Book Review

Simplifying Healthcare Architecture

Book: Hospitals Designing for Healing Author: GD Kunders Publishers: Prism Books Private Limited, Bangaluru Pages: 322 Price: Rs1,950 Outside India: $95

When I used to be the President at Asian Health Services Ltd, a healthcare architecture and consulting firm, we released a recruitment advertisement aimed at young architects. I still remember the headline. It said, "Wanted architects who can help in curing patients." This book is based on this fundamental belief.

'Hospitals should be built as places to promote healing, not just as places for providing treatment'. Mending broken bones and damaged body parts is no longer the sole mission of hospitals. Their mission is to take a more holistic approach and design a facility in which the entire environment is directed towards healing. In this context, 'Hospitals: Designing for Healing' is one of the few books which focus on the critical aspect of planning and designing a new hospital. This has been further illustrated by various successful examples and models which, in turn, help understand the intricacies of hospital planning and designing. The book is in fact a comprehensive remake of the author's earlier book, 'Designing for Total Quality in Health Care'.

The book is neatly divided into six parts. The first part is all about planning and designing a new hospital. Part two delves deeper and looks into the critical aspects of planning hospital facilities. Examples and models in part three give a more holistic view of the ideas developed in earlier parts. The fourth part deals with planning and designing various departments. Hospital equipment planning is taken up in the fifth part. The last part deals with planning and designing of various nursing and patient care areas.

Talking about planning and designing a new hospital, the author elaborately discusses circulation and traffic plan of a hospital (both inside and outside) and then looks into devising shortest traffic routes. Specific traffic flows in relation to some major services such as nursing services, surgical suites and labour and delivery suites have been elaborated towards the end of chapter two, part one. Creating a healing environment, the last chapter in the first part typically characterises a patient-centric hospital, which is the need of the hour. In fact, it goes a step further and highlights the fact that today patients too demand that they be treated in their totality and not simply as 'medical cases'. In pursuance of this concept, the new age hospitals feature natural light, gardens, fountains, aquariums and music to meet the emotional needs of the patients. It also has a section on 'Green Building' which lists criteria such as lighting, water efficiency, indoor environment quality and hospital food among others used by 'The Green Guide' for assessing green hospital candidates.

Space requirements and hospital building cost have been discussed in detail in the second part. It also lists general standards for details and finishes which serve as a detailed guide for anybody designing a healthcare facility. The author has even described the ideal angle of slope for ramps, width of stairways and ceiling heights. The often ignored area of interior designing in hospitals finds its much deserved place in this section. It also elaborates on the importance of harmony among exterior and interior elements of a hospital. All of this has been followed by illustration of some world class Indian and international designs developed by HKS architects, USA, Fortis Healthcare, Vinyas Architects and Asian Health Services. The last chapter in part three, 'Different Strokes' deals with some variant examples and models such as the Apollo Health and Lifestyle Clinics and details on what sets them apart from other similar existing facilities.

Hospital lobby is one of the first contact areas of the patient and plays an important role in shaping the overall impression of the hospital. Part four opens with a description of the lobby and some major design elements of the same. The bubble diagram in chapter 11 succinctly shows the layout of main entrance lobby featuring its major sub areas. This part not only lays out a detailed description of major services such as admissions, outpatient and surgical suites but also deals with supportive services such as central sterile and supply department (CSSD), hospital food service department and hospital laundry. With outpatients outnumbering the inpatients in present times, chapter 13 describing the outpatient department, including physical facilities, multi pod and concourse clinics helps one plan the outpatient department in greater detail.

Equipment planning is an integral part of any hospital design and must be done early in the design development stage. In this context, 'Equipment Planning', Chapter 18, part five comes in handy. For the purpose of architecture, the equipment has further been classified into fixed and movable. A description of the steps involved in equipment planning and procurement further simplifies this aspect of the architectural design of a hospital. One interesting finding elaborated in this chapter is that the hospital equipment should be distanced from cell phones by a minimum distance of one meter. Guidelines on the specifications of elevator is another area which has been given due importance in the chapter.

Designing nursing care facilities and patient care areas in hospital forms the last section of the book. It also deals with specialty units such as isolation rooms and intensive care units. ICU being one of the most complicated areas of a hospital finds a detailed mention in this book right from its ideal location to the minimum separation between beds and walls. Newborn nurseries design is a highly recommended section for any hospital with labour delivery suites. This design has been differently described for full term nursery, observation or suspect nursery, premature nursery and isolation nursery. Graphical illustrations of birth centre layouts further make it simpler for the reader to understand.

Throughout the book, every chapter is interspersed with illustrations which include actual layouts, designs and photographs of some world class facilities. The case studies of North Staffs City General Hospital and Leicester General Hospital in England, Clarian North Medical Centre, Indiana and Intermountain Health Care, Utah help the reader better understand every detail discussed in the book. In fact, all these keep the reader highly engaged. The visuals in the book contributed by Archimedes Consultants, HKS Architects, Asian Health Services, Fortis and Vinyas Architects are truly refreshing and help the reader actually visualise an ideal facility. The reader will also appreciate the lucid manner in which the book is penned down as well as the simplification of the entire hospital designing. The author has managed to illustrate almost each and every element of the book with examples to make it easier for the reader.

Overall, the book is an invaluable guide and serves as a ready reference for all those in healthcare willing to understand more about healthcare architecture in the present day context. Fortunately, the book makes healthcare architecture much simpler even for those who would like to have their own set up but lack knowledge of designing a facility.

In short, the book is a must read for architects, hospital planners, consultants and engineers to get a broad yet clear insight into hospital facilities planning through several tips and suggestions. With imagination and professional acumen, healthcare providers could use the book to plan and design innovative hospitals.

Reviewed by Ratan Jalan, Founder and Principal Consultant, Medium Healthcare Consulting Private Limited