OVERVIEW OF HOSPITAL /

HEALTH FACILITY
BUILDING NEEDS

Contents

Introduction

Type of Health Facilities in MOH

General Hospital Set Up

Health Building Needs

EBD

Introduction

Health / Hospital Building is complex

Requires talents and expertise of many professionals

Complexity of practice = complexity of design

Need to understand hospital functions, operations which are

complex and evolving

Complex variation of needs of various department

Introduction

Interdependence of departments

Controlled environments

Compliance to Acts, standards, and other governmental

regulations

Need concerted and coordinated effort in design

Types of Health Facilities in MOH

Hospital

Specialised Hospitals/Institutions eg.

NCI, Rehabilitation Hospital, Women
& Children Hospital
Major Specialist Hospital hospital
with at least 14 specialties and 6
subspecialties eg. State Hospitals,
some District Hospitals
Minor Specialist Hospital hospital
with 10 specialties
Non-Specialist Hospital / Hospital with
visiting specialists no specialties

Standard MOH Hospital Scope / Size

Purpose : to expedite the project implementation
- standard MBOR
- standard costs
- standard plans?
Types :

76 beds

108 beds

268 beds

306 beds

500 beds

Types of Health Facilities in MOH

Health Clinics run by Doctor / Medical Assistant &

Nurses
KK
Type

Expected
Workload
(attendances)

Main Scope of Services

>800

OPD, MCH, Dental, Pharmacy, X-Ray, Lab,

Rehab, Home Nursing, Admin, FMS

500-800

OPD, MCH, Dental, Pharmacy, X-Ray, Lab,

Rehab, Home Nursing, Admin, FMS

300-500

OPD, MCH, Dental, Pharmacy, X-Ray, Lab,

Rehab, Home Nursing, Admin, FMS

150-300

OPD, MCH, Dental, Pharmacy, X-Ray, Lab,

Rehab, Home Nursing, Admin

100-150

OPD, MCH, Dental, Pharmacy, Lab, Home

Nursing, Admin

<100

OPD, MCH, Pharmacy, Lab, Home Nursing,

+/- ABC & Observation Bed

<50

OPD, MCH, Dental, Pharmacy, Lab,

+/- ABC & Observation Bed

Types of Health Facilities in MOH

Rural Health Clinics /

Klinik Desa (KD)

Run by Rural Health

Nurse

I Malaysia Clinic

Run by Medical Assistant

GENERAL HOSPITAL
Set-Up

General Hospital Set-Up

Will depend various factors:

Level of medical services

Operational policies

secondary, tertiary, specialised

primary care services
privatisation
outsourcing

Special needs

hospital
community

General Hospital Set-Up

Outpatient Services

Emergency Dept.
Clinic GOPD, Specialist Clinic
Day Care
Dialysis (Haemo-dialysis & PD)

General Hospital Set-Up

Inpatient Services

Wards

Standard ward for various discipline

2nd & 3rd Class
Paeds ward classless & with MAC facilities

Multidiscipline 1st Class & VIP, Royal

Intensive Care (ICU,CCU,HDW, NICU, SCN)
Special Ward ie isolation ward

General Hospital Set-Up

Diagnostic & Treatment

Operating Theatre Suites

Double corridor
Single corridor

Labour & Delivery Suites

Single room

General Hospital Set-Up

Diagnostic & Treatment

Imaging (XRay)
Pathology (Lab)
Forensic
(Mortuary)
Rehabilitation
(OT & PT)

General Hospital Set-Up

Medical Support Services

Pharmacy

Inpatient
Out-patient Pharmacy

Medical Store

General Hospital Set-Up

Medical Support Services

Central Sterile
Supply (CSSD)

Haemodynamic
Respiratory

General Hospital Set-Up

Medical Support Services cont

Medical Record
ITD
Medical Social Services
Infant Nutrition (Milk
Kitchen)
Dietatics

