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ISSUE 2 2012

Licensed by International Media Production Zone


Supporting investment in the

regions healthcare infrastructure


The application of a suite environment can

provide a more operationally friendly facilty


Urban Planning

Equipment Planning

Simulation Modeling

Interior Design


Architecture | Interior Design | Equipment Planning | Technology Systems Design | Data Center Planning + Design | Urban Planning | Strategic Facilities Planning
Sustainable Design | Landscape Architecture | Branding + Wayfinding | Simulation Modeling | Facility Transitioning | Translational Research Planning

hospital build 2012 ISSUE 2 FOREWORD





Now in its forth year, the Hospital Build and Infrastructure Middle
East Exhibition and Congress will open its doors at the Dubai
Exhibition and Trade Centre from 4-6th June 2012. Just like this
magazine, the event is designed as a educational platform for all those
involved in the entire spectrum of non-clinical healthcare, including
planning, design, construction, management and operations of
hospitals and health facilities.
The current worldwide economic slowdown has had far reaching
effects and ripples are still being felt around the world in almost all
industries. However, the intrinsic robust nature of the healthcare
industry has softened the impact of the economic slowdown when
compared to other industrial sectors. This phenomenon is even more
pronounced in the GCC due to the welfare-styled, publicly subsidized
healthcare systems predominant in the region. In addition, though
compulsory health insurance is becoming more widespread here, its
share of total healthcare expenditure still remains low compared with
western countries.
However, in his article on page 38, Michael Lindell introduces the
idea that hospitals are becoming an endangered species, even here in
the Middle East. He believes healthcare is in a process of devolution.
The shift is from the major acute hub to community facilities in the
workplace, in the school, and at home. In addition, the evolution in
nanotechnology applications will facilitate the devolution of diagnosis,
treatment and care into the patient. Conditions will be monitored and
treated remotely, and if appropriate automatically, therefore reducing
the need for hospital-centred care in the future. How this region
responds to this change in the future remains to be seen.

ISSUE 2 2012

Jenna Wilson





Licensed by

How will healthcare be delivered in the future?
Turn to page 38 to find out

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Jenna Wilson
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Assistant Editor
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Advertising Sales Executive

Leslie Failano

Art Director
Mark Walls

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A roundup of regional and international news, developments and projects




Make sure you dont miss the regions most important hospital infrastructure
exhibition and congress taking place in Dubai on June 4-6th 2012


A Suite arrangement: The benefits of utilizing the suite allowances of the

Life Safety Code-2012 Edition




Learn about the latest developments in the regions healthcare sector by

attending Deloittes free presentations during Hospital Build Exhibition and
Congress next month

028 Electronic Health Records

The need for UAE to adopt national Electronic Health Records


The hidden problem - Health human resources in the eye of healthcare

facility planners


Are hospitals an endangered species?



Q&A with Lee Zebedee about the development of Building Information

Modeling (BIM) in hospital construction

KEC in deal for Madinah
medical project
The International Medical Center
(IMC) has signed a contract with
the Knowledge Economic City
Company (KEC) to set up a new
medical centre in Madinah. The
new centre will set new standards
in terms of infrastructure, services,
location and design.
mHealth will revolutionise
the future of care
The rapid emergence of mobile
health technology will revolutionise
future healthcare delivery and
management. mHealth has been
adapted to enhance healthcare
over the last decade, during
which it has become essential in
day-to-day life. The digitalisation
of medical information for
exchange demonstrates the key
changes taking place to attempt
to modernise the medical market
Mubadala Healthcare signs
MoU with DHA
Mubadala Healthcare and DHA
have signed a MoU to discuss
several key collaboration areas
that will facilitate knowledgesharing, partnership initiatives
and improved access to care for
patients in Dubai. The initial areas
for collaboration outlined in the
MoU relate specifically to three
of Mubadala Healthcares facilities
- Wooridul Spine Centre, Tawam
Molecular Imaging Centre and
National Reference Laboratory.
Saudi govt hospitals to have
separate rooms for patients
The Ministry of Health in KSA
has allotted SR700 million to
add 250 new beds to ICUs in
various provinces and regions. It
has also earmarked SR40 million
to transfer long-stay patients
with chronic diseases to private
hospitals. The plan is for future
hospitals to provide each patient
with a private room instead of the
current practice of putting four or
five patients in one room.


Healthcare infrastructure upgrade in UAE

brings management of hospitals into focus
According to Zawya
healthcare infrastructure in the
GCC is valued at more than
$10.2 billion. Industry experts
estimate that strengthening
healthcare infrastructure in
the GCC would boost overall
expenditure as well as per capita
spending through improved
services at new facilities.
GCC-wide plans for hospital
enticing big investors into the
region such as UAE-based
medical company DM Healthcare
who plan to grow their
healthcare units to 300 across
the Gulf and India by the end of
2015 with investments of $500
million. Alpen Capitals GCC
Healthcare Industry Report (Dec
2011) indicates that the UAEs
2011-2012 national budget
allocated AED3 billion for health
projects and services. The UAE

Sharjah to set up
healthcare city
His Highness Dr Shaikh
Sultan Bin Mohammad Al Qasimi,
Member of the Supreme Council
and Ruler of Sharjah, recently issued
an Emiri decree setting up Sharjah
Healthcare City (SHCC) as a free
medical zone authority.
As per the decree, the newly
established healthcare city will be a
corporate body, enjoying financial
and administrative independence
with full capacity to carry out its
legal practices.
The location and geographic
boundaries of the healthcare
city will be determined upon a
resolution to be issued later by the
Ruler of Sharjah.
It will be managed by an
administrative body, called the City
Administration, and will work under
the supervision of the Free Medical
Zone Authority and will be run by a
board of directors.


healthcare market is expected to

expand to 12.1% to $8 billion from
an estimated $4.5 during 20102015 while the number of hospital
beds is estimated to increase at
CAGR of 2% to 10,562 in 2015.
The report also states that hospital
infrastructure projects worth $5.7
billion have either been announced
or are in progress in the country.
What differentiates the UAE
from the rest of the GCC in terms
of its healthcare landscape is that
85% of the population is made of
an expatriate population. In order
to reverse the trend of patients
seeking medical treatment abroad,
relevant authorities must continue
to actively encourage more privatesector investment into the industry,
offer efficient and culturally sensitive
healthcare services, as well as
upgrade and expand on existing
medical facilities in the country,
says Dr. Malik.

Speaking as Chair of the

Excellence Congress, taking place
at Hospital Build & Infrastructure
Middle East 2012, Dr. Malik says:
There is a paradigm shift in the
way hospitals are constructed,
designed and managed today.
With new players coming into
the private healthcare segment
in the UAE, it is important that
healthcare services are provided
efficiently, with empathy, be
medicine and that healthcare
facilities embrace the tools
and techniques of effective
principles. The introduction of
mandatory Health Insurance
in most GCC countries means
that the demand for efficient
and cost sensitive healthcare
will increase exponentially
in the coming

American Hospital Dubai earns

record 5th JCI accreditation
The American Hospital
Dubai has announced its reaccreditation by Joint Commission
International (JCI), a subsidiary of the
American accreditation organization
which sets the standards for the
quality of healthcare organizations in
the USA. American Hospital Dubai
became the first hospital in the
Middle East and only the second
in the world - to be awarded JCI
accreditation in May 2000 and
successfully underwent further
surveys by the JCI in 2003, 2006,
2009 and now 2012, to maintain its
accredited status.
Joint Commission Internationals
latest on-site evaluation of American
Hospital Dubai took place on April
1-4th 2012 and was conducted by
a team of international healthcare
experts. The four-day survey

covered around 374 JCI standards

and over 1,200 Measurable
Elements were examined.
Mr Thomas Murray, CEO of
the American Hospital Dubai,
commented: We are delighted to
successfully undergo this latest JCI
survey because maintaining our JCI
accreditation is a continuation of the
quality journey and is only achievable
through the close collaboration of all
our physicians, staff and management
as we continue to expand and
develop our services. This JCI
survey was very extensive and
rigorous and we are very pleased to
report that the hospital passed the
inspection with a very high degree of
compliance across all JCI standards.
The result is a testament to the
strong teamwork at the hospital and
another notable milestone.

industry news


New mobile health category highlight of

2012 Middle East Hospital Build Awards
organisers of the 4th Hospital
Build & Infrastructure Middle East
2012 Exhibition and Congress,
has introduced a new category to
the upcoming 2012 Hospital Build
Awards. The m+Health Award
for the Best Healthcare Initiative
by a Telecom Provider is aimed
at recognising the use of mobile
technologies to improve health
care initiatives in the Middle East
whilst positively impacting the
bottom line across the range of
stakeholders in the healthcare
The new m+Health Award looks
at providers in the Middle East
region working to build capacity
and implement mobile health
(mHealth) solutions that address
the global healthcare challenges.
Middle Eastern governments are
spending vast amounts of money
on the construction of healthcare
facilities, and these facilities designed and developed using the

Winners 2011

latest specifications, designs and IT

infrastructure protocols - are ready
to adopt mHealth to increase
patient care, patient experience
and reduce costs.
With the advancement of
technology such as smart phones,
computing clouds, voice recognition
software, to just name a few, it
is only logical to see the market
advancement of mHealth solutions,
says Steven A. Matarelli, Chief
Operating Office, Administration,
Tawam Hospital, Al Ain and

member of the Hospital Build

Awards judging panel. Superior
healthcare delivery is fundamentally
based on information, timing,
decision-making, and consumer
involvement. Solutions in the arena
of mHealth products provide real
time experiences that enhance these
fundamentals to a great extent.
The Hospital Build Awards
winners will be announced on
the 4th June at the Hospital Build
& Infrastructure Middle East
Exhibition and Congress 2012.

