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Hospital Design – a brief insight on the development of hospitals in Malaysia in comparison to projects overseas. Presented by Assoc. Prof. Datin Ar. Norwina Mohd Nawawi International Islamic University Malaysia. Outline. Introduction Healthcare Hospital Architecture

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Hospital Design – a brief insight on the development of hospitals in Malaysia in comparison to projects overseas

Presented by

Assoc. Prof. Datin Ar. Norwina Mohd Nawawi

International Islamic University Malaysia

PAM CPD 9th August 2008


Outline

  • Introduction

    • Healthcare

    • Hospital Architecture

  • Development of Hospital Abroad

  • Malaysian Healthcare Services

  • Development of Malaysian Hospitals pre and post independence

  • Current issues in hospital development

  • Summary

PAM CPD 9th August 2008


Introduction

Healthcare and Hospital Architecture

PAM CPD 9th August 2008


Introduction

  • “Health care presents a different problem in every country for the way it is organised is a response to geography, climate, historical development, economic situation and social, cultural and political conditions…

  • Appreciation of these differences is fundamental to understanding of the situation which prevails in a country.”

Anthony Cox, Philip Groves.1990.

Hospitals and Healthcare Facilities.

Gt.Britain.Butterworth & Co.

PAM CPD 9th August 2008


Definition on Health

“Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity”

W.H.O.

“Health, as we define it today, is a state of complete physical, psychological, social and spiritual well being.”

Islamic worldview

……………………Thus, provides the overview that health isnot just the absence of disease in physical sense but encompass the whole well-being of the person.

PAM CPD 9th August 2008


What is healthcare?

  • “Essential health care based on practical, scientifically sound and socially acceptable methods and technologies made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self determination”

    The Declaration of Alma Ata in 1978

PAM CPD 9th August 2008


Health Pyramid

  • Healthcare buildings encompass the predefined healthcare strata of PRIMARY, SECONDARY and TERTIARY level of care.

Tertiary

Secondary

Primary

PAM CPD 9th August 2008


The Level of Care

  • Primary care embraces all the general health practices, educational, preventive and curative, that are offered to the population at the point of entry into the System.

  • Secondary Care comprises the care provided by more specialised services to which people are rendered by the primary care services.

  • Tertiary Care includes highly specialised services not normally found at secondary level, including super-specialities such plastic surgery, neurosurgery and heart surgery.

Anthony Cox, Philip Groves.1990.

Hospitals and Healthcare Facilities.

Gt.Britain.Butterworth & Co.

PAM CPD 9th August 2008


Principle of Referral of Patients

  • The principle of referral of patients from a lower level of care to a higher level as a method of sorting them according to their need for specialist diagnosis or the nature or the degree or their disabilities is also universally recognised.

  • Another is aim to work in both direction for which the reverse is meant for convalescence.

PAM CPD 9th August 2008


Basic Hospital Forms and Configurations

Outpatient entry

Emergency Entry

The Outpatient Zone

visitors

Visitors Control

Visitors

Diagnostic & Treatment zones

Inpatient zones

Naturally ventilated areas are normally long and thin while fully air conditioned areas are thick and wide

Medical and Non Medical Support Zones

Supplies and Disposal

In the tropics

PAM CPD 9th August 2008


Ward Layout

natural ventilation and natural lighting.

Clinic Layout

Patient

Waiting

Area

C/E rooms

C/E rooms

Treatment Room

Dirty Utility

Stores

Linking to Main Entrance or Hospital Street

Staff corridor

Linking to staff areas

Procedure Room

C/E rooms

C/E rooms

C/E rooms

Clean Utility

reception

Natural Day light

PAM CPD 9th August 2008


Development of Hospital Architecture Abroad

UK, USA, EUROPE,JAPAN, SOUTH AFRICA, BRAZIL…

PAM CPD 9th August 2008


British Experience

  • In the early 50s-60s during the energy crises,the British embarked on several hospital development program starting from

    • the Greenwich experience,

    • through the Harness system,

    • the Best Buy Mark I, then Best Buy Mark II,

    • through the varied Nucleus Hospital program including the energy efficient Nucleus Hospital of St. Mary on the Isle of Wright.