General Hospital Set-Up

Non-Medical Support Services

Catering/Kitchen

Linen holding

Waste disposal

General
Clinical/Biohazard
Chemical

General
Maintenance/Cleaning &
Housekeeping

Engineering

Porter/Transport

Helipad

General Hospital Set-Up

Training Education & Research

CME seminar room, auditorium

Library
Clinical Research
Quality Assurance

General Hospital Set-Up

Administration

General Administration
Nursing Administration
Admission & Revenue Collection
Telephone Operator & PABX

General Hospital Set-Up

Staff Facilities

Specialist & Doctors Offices

On-call complex
Staff change
Staff rest
Prayer rooms
Recreational facilities
Staff accommodation quarters, nurses
hostel & housemen quarters

General Hospital Set-Up

Public Amenities

Main entrance & hospital street

Shops & kiosks
Information counter
Cafeteria
Visitors lounge
Prayer rooms
Public Parking
Public Phones etc.

Health Facility Planning

Most complex building

Wide range of
services & functional
units
Governed by various
regulations, codes,
guidelines etc.

Health Facility Planning

Requires specialised knowledge

& expertise
Competing needs & priorities
among various functional units
Ideal & strong individual
preference VS mandatory
requirements, functional needs
& financial status

Health Facility Planning

Serve & support many

different users &
stakeholders
Design process to
incorporated direct input
from owner & key
hospital staff
Good hospital design
integrates functional
requirements with the
human needs of its varied
users

Hospital/Health Facility Building

Needs

Regardless of their site,

size, budget,
hospital/health facility
have certain common
needs :

Efficiency & Cost

Effectiveness
Flexibility &
Expandability
Therapeutic Environment
Cleanliness & Sanitation

Hospital/Health Facility Building

Needs

Accessibility
Controlled circulation
Redundancy
Aesthetic
Security & Safety
Sustainability

Efficiency & Cost-Effectiveness

Promote staff efficiency

eg. reduce walking
distance
Easy visual supervision of
patients by limited staff
Efficient logistics systemlifts, pneumatic tube,
conveyors
Efficient use of space &
prudent use of
multipurpose space

Efficiency & Cost-Effectiveness

Group functional
areas with similar
system requirements
Encourage sharing of
resources & avoid
duplication
Provide optimal
functional adjacencies
eg. ICU next to OT

Flexibility & Expandability

Follow modular concepts

of space planning &
layout
Use generic room sizes
and plans as much as
possible
Be open ended, well
planned directions for
future expansion eg. soft
space next to hard space

Therapeutic Environment

Unthreatening,
comfortable and stress
free
Using familiar & culturally
relevant materials
Using cheerful and varied
colours & texture (note:
some colours are
inappropriate)

Therapeutic Environment

Ample natural light

External views for
patient bed
Designing a way
finding process
making spaces easy
to find, identify and
use

Cleanliness & Sanitation

Easy to clean &

maintain
Appropriate & durable
finishes
Careful details to
avoid dirt-catching
and hard to clean
surfaces

Cleanliness & Sanitation

Adequate &
appropriately located
housekeeping spaces
Special materials,
finishes, and detail of
spaces for sterile
areas

Accessibility

Disable friendly facilities

Does not hinder trolley
movements
Corridors are wide
enough
Marking glass walls &
doors to make their
presence obvious
Direct Vehicular access to
eg. A&E, L&D, Mortuary

Controlled Circulation

Typical outpatient route

simple & well defined
Avoid unnecessary
movement through
inpatient functional areas
Visitors have simple &
direct route to each
patient nursing unit
without penetrating other
functional areas
Separate patients &
visitors from support
services & engineering
areas

Controlled Circulation

Dirty material flows

separated from
movement of food &
clean supplies
Transfer of cadavers
to & from Morgue
should be out of sight
of patients & visitors

Redundancy/Back-up Plan

Able to
service/maintain
systems without greatly
affecting service
Able to tolerate certain
degree of system
failure

Medical gas zonings

Water supply
Electrical supply
Air-condition system

Aesthetics

Use natural light,

materials & textures
Use artworks
Attention to proportions,
colour, scale & details
Bright, open, generouslyscaled public spaces
Homelike & intimate scale
in patient rooms, day
rooms etc.
Compatible exterior
design with physical
surroundings