Johns Hopkins Hospital Unveils Sheikh Zayed

Cardiovascular and Critical Care Tower
Johns Hopkins Hospital
has dedicated the Sheikh Zayed
Tower and the Charlotte R.
Bloomberg Childrens Center
as part of a new state-of-the art
medical complex, which covers
five acres in Baltimore, Maryland.
More than 1,000 people,
including many dignitaries, took
part in the dedication ceremony
at the facility, which includes 560
all-private patient rooms and
expansive adult and paediatric
emergency departments.
The Sheikh Zayed Tower
is the result of a gift from His
Highness Sheikh Khalifa bin
Zayed Al Nahyan, President
of the United Arab Emirates
(UAE), in honour the late Sheikh
Zayed bin Sultan Al Nahyan,
founder and first President of
the UAE. The Charlotte R.
Bloomberg Childrens Center
was donated by New York City

Mayor Michael R. Bloomberg in

honour of his late mother.
Representing the UAE were
His Highness Dr. Sheikh Sultan bin
Khalifa Al Nahyan, Advisor to the
UAE President, His Highness Sheikh
Zayed bin Sultan bin Khalifa Al
Nahyan, and UAE Ambassador to
the United States Yousef Al Otaiba.
Sheikh Zayed saw in Hopkins
not only passion for excellence and
innovation, but a shared commitment
to advancing the understanding and
treatment of disease. This shared
commitment is lived out today
in an active partnership between
the UAE and Johns Hopkins, said
His Highness Dr. Sheikh Sultan bin
Khalifa Al Nahyan.
The UAE and John Hopkins
have a long-standing partnership
dating back several decades. Since
the mid-1980s, Johns Hopkins
has provided specialized care to
thousands of Emiratis, including

Sheikh Zayed himself. Johns

Hopkins has also helped build
and improve overall healthcare
delivery in the UAE by assisting
with management and oversight
of three of the UAEs major
hospitals, Tawam Hospital,
Corniche Hospital, and Al
Rahba Hospital.
The Sheikh Zayed Tower,
offering a full range of
cardiovascular services, has 355
private inpatients, including: 224
acute care rooms, 96 intensive
care rooms and 35 obstetrics
rooms. The rooftop of the
Sheikh Zayed Tower holds the
helistop for patients who arrive
by helicopter. The tower will also
house advanced neurological
as well as transplant surgery,
trauma care, orthopaedics and
general surgery, as well as labour
and delivery.

Image Veolia Water

Optimal water purity guaranteed

Article provided by Veolia Water

Who we are?
ELGA LabWater is the global laboratory water brand name of Veolia
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Range of water purification systems

CENTRA for Centralized Distribution of Pure Water
The CENTRA range delivers the flexibility, reliability and economy
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MEDICA for Clinical Analyzers

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BIOPURE for Healthcare Applications
The BIOPURE range is compliant with the latest medical standards and
water specifications (EN 15883, HTM2030/2031, NHS MESc32, MDA/
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PURELAB for Laboratory Research & Testing Applications
The PURELAB range is designed to offer water purity to match specific
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ELGA representatives
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More info
If you want to find out more about these products, contact
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Alternatively, visit the website:


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Supporting investment in the regions healthcare infrastructure
By: Informa Exhibitions, Life Sciences

ealthcare construction projects are continuing across

the Gulf region, with a mixture of private, public and
joint-venture initiatives. The aim is to address the needs
of the patients, both local nationals and expatriates, and
reduce the number of people who are seeking treatment abroad. As
the demand for healthcare services within the Middle East continues
to rise over the next decade, backed by rapid population growth, an
ageing segment, and the prevalence of non-communicable diseases, the
demand for healthcare services in the MENA region will be maintained.
The Hospital Build and Infrastructure Middle East Exhibition, which is
due to take place for the forth year running in June, will bring together
investors, commissioners, backers and managers of healthcare building
projects along with suppliers in the best services in architecture,
planning, design and construction.
With most Gulf states developing many new hospitals and clinics,
the long-term aim is to promote medical tourism between Gulf States
rather than overseas, and also to attract patients from around the world.
This has resulted in huge investment across the entire value chain of
healthcare throughout the Middle East, from hospitals to primary clinics
as well as more specialised treatment centres and laboratories.

Hospital Build & Infrastructure Middle

East Awards 2012
The Hospital Build Awards 2012 will recognise leaders in the healthcare
industry who have devoted their efforts to building hospitals that help
improve healthcare services and raise the bar in providing world-class
patient care. They will act as a platform to promote the professionals who
have worked hard to achieve a hospital environment that enables and
promotes a healthy life. The awards will be presented at 11am on June 4th.

The award categories

Best Hospital Design Award (Built or Future)

Best Physical Environment Award (Built)
Best Sustainable Hospital Project Award
Best Healing Environment Award
Best Technology Initiative Award
The m+Health Award for the Best Healthcare Initiative
by a Telecom Provider

The Best Initiative to Improve the Design Standard of Healthcare Facilities


More info
To book at stand at Hospital Build and Infrastructure 2012, email More information about the entire
portfolio of Hospital Build events globally can be found on the website



Hospital Build and

Exhibition and Co
is taking place fro
4-6th June 2012


Conferences running alongside the
The Hospital Build and Infrastructure Congress will consist of eight leading
conferences designed as an educational platform for anyone involved across
the spectrum of healthcare facilities.
Healthcare Management
This years annual Healthcare Management Conference offers solutions to
all crucial challenges and areas to ensure the running of a hospital in a more
efficient and effective way.
Imaging and Diagnostics Management
This conference will assist medical imaging departments, both in the hospital
setting and outpatient imaging centres, to develop and implement strategies
and techniques that result in improved profitability, increased efficiency and
continued market growth.


To reg
ister fo
r one o
of the
r more
or call
4 3367

Leaders in Healthcare
Healthcare isnt about size; its about care. Do we really need huge hospitals or
should the focus align to specialised clinics? Either requires a framework, strategy
and vision to implement. This region is unique and its healthcare system needs
passionate overhaul. We cannot just let it replicate other healthcare systems
around the world. Therefore Hospital Build and Infrastructure has chosen
Leaders in Healthcare to address the pressing issues facing our region today,
creating a platform for solutions via debate and discussion on 6th June 2012.

m+ Health EW!
The Middle East is an innovative region, ahead of its times by far. While the
world works via text messages in the mHealth space, this region is focused
on remote monitoring, diagnosis and e-prescriptions. The pace is escalating
enormously via stakeholder support. To help us keep up with progress, the
m+Health conference is taking place on 6th June to discuss progress on the
strategy set at Arab Health back in January.
Surgery Management
Hospital Build and Infrastructures new Surgery Management conference
will focus on the most up-to-date technological advances that assist surgery
management professionals in navigating through the complexities of
efficiently and effectively managing their facilities operating rooms, surgical
team and equipment.
Hospital Design and Infrastructure
While demand for high level facilities is increasing as the Middle East strives
to become a world-class destination for healthcare, the Hospital Design and
Infrastructure conference will cover healthcare facilities design and construction,
and the challenges faced in this region.
Quality Standards and Accreditation
This conference will address the challenges faced by todays quality professionals
in healthcare and will offer a range of updates and solutions to build a quality
framework, address quality management across the healthcare industry and assess
current challenges in accreditation and reaccreditation. Furthermore, it is one of
a handful of events in the region that offers Continuing Medical Education (CME)
credits to all medical professionals attending.
Architects Congress NEW!
New for this year, this conference will address key challenges faced by
architecture professionals, focusing on the development and construction of
healthcare facilities. Even through the slowdown of new build projects, hundreds
of healthcare facilities have been planned and continue to be developed.

meets the demands of the healthcare Sector with its modular ready building systems
Article provided by PREKONS
All images PREKONS

REKONS, with more than 20 years experience, is the premier and

leading company of prefabricated construction systems in Europe,
Asia, Africa and South America. Today, PREKONS designs and
constructs high-quality, sustainable buildings with its design team of
architects, engineers and project team who are highly committed to their work.

Why modular-ready buildings?

Compared to the traditional methods, PREKONSs fast-track
construction approach can save up to 60% on the time required to
provide a new modular building. This leads to an earlier start of service
provision and return on the investment.
A shorter construction time is achieved by:
Enabling works and foundations to be prepared simultaneously with
off-site manufacturing and fit-out of building sections
95% of the construction takes place in a factory environment, eliminating
weather disruptions and lowering the risk of over-runs and delays
Construction processes are standardized and simplified due to the
repetition in the design of building modules
Greater quality control reduces the time spent on corrections and
Off-site construction allows less construction activities on site, fewer
deliveries and less on-site labour. All this leads to less disruption to the
operation of the existing hospital, school or business. Furthermore, offsite construction reduces the build time of the traditional development



schemes. This is achieved by out-sourcing the construction of complex

areas, such as operating theatres/laboratories/technical rooms, to be
built off site, whilst the main superstructure is being erected on site.

