Business Accent

Engineering a Hospital: Design Tips

Successful engineering of a hospital with its diverse paradigms is the result of excellence in customer satisfaction, quality inputs and outcomes benefited by cost-effective use of resources

Conceptualisation Phase

It is important to begin designing a hospital keeping in view the high level of planning that goes into it from an engineering perspective, in terms of both architectural design and building engineering services.

To begin with, it will be necessary to determine what type of hospital is intended. The types can vary from a secondary care to a primary care small scale hospital, to tertiary care hospitals, multi-specialty to super-speciality hospitals comprising of a larger facility mix; medical college teaching hospitals, and lastly medical tourism oriented boutique hospitals. These realities are brought together and combined with the existing workable paradigms of the hospital through facility planning and generation of space programs with defined functional requirements.

The architect/s or facility planners receive this information to begin with some hard ground realities derived through site surveys, existing site conditions, geographic enhancements and limitations, plus their take off from municipal laws which govern the plot of land. The team also evaluates from the soil test report, the type of foundation required as structural development is undertaken, usability and availability of water by the water test report, the modulations in ground levels through site survey reports; finally checking the re-usability and environment benefiting options before beginning the design. It's a common mistake to start off designing without taking the above in cognisance and land into trouble later.

Concept Design Phase

The development of the hospital planning starts by creating the form; allocating spaces as per the space program; bringing in appropriate functional adjacencies, designing through standards specified and providing for the best mechanical engineering design parameters. The planning grid enables us to determine the form, shape, size, length, breadth, spread, linkages, etc of and within the building. The grid also creates way for structural systems and mechanical/electrical/plumbing (MEP) services to be brought in tandem with the rest of the design functionality. Flat slab structural designs are engineering friendly, but are not very flexible in terms of cutting through the slabs at a later date to accommodate for plumbing runs. Conventional beam structure give more flexibility but create engineering co-ordination problems and generally will require higher floor heights for therapeutic floors to accommodate for long runs of air-conditioning ducting and accommodation of HEPA filters etc. The form of the hospitals can be created in various shapes and sizes. These can be classified into Horizontal Monolithic and Vertical Monolithic form typologies. Another important factor would be the decision of a fully centrally air-conditioned building versus partially air-conditioned building as then one needs to bring in light and ventilation deep inside the building. Further development makes us see also how other layouts like horizontal courtyard inclusions, plugged-in block methodologies, independent departmental stacking strategies - as in separation the inpatient department (IPD) from other clinical services, etc have given rise to alternate guidelines to derive the form of the facility. In a conventional hospital, planning grids are decided to accommodate inpatient rooms with en-suite toilets. Such configurations lead us to design a tower and podium style of construction. Here, it is seen that the grid starts with the size of an IPD room in the tower allowing the clinical departments to be 'fitted-in' on lower floors. Everything that is to be taken in for the working hospital is accommodated in this style of planning. To summarise, the planning grid conforming to the IPD starts from the topmost level and filters down to the rest of the facility. As the vertical transport is developed, it becomes necessary to also keep in view the main routing of electrical lines, mechanical chutes and ducts, plumbing pipes and ducts. Easiest solution is to stick these ducts or chutes to the vertical cores as it becomes easier to accommodate these without interfering with any usable space. Allocation of areas for all these three services should always be provided in the space program as else the designer has to accommodate for these later restricting the planning flexibility.

Design Development Phase:

The development of detail design process entails further movement from conceptual level planning. The interior planning in such designing is specific to the intrinsic process workability of each department. The intra-departmental and internal relationships make up the schematic design. The effort here should also be to amalgamate pre-decided design templates for their respective clinical and non-clinical requirements. This kind of a methodology in planning allows us to achieve desirable outcomes through combinations of functional feasibility. Inputs based on stipulated best practices through defined standards, can supply a process which enables detailed design outputs. The MEP service data sheets are to be simultaneously developed for each unit of the department, which now works as a total solution to the entire design exercise. A detailed engineering design brief would be a very crucial deliverable to be closed with the client as it sets the tone for building engineering and had financial implications depending on level of technology desired.

The other types of refinements follow in terms of providing information at the onset for the functional plan through the design templates. For example, the planning criteria for an Operation Theatre (OT) shall be made by defining the size and minimum dimension at 6100mm for a General OT, let's say. Next, the finished ceiling height shall be determined as per standards at 3000mm, keeping in mind to bring in other major determinants like operating room lights, proper air handling provisions above and around OT table where about 1/3 of air is supplied over the OT table and 2/3 is supplied around the OT table through a HEPA filter plenum. The locations of storage and case carts which carry sterile packs (include gowns, patient's drapes, towels, etc), disposable supplies, sterile utensil items; are pre-determined through the design template. A steriliser room is to be provided as close as possible to the OT, preferably with access from the peripheral corridor for maintenance and service. Next, a scrub area is required as the surgical team must wash their hands prior to each surgical intervention..

Electrical communication is provided through view boxes, intercom units, telephones, computer monitors, etc which are conveniently located in the circulation zone of the theatre. Two isolated power panels or pendants are provided near to the operating table to ensure constant current and eliminate power surges.

This kind of project briefing will benefit the engineering services to work together with the design need. Further, to enhance such a design union it becomes important to develop the graphic standards in terms of defining functional areas from the 'need' chart, followed by detailed space program; bubble diagrams come next, followed by block diagrams. This will lead us to the preliminary plan form culminating further into a workable schematic plan.

It will be a good practice to note down the future trends by highlighting such awareness to the client, as this shall become the value addition in the work. It'll also define the intent of the design to be progressive as such accommodation may already have been thought of in the developmental stages.

In a nutshell, it is important to have a systematic approach to hospital planning to get the best results in building an environ which is aesthetically pleasing and optimally functional.

nandini.shah@hosmac.com