Security & Safety

Protection of
hospital property &
assets
Protection of
patients & staff
Safe control of
violent or unstable
patients

Sustainability

Operational Costs
Maintenance Costs
Energy saving features

Basic Principle
Small vs Bigger Hospitals / Non Specialist vs Specialist
Hospitals
Small Hospital
(<150 beds)

Bigger Hospital
(>300 beds)

Combine out-patient &

inpatient pharmacy

-May be separated
-May have satellite
pharmacy

Combine L&D with Obstetric -May be separated

Ward on GF
-PAC if L&D located on
higher floor
Centralised OT Complex

-May separate main OT,

Daycare OT and Maternity
OT

Multidisciplinary Ward eg
Obst + Pediatric Ward;
Female Ward

- May be dedicated eg. Male

Medical, Pediatric, Female
Obstetric etc.

Centralised Pathology / Lab

-May have satellite lab

Basic Principle

Doctors examine
patient on the right
side; hence it shall be
the basis for the
orientation of patient
bed, examination
couches and procedure
table within a room etc.

Lessons Learned (Architecture)

No wet areas above

clean/sterile areas eg OT, CSSD
packing & sterile stores, clean
rooms
Corridors where there are patient
/trolley movement shall be wide
enough and with no hindrance
eg fire doors.
All room doors where patient
enters shall be wide enough for
wheelchair and able to be hold
opened.

Lessons Learned (Architecture)

Doors into rooms where patients are

being examined shall have no
glazing.
All patients toilet with shower
facilities shall have textured non
slipped floor tiles.
ALL sinks (clinical/non clinical/builtin) shall have sufficient backsplash.
Provide seamless finishes to floor
and wall in clinical areas.

Lessons Learned (Architecture)

Use washable paint in all clinical

areas.
ALL windows shall be lockable.
Avoid ledges (surface) especially
in clean rooms.

Avoid grey colored flooring in

Operating Rooms.

Lessons Learned (M&E)

Filtered water supply for autoclaves,

haemodialysis, kitchen.
Dedicated water tank for
haemodialysis.
Special treatment for laboratory
sewer i.e dilution tanks.
Task light at nurses counter/station
Sufficient & appropriately located
floor traps.
Easy to maintain materials.

Avoid sprinkler at clean/sterile areas

and areas with expensive equipment eg
ICU, CCU, Burns etc.
Digital Calling system shall be provided
for ALL rooms where patient need to
queue eg. CE rooms, Treatment,
Procedure, Assessment, ECG etc.

Lessons Learned (M&E)

Room air flow shall be from the

doctor/medical staff to the
patient before being exhausted
out.
Provide dedicated plug point for
electric beds in 1st class.
Provide sufficient & appropriate
power supply:

eg. essential supply for all

medical fridges
eg. UPS for life supporting
equipment ie. ventilators,
angiography etc

EVIDENCE BASED DESIGN (EBD)

Dr Maarof Sudin
Planning & Development Division
Ministry of Health Malaysia

Introduction

Healthcare business is about

selling care experiences
An aesthetically pleasing facility
is a key aspect of the perceived
quality of care

Does health facility design really

have impact on patients and staff
outcome?

Growing evidence - design can

produce positive impact on the
desired outcomes

Introduction
Impact of building on
people/occupants
Second to fresh air, I should be inclined to
rank light in importance for the sick. Direct
sunlight, not only light is necessary for speedy
recovery. I mention from experience, as quite
perceptible in promoting recovery, the being
able to see out of a window, instead of looking
against a dead wall
- Florence Nightingale on Light, 1860

First we shape the building; thereafter, they

shape us
- Sir Winston Churchill, May 10, 1941

Well Designed Hospitals

Create a built environment
that take into consideration
patient and staff requirements
that can have positive impact
on patient outcome, staff
performance and staff and
patient safety