Modular construction is an environmentally conscious choice for the
construction industry.
With reusability of the modules, minimal site disruption and
waste, efficiency in materials, reduced environmental pollutants from
transportation and construction materials, and shorter build-time,
modular construction is more sustainable than traditional site-based
construction and is inherently eco-friendly.
Using dedicated teams, required equipment and materials, PREKONS
strategy of manufacturing within a controlled factory environment ensures
that the work is regularly inspected according to a quality assurance
regime. Combined with regular feedback this, in turn, leads to continuous
improvement. By maintaining the simultaneous off-site and on-time
production, the budget of the project becomes fixed. When you receive a
quote from PREKONS technical team that means it is a fixed budget.
It has been reported that only 63% of traditional building projects
are completed on time and only 49% to the agreed contract sum.
In contrast, over the years, more than 96% of PREKONS projects
have been completed on time and 94% on budget clearly exceeding
construction industry averages.

Transforming human waste management

with Vernacare
Article provided by Vernacare

n alternative,
friendly and time-saving
single-use system for human waste
management is now available from Vernacare, and is fast
becoming the system of choice around the world.
Used in over 50 countries and various hospitals including King Fahd
Medical City in the Kingdom of Saudi Arabia, City Hospital Dubai in
the United Arab Emirates, and in 94% of UK hospitals, the Vernacare
system is a cost-effective alternative that can help reduce the risk of
cross infection.
Offering a wide range of products, Vernacare manufacture singleuse bedpans, urine bottles, jugs, and an award-winning washbowl that
can be used with warm water and detergent. Once used, the medical
pulp products are then disposed of using the Vortex unit, therefore
eliminating the risk of cross infection. The products are manufactured
using clean, recycled, over-issued newspaper, along with a wax resin to
ensure products hold water for at least four hours. They also contain
no bleach or colouring and are similar in composition to toilet paper
when disposed of into the drainage system.
Compared to alternative systems, the Vernacare single-use system
delivers many benefits, including using 60% less water and up to 96.5%
less power. A 36% saving in operation costs can be achieved together
with an estimated 33% in time savings, allowing staff more time to
spend on patient care. The system may also support a reduction in
Healthcare Acquired Infections.*

More info
For more information on the Vernacare system please email info@ , visit or meet with us at Hospital
Build & Infrastructure Middle East 2012, Dubai, Stand Number RK34



The Vernacare Vortex is a hands-free system, which is opened by

placing the foot inside the foot well. The unique infection prevention
features include an automatic anti-bacterial deodoriser which cleans
inside the machine at the end of the cycle, and assists in improving the
sluice room environment.
The Vortexs robust twin-blade combines ease-of-use with fast
cycle times, reliability and outstanding environmental performance.
A self-diagnosing LCD together with a manual emptying override
makes maintaining the Vortex even easier. The Vortex incorporates
an industrial 3 phase motor ensuring the pulp and waste is completely
broken down.
Vernacare specialise in the design, manufacture and supply of
products to hospitals which help to reduce the risk of cross infection. An
award-winning organisation, established for nearly 50 years, Vernacare
provides single-use products for human waste management for patients
who are not fully mobile. All products are manufactured in accordance
with the highest standards and carry the BSI Kitemark. Over 140 million
mouldings are produced each year including the detergent-proof
washbowl, recently awarded the Queens Award for Enterprise.
* A 56% reduction in HCAIs was achieved using Vernacare disposable washbowls
alongside other interventions reducing Clostridium Difficile infection in acute care by
using an improvement collaborative, Power M et al, Salford Royal NHS Foundation
Trust, BMJ 2010;341:c3359

our values translate

in any language
Compared to alternative systems, the Vernacare single use system
delivers many benefits, including:

uses 60%
less water

uses 96.5%
less power

a 36% saving in
operation costs

estimated 33%
time saving

may support
a reduction
in HCAIs*

Vernacare specialise in the design, manufacture and

supply of products to hospitals which help to reduce the
risk of cross infection.
An award winning organisation, established for nearly 50 years,
Vernacare provides single use products for human waste
management for patients who are not fully mobile, together
with the Vortex disposal unit.
This system is a best practice method used in more than 40
countries worldwide and by 94% of UK hospitals.
Vernacare products are manufactured in accordance with the
highest standards and carry the BSI Kitemark. We produce
millions of medical pulp mouldings per year and have recently
won the prestigious Queens Award for Enterprise for our
detergent proof washbowl.

Visit us at
Hospital Build & Infrastructure Middle East 2012,
Dubai. Stand Number RK34.

* A 56% reduction in HCAIs was achieved using Vernacare disposable washbowls alongside other interventions reducing Clostridium Difficile
infection in acute care by using an improvement collaborative, Power M et al, Salford Royal NHS Foundation Trust, BMJ 2010;341:c3359

A Suite Arrangement:

The benefits of utilizing the suite allowances

of the Life Safety CodeEdition
By: Diana E. Hugue, P.E., Registered Fire Protection Engineer, Koffel Associates, Inc., Columbia, MD, USA





he application of suite requirements can be used to a

hospitals advantage in both existing buildings or for
new designs. The requirements for suites have been
somewhat perplexing in the past, due to lack of clarity
in code language and a lack of understanding of the advantages of
using suites. Once facility managers and designers realize how the
application of suite requirements can help them provide a more
operationally friendly space for the hospital staff while meeting fire
protection and life safety standards, they are quickly sold on the
usefulness of suites. Over the past 12 years, these requirements
have become clearer and more useful.
Chapters 18 and 19 of the 2012 Edition of the Life Safety
Code, NFPA 101 (LSC) discuss healthcare requirements and
permit three different types of suites: sleeping suites, patient care
non-sleeping suites, and non-patient-care suites. Each arrangement
has slightly different requirements due to the various occupants
served by them; and the different departments reap multiple
benefits from having suites used in their layout.

General benefits
From hospitals built in 1812 to those newly constructed in 2012,
no healthcare facility ever seems to have enough room for storage.
Utilizing suite provisions allows for storage in the circulating spaces,
which would have otherwise been considered corridors. The
2012 LSC requires corridors in healthcare to maintain 2440mm
(8ft) clear width. An exception is made for wheeled equipment
and fixed furniture meeting certain requirements. The circulating
space within a suite allows for greater flexibility though, permitting
non-combustible storage as long as 915mm (36in) of clear width
is maintained, per the LSC. Operationally, a facility may wish to
maintain 1220 mm (48in) or more for ease of moving beds and
other equipment. The storage must be limited to less than 4.6 m2
(50ft2). Any areas of storage greater than that must be protected
as a hazardous area.
Additionally, since the circulating space within a suite is not
considered a corridor, the walls and doors do not have to be
maintained as required for corridors. There are no requirements
for a fire-protection rating or smoke resistance for the walls and
doors within a suite. Doors are not required to self-latch and
actually are not required at all. Only the suite boundary must meet
corridor requirements for both walls and doors, limiting required
maintenance of the area.

Sleeping suites
Sleeping suites (see image 1) refers to a collection of rooms housing
patient sleeping, such as an intensive care unit (ICU) or coronary
care unit (CCU). Special nursing units like these tend to have an
open floor plan and a high staff-to-patient ratio. The LSC requires
constant staff supervision within the suite, with either direct visual

In short
The requirements for suites has up until now been confusing
due to the lack of clarity in code language and a lack of
understanding of the advantages of using suites
2012 Edition of the Life Safety Code, NFPA 101 permit three
different types of suites: sleeping suites, patient care non-sleeping
suites, and non-patient-care suites
Using a suite arrangement can allow for more storage space
on a ward.

supervision (with smoke detection in sleeping rooms that cannot be

seen) or smoke detection throughout required.
Prior to the 2006 Edition of the Life Safety Code, sleeping suites
had a maximum area of 460m2 (5,000ft2). Currently sleeping suites
are permitted up to 930m2 (10,000ft2) with special provisions.
Sleeping suites greater than 700m2 (7,500ft2) and up to 930m2
(10,000ft2) must have direct visual supervision throughout and
IMAGE 1: Patient Care Sleeping Suite (ICU)

complete smoke detection coverage.

Sleeping suites, 93m2 (1,000ft2) or less, are permitted to have
only one exit access door. The single exit access door must open to
a corridor or be part of a horizontal exit. Larger sleeping suites are
required to have two exit access doors, with one of the required
means of egress going to a corridor. For the second required
means of egress, the 2012 Edition of the LSC permits multiple
design options. The second exit access door can be to an adjacent
suite, an exit stair, an exit passageway, or lead directly to the
exterior of the building.
Earlier editions of the LSC regulated the number of intervening
rooms permitted in a suite. The 2012 edition has requirements
for travel distances in lieu of intervening room restrictions. To get
to the required exit access doors, a 30m (100ft) travel distance is
permitted from anywhere within the sleeping suite. A limit of a 6m
(200ft) travel distance is permitted from any point in the suite to
an exit.

Patient Care Non-Sleeping Suites

IMAGE 2: Patient Care Non-Sleeping Suite (Cardiac Catheterization Lab)

Many areas of a hospital are used as non-sleeping patient care

areas (see image 2). Operating rooms, emergency departments,
and radiology are all prime areas for the use of suite provisions.
Operationally, many surgeons prefer operating room doors
not to latch. Equipment and gurneys are frequently stored in
the circulating space outside of the rooms for easy accessibility.
Emergency departments tend to have curtained cubicles or rooms
with sliding doors. Overflow may require beds in circulating spaces
as well. Radiology departments frequently have open control
room areas, dressing rooms, and lead-lined doors that may not
have positive latching.
Patient care non-sleeping suites are permitted to be up to
930m 2 (10,000ft2) in size. Suites up to 230m2 (2,500ft2) are
allowed to have only one exit access door. The single exit access
door must open to a corridor or to be part of a horizontal
exit. atient care non-sleeping suites between 230m2 (2,500ft2)
and 930m2 (10,000ft2) must have two means of egress. Like
the sleeping suites, one required means of egress must go to a
corridor while the other may be to an adjacent suite, an exit stair,
an exit passageway, or directly to the exterior. Travel distance
requirements for patient care non-sleeping suites are the same as
those for sleeping suites.

