Planning Healthcare Facilities: Building a Programme

On the first part of this series of articles, we looked at the importance of accurate data when planning hospital facilities.

What we do with that data, however, is of major importance, if we want to accurately translate it into a useful Schedule of Accommodation that clearly translates the needs into a coherent and valuable program.

Preparing a Schedule of Accommodation requires prior understanding of the client requirements and target population. The team responsible for the Medical Planning must first profile the population, catchment area, identify the type and number of expected patients and the most common clinical cases.

When characterizing the population, valuable data as gender, age, or typical diseases will help in defining the type and size of the medical departments. It is also essential to identify at this stage the existence of other healthcare facilities that may already provide some of the required services, and evaluate the viability of the new hospital.

ARC has developed several space programs for healthcare facilities in the Middle East, Africa and Asia, seeking the best and most viable solutions, medically and economically. It is our goal to ensure that our hospitals can reach occupancy rates close to 80%, avoiding overcrowded or non-functional departments.

Each country requires different approaches. In Pakistan, for instance, the ratio of doctors, or beds per 1000 patients is so low, that we can expect that any new hospital will have very high occupancy rates. High capacity hospitals, with hundreds of beds are the standard, with a ratio of one bed per 80-90m2 dictate very dense and optimized space programs, stripped to their bare minimums.

On the opposite side of the spectrum, we can expect ratios of 200 sqm per patient in Middle East hospitals, with all amenities and the most advanced treatments.

Finding the right balance has been of the greatest concern at ARC, who successfully has developed several hospital programs that met the client’s expectations.

Approach

Due to the complexity and amount of data, healthcare facilities and hospital design require an iterative approach, from Data analysis to room to room layouts and medical equipment planning. The high level of complexity associated with these projects demand a holistic approach and breaking the program into smaller parts.

Our approach focuses on identifying those key elements that will characterize and define the building requirements. If the major lines of intervention are not clearly defined, or the relations are wrong, hardly later corrective measures will result in a good project at the later stage.

Requirements Calculations

The first step of data translation into a design is the identification of the required design Key Planning Units, understood as the major clinical rooms that define a department capacity, such as a number of Operating Theatres, or a number of clinics.

To accurately calculate the required rooms, we need to understand their capacity, which requires also knowledge on the type of procedures done at those rooms, time it requires per procedure, and operating hours of the service, as well as the down times (periods when the room is not operative, or under maintenance).

It is also important to clearly define the expected occupancy ratio. Ideally, we should always allow for extra capacity and consider a usage of 75-80%, to cater for workload peaks.

If done correctly, calculations will work as a basis of design and justify the options taken.

Department Program

Using benchmarks, it is possible to develop a preliminary Department program that will include all the Key Planning Units and area allowance for supporting areas. This provides us an expedite tool for fast evaluation of the building design and hospital size, including the grossing factors for hospital departments and building.

 Without the need of developing a full Schedule of Accommodation, it is possible to achieve a very close approximation of the facility sizing and characteristics that can be presented to the client for validation.

Schedule of Accommodation

With the client validation on both Calculations, Key Planning Units, and Department Program, it becomes relatively straightforward the development of a Schedule of Accommodation.

Deep knowledge of international and local healthcare is required at this stage, mainly the full understanding of the required support rooms to each department, including room size and capacity. Critical is also the understanding of the operating models to implement, and specific requirements and local context. Some examples can range from the client options for individual rooms or open wards, or the circulation model, and flows segregation in operating theatres (do we have a double corridor, or single? Are induction rooms expected or not? etc.)

Matrix Adjacencies

Complementary to the Space Program, the matrix adjacency is a tool that helps the design team understanding the critical relations and levels of proximity that are mandatory, advised or simply not required between departments. A matrix can originate several different design alternatives. Its purpose is not to provide a solution, but a guidance to the design team.

Stacking Diagram

Vertical diagrams, and bubble department plans are often developed in the early stages of the project. These serve to resolve the matrix adjacency and start shaping the building accordingly to the Schedule of Accommodation and all required space relations.

These first modules are simple approximations and mainly serve to test possible approaches to the design. Through it, we can evaluate possible massing solutions, footprint, general circulations, and detect critical relations that need to be further studied.

These diagrams are part of ARC workflow and serve to define the approach strategy to the new hospital.

Existing Hospitals

Interventions on existing hospitals have an additional layer of complexity. Moving patients is no easy task, and phased interventions need to be considered. Hospitals need to remain operational, and key departments cannot be decommissioned if no viable alternative is provided.

Construction Site access, increased risk of infection, noise and discomfort for patients and staff are hazards to be expected in renovation works.

Development of phasing strategies is part of ARC capabilities, being our focus to ensure that both - construction and hospital operation are ensured with minimum disturbance.

Apart from it, any program to be developed must have in consideration the existing facilities, its own flaws and building constrains, such as lower ceiling heights, or structural obstacles.

Tailored made schedules of accommodation are often required, with concessions done that must at the same time ensure that no critical services or clinical functions are sacrificed.

Expansion

A good planning and a well-structured schedule of accommodation are mandatory when dealing with expansions.

Different strategies can be envisioned for planning hospital expansions, depending on client´s future objectives. Usually, it is not possible to decommission the existing building, which implies to work around the existing infrastructure without disconnecting it.

Vertical growth, by addition of extra floors (usually nursing units), is probably one of the most sought solutions by clients, although its implementation is far to be easily achievable. The necessary decommission of the vertical cores and last floor (usually a technical floor) are often constrains that prevent such interventions. One solution might pass by considering from the beginning a transitional floor that will enclose all MEP areas and serve as a basis for the development of new vertical cores.

Horizontally, the easiest way of expanding a hospital is by growing the building limits. Naturally, such approach requires the availability of free land and a building planning that allows its growth. Typically, a Linked Pavilions solution, such as first rehearsed on the Huddinge Hospital (Karolinska Institute, Home of the Nobel Prizes) will provide great flexibility when an expansion is a key aspect to consider.

Medical departments located inside of rigid podiums tend to be harder to increase, mainly if they have boundaries with other departments. Sometimes, patios can work as expansion area, although such interventions usually lead to the loss of natural light, partially or in full.Department organization and proximity can also be used in advantage. By placing easier to relocate departments (such as administration, or outpatient clinics) near departments that will expand, we can create decanting areas that after being empty will provide the necessary space for expansion.