the breadth and specificity of regulations, codes, and oversight that govern hospital construction and operations. Each of the wide-ranging and constantly evolving functions of a hospital, including highly complicated mechanical, electrical, and telecommunications systems, requires specialized knowledge and expertise. No one person can reasonably have complete knowledge, which is why specialized consultants play an important role in hospital planning and design. The functional units within the hospital can have competing needs and priorities. Idealized scenarios and strongly-held individual preferences must be balanced against mandatory requirements, actual functional needs (internal traffic and relationship to other departments), and the financial status of the organization. In addition to the wide range of services that must be accommodated, hospitals must serve and support many different users and stakeholders. Ideally, the design process incorporates direct input from the owner and from key hospital staff early on in the process. The designer also has to be an advocate for the patients, visitors, support staff, volunteers, and suppliers who do not generally have direct input into the design. Good hospital design integrates functional requirements with the human needs of its varied users. The basic form of a hospital is, ideally, based on its functions: bed-related inpatient functions outpatient-related functions diagnostic and treatment functions administrative functions service functions (food, supply) research and teaching functions Physical relationships between these functions determine the configuration of the hospital. Certain relationships between the various functions are requiredas in the following flow diagrams. These flow diagrams show the movement and communication of people, materials, and waste. Thus the physical configuration of a hospital and its transportation and logistic systems are inextricably intertwined. The transportation systems are influenced by the building configuration, and the configuration is heavily dependent on the transportation systems. The hospital configuration is also influenced by site restraints and opportunities, climate, surrounding facilities, budget, and available technology. New alternatives are generated by new medical needs and new technology. In a large hospital, the form of the typical nursing unit, since it may be repeated many times, is a principal element of the overall configuration. Nursing units today tend to be more compact shapes than the elongated rectangles of the past. Compact rectangles, modified triangles, or even circles have been used in an attempt to shorten the distance between the nurse station and the patient's bed. The chosen solution is heavily dependent on program issues such as organization of the nursing program, number of beds to a
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BUILDING ATTRIBUTES
Regardless of their location, size, or budget, all hospitals should have certain common attributes.
Therapeutic Environment
Hospital patients are often fearful and confused and these feelings may impede recovery. Every effort should be made to make the hospital stay as unthreatening, comfortable, and stress-free as possible. The interior designer plays a major role in this effort to create a therapeutic environment. A hospital's interior design should be based on a comprehensive understanding of the facility's mission and its patient profile. The characteristics of the patient profile will determine the degree to which the interior design should address aging, loss of visual acuity, other physical and mental disabilities, and abusiveness. (See VA Interior Design Manual.) Some important aspects of creating a therapeutic interior are: Using familiar and culturally relevant materials wherever consistent with sanitation and other functional needs Using cheerful and varied colors and textures, keeping in mind that some colors are inappropriate and can interfere with provider assessments of patients' pallor and skin tones, disorient older or impaired patients, or agitate patients and staff, particularly some psychiatric patients .
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Accessibility
All areas, both inside and out, should: Comply with the minimum requirements of the Americans with Disability Act (ADA) and, if federally funded or owned, the GSA's ABA Accessibility Standards In addition to meeting minimum requirements of ADA and/or GSA's ABA Accessibility Standards, be designed so as to be easy to use by the many patients with temporary or permanent handicaps Ensuring grades are flat enough to allow easy movement and sidewalks and corridors are wide enough for two wheelchairs to pass easily Ensuring entrance areas are designed to accommodate patients with slower adaptation rates to dark and light; marking glass walls and doors to make their presence obvious
Controlled Circulation
A hospital is a complex system of interrelated functions requiring constant movement of people and goods. Much of this circulation should be controlled. Outpatients visiting diagnostic and treatment areas should not travel through inpatient functional areas nor encounter severely ill inpatients Typical outpatient routes should be simple and clearly defined Visitors should have a simple and direct route to each patient nursing unit without penetrating other functional areas Separate patients and visitors from industrial/logistical areas or floors Outflow of trash, recyclables, and soiled materials should be separated from movement of food and clean supplies, and both should be separated from routes of patients and visitors Transfer of cadavers to and from the morgue should be out of the sight of patients and visitors Dedicated service elevators for deliveries, food and building maintenance services
Aesthetics
Aesthetics is closely related to creating a therapeutic environment (homelike, attractive.) It is important in enhancing the hospital's public image and is thus an important marketing tool. A better environment also contributes to better staff morale and patient care. Aesthetic considerations include: Increased use of natural light, natural materials, and textures Use of artwork Attention to proportions, color, scale, and detail Bright, open, generously-scaled public spaces Homelike and intimate scale in patient rooms, day rooms, consultation rooms, and offices Compatibility of exterior design with its physical surroundings
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system.