Non-Patient-Care Suites
IMAGE 3: Non-Patient-Care Suite (Office space)

Non-patient-care suites (see image 3) would include any kind of

suite, which does not see patients, such as a collection of offices,
a multi-room pharmacy, or an area of mechanical rooms. Nonpatient-care-suites must meet egress requirements for their primary
use and occupancy. For example, an office suite would need to
meet business egress requirements, increasing dead-end and travel
distance limits over what would be permitted in a healthcare
occupancy. Being able to use egress requirements from primary
use and occupancy of the space allows for greater flexibility when
designing these areas.

The use of suites in your healthcare facility can greatly help facilitate
efficiency of departments and ensure the safety of occupants. Suites
can increase the ease of operations in a unit while decreasing the
time spent maintaining fire protection features. Whether youre
designing a new hospital or evaluating an existing building, suites can
be invaluable to your facility.



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Guidance and Design solutions for Internal and external doorsets
By: Elie Jaalouki, Country Sales Manager, DORMA


ORMA has successfully executed and completed the

regions well-known hospitals namely The Saudi German
Hospital, Dubai, UAE and Ruwais Hospital, Abu Dhabi,
UAE. For the Saudi German Hospital, DORMAs, in
association with its long-time channel partners Habib Trading Co.
LLC., state-of-the-art door solutions ranging from swing to sliding door
operators are used along with the ironmongery package. The 150-bed,
fully furnished hospital is owned by the Saudi Authority and Adnan
Saffarini are the design consultants. Ruwais Hospital, Abu Dhabi is a
100-bed specialty hospital which is furnished with DORMAs swing and
curved sliding doors. The hospital belongs to ADNOC and has been
designed by Kling Consultants.

Hospitals prefer automatic low energy doors in the interiors due

to hygienic and safety reasons. So, low energy doors are suitable for
disabled applications as they are slow in motion. DORMAs ES400
automatic sliding door system is customized for the hospital segment
with a reliable and powerful compact design. Due to the high operating
dynamics, the door operator provides a smooth operating behaviour
combined with excellent operating characteristics. In addition,
DORMAs swing door operates with a low energy capacity and can be
activated by a disabled person either by a push or sensor button. This
also has the provision of converting to full energy. This sets DORMA
apart with its unique product application in the healthcare industry.

DORMA products for Hospitals

Tailor-made solutions for hospitals


DORMA has many years of experience in providing solutions for

the healthcare segment. Each DORMA product is manufactured to
the highest standards for longevity, long-term value and compliance,
making it ideal for use within hospital establishments. The products
solutions from DORMA meet the performance criteria defined by the
Department of Health in each country and are also considered the
most suitable for the following areas:
Entrance doors
Fire doors
Escape doors
Security (locks)
Movable walls (acoustic, manual and automatic).

DORMAs entire range of door hardware locks, latches and handles have
microbial coating for hygienic reasons. DORMA has special doors for
hospitals with low energy operators, which enable smooth passing in and
out. In addition, DORMAs rest rooms for differently able with special key
switches, push buttons and locks enable easy access. Brailed lever handles
and ICU doors are some of the prominent solutions provided by DORMA
to the healthcare industry. Another great solution is the DORMA ES200
sliding door that can be used internally and externally, as single or bi-parting
sliding doors and can be telescopic and curved. It can be linked to an access
control system to restrict entry to authorized personnel only. The DORMA
CS 80 Magneo features a unique magnetic linear drive. It is virtually silent in
operation making it ideal for use in areas of patient care.



visit now

Visit Hospital Build & Infrastructure Middle East to see the latest clinical
solutions in healthcare such as hybrid operating rooms, intensive and
emergency care solutions, medical equipments and devices and many more.
Hospital Build & Infrastructure will also feature many non-clinical solutions
such as the latest innovations in security, building management, prevention
of hospital acquired infections, and facilities management which will all
effect the clinical services you provide.

To pre-register
your visit or
for more
information visit:

Organised by:

Hestia Facilities Management

Creating an environment that fosters healthcare excellence

Article provided by Hestia FM

One cannot stress enough the

significance of cleanliness,
quality air control, sterilisation
and all other support services
that contribute to the hospitals
overall environment




ost of us go to the hospital for treatment and expect to

be cured and return home safe and sound. Unfortunately
this is not always the way the story unfolds. If the healing
environment is not spick and span, the best medical
practitioners in the world could not prevent patients from the risks of
Healthcare-Associated Infections (HAIs). It is a much silenced fact but
surveys and data collections have revealed that HAIs are the fourth
leading cause of death worldwide. According to a report by economist
R. Douglas Scott, in the United States of America alone, HAIs claim
about 100,000 lives each year, costing the American healthcare system
between $30 and $40 billion annually.
Even if there is no clear and reliable data collection in this part of
the world, researchers have stated that figures regarding HAIs in the
Middle East, Central Asia and South-East Asia are staggering, with
proportions much higher than in any country of Europe and North
And the worst part is that most of these infections are preventable
and can be minimised, with just a little more care and focus on what
happens before and after treatment and operations.
With that in mind, one cannot stress enough the significance of
cleanliness, Quality Air Control, sterilisation and all other support
services that contribute to the hospitals overall environment. This is
where the facilities managers role is crucial and it is in this area that
Hestia FM differentiates by providing highest international standards.


On a global scale, the healthcare sector is changing, with a clear
increase in demand due to demographic, macro-economic and social
factors. Healthcare systems are thus facing emerging challenges with
ageing patients; a rise in chronic and lifestyle diseases which require
complex and costly treatments; fierce competition to retain not only
the best medical professionals, but also patients who are behaving
more and more like consumers, with ever growing needs, expectations,
and choices.
Whether it is reducing costs, increasing quality and safety or
enhancing their reputations; at the end of the day healthcare institutions
have new challenges and priorities, defined by their business and
political strategies and the economic environment. It is part of Hestia
FMs top priorities as a Strategic Partner to fully understand these new
parameters, to have a real impact on hospitals performances.
The bottom line question is often how to provide quality care and
control expenses at the same time? In recent years, many healthcare
providers across the globe have chosen to partner with industry
specialists such as Hestia FM, allowing them to fully focus on curing and
saving lives while the experts take care of the rest.


Hestia FM believes that it works to an organisations advantage to
offload a comprehensive group of services to a single provider. Case
studies have proven that having a single point of contact streamlines
the organisation, generates substantial savings and ensures higher
standards in service delivery, monitoring and reporting.
However this comprehensive model is not yet a common practise
in the Middle East. Healthcare facilities management is still very much
about cleaning floors and making sure all HVAC systems are up and
running; and such services are usually outsourced individually, to
different providers, with no consistency with regards to standards or
service levels. In some cases, these tasks are even self-performed by
handymen, who are neither trained nor specialised, and have to be

In short
The facilities managers role is crucial and it is in this area
that Hestia FM differentiates by providing highest international
Hestia FMs added value is measured through the impact on our
clients own KPIs
Hestia FM goes beyond expectations to create a unique
experience of quality care for patients, a reassuring stay for visitors
and better working conditions for medical staff.
monitored by the medical staff themselves, leading to overtime, stress
and an inevitable drop in efficiency.
This is why Hestia FM works closely with clients to design, manage
and deliver fully customised and comprehensive High Impact Solutions
that contribute directly to the operational and financial performance.
Each tailor-made solution follows a strict five-step cycle: Understand
needs, design the offer, implement solutions, monitor and deliver
commitments, improve and innovate.
These solutions add value by optimising the three principal assets of
a hospital:
People: by increasing satisfaction, motivation, and effectiveness
Processes: by enhancing quality, efficiency and productivity
Infrastructure and equipment: by improving utilisation,
reliability and safety.
Solutions are delivered to the highest standards and in compliance
with all statutory rules and regulations. Services are carried out in
a professional manner maintaining the good image of the Hospital,
ensuring a safe and optimised environment and supporting in the
achievement and retention of internationally recognised accreditations
such as Joint Commission International (JCI).
It is part of Hestia FMs commitment to clients to always be as
transparent as deemed possible: all services rendered are closely
monitored and reported periodically, highlighting all improvements and
compliance to the Key Performance Indicators (KPIs) and Service Levels
agreed upon with the client.
Also, Hestia FMs added value is measured through the impact
on our clients own KPIs, such as average patient transport time
from room to operating theatres, clinical equipment uptime, energy
consumption, JCI pass rates, etc.
So from people driven services like reception, cleaning, staff training
and processes managing patient transport, bed allocation, medication
distribution, all the way to sterilising surgical instruments, biomedical
engineering and clinical technology management; Hestia FM aims to add
value through total facilities management solutions tailored to positively
impact the overall environment of each healthcare institution.
Hestia FM goes beyond traditional expectations to create a unique
experience of quality care for patients, a warm and reassuring stay for
visitors and family members and better working conditions for medical
staff; i.e. improving the Quality of Daily Life for all who flow through
hospital wards.