    • Now ..one off designs through……Private Finance Initiative (PFI)

PAM CPD 9th August 2008


Greenwich hospital

PLAN

Interstitial

Service floor

floor

The construction methods would be revolutionary - all lateral engineering services were to be contained in a 6-foot gap between floor and ceiling of each pair of floors so that repairs and maintenance works could be carried out without disturbing ward or department routine. All wards would have natural light but the service departments e.g. x-ray, pathology and operating theatres would be in the centre and artificially lit.

The whole hospital was to be ventilated mechanically and none of the windows would open so that the air in the wards would be as ‘pure’ as possible.

closed on 31st March 2001.

PAM CPD 9th August 2008

http://mysite.wanadoo-members.co.uk/offkilter/page6.html retrieved 070808


USA Experience

  • Being on private insurance based healthcare system, architects in the United States had to convince the facility management that good healing design is profitable.

  • Extensive campaign or crusades on both sides of the Atlantic to market the will of healing environment through provision of good view, music therapy, good interior design, lots of sunlight, fresh air and energyefficiency through passive design strategies are done with many researches being conducted to provide evidence that environment do indeed improves the person health outcomes.

PAM CPD 9th August 2008


European Experience

  • In Europe, apart from access to daylight and fresh air, strategies for passive design include the choice of building materials for healthcare buildings that has rigorous requirements.

    • The material is specifically specified to be environment friendly e.g.the choice of wall and floor finishes should not be from material that can burn nor emit toxic fumes.

  • Building services system should promote the recycle of waste water; retention of natural water before gradual discharge; recycle heat energy of air condition to radiators; use of solar power with photo voltaic, wind energy and others.

PAM CPD 9th August 2008


The Asian Experience

  • There have been movement in the Asian scene about going back to tradition and local Asian values when designing hospitals.

  • The deep rooted wisdoms on the use of Feng Shui (literally means wind, water) by the Chinese and Vaastu Shastra by the Indians had made significance come back in this millennium.

  • Both values, are basically based on the planning of the environment that deals with orientation and provision of good healthy living.

PAM CPD 9th August 2008


Worldwide experience summary

More hospital planning layouts are going away from deep planning and massive concept to thinner blocks with courtyardsto provide

  • opportunity for all habitable rooms or spaces to have a natural daylight and view to the outside;

PAM CPD 9th August 2008


  • More patients’ spaces are accessible to the gardens or sizeable courtyards whether it is on the roof-tops or on the ground floors;

Nortalie Hospital, Sweden

Albert Einstein Hospital, Sao Paolo

PAM CPD 9th August 2008


Sunderby Hospital, Sweden

  • More external cladding, although of high tech material, provides the shades and light at their openings through provision of retractable blinds or hoods as and when necessary.

PAM CPD 9th August 2008


  • Atriums with gardens and natural daylighting are a common feature. Due to their four seasons and differential natural day-lighting intensity throughout the year, ventilation systems need to be boosted with mechanical means to provide the space with the required thermal comfort level.

PAM CPD 9th August 2008


Malaysian Healthcare Services System

PAM CPD 9th August 2008


Malaysia – Vital Statistics

Other Vital Statistics

Land Area: 330,252 sq km

Population ( 2006): 26,640,200

Population Density: 81 / sq. km

Population Growth: 1.5%

14 States

15-64 years –63%

65 years & above-4%

Below 15 years – 33%

Source: Health Facts 2006, Ministry of Health Malaysia

PAM CPD 9th August 2008


Malaysian Health Vision

Ministry of Health Malaysia

  • “ Malaysia is to be a nation of healthy individual, families, and communities, through a health system that is equitable, affordable, efficient, technological appropriate, environmentally adaptable and consumer friendly, with emphasis on quality, innovation, health promotion and respect for human dignity, and which promotes individual responsibility and community participation towards an enhanced quality of life”

