Wilson Churchill has once remarked First we

shape our buildings, thereafter they shape

us. This is certainly true for hospital
buildings.
"A functional design can promote skill,
economy, conveniences, and comforts; a
non-functional design can impede activities
of all types, detract from quality of care,
and raise costs to intolerable levels."

Presented by
DR. ANU GUPTA
KALPANA VERMA
IIHMR JAIPUR

BUILDING ATTRIBUTES
1.Efficiency and Cost-Effectiveness
2.Flexibility and Expandability
3.Therapeutic Environment
4.Cleanliness and Sanitation
5.Accessibility
6.Controlled Circulation
7.Aesthetics
8.Security and Safety
9.Green Architecture
10.Energy Savings
11.Water and Waste Management
12.Materials

EFFICIENCY AND COST-EFFECTIVENESS

An efficient hospital layout

should:
Promote
staff efficiency by minimizing distance of
necessary travel between frequently used spaces
Allow easy visual supervision of patients by limited staff
Provide an efficient logistics system, which might include
elevators,
pneumatic tubes, box conveyors,
manual or automated carts,
gravity or pneumatic chutes

for efficient handling of food and clean supplies and

removal of waste, recyclables, and soiled material

Make efficient use of space by locating support spaces so

that they may be shared by adjacent functional areas

Consolidate outpatient functions for more efficient

operationon first floor, for direct access by outpatients

Group functional areas with similar system requirements
Follow modular concepts of space planning
Use generic room sizes and plans , than highly specific

ones

Provide optimal functional adjacencies, such

as
locating

the surgical intensive care unit

adjacent to the operating suite.

These adjacencies should be based on the

hospital's intended operations ,from the

standpoint of patients, staff, and supplies.
Be served by modular, easily accessed, and
modified mechanical and electrical systems
Be open-ended, with well planned directions
for future expansion

THERAPEUTIC ENVIRONMENT

Using familiar and culturally relevant materials

consistent with sanitation and other functional needs

Using cheerful and varied colors and textures, keeping

in mind that some colors can interfere with provider

assessments of patients' pallor and skin tones,
disorient older or impaired patients, or agitate patients
and staff, particularly some psychiatric patients .

Admitting ample natural light

Providing views of the outdoors from

every patient bed,

photo murals of nature scenes are helpful

where outdoor views are not available

Designing a "way-finding" process into

every project. Building elements, color,

texture, and pattern should all give cues,
as well as artwork and signage.

CLEANLINESS AND SANITATION

 durable finishes for each functional space

Careful detailing of such features as doorframes,

casework, and finish transitions to avoid dirtcatching and hard-to-clean crevices and joint
Special materials, finishes, and details for spaces

which are to be kept sterile, such as integral cove

base. The new antimicrobial surfaces might be
considered for appropriate locations.

ACCESSIBILITY

All areas, both inside and out, should:

be easy to use by patients with handicaps
grades are flat enough to allow easy movement
sidewalks and corridors are wide enough for two

wheelchairs to pass easily

entrance areas are designed to accommodate

patients with slower adaptation rates to dark and

light; marking glass walls and doors to make their
presence obvious

CONTROLLED CIRCULATION

Outpatients visiting diagnostic and treatment

areas , not travel through inpatient functional

areas nor encounter severely ill inpatients
Visitors have a simple and direct route to each
patient nursing unit without penetrating other
functional areas
Outflow of trash, recyclables, and soiled
materials separated from movement of food
and clean supplies, and both separated from
routes of patients and visitors
Transfer of cadavers to and from the morgue ,
be out of the sight of patients and visitors
Dedicated service elevators for deliveries, food
and building maintenance services

AESTHETICS

Increased use of natural light, natural materials, and

textures
Use of artwork
Attention to proportions, color, scale, and detail
Bright, open, generously-scaled public spaces

SECURITY AND SAFETY

Protection of hospital property and assets, including

drugs
Protection of patients and staff
Safe control of violent or unstable patients
Vulnerability to damage from terrorism

GREEN ARCHITECTURE

Minimize the use of carpets and other such

materials that have the potential to absorb and

release indoor pollutants.
Use high-reflectant roofing.
Use high-performance windows (double-glazed,

argon, etc.).
Use rapidly renewable building materials, such as

bamboo flooring, wool carpet, strawboard, linoleum,

sunflower seed board, wheatgrass cabinetry, hemp
fabrics, etc

Install and maintain a temperature/humidity

monitoring system to automatically adjust to

building conditions and link system to building
automation system.
Evaluate safe strategies to recycle wastewater/gray

water for other purposes on the site.

Use low-flow taps, nozzles, and toilets.