Hestia Facilities Management LLC is a joint venture between the UAE
group Al Jaber and the French services company Sodexo, world-leader
in Quality of Daily Life solutions. Hestia FM is proudly participating as
the unique Healthcare Facilities Manager at this years Hospital Build &
Infrastructure Middle East exhibitions and conference, as official Gold
and Registration area sponsor.



Designing the Ideal Healthcare Environment

By: Ghassan Freiwat, Commercial Leader, Trane Middle East & Africa

opulation growth, ageing population and health risk factors

in our region will increase the demand for healthcare needs
in the coming decades. Rapidly developing technologies and
environmental policies are enabling and helping to define new
standards for healthcare facilities.
The blueprint for healthcare facilities includes several quality
expectations: precise environmental quality, efficient operations and
ease of maintenance. HVAC systems have a direct and significant
impact in all these areas.
Each subsection of the hospital is driven by patient and staff
comfort, infection control and disease management parameters. Indoor
air quality affects all aspects of a hospital.
HVAC systems must protect positive pressure of operating rooms,
intensive-care, nurseries and residential rooms. Many other environments
must be kept at a negative pressure for airborne-infection-isolation.
There are special ventilation requirements for autopsy, sterilization, and
soiled-laundry rooms, where all air should be exhausted to the outdoors.
Managing space airflow helps control the spread of infections. 8090% of bacterial contamination found in a wound comes from ambient
air. Proper ventilation and frequent air changes remain the primary
objective for a hygienic operating room.
As hospitals are open 24/7 and have extra commitments on air
filtration and circulation, cooling and waste management, they use
about 2.5 times the amount of energy as a similar-sized commercial
building. HVAC systems contribute almost 50% to a typical hospitals
energy consumption. Governments and other stakeholders are
challenging healthcare organizations to reduce energy consumption,
eliminate emissions and become sustainable.
Here are some design guidelines to drive energy efficiency and
Energy analysis software allows creating an accurate model of
almost any building to analyze energy use and estimate potential savings
Good control systems improve energy efficiency through
strategies that reduce energy use at part load and minimize system
fighting (reheat)
Air handling units dedicated to operating rooms. Each
operating room should be provided with one thermostat and

humidistat for precise temperature and humidity control

Building management systems provide the most
comprehensive means to control targeted areas, and are elaborate
systems justifiable for large, multi-disciplinary facilities, especially when
combined with other hospital controls
Mechanical design concepts can improve energy efficiency.
Properly controlled variable air volume systems can be used to
reduce the air rates during unoccupied time in operating rooms and
other areas
Proper HVAC insulation can reduce the cost of operating the
HVAC system
Focusing on the entire building envelope roof, walls, windows,
doors and floors is critical when creating a sustainable building
Service programmes will maintain system integrity and sustain
the overall investment.
Sustainable design that integrates system optimization strategies can
help save costs and realize return on investment.
Trane, a global provider of indoor comfort systems and services
and a brand of Ingersoll Rand, is a Silver sponsor of the Hospital
Build Middle East exhibition and congress. Learn more about
Trane Healthcare Solutions at stand #RM 30-3.
At the concurrent Architects Congress Maureen Lally, vice
president of strategic marketing for Trane, and Michel van
Roozendaal, vice president of services and contracting for Trane
in the Europe, Middle East, India and Africa region, will discuss
how HVAC design can improve facility performance and patient
Presentation Details
Session Title: Designing HVAC systems for Optimized Healthcare
Facilities and Improved Patient Outcomes
When: Monday, June 4, 3:15-3:45 pm
Where: Architects Congress, Dubai Exhibition Centre

The need for

UAE to adopt
Health Records
By: A. Tawab Hamidi, IBM Software Group Healthcare Leader, IBM Middle East, Dubai, UAE

Playing Russian roulette with your life

Imagine a resident/citizen of the UAE getting into an accident and is
in critical condition. The individual is rushed to the hospital, and they
immediately determine that the patient needs to be prepared for
an emergency operation. The healthcare providers face a daunting
challenge, as they dont have any patient medical history, nor are
they able to access any family member to get pertinent medical
information. The providers cant determine whether the operation
will have an adverse effect on other pre-existing medical conditions
(e.g. heart condition) or if the patient is allergic to certain anaesthetics
and antibiotics. Given the criticality of time, the providers are forced
to make a decision, which amounts to nothing more than playing
Russian roulette with someones life.
In the United States alone, it is
estimated that medical errors are
responsible for the death
of between 44,00098,000 people
per year, which is
quite a conservative
estimate. The UAE
is not immune to
these errors either,

In short
Introducing a national electronic health record system would be
an important tool to reduce medical errors
A national implementation of a electronic health record
system would give the UAE an attractive advantage in the
medical tourism market
A costly implementation could be off-set using a pay-peruse system and could also potentially bring revenue to the
Health Authority.



FEATURE Patient safety


and while it is acknowledged that medical errors exist within the

UAE, statistics are not available.
Achieving high quality of care and preventing medical errors
entail various measures, but one essential requirement is equipping
healthcare practitioners with patient related information, in other
words, full patient healthcare records. This is achieved by having a
Centralized National Electronic Healthcare Record System, more
commonly known as Health Information Exchange (HIE).

About HIE
Imagine going to a new clinic or hospital for the first time, whereby
the hospital automatically has access to your medical history, allergy
list, bio, etc. No need to file any more paperwork or conduct
medical tests that you have just recently done with another
provider. You meet a physician that already knows your medical
history, has access to your past and present lab results, images (CT
scan, EKG, MRI, etc), can read notes from previous doctors, your
medication list, operations you have had in the past and more. This
is the potential of a national HIE system that has been implemented
in certain nations around the world.
The HIE system ensures that all patient medical records
are centrally stored, which consumers, Health Authorities, and
healthcare providers (hospital, clinics, physicians, etc) can access at
any point (upon the patients consent of course) and subsequently
update appropriately (see figure 1). The concept is not new, and

As the UAE has prioritized on building a

state-of-the-art infrastructure, I contend
that having an HIE system is essential
many nations are pursing it with various degrees of adoption.
Some of the nations that have reached advance stages are Canada,
Singapore, and Australia. Smaller nations have an advantage when
it comes to adopting, as the numbers of integration points are far
fewer than larger nations.

Why the UAE should prioritize

adoption of HIE
This leads to my next point, as to why the UAE
should pursue the adoption of a national
HIE model with high priority. As the UAE
has prioritized on building a state-of-theart infrastructure, I contend that having
an HIE system is essential. Furthermore,
this would position UAE/Dubai amongst
the top nations/cities in the world in the
healthcare space. Among the numerous
benefits of an HIE system in the UAE, the
following are a few key ones:

Adoption of such a system would extensively boost the quality of

care provided in the Emirates
It will boost UAE healthcare reputation and attract people for
medical tourism as well as knowledge/skilled workers to reside in
the UAE
It will further attract businesses and investor to the UAE, from the
healthcare sector
Attract top-notch physicians/practitioners providing them avenues
of research by easily extending the HIE system. It has to be noted
that patient privacy is heavily guarded with all HIE systems, complex

information superhighway, is its extensibility to build additional value

added services on top of it (e.g. research), thereby providing stateof-the-art quality of care.
The system can easily be extended to provide physicians a
mechanism of knowledge sharing and collaboration on remedies and
treatment for challenging illnesses. For example; a patient with a specific
illness (Irritable Bowl Syndrome-IBS) can be matched using numerous
criteria against another patient, whereby physicians can be made aware
of certain treatments that have resulted into a positive outcome for
other patients.

The patient medical records residing centrally

in a cloud are only valuable if providers
continually update them as they see patients in
a standardized and auditable manner
algorithms exist to de-identify patient information and ensure privacy
Provide local universities ability to conduct research (ex. usage of a
specific diabetes drug and its effects)
With the continuous migration of expats into and out of the UAE,
their medical records can be provided to them or home country, as a
fee based service
Patients can have access to their medical records and further be
empowered (etc, update their bio, allergy list, etc).
The solution can be a cloud-based model, which all hospital/
clinics can easily connect to, and obtain/update patient medical
records, upon patient consent (with an audit trail running). What
is unique about adopting such an infrastructure, or a healthcare

Figure 1: Health information exchange



Of course, as with any good solution, it comes with certain challenges,
and in our case the following three challenges need to be remediated:
Financials, regulation, and ease of integration and adoption.
Financial Cost Model: Implementing a solution of this magnitude
can take years and incur a hefty cost, as it needs to be integrated with
every hospital/clinic in the country and fully adopted. While the MoH
can play a critical role as a regulatory body, shouldering the cost of
such an effort can be prohibitive for any health authority, thus it is
necessary to have appropriate cost recovery models.
A viable financial model that might prove to be feasible can