PAM CPD 9th August 2008


  • The health vision is not static but dynamic that sets in place framework to ensure that the health system could develop and adapt to the changing environment

  • Health care facilities were pragmatically plan and developed to provide the support towards that vision

PAM CPD 9th August 2008


Spectrum of Healthcare Facilities

PAM CPD 9th August 2008


Private Sector 20-25 %

Government / Public Sector 75-80%

PRIVATE

HEALTH CARE

FACILITIES

FEDERAL

GOVERNMENT

Public health/

medicine

Disease Control

Law Enforcement

STATE/ LOCAL GOVERNMENT

Environmental Sanitation,

Housing Standards,

Implementation,Law enforcement

Min. of Health

Armed Forces

Dept. of Aborigines

Min. of Home

Affairs

Min. of Education

Source: Ministry of Health Malaysia

PAM CPD 9th August 2008


Introduction

  • On the macro level, the paper relate on the national referral system then, in place and in the process of planning;

  • On micro aspect, the design development of these hospitals were discussed on the rationale of its development as outcome of the country’s health trend.

PAM CPD 9th August 2008


Malaysian Healthcare Referral System

National Referral

Hospital

TERTIARY CARE

Just over 1000 beds

State/General

Hospital

Not more than 1000 beds

Large District

Hospital

Emergency referral

Normal referral

500-750 beds

Medium District

Hospital

SECONDARY

CARE

300-500 beds

Small District

Hospital

150-300 beds

26-150 beds

Health Clinic

PRIMARY CARE

With and without

Alternative Birthing Centre

Community Health Clinic

/ Rural Health Clinic

PAM CPD 9th August 2008


Bed Numbers

PAM CPD 9th August 2008


The Private Sector

PAM CPD 9th August 2008


Private Healthcare Facilities

and Services Act 1998

PRIVATE HEALTHCARE ( URBAN BASED)

Mid 1970s-

1990s

Pre

Colonial

Period

post independent period

1957-1970s

Medical Tourism

After care

Hospices

Colonial

Period

1700-1957

Shops change to hospital

Home

based

Shop lots to clinic and maternity homes

Purpose built hospital

Simple structures

Tropical

Architecture

Non Standard

Single, low rise sprawling structures in Estates/ Plantations

medium rise donation based hospitals in capital cities for the poor

  • New Hospitals

  • (Maternity/ Chinese)

  • GPs (Clinics)

  • Support Services

  • Nursing Homes

  • Integrated within commercial

  • Centres for GPs,

  • Nursing homes with the

  • suburbs

  • Customised design for

  • hospitals

  • More GPs Clinics

  • Pharmacies

  • Laboratory Services

  • X ray services

  • Teaching (Medical/

  • Nursing schools)

Architecture

PAM CPD 9th August 2008

5yrs x 1,2,3,4,5,6,7,8,9.. Malaysia Plans 50yrs

1957


Healthcare Facility

  • “….means any premises in which one or more members of the public receive healthcare services..”

Part 1, Preliminary,

Section 2. Interpretation,Private Healthcare Facilities

and Services Act 1998

Proposed HUKM teaching block

Damansara Arkitek

PAM CPD 9th August 2008


What is Government Healthcare Facility

  • …” GHF Means any facility used or intended to be used for the provision of healthcare services established, maintained, operated or provide by the Government but excludes privatised or corporatised Government healthcare facilities;”