Sustainability
Hospitals are large public buildings that have a significant impact on the environment and economy of the surrounding community. They are heavy users of energy and water and produce large amounts of waste. Because hospitals place such demands on community resources they are natural candidates for sustainable design. Section 1.2 of VA's HVAC Design Manual is a good example of health care facility energy conservation standards that meet EPAct 2005 (PDF 1.3 MB, 550 pgs) and Executive Order 13423 requirements. The Energy Independence and Security Act of 2007 (EISA) (PDF 740 KB, 310 pgs) provides additional requirements for energy conservation. Also see LEED's (Leadership in Energy and Environmental Design) USGBC LEED for Healthcare
Related Issues
The HIPAA (Health Insurance Portability and Accessibility Act of 1996) regulations address security and privacy of "protected health information" (PHI). These regulations put emphasis on acoustic and visual privacy, and may affect location and layout of workstations that handle medical records and other patient information, paper and electronic, as well as patient accommodations."
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EMERGING ISSUES
Among the many new developments and trends influencing hospital design are: The decreasing numbers of general practitioners along with the increased use of emergency facilities for primary care The increasing introduction of highly sophisticated diagnostic and treatment technology Requirements to remain operational during and after disasterssee, for example, VA's Physical Security Manuals State laws requiring earthquake resistance, both in designing new buildings and retrofitting existing structures Preventative care versus sickness care; designing hospitals as all-inclusive "wellness centers" Use of hand-held computers and portable diagnostic equipment to allow more mobile, decentralized patient care, and a general shift to computerized patient information of all kinds. This might require computer alcoves and data ports in corridors outside patient bedrooms. For more information, see WBDG Integrate Technological Tools Need to balance increasing attention to building security with openness to patients and visitors Emergence of palliative care as a specialty in many major medical centers A growing interest in more holistic, patient-centered treatment and environments such as promoted by Planetree. This might include providing mini-medical libraries and computer terminals so patients can research their conditions and treatments, and locating kitchens and dining areas on inpatient units so family members can prepare food for patients and families to eat together.
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MAJOR RESOURCES
WBDG
Federal Mandate Executive Order 13423 Technical Guidance Products and Systems Building Envelope Design Guide
Websites
See WBDG Health Care Facilities for generic health care facilities websites
Publications
Design Details for Health: Making the Most of Design's Healing Potential, 2nd Edition by Cynthia A. Leibrock and Debra Harris. New York: John Wiley & Sons, Inc., 2011.Innovative design solutions in key areas such as lighting, acoustics, color, and finishes Design Guide for Improving Hospital Safety in Earthquakes, Floods, and High Winds: Providing Protection to People and Buildings. FEMA, 2007. Development StudyVA Hospital Building System by Building Systems Development and Stone, Marraccini & Patterson. Washington, DC: U.S. Government Printing Office, rev. 1977. Emergency Department Design: A Practical Guide to Planning for the Future by John Huddy and Michael T. Rapp. Irving, Texas: ACEP (American College of Emergency Physicians) 2000. Healthcare Facility Planning: Thinking Strategically b y Cynthia Hayward, AIA, FAAHC, ACHA. Health Administration Press and the American College of Healthcare Executives, 2005. Hospitals, The Planning and Design Process, 2nd ed. by Owen B. Hardy and Lawrence P. Lammers. Rockville, Md.: Aspen Publishers, 1996. Hospital Interior Architecture: Creating Healing Environments for Special Patient Populations by Jain Malkin. New York: John Wiley & Sons, Inc., 1992. Healthcare DesignA quarterly magazine with design articles and presentations of recent projects Medical and Dental Space Planning: A Comprehensive Guide to Design, Equipment, and Clinical Procedures, 3rd Edition , by Jain Malkin. New York: John Wiley & Sons, Inc., 2002. Sound & Vib ration: Design Guidelines for Health Care Facilities by the Acoustics Research Council. 2010. UFC 4-510-01 Design: Medical Military Facilities See WBDG Health Care Facilities for generic health care facilities publications
Tools
SpaceMedGuide-A Space Planning Guide for Healthcare Facilitiesa popular planning tool providing state-of-the-art planning methodologies, industry benchmarks, and planning tips.
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