Avoid ozone-depleting chemicals in mechanical

equipment and insulation (zero tolerance for CFC-based

refrigerant).
Avoid materials that will offgass pollutants, such as

solvent-based finishes and adhesives, carpeting, and

particleboards that release formaldehyde
Audit existing building systems using refrigerant and fire

suppression chemicals and remove HCFCs and halons.

Identify opportunities to incorporate recycled materials

into the building, such as beams and posts, flooring,

paneling, bricks, doors, frames, cabinetry, furniture, trim,
etc

Specify materials free from toxic chemicals and

that do not release toxic byproducts throughout

their life cycle, and avoid those toxins that are
carcinogenic or bioaccumulative. Key materials to
avoid include mercury (switching equipment),
arsenic (pressure-treated wood), urea formaldehyde
(engineered wood), PVC (floors, wall coverings,
furniture, roof membranes, plumbing pipe, electrical
wire), and asbestos.
Place air intakes away from vehicles and other such

sources of pollution to prevent indoor air

contamination.

ENERGY SAVINGS

Maximum use of natural light, solar energy and green

power can lead to plenty of energy being saved.

Solar energy can also be used to produce thermal

energy which can further be used to produce

electrical energy.
construction of the building aligned at an angle to
the sun .
The major orientation of the building to face north
and south maximises use of natural light.
Shades on the south side block unwanted direct
sunlight while reflecting light onto the ceiling of the
interior.
This in turn will lead to proper lighting, heatingcooling and ventilation process of a hospital..

 Courtyards increase access to air movement and

daylight. Windows must be located in such a

manner so as to ensure ventilation, and increase
access to natural light, which will reduce heat.
Green power like bio-gases, bio fuel and renewable

sources of energy should be used.

WATER AND WASTE

MANAGEMENT

Rainwater harvesting and storm-water

management , to conserve water efficiently. This

method requires rain water to run across terraces
through clean pipes to storage tanks where they
are purified and then used.
Sewage water is recycled for further use.
Minimise wastewater by using ultra-low flush

toilets, low-flow showerheads, and other water

conserving fixtures

Waste can be effectively disposed through

vermicomposting or simple composting,.

During construction, waste materials and debris

can be further re-used to built inland roads,

pavements and gardens.
.In the same manner, paramedical waste should be

reused, recycled and then disposed

MATERIALS

Hospitals should use

PVC, VOC and arsenic-free material
Digitalised devices , instead of mercury
counterparts.
When disposing acids they should be diluted in
alkaline
High Density Poly Ethylene (HDPE) products ,
for plumbing and roofing purposes.
Concrete, the de-facto building material be
mixed with industrial by-products like Flyash,
cinder, stone dust, is an acceptable substitute.

 Powdered well-burnt brick , for water proofing roofs

and in outdoor pathways.

Biodegradable materials, especially for syringes,

as they are cheap and can be easily disposed.

In a country like India, minimum glass should be put

in the east and west side since the maximum

amount of heating and cooling happens there
leading to abnormal heating of the building.

EXAMPLES

Thank you

COST ANALYSIS AFTER IMPLEMENTATION OF

GREEN ARCHITECTURE

Green architecture promotes good environment

and health. It has also been found to aid in early

recovery and shorter hospital stays. Since the
average stay of patients is reduced, hospitals can
expect an influx of patients, thus increasing profits
An upfront investment of two per cent in green

building design, on an average, results in lifecycle

savings of 20 per cent of the construction costs
more than ten times the initial investment. The US
Environmental Protection Agency (USEPA) estimates
that a $4 investment (per square foot) in green
buildings nets a $58 benefit (per square feet) over
20 years

Jehangir Hospital saved Rs 46.25 lakh with an

investment of mere Rs 27.95 lakh. The hospital

through its innovative strategies reduced electrical
energy consumption by 12.66%, water energy
consumption by 53.9%, specific energy
consumption for air conditioning by 17.9% and
lighting by 5.99%..
Banner Health in Phoenix, saved nearly $1.5 million

in 12 months from reprocessing operating room

supplies such as compression sleeves, open but
unused devices, pulse oximeters and more

According to the survey, hospitals with a high

dependence on artificial lighting spent more than 3

times as compared to hospitals depending on
natural lighting systems. Hospitals which have
higher level of technology spend four times more
than those with basic technology infrastructure.
Indian hospitals have also documented evidences

on energy conservation, reducing electricity

utilization by 27 per cent and saving up to Rs 40
lakh rupees per annum.

The medical centres including the six All India

Institute of Medical Sciences (AIIMS) facilities

coming up in the country will implement Green
Architecture and Green Engineering as an option
to save the rising electricity consumption.
Some of the other hospitals which are now taking

on the Green Design route are Breach Candy, Jaslok

and Hinduja in Mumbai; Batra Hospital in New
Delhi., Kovai Medical Centre and Hospital,
Coimbatore, Fortis and Apollo