FEATURE patient safety

be a pay-per-use model. This model, in which the HIE solution
can be located centrally in a cloud and providers (hospitals/clinics,
etc), can access Health Record on a pay-per-use model upon
every patient interaction with the provider. The charge can be as
nominal as 1% of the hospital visit cost, which can be ultimately
charged to the patient/insurance. The time efficiency for both the
patient and providers alone would be worth far more than the
nominal 1% fee. While this will requires an initial investment, the
cost recovery can be reaped in a short time. This brings us to next
challenge, which is ensuring adoption of the system by each and
every provider.
If we are to take a very rudimentary stab it at, we are looking at
generating $45 million dollars per year with the pay-per-use model.
This is based on the fact that UAE healthcare market for 2010 was
estimated to be $4.5 billion dollars (which is expected to grow to $8
billion by 2015). This amount would be more than sufficient to pay for
itself, while at the same time generating business and improving the
quality of care.
It is important to note that the pay-per-use model rate of 1%
is just a random number at the moment, and proper calculations
have to be made to provide a more accurate understanding.
Also, after reaping the initial investment cost for the HIE, Health
Authorities can either lower the pay-per-use rate or use the
money to invest in value added services to further benefit patients
(e.g. research).
Regulations: The patient medical records residing centrally in
a cloud are only valuable if providers continually update them
as they see patients in a standardized and auditable manner.
Of course here in lies the greatest challenge of ensuring that
after each hospital/clinic visit, patient records are updated and
uploaded in the cloud accordingly by the caregivers. The role
of regulatory bodies (Health Authorities) to adopt stringent
regulations and measures are absolutely critical for this to work.
Regulatory bodies needs to tackle the issue at three levels:
Provide explicit and detailed information on usage of the HIE
cloud system (updating all patient information, lab
results, images, records, etc., along with time span allocated
for each update)
Stringent and incremental fines for delay of patient updates to
the system, while at the same providing monetary rewards for
providers that adhere to regulations. The monetary reward can
be a lesser charge for usage of the pay-per-use model (e.g. 8
AED per patient, whereby the provider can keep the
additional 2 AED)
Health Authorities need to pave the way and provide easy
means of adoption and integration for providers. The next
section will explain how this can be achieved.

importantly the IT vendors and service integrators need not be

paid by the Health Authority, rather they can get a share of the
pay-per-use cost that hospitals get from each patient. Hospital
can also be given the option of implementing themselves or pay
the IT vendors the cost of integration and keep the full pay-peruse charge for themselves.

There is unanimous agreement amongst healthcare experts
and analyst on the value and need of adopting a national
HIE model, and more importantly the solution is proven and
already implemented in some nations across the world. The key
challenges for HIE adoption resides in how it can be monetized,
localized, integrated and adopted with speed, all while taking into
consideration the population size, type of government, and patient
privacy laws. As in the case of the UAE, this article has aimed to
address the challenges of HIE adoption and how it can be adopted
in the UAE market.
By pursuing and achieving a national HIE model, the UAE will
be considered amongst the top quality of care providers in the
world. It would provide the UAE a stellar reputation in healthcare,
attracting medical tourists from the region, high-end skilled
workers, and top-notch practitioners (physicians/nurses). Given
the monetizing model, the cost would be nominal to the health
authorities (might even be a source of revenue) and would propel
economic growth and development of the nation.

References available on request (

Adoption and integration

Adopting and integrating clinics and hospitals to the central cloud
will entail extensive time and effort, and it would be a daunting effort
for any health authority to own, implement and roll out across the
nation. Thus an innovative approach needs to be taken to expedite the
integration and adoption of HIE.
Health authorities should focus on doing what they do best,
which is creating regulations and specifications for adoption and
integration of the HIE, and leveraging the free market enterprise
for the actual implementation. Multiple specialized IT vendors
or IT service integrators can work simultaneously to integrate all
providers and play an integral role in expediting this process. More

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Regional Office Middle East/Africa
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B/P49 Office Unit No. 401-402
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Phone : +971 (0)4 429 8510

: +971 (0)4 429 8508
Email :

The hidden

Health human resources
in the eye of healthcare
facility planners
By: Architect. Awn Sharif, M.A Healthcare Facility Planning, Doha, Qatar


Since many countries are investing in large healthcare facility
projects, the success and failure of their investment, whether
public or private, is a priority issue. Health human resources
(HHR) planners and health administrators need to be fully aware
of the healthcare facility planning and design process and all the
many phases involved. Especially the planning and design phases
since lots of the problems detected in operation are attributed to
omissions and deficiencies at that stage. Unawareness of the direct
responsibility to plan, and for the lack of HHR contribution to the
planning process, does play a major role.
The result is usually, especially when these healthcare facilities are
constructed under the pressure of irresistible political will, that these
facilities are located at unsuitable sites. Their services are inadequate,
no proper thoughts have been given to health human resources
availability and in some cases do not meet the real health problems,
ending with a costly capital and operational investment that does not
serve the purpose for which it was constructed.
Even though the shortcomings of such situations are often
discussed in healthcare services planning literature and publications,
and actions are taken to avoid such shortcomings, little
consideration has been given to the ones related to HHR planning,
especially in relation to healthcare facility planning and design.


There are a number of factors that could be considered as
being the opportunities and challenges facing the healthcare
field in the Middle East, North Africa and South Asia (MENASA)
regions. In recent years, the population of the GCC has grown
at an average annual rate of around 3.4%. The population of
MENASA is projected to increase 1.4 times by 2025. In the same
period, the GCC population is set to double. As life expectancy
improves and infant mortality rates drop, there is a need for
$250 billion in healthcare expenditure in the region, $60 billion
in the Gulf alone. This will lead to a further demand for highquality medical
In short
Health human resources planners must be involved from the
design stage of any healthcare facility project
Healthcare is a labour-intensive industry with on average 11.5
healthcare staff required for every 1,000 population
Applying Lean design principles to any healthcare facility is fast
becoming an essential tool in creating sustainable healthcare.





care across the region. The impact of the increasing number

of population and related healthcare expenditures will result in
increased pressure on public facilities, including healthcare, and the
need for the provision of more health human resources to fulfill
those needs.


Healthcare organizations in the US and worldwide are facing
significant staffing shortfalls. Data from the US Department of Health
and Human Services predict that by 2020, America will be short
of 24,000 doctors and nearly one million nurses. This is, however,
predicted by other sources to be even worse. A study sponsored
by the American Hospital Association shows a consistent trend in
staffing vacancies across all types of healthcare work. Consequently,
these shortfalls, - in the US and worldwide - of nurses, pharmacists,
technicians and other clinical workers have driven up salaries for
those positions, and the changing roles of physicians within hospitals
have boosted labour costs as well.


Healthcare has always been considered as a labour-intensive industry.
The total number of the practicing healthcare team members
(doctors, nurses, hospital pharmacists) per 1,000 population varies
from one country to another, ranging from 7.44 in Poland to 17.5 in
Ireland with an average of 11.5 across the world.
This means that using the average number of required staff
for a small country like Bahrain with a population of 739,000, a
total of 8,528 practicing healthcare staff are needed. The number
will be bigger for more populated countries like the Kingdom of
Saudi Arabia (population of 24,175,000) where 278,979 staff are
needed. This is not mentioning largely populated countries like India
(1,151,751,000 population) where 13,291,206 staff are needed.



Obviously, the numbers will be bigger considering the need for

healthcare staff worldwide and the ever-growing rise in population
in the MENASA region.


The increasing healthcare demands generated by the growing
population and the shortage of healthcare professionals worldwide
have driven up healthcare expenditures, and salaries resulting in
increased labour costs in a way that wages, salaries and benefits
accounted for 35% of the growth in healthcare expenses between
2004 and 2008. For the US hospitals, the total labour expenses
accounts for about half of hospital operating costs making it the largest
single driver of operating costs in the healthcare industry, which is
considered one with the highest median percentage of salaries.

The issue that generates 50% of the healthcare facilities operational
costs is often neglected, or not taken into account properly during
the healthcare facility planning process, it is almost always left until the
end of this process - the commissioning stage. The facilitys structural
organization and the physical/spatial interpretation need to be
considered in the early stages and HHR planners need to be present
right from the planning stage as their decisions will, to great extent,
impact the output facility performance, efficiency, waste, capital and
operational costs. In addition, the absence of HHR planning and proper
consideration of the facility organization structure in HR terms during
the planning stage will affect many aspects. Vice versa, the multiple
structural variations that organizations could take on at a later stage
after the facility is provided, would in return affect the way healthcare
facilities are used. A mismatched facility results in high capital and
operation costs and waste of precious human and financial resources
that are extremely important, especially in economic downturns.




The provision process of a healthcare facility covers the entire

working process from assessing the need for the facility, to the
successful use of it. It consists of many interdependent activities that
could be grouped into four consequent stages: Planning, design,
construction and commissioning.
Even though all are important, clearly the most crucial stage is
the development of the planning stage. It is the time where all main
decisions are taken regarding the best ways to use financial, manpower
and facility resources. Once the construction stage starts and funds are
being rapidly utilized, it is very difficult to alter the size and the shape of
the healthcare facility.

According to the Top 10 health industry issues in 2010 presented

by PWC: The recession has pinched budgets, and both new and
existing players are examining the value they bring to costumers.
The potential of saving multiplies as the industry converges,
squeezing out inefficiencies and duplication. Health leaders must
look beyond their own organizations and figure out how they can
benefit by reducing costs elsewhere in the value chain.
Health human resources planners, healthcare facility planners
and architects should really try and think outside the box and
figure out how they can benefit by reducing costs elsewhere in the
value chain of the health system. Two way of doing this is by:



Integrating HHR in healthcare facility planning

As a major component of any national health system, infrastructure

work together and affect all other healthcare system components.
Inaccurate health service and facility planning drive human resources
planning in the wrong direction causing financial losses, inefficiency in
the provided care and wasted HHR efforts investing and looking in the
wrong direction. How healthcare facility planning impacts on human
resource planning could be identified as follows:

Opex impact
Healthcare planning and design have a considerable impact on
Healthcare Facilities Operational Expenditures (OPEX) of the ongoing
cost for running the facility, and also the Capital Expenditure (CAPEX),
meaning the cost of developing or providing the facility.
In general, there are many ways in which human resources are
influenced by healthcare facility planning, design and construction,
and could automatically imply a staff increase of 10%, 15% or even
higher than they should have been. Consequently, if the staff number
increase due to inappropriate facility planning and design, and if the
operational budget is not sufficient, then the facility will be understaffed,
undersupplied and underutilized.

