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

1. PAM CPD 9th August 2008 1 Presented by Assoc. Prof. Datin Ar. Norwina Mohd Nawawi International Islamic University Malaysia Hospital Design – a brief insight on the development of hospitals in Malaysia in comparison to projects overseas

2. PAM CPD 9th August 2008 2 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

3. PAM CPD 9th August 2008 3 Introduction Healthcare and Hospital Architecture

4. PAM CPD 9th August 2008 4 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.”

5. PAM CPD 9th August 2008 5 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

6. PAM CPD 9th August 2008 6 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

7. PAM CPD 9th August 2008 7 Health Pyramid Healthcare buildings encompass the predefined healthcare strata of PRIMARY, SECONDARY and TERTIARY level of care.

8. PAM CPD 9th August 2008 8 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.

9. PAM CPD 9th August 2008 9 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.

10. PAM CPD 9th August 2008 10 Basic Hospital Forms and Configurations

11. PAM CPD 9th August 2008 11 Ward Layout

12. PAM CPD 9th August 2008 12 Development of Hospital Architecture Abroad UK, USA, EUROPE,JAPAN, SOUTH AFRICA, BRAZIL…

13. PAM CPD 9th August 2008 13 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)

14. PAM CPD 9th August 2008 14 Greenwich hospital

15. PAM CPD 9th August 2008 15 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 energy efficiency through passive design strategies are done with many researches being conducted to provide evidence that environment do indeed improves the person health outcomes.

16. PAM CPD 9th August 2008 16 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.

17. PAM CPD 9th August 2008 17 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.

18. PAM CPD 9th August 2008 18 Worldwide experience summary More hospital planning layouts are going away from deep planning and massive concept to thinner blocks with courtyards to provide

19. PAM CPD 9th August 2008 19 More patients’ spaces are accessible to the gardens or sizeable courtyards whether it is on the roof-tops or on the ground floors;

20. PAM CPD 9th August 2008 20 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.

21. PAM CPD 9th August 2008 21 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.

22. PAM CPD 9th August 2008 22 Malaysian Healthcare Services System

23. PAM CPD 9th August 2008 23 Malaysia – Vital Statistics

24. PAM CPD 9th August 2008 24 Malaysian Health Vision “ 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”

25. PAM CPD 9th August 2008 25 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

26. PAM CPD 9th August 2008 26 Spectrum of Healthcare Facilities

27. PAM CPD 9th August 2008 27

28. PAM CPD 9th August 2008 28 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.

29. PAM CPD 9th August 2008 29 Malaysian Healthcare Referral System

30. PAM CPD 9th August 2008 30 Bed Numbers

31. PAM CPD 9th August 2008 31 The Private Sector

32. PAM CPD 9th August 2008 32

33. PAM CPD 9th August 2008 33 Healthcare Facility “….means any premises in which one or more members of the public receive healthcare services..”

34. PAM CPD 9th August 2008 34 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;”

35. PAM CPD 9th August 2008 35 Private Sectors in the Industry

36. PAM CPD 9th August 2008 36 Private Sectors in the Industry

37. PAM CPD 9th August 2008 37 The Public Sector

38. PAM CPD 9th August 2008 38

39. PAM CPD 9th August 2008 39 Facility Planning Norms State Hospital at every State Regional Hospital Hospital for every district Network of facilities for sub-specialties

40. PAM CPD 9th August 2008 40 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

41. PAM CPD 9th August 2008 41 Site Planning Healthcare facilities should be provided complete according to its hierarchy: a) Hospital-includes general hospital, district hospital, with or without 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.

42. PAM CPD 9th August 2008 42 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;

43. PAM CPD 9th August 2008 43 Site Planning

44. PAM CPD 9th August 2008 44 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.

45. PAM CPD 9th August 2008 45 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.

46. PAM CPD 9th August 2008 46 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;

47. PAM CPD 9th August 2008 47 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;