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| Sheila Sri Prakash |
Hospitals and healthcare facilities exist to preserve the human condition and spirit. Philosophically, these buildings and spaces must be designed for society’s long term health, well-being and sustainability. It is very well understood that our health depends directly on the quality of our environment. This fact therefore makes the strongest case for hospitals that are designed to make a positive impact on the environment, or at least leave the smallest possible ecological footprint. While India has a heritage of sustainability, the new development and break-neck pace of development is generally resulting in unsustainable environmental damage. I have had the opportunity to be involved with the design visualisation of one of the largest LEED silver certified children’s hospitals in the world at the C S Mott Children’s and Women’s Hospital in Ann Arbor, Michigan, US and am currently working on several large-scale healthcare projects in India that are setting new standards for ecological impact and socio-economic growth by delivering holistic sustainability.
I developed the Holistically Sustainable Reciprocal Design Index, with an aim to serve as a design methodology, during my term at the World Economic Forum’s Design Innovation Council. The principles within the framework can ensure that hospitals in India can minimise their environmental footprint while serving as socio-economic engines for the societies that they serve, by incorporating strong themes of culture, art, tradition and vernacular materials.
Hospital design is among the most complex design process of all building types and is therefore subject to a set of unique criteria. This is because the services required for the efficient functioning of a hospital are numerous. There is no way in which any of these services can fail, as it involves the lives and care of people who need medical aid for their survival. Some of the parameters in hospital design that result in exacting design standards are mentioned below.
Consumption of water and power is maximum in hospitals. Total power backups are an absolute must.
Clean areas account for a substantial percentage of the total built up areas in buildings that are designed for providing healthcare, and treatment of patients.
The areas catering to the critically ill and surgical areas warrant a more stringent HVAC system requiring more air changes per minute and directional flow of conditioned air, which follow the clean room mandates.
The load on the requirement of water increases in order to accommodate the water requirement of the HVAC system. While conditioned air is definitely crucial to healing, care must be taken to ensure that the conveyance mechanism to conditioned air does not convey infection as well. The requirement for water per user is maximum in hospitals is as much as 150 to 250 gallons per user daily. In comparison, a hotel only needs around 70 to 150 gallons per user daily while homes need anywhere from 50 to 100 gallons per user daily. Disposal of radioactive and medical wastes are a critical component of hospital design. Three per cent of medical wastes are toxic and infectious. Safe disposal of body parts and surgical wastes are an environmental challenge. The safety of the health workers from over exposure to harmful chemicals is unique to healthcare as these chemicals are required for maintaining hygiene and well being of patients.
Interestingly, there is no widely accepted global standard yet, that defines a ‘green and healthy hospital’. According to Global Green and Healthy Hospitals Network, a green and healthy hospital “promotes public health by continuously reducing its environmental impact and ultimately eliminating its contribution to the burden of disease. A green and healthy hospital recognises the connection between human health and the environment and demonstrates that understanding through governance, strategy and operations. It connects local needs with environmental action and practices primary prevention by actively engaging equity and a green economy”.
While there are no specific LEED certification norms from the Indian Green Building Council pertaining to hospitals, as a building typology, hospitals can be rated by the norms for new construction of buildings. It is worth noting that GRIHA also offers a template to green certification.
As a designer, a collaborative effort with the services consultants is necessary. Before starting on the design, orientation studies, contour studies and resource availability studies, have to be made. This can ensure efficiency in energy consumption. However, it is crucial that hospital design is approached in a manner that optimises the use of resources and ensures efficient movement of patient, supplies, staff and waste.
It is very often the case where the patient care givers take the toll through inadequate facilities while the patients are getting the best of care. Out-patient and in-patient facilities should be designed to accommodate the patient care givers as well. Waiting areas with connectivity to nature, can de-stress the people attending to the patients.
Whether certification is obtained or not, it is imperative that buildings designed for the healthcare industry would do well to optimise their expenditure, which will eventually benefit the patient, by lowering the cost of healthcare. It will also enable the hospital to be more profitable.
The use of renewable energy, to replace the use of grid power, can result in a substantial saving in expenditure and running costs. The energy requirements for heating water, can be met by the use of solar power. Good design can ensure day lighting for public areas and corridors as well. Research studies have shown that visual connectivity to nature can accelerate recovery in a recuperative environment, strengthening the case for landscaped gardens and vegetated spaces. Many of my own projects are achieving this in hospitals that are space-constrained in urban centres, by creating landscaped roof-tops equipped with solar gazebos.
In the recently concluded World Economic Forum’s India Summit in Gurgaon (NCR), I served as a panelist to shed light on insights regarding the impact of architecture and urban design on global health. It is becoming obvious to the world that the direct impact of architecture, design and sustainability within hospitals is a reflection of the societies that are served by them. The fact is that India’s healthcare infrastructure has an unprecedented issue with the scale of the demand for health are. However, well-designed holistically sustainable architecture will ensure the long term health of society and our environment, while lowering the cost for upkeep of infrastructure.
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