Activity flow impact

Healthcare facility planning and design, when not coordinated with
health human resources planning and talent management processes,
could lose significant business advantages with:
Lower revenue per employee
Higher turnover of lower performers
Significantly unimproved ability to develop leaders
Scattered organizational structures and functions
Increase duplicative administrative systems
Increase interruptions, delays within the process
Misuse of time and resources
Workload calculations and increasing labour cost by misuse of time
and resources
Increasing the use of staff.
Therefore, imposing an organizations structure on an existing
healthcare facility would be a daunting managerial task, and the
immensity of such a project is, at least partly, responsible for why
organizational structures frequently fail. The scope of the problem
is even bigger when understanding the international new trends
in the healthcare industry. Consolidation and creating huge global
corporations through joint ventures, mergers, alliances, and other
kinds of inter-organizational cooperative efforts has become
increasingly important in the 21st century, e.g. outsourcing some
services within a healthcare facility and the associated space and
staff needs.

The responsibility for taking actions, or making decisions concerning the

integration of health HR planning with the whole process of general
healthcare planning for any healthcare facility in particular should be
clearly understood as it has a direct impact on:
The healthcare models that should be redesigned to meet the
expected work force shortage
The operational cost of healthcare facilities that could reach up to
50% of it
The approval or rejection of a healthcare facility project
Healthcare facility planners and designers who dont consider the
possible unavailability of workforce for the facilities they are planning for.
When human resources and healthcare facility planners are
closely involved in the planning and design of healthcare facilities
within a multi-disciplinary planning team, including health human
resources planners, buildings will be planned, designed and
constructed to simplify the work process, making it more time
effective and requiring less staff to operate.

Squeezing out inefficiencies and duplication

Healthcare planning and design improvement could be achieved by
the implementation of Lean principles with healthcare planning teams,
which has proven that it can improve:
Turnaround times
Efficiency and productivity
Staff morale
The adoption of Lean principles is fast becoming the
premier strategy for responding to the worlds healthcare
crisis. Using Lean methods to improve quality and safety while
eliminating waste are showing dramatic, sustained benefits when
applied to healthcare. The core of Lean techniques include:
Eliminate, combine, simplify and sequence and is based on
eliminating waste and providing value for the customer while
only consuming the fewest possible resources. From a current
state map for a function and by implementing Lean techiques,
it will be possible to identify where the significant problems in
healthcare delivery occur.
The most prevalent problems are most likely to be waits and
delays, with the largest amount of work in the progress between
process steps or where there is considerable duplication in the
work flow.

References available on request (



Opinion Hospital development


Are hospitals
an endangered
By: Michael H Lindell, Strategic Planner, McMullan Solicitors,
Melbourne, Australia


In short
The function of a hospital has changed a lot in the past centuries
and will only continue to do so
The hospital as a system must be ready to adapt and respond
to changes in the market, technology, demographic and economy
Hospitals as care hubs will change as technology advances
and allows patients to be diagnosed, treated and cared for in
their homes.

In 1838 Charles Darwin, after thorough investigation, conceived his theory

of natural selection. In his remarkable book, On the Origin of Species,
he opened up the dynamic interaction between an organism and its
environment. His focus was particularly on the way animals changed, changes
that sometimes assisted in coping with environmental pressure, sometimes
they did not. Often there was no effect. Emerging from this analysis came
the concept of The survival of the fittest. Creatures suited to environmental
navigation prospered, those not suited, struggled or died out. I believe this
thinking is absolutely relevant to the history and evolution of hospitals. While
hospitals are not animate, in many ways they behave as if they are.
The word hospital is derived from the Latin hospes - the guest or the
host. We tend to imply that the function of a hospital is relatively constant.
This is absolutely not the case. The function of the hospital has changed
many times and often over the last 7,000 years. Hospitals have been created
usually as a response to a compelling external imperative. At times the need
was medical, religious or social, at times military and political. It was not long
before commercial and risk management pressures transformed hospitals
motivations and aspirations. Hospitals thus have been designed as very
different vessels:
Care centre
Hospitals have emerged as a reaction to a need, identified by persons
of influence, this has resulted in a turbulent history. I believe hospitals
have always been endangered and will remain so. The environment
within which the hospital exists has always been changing. Now
however the rate of change is much, much faster and still accelerating.
So, if hospitals are to remain as essentially reactions to emerging
pressures, their future is precarious.
The challenge now is to, as much as is possible, anticipate change
and also prepare for the inevitable chaos of change. The hospital as a
system must be ready to adapt, to respond. This approach calls into
question the historic reliance on a brief of certainty. A brief will always
be required but it must be balanced with a crucial penumbra. In this zone
there must be identification of possibilities and even surprises and I believe
the navigational approach should be adopted to the development of
complexes and systems, and remain responsive.

Early in Greek history, hospitals emerged as Halls for Dreamers. Patients
rested and were cared for by physicians who were also

While hospitals are not

animate, in many ways they
behave as if they are
priests, these individuals interpreted patients dreams. From this
understanding an approach to care was developed. It is fascinating that
the patient was the source of direction, as in more recent centuries
we have come to rely much more on the direction given by qualified
carers. The patient may yet re-emerge as a key player in evolving an
appropriate care approach.
In Roman times new treatment settings developed, physicians cared for
soldiers, orphans and the impoverished. Clearly these hospitals were serving
a social purpose. Logically the care extended from the living to include the
dying. The emergence of Christianity significantly changed the direction of the
hospitals evolution, the focus was now on the soul as well as the body. This
spiritual care was not interventionist but more supportive in character, the
care settings ranged from asylum, to refuge, to spiritual sanctum.
In Eastern Europe regional care networks developed supporting
residents and travellers, in this context specialist facilities emerged.
Cities were the logical places for such hospitals and substantial
complexes quickly grew. These overcrowded and unhygienic settings
were care places of last resort, they were sad, desperate and
dangerous places. Hospitals had become warehouses for the cast-offs
of society. The Order of St John developed civilian and military hospitals
for the poor and for the crusaders. These facilities generated innovation
in research and training and helped develop physiological understanding
on which future care would be based. Hospitals sprung up quickly to
meet the pressing demands of care for leprosy and plague patients. As
the demands fluctuated, the role of hospitals changed.
In France some hospitals even became prisons, and prisons became
hospitals. Hospitals were considered dangerous and even the generators
of poverty. Hospitals often remained part of religious settings, in this
context gradually hygiene standards improved, as did diet and anatomical
awareness. Teaching, research and observation began the medicalisation of
hospitals. In the 18th century more secular and scientific settings emerged hospitals were dramatically transformed with the developing understanding
of anaesthesia, sterility and infection. Surgery eventually became
integrated into treatment programmes and hospital buildings
emerged to offer better ventilation, sanitation and observation.
Florence Nightingale was a major force in making
hospitals a safer place. In recent decades highrise buildings developed as part of hospitals
becoming shrines to technology. Specialities
were a logical extrapolation of this
growth. These spectacular political
statements were expensive to run
and before long medical aspirations
were modified to meet economic
and risk management constraints.
The hospitals evolution has been
turbulent and extravagant. To date
hospitals have been reactionary,
they have served many masters,
medical, spiritual, economic,
insurance, political and
even patients.



Today I think we are in a precarious position. We have a catchment
now, which has exceptionally high expectations for every facet of its
healthcare. Demographic shifts have skewed the population to be older
and inevitably more demanding of services. The costs associated with
healthcare delivery are rising significantly. The existing institutionalised
model is outmoded and intrinsically expensive to operate and maintain,
as often a massive, complex aggregation it is formidably difficult
to modify. Collateral damage and disruptions associated with such
alterations are often extensive and risky. A major part of the recurrent
expenditure associated with todays structures, are people costs. The
development of super-specialities is exacerbating this trend. There is now
ominous evidence that many of todays medical edifices are not safe
places. Infection control is proving to often be an intractable problem.
It is interesting to recall Florence Nightingales writing on nursing where
she made rule number one - Do the patient no harm. We thus have a
dilemma emerging - should we bring vulnerable patients and their families
into highly sophisticated, yet dangerous settings? Keeping these places truly
safe is becoming more difficult. Todays hospitals reflect momentum from
earlier eras, understandably they involve entrenched practices, which
in todays care environments are often extravagant, inappropriate and
unresponsive. In this atmosphere there is now injected a
developing commercial imperative, sometimes
expressed in terms of cost-control,
sometimes in terms of profitability.
This focuses attention on
the care of older people.
A high proportion of
inpatient beds are
occupied by older
patients, often

Opinion Hospital development

for long-stay treatment, this is an extravagant way to care for this growing
population and as a consequence, care for other patients is limited. The
character of care is now changing. Diagnostic precision has advanced to a
level where surgical interventions can be much more thoroughly targeted
and thus less exploratory in nature. This has led to a significant reduction in
patients stay and to the creation of short-stay facilities. Other less invasive
procedures using sound, catheters and keyhole approaches are accelerating
turnover. This trend is lifting the numbers being treated and making access
even more important. Historically major hospitals have grown in the heart
of large cities and their growth often results in complex campus structures.
Access too often is tortuous and intimidating. The essence of the hospital
conundrum is that our wants are significantly greater than our healthcare
needs. The resources available to address such needs are often insufficient.
It is not a politically palatable strategy but rationing is happening now and
will become a more and more pervasive part of healthcare delivery. The
interesting issue will be the rationale behind decision-making - is it welfare,
economic, risk mitigation or political appeal? Political attention too often is
focused on the dramatic and superficial rather than the logical and prudent.
Hospitals of today, to a significant extent, are mirrors of other eras.
Challenges are presented to develop new approaches to the timeless issue
of appropriate healthcare.