Part 1, Preliminary,

Section 2. Interpretation

Private Healthcare Facilities and Services Act 1998

PAM CPD 9th August 2008


Private Sectors in the Industry

Miriam Hospital,Penang

Island Hospital, Penang

Upgrading and expansion

PAM CPD 9th August 2008


Private Sectors in the Industry

Mahkota Medical Centre,

Melaka

Damansara Specialist Centre

Tower and podium, atrium/lobby, cafeteria, shops,

Services Outpatient (general and Ssecialist) and Inpatient

PAM CPD 9th August 2008


The Public Sector

PAM CPD 9th August 2008


PUBLIC HEALTHCARE NATION WIDE

Package Deal Procurement

Paperless Hospitals

Masterplans

Telemedicine late 90s-early 2000s

Greening

Healing environment

up-grading, customised design building

2007-to date

Conventional Procurement

Pre

Colonial

Period

Early post independent period

1957-1970s

Upgrading works

1970s-

1990s

Colonial

Period

1700-1957

homebased

Architecture

High-rise, High-tech, art décor, post modern, retro, urban based, smaller land lots for Bigger Hospitals

Simple structures

Tropical

Architecture

Non Standard

Single, low rise sprawling structures in small towns and

medium rise in capital cities

  • Standard Architecture

  • Design for

  • Nation Building

  • Hospitals

  • Clinics

  • Support Services

  • Staff residence

  • Medical & Nurisng

  • schools

  • Single, low rise sprawling

  • structures in small towns

  • New Standard

  • Architecture

  • Design for

  • Nation Building

  • District Hospitals

  • Clinics

  • Support Services

  • Staff residence

  • Teaching facilities

Customised

Architecture

Design for

Nation Building

PAM CPD 9th August 2008

5yrs x 1,2,3,4,5,6,7,8,9.. Malaysia Plans 50yrs

1957


Facility Planning Norms

Rural Health Clinic

  • State Hospital at every State

  • Regional Hospital

  • Hospital for every district

  • Network of facilities for sub-specialties

Community Clinic

For 2,000 to 4,000 population.

Health Centre

For 15-20,000 population

PAM CPD 9th August 2008


General Guide

  • Base on the principles of total planning & development, the general guide to planning healthcare facilities are as follows:

  • Site planning

  • Minimum area or acreage

  • Component of healthcare

    facilities

  • Support facilities

PAM CPD 9th August 2008


Site Planning

  • Healthcare facilities should be provided complete according to its hierarchy:

    a) Hospital-includes general

    hospital, district hospital, with

    orwithout specialists.

    These are provided at state

    and district level.

    b) Health Clinics are provided

    at local level, and

    c) Rural Health Clinic is provided

    at the rural areas.

PAM CPD 9th August 2008


Site Planning

ii) The planning on the type of healthcare facilities must be according to the region and the catchment area as shown in the Table A;

iii) The location of healthcare facilities should be suitable and appropriate in terms of its accessibility, quality of the environment, and safe for the community;

iv) The healthcare site should be access by the network of roads and near to the public transportation system;

PAM CPD 9th August 2008


Site Planning

TABLE A

PAM CPD 9th August 2008


Site planning

v) The location of a hospital need not necessarily be in the town centre to avoid traffic congestion; but accessible

vi) The location of hospital is not suitable at noisy and polluted areas;

vii) The site planning of healthcare facilities must be in accordance to the proposed and development strategy in the local plan as well as approved by the state authority.

PAM CPD 9th August 2008


Site Sizing and Acreage

  • The minimum size varies according to the hierarchy of the facilities as shown in the Table A;

  • The lot size should be able to accommodate the main building, the car park, the landscape, the support facilities as well as the probable expansion;

  • The acreage for healthcare facilities should be adequate as to include planned activities and the required components as per prescribed in accordance to its hierarchy.

PAM CPD 9th August 2008


Layout Plan and Design

  • The design of healthcare facilities should be a functional design to serve as the health centres for all communities; the building should reflect friendliness;

  • The design should take note the function and adjacency of the various work area or departments base on the workflow of patients and medical procedures so as not to obstruct;

PAM CPD 9th August 2008


Layout Plan and Design

iii) The design should consider the requirements of emergency treatment by providing emergency access for vehicles in cases of emergencies;

iv) Healthcare facilities design should consider the local culture that is clean, organised and beautiful whilst establishing a community park;

v) The circulation for the facilities should be clearly organised and without obstruction with provision for safe pedestrian crossing, the disable, the elderly and children;

PAM CPD 9th August 2008


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