No Environment is Neutral
The design of facilities,
organizations, work
processes, and
equipment impact one
another as well as patient
outcomes, safety and
staff satisfaction
Either positively or
negatively, the design will
exert its impact

Connecting Environmental Design to

Quality Improvement
Hospital Built Environment

Safety and Quality

Of Patients Care
Patients Perception
Of Care Given / Care
Experiences

Staffs Job Satisfaction

And Stress

How supportive healthcare design

improve outcomes?
Ability to alleviate STRESS
Promoting stress reduction, buffering
and coping
Patient can use their limited energy
to get better, instead of having to
fight the environment
Stress in itself is a negative health
outcome
AND
detrimental to psychological,
physical, and behavioral effects that
worsened other outcomes

EVOLUTION OF HOSPITAL DESIGN

Traditional

Approach

Hospital
Outlook

New

Narrow wellness perspective

Holistic wellness perspective

Emphasis on functional efficiencies

Also include:
-psychological needs
-social needs
-spiritual needs

Pathogenic conception
-reduction of infection and disease
risk exposure
-prevent illness and physical harm

of patient, staff and improve

medical outcomes

Institutional

Patient and Family Centred

Stressful

Healing Environment

Detrimental to care quality

Friendly
Quality Care

Traditional Hospitals

Institutional & Stressful

New Hospitals

Patient Centred & Promote Healing

Reasons For Change In Design Approach

High
demand
satisfaction

Growing stress,
healthcare staffs

to

increase

work

patient

demands

for

Declining staff / patient ratios

Need to attract and retain quality employees

Advances in mind/body medicine

Stress and psychological factors impact on
health

Increase adoption of patient centred and

family centred care philosophies

Mounting scientific researches linking welldesigned healthcare environments to

improved outcomes

New Health Facility Design Approach

Evidence Based Design /
EBD
Design is less of an art BUT
more of a SCIENCE

- Empirical Approach /
Engineering-style Approach
Measure first then fix

Architects / designers and

informed clients make decisions
guided by credible evidence

Evidence Based Design (EBD) Definition

General :
Evidence based design is the conscientious, explicit and
judicious use of current best evidence from research and
practice in making critical decisions, about the design of
each individual and unique project
Hamilton, DK & DH Watkins 2009

A process of basing decision about the built environment on

credible research to achieve the best possible outcome
The Centre for Health Design, 2008

EBD in Healthcare Setting

In Healthcare Buildings,
Built environment = Healing environment
A Healing Environment
is the result of a design that has
demonstrated measurable improvements
in the physical and/or psychological ,
social and spiritual states of patients
and/or staff, physicians, and visitors

- complementary treatment modality

- makes a therapeutic contribution to the
course of care

EBD Research Initiatives

1. Centre for Health Design
& Robert Wood Johnson
Foundation, Chicago
2. Georgia Institute of
Technology

3. Rubensi & Golden metaanalysis on 84 studies

(1998)
4. Ulrich & Zimring metaanalysis on 600+ studies
(2004)

Centre for Health Design

Literature Search 2004

by Ulrich & Zimring
Organizes the substantial research knowledge
base on the effects of the environment to various
outcomes.
Findings :
Rigorous studies link the environment to
outcome in 4 areas :
1. Reduce patient stress & improve outcome
2. Reduce staff stress & fatigue
3. Improve safety
4. Improve quality

Literature Search 2004

by Ulrich & Zimring
Research Conclusion / Recommendations
Provide single bed room
Hospital should be much more quieter to reduce
stress and improve sleep
Provides stress reducing views of nature
Develop efficient way finding systems
Improve ventilation
Improve lighting
Design to reduce staff walking and fatigue

Saint Alphonsus
Centre for Advanced Healing
Identify evidence based design elements with
positive outcomes (in order of the strength of evidence):

1. Single patient rooms

2. Installing HEPA filters
3. Providing access to nature
4. Installing ceiling lifts
5. Installing sound-absorbing ceiling tiles
6. Family areas within patient care spaces
7. Providing access to sunlight
8. Promoting the use of visible and accessible
hand washing facilities/dispensers
9. Promote visual access and accessibility to patient
10.Providing areas of respite for staff