The Sword of Damocles in hospitals evolution is change. When
the pace of change was glacial, planning could move in a thorough
predicable and careful manner. The pace of change today is rapid

Mr Lindell is speaking on this subject at the Architects Conference
as part of the Hospital Build & Infrastructure Congress running
from 4-6th June 2012. To find out more about the conference
and how to book your place as a delegate, visit the website www. or call +971 4 336 7334 or call +971 4 336 7334.
and is accelerating. Planning must be radically different and it should
be predicated on creating the capacity to cope with the certainty
of change. Massive consolidated aggregations are not suited to such
thinking. This challenge calls into question initial siting. It really would
make more sense to create facilities on open sites outside city centres
where space is allowed for future developments to be woven into a
complex without massive dislocation and disruption. To maintain the
continuing humanity of such a complex it may be prudent to create a
tranquil courtyard as a sanctum at the heart of a complex or village.
Thus with turbulent activity around, the identity and stability of the
structure would be sustained.
Healthcare is in a process of devolution. The shift is from the major
acute hub to community facilities into the workplace, into the school,
and into the home. The evolution in nanotechnology applications will
facilitate the devolution of diagnosis, treatment and care into the patient.
Conditions will be monitored and treated remotely, and if
appropriate, automatically. Site-based care is being
eroded, and developed outreach approaches are
proliferating. Such initiatives will allow older patients
to be released from acute centres and returned to
home, but they must be supported at home. There
will in the short-to mid term be an escalation in
those older patients with Alzheimers and care
environments must enable such individuals to
be safely housed without extravagant reliance
on trained staff. The economic pressure on
healthcare delivery will demand patients and
their care partners assume much greater
control of care delivery. This will often involve
device or system support, helping patients
care for themselves. The pervasive digital
interactivity of this millennium will
allow such care autonomy to
be supported. Clearly urban
structures should be part
of a truly prosthetic living
environment. The future will
contain surprises they may
be technological, commercial,
social, medical, military or
political. The atomised
hospital of tomorrow must
be responsive as a facility, as
a network, as a village, even
as an attitude. Hospitals are
an endangered species and
will remain so. They must be
taught to anticipate, not just
react. They will reflect our
vision if we dare to have


Lee Zebedee
BIM Manager, Ramboll, Dubai, UAE

With 20 years experience at Ramboll, Mr Zebedee

has been instrumental in the practices adoption of
3D modelling. Hes currently the manager of the
Building Information Modelling (BIM) capability,
and has recently been heavily involved in the
development of Rambolls Laser Aided Modelling
(LAM) process. Ramboll is an engineering, design
and consultancy company founded in Denmark
in 1945. Today the Ramboll group employs close
to 10,000 people with 200 offices in 21 countries
and has a significant presence in Northern Europe,
Russia, India and the Middle East.
Rambolls experience in the healthcare field
helps their hospital and healthcare customers
modernise and optimise their facilities. Ramboll
knows how the hospital sector operates and can
offer customers the skills needed for the design,
construction and operation of all types of hospital,
pharmaceutical, and healthcare sector buildings.

Q. What is BIM?
A. There is a wide range of definitions of Building Information
Modeling (BIM), most of which struggle to succinctly capture the
real essence of BIM. At its best BIM is the process of collaboratively
developing an accurate digital prototype of the built asset. This
digital prototype should be data rich, offering a wide range of
benefits to all stakeholders throughout the whole life of the asset.
There is a tendency for BIM to be seen as a tool for construction,
but for the enlightened the real benefits comes in the long-term
operation of the building. This should not be limited to the asset
management; it should also be considered as a tool for all aspects of
the use of the building.
The BIM model for construction should be built with embedded
data that can be harvested and built on by the various stakeholders



to enable their wide ranging needs to be met.

Although working in 3D can offer major benefits
in achieving this outcome, BIM models should not
be misunderstood as just being 3D models; the
embedded data is key.
Effective BIM working requires a cultural mind-set
change by the construction industry, clients and building
operators to realise that early, close collaboration brings
significant, mutual benefits.
Q. Why is BIM particularly suitable for healthcare
A. Most healthcare facilities are heavily serviced, heavily populated
buildings. This means that the better the building is understood,

Q&A Ramboll


Lee will be speaking on the subject of The role of BIM in delivering
modern healthcare facilities at the Architects Conference running
alongside the Hospital Build & Infrastructure Exhibition in Dubai
on June 4-6th 2012. Lees presentation is part of the session on
Present and future of healthcare architecture II on June 5th. To
find out more about the conference, or to register your place as a
delegate, please visit the delegate zone on the website: or call +971 4 336 7334.
the easier and less disruptive the operational maintenance becomes.
This requires accurate, reliable data about the equipment and services
within the facility. Effective BIM models deliver such information.
Certainty of delivery and operations enables improved, more
cost-effective healthcare provision and less disruptive maintenance.
Our experience proves that a collaborative BIM approach allows the
building detail to be developed and communicated more effectively
leading to improved coordination and quicker delivery.
An accurate, well structured, easily accessible, digital record of all
parts of the building (i.e. a BIM model) can prove an invaluable way of
providing the above objectives. For example, if a maintenance engineer
knows exactly what and where everything is, repair and maintenance
becomes easier and more certain. If virtual maintenance checks are
carried out before construction then the risk of key maintenance being
needed in clinical areas is reduced.
In summary, healthcare facilities need to be operated and maintained
in a manner that minimises impact on clinical activities. Virtual prototyping
and accurate asset recording using BIM can help this happen.

Q. Whats the potential for BIM in medical equipment

A. A BIM model allows virtual prototyping of a built asset. This can
extend to the planning of the full fit-out and operation of the building,
including issues such as how and where equipment is sited and how
it will be operated. This gives a full picture of where each piece of
equipment is serviced.
The potential benefits of having this BIM information on the medical
equipment linked to intelligent maintenance software are significant.
Having certainty of information in an intelligent medical equipment
management tool will improve the reliability and effectiveness of clinical
Q. How can BIM help in keeping financial control of a
A. The most effective way of controlling costs is to have certainty of
what works are being carried out and when. Using a data-rich BIM
model to accurately prototype the whole delivery process will deliver
this certainty. Surprises cost money.
If the BIM model is accurate and well coordinated, then onsite
clashes will not happen. By building the project first in a virtual BIM
environment, any risks with the actual construction can be spotted
before works start on site. Having confidence that each part of
the project can be accurately scheduled enables accurate pricing.
Contractors do not feel they have to add costs to cover risks.
Continuous financial control can be achieved through using a BIM
model to track and monitor the works. This can be a very detailed
plan relying on good quality data embedded in the model reducing
manual input. This cuts down on the risk of human error if the
meddling process is effectively monitored using tools such as Solibri
and Navisworks.

All images Ramboll

This is a project for Birmingham City University where Ramboll are the structural
engineers. It is a fully coordinated model with input from the architect, the M&E
Engineer and Ramboll. The name of the project is Birmingham Institute of Art and
Design (BIAD)

Q. How will BIM develop in the future?

A. The more data BIM models start to contain then the greater
the benefits to all project stakeholders. At present the main focus
in BIM has been in developing coordinated 3D models with some
embedded information for construction. The construction costs are
generally only a small part of the whole life operational costs. Hence,
as BIM modelling matures it will become more useful in the entire life
of the asset. Improved engagement of operational teams in briefing
construction projects will follow.
This will require closer collaboration of the whole project team
in the building of the model. This will mean the boundaries between
disciplines will become more blurred as collaborative building of a
model develops. Better models will enable commonplace activities
in manufacturing industries, such as prototyping and automation, to
become the norm in construction.
Q. Evidence-based design and BIM whats the relationship?
A. A virtual prototype can be used to model the true behaviour of
an object rather than having to rely on code based assessments of
structural and fluid behaviour. This allows the subtleties of the actual
shape and form of a building and its environment to be accurately
modelled rather than having to simplify the forms to allow codebased design to be applied. The accurate geometry that BIM models
provide enable this performance based approach to be used within the
construction information.

Pembury Hospital, UK

LIFE Sciences Magazines

+971 4 336 5161



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Key topics includes:

Green Building: Energy efficient construction

Complexities of designing healthcare facilities
An update on construction requirements and regulation in the region
Regulation of sustainability across the Middle East region
Design of smart hospitals for improved work efciency
Current techniques in Evidence-based design


Organised by:

Efficiency and Economy are

the Result of good Planning
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In intensive collaboration with ENT specialists, we have created a new, ergonomic surgical
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OFFICE1 1/02/11/A-lb

We optimized the indispensable computer workstation and the paths to the microscope,
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KARL STORZ GmbH & Co. KG, Mittelstrae 8, 78532 Tuttlingen/Germany Telephone: +49 (0)7461 708-0, Fax: + 49 (0)7461 708-105, E-Mail:
KARL STORZ Endoskope East Mediterranean and Gulf (Offshore)., Solidere Beirut Souks, Block M, 3rd Floor, 2012 3301 Beirut, Lebanon,
Phone: +961 (1) 999390, Fax: +961 (1) 999391, E-mail: