Hospital Design Tips

Designing a hospital is a much more complex and drawn out process than, say, designing a shopping mall or a hotel. To give you an idea of what is involved and the extent of details that have to be encompassed; we will discuss some of the components contributing to the complexity of this process. The design process of a hospital involves all of the following activities but is not necessarily limited to them:

1. One of the main considerations before embarking on the process is number of specialties that are required in the hospital;
2. What departmental interdependence (such as imaging department to be accessible by most departments but in close proximity to A&E and some outpatient clinics) is required?
3. The sheer number of services required, such as medical gasses;
4. The co-ordination required between the lead consultant (usually the architects) and M&E, structural, and specialist consultants such as the Radiation Protection Advisors, local authorities, fire brigade, infection control to name but a few;
5. What studies and surveys are required prior to commencement of the hospital design process;
6. Whether the hospital project will be built on a greenfield site, demolition is involved or if an existing hospital has to be re-developed;
7. Consideration of legal aspects & legislations, building regulations, health service technical memorandums;
8. Consideration of environmental legislations and changes in environment, weather and temperatures;
9. Consumerism issues;
10. Disability issues;
11. Safety and security – from terrorism to safety of drugs in pharmacies;
12. Hospital Personnel/Staff safety ;
13. Aspects dealing with safe usage of dangerous drugs, gasses, radioactive substances and the like as well as their safe disposal;
14. Recycling/Incineration issues;
15. Day to day hospital infrastructure and equipment maintenance issues;
16. Access and egress of big ticket medical equipment – you can bring in and assemble and install a large piece of kit such as a CT scanner during construction but after the hospital is built how will you take it out of the hospital when it needs replacing;
17. Services that each different piece of medical equipment requires – power (single or 3 phase, what amperage, socket or spur, UPS, IPS), data (RJ45, broadband), & medical gasses;
18. Structural requirements for walls, ceilings and floor – such as a theatre lights and pendant hang by the ceilings, or ultra clean canopy in orthopaedic theatres is fixed to the ceiling. The weight of heavy equipment such as burns bed needs considered to reinforce floors.

Having considered all the above mentioned aspects of hospital design, the process kicks off with a brief from the client. The brief for a hospital is actually not brief by any means. It can easily run in to several hundred pages going into such detail as types and number of clinical and non clinical rooms, department and room adjacencies and description of functions performed in each room, its critical dimensions, and main equipment requirements.

In traditional contracts, a firm of architects and health planners who have experience of designing hospitals, will lead the project on the client’s behalf and will employ the main contractors including the building firm. In the UK the building contractors employ the architects and other main contractors and consultants, under Private Finance Initiative (PFI) schemes.

We will consider the hospital design process as followed under PFI schemes in the UK for the purposes of this article. Note that this article is aimed to provide an approximation of the process. The process can change and various steps can be performed in different sequences.

The building contractor employs the firm of architects to translate client requirements into a practical design proposal that involves the building shape, 1:500 scale floor plans showing the shape, size and locations of all the required departments, rooms, corridors, clinical, non-clinical and support rooms such as risers, hubs, stairs etc. These are developed over months in close consultation with the client. The shapes, height, looks of the buildings have to be in keeping with its location, and compliant with the local regulations, and approved by local council and fire brigade in addition to others.

Once this high level design is agreed, the process moves on to 1:200 scale and later on to 1:50 scale drawings, showing furniture, equipment and services outlets for each room showing the plan layout (as if you are looking at the room from the top). It is prudent to also draw and review room elevations of heavily loaded rooms and specialist rooms such as theatre suites and High Dependency Units (HDU). This will help avoid any clashes of equipment with the fixed joinery, service outlets and fenestrations such as windows.

The drawings are augmented by a document called Room Data Sheets. This document provides detailed design, engineering, equipment, fittings and fixtures information for each room in the project. The data behind the room datasheets later provides invaluable information when its time to develop production design and later when the commercial department goes out to tender and procure everything from the light switches to the Magnetic Resonance Imaging (MRI).

Up until the 1:50 drawings and datasheets are developed, the end users / clinicians involvement is limited and ad-hoc. Once the detailed design starts at 1:50 level, programme is developed to hold series of user consultations where the architects present and explain the design to the users and seek their feedback. This involves extensive changes to the design which then eventually gets signed-off by the client.

As and when the clinical design by departments is signed-off, the production design (mechanical, electrical, structural etc) kicks off which then starts to shape the routes, spatial planning, plant size and location of the various services required to support the designed hospital. More often than not, production design can impact on the already agreed clinical design, such as the structural columns required to hold the building or rain water pipes can appear in the middle of a clinical area and hence further tweaking is always required.

Parallel to the clinical design myriad of other design and research is being carried out such as the signage, landscaping, radiation & laser protection, fire escape routes, energy efficiency of the building, heat gains for the areas facing the sun, access and welfare areas for the disabled (not just wheelchair users but also, blind, deaf, hard of hearing, colour blind or frail).

All of these studies require co-ordination among various disciplines and sub-consultants and is usually done via the lead consultant – normally the architects. The need for co-ordination is paramount and just to highlight why, imagine the consequences of designing a large plant on the level above clinical area with ceiling mounted microscopes. The vibration from the plant above will effectively render the microscopes useless.

What has been described above as design process can take a couple of years for a hospital with 3-4 specialities and around 600-800 inpatient beds. This is a rough guide and obviously can vary from project to project.

We will be writing on various aspects of the above process to explain it in more detail. So do visit us more frequently.

About the Author:
Harry McQue is a hospital design manager with three masters degrees including business management and information technology. Harry has 15 years of international experience ranging from working on hospital projects in Dubai (Middle East) to over £1 Billion hospital projects in the UK. You can benefit from his experience at: www.hospitaldesigntips.com. If there are topics that you would like his advice on, you can get in touch on Harry_Mcque@HospitalDesignTips.com

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