Single Patient Rooms

-High HAI
-More medical error
-Increase patient transfers
-Privacy violation
-Lack family involvement
-Stress
-Reduced quality of care
-Reduced satisfaction
-Reduced staff productivity

-Faster recovery
-Lower HAI & medical error
-Better privacy
-Less noise
-Better communication
between staff and patient
-High satisfaction

Installing HEPA filters

-Control indoor air pollution

-Filter harmful pathogens
-Reduce impact of infections

-Isolation of patient
-During construction and renovation
(portable HEPA) to filter m. organism
eg. aspergillus from soil

Providing access to nature

View to Nature
-large window
Healing Garden
-visibility, accessibility, familiarity, quiet
environment

Positive Distraction
-ARTS, music etc

-Increase satisfaction
-Positive escape & recuperation from stress
-Opportunity for patient-visitors interactions

-Positive mood change

Artwork - Example
Comforting/Healing

Stress Induced

Installing Patient Lifters

- 44% of injuries to nurses that

result in lost workdays

- patients becoming heavier & nurses

ageing( 40% US nurses aged >50 by 2020 )
- integrated with staff education,
ergonomic program,
& no manual-lifting policy

- reduce staff injuries

-reduce staff MCs
-reduce medical claims

Installing sound absorbing ceiling tiles

- Acoustic environments

-High ambient noise levels

- Reduced sound reverberation

times & sound propagation

- Staff emotional exhaustion

and burnout

-Reduce noise
- Reduce stress

-Threat to patient confidentiality

and safety

- Improve sleep
- Improve communication

- Impeding effective communication

- Reduces perceived work pressure

Family areas within patient care spaces

-Unfriendly facilities for family

- Space within patients room

- Family lounge &
-Family counseling room

-Intermittent contact with patient

-Unable to participate actively in
patient care
-Reduce family involvement &
satisfaction in care

-Encourage active family participation

-Patient-family interaction privacy

Providing access to sunlight

-Reduce depression & stress

-Patient & staff rooms, family lounge

-Large windows
-No glare

- pain
- Less
-Decrease LOS

-Improve sleep & circadian rhythm

-Less agitation among dementia patients

-Able to control light level

-Vitamin D intake

Visible and accessible hand washing facilities

Scrub troughs, clinical sinks or hand sanitizers
-Easy access
-Good visibility
-Within easy reach
-Unobstructed access
-Placed at comfortable height
-Minimal effort to use
-All patient rooms

Hand washing frequency among healthcare staffs generally still low

Promote visual access and accessible to patient

-Centralized nurse base

-1/3 nurse time walking

-Decentralized nurse stations

-Alcoves outside patient rooms
-Locating frequent used supplies
in / near patient room

-Walks 6 miles/shift

-No direct visibility of patients

-Time wasted in hunting &
gathering supplies

-Reduce staff walking distance

-More time on direct patient care
-Reduce staff fatigue
-Reduce patient fall rate

Providing area for respite for staff

-non revenue generating space

-very cramp/compact

-contribute to staff stress

-poor staff satisfaction
-poor staff retention

-Large staff lounge

-Windows with view
-Respite area
-Staff toilets and shower

-Staff satisfaction & retention

-Increase staff effectiveness

Nowhere to Rest

Conclusion
Environmentally preventable hospital

acquired conditions can no longer be tolerated

eg.
-infections and falls
-injuries to staff,
-unnecessary intra hospital transfers
that can increase errors,
-increase patient and family anxiety,
stress,
-LOS caused by noisy, confusing care
environments
Clear connections between constructing well-

designed healing environment and improved

health care safety and quality for patients,
families and staff as well as long run cost
saving

Conclusion
Cost-effective, evidence based
environmental design
interventions should be included
in all hospital improvement
programs

Evidence-based environmental
design intervention should be
implemented together with other
process improvements for them
to be effective

We can show empathy through EBD..

THANK

YOU