Assoc' Prof' Datin Ar' Norwina Mohd Nawawi

1
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

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
Introduction

• Healthcare and Hospital Architecture

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.

Anthony Cox, Philip Groves.1990. Hospitals and
Healthcare Facilities. Gt.Britain.Butterworth
Co.
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

Thus, provides the overview that health
is not just the absence of disease in physical
sense but encompass the whole well-being of the
person.
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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
Health Pyramid

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

Tertiary
Secondary
Primary
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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.
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
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
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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
C/E rooms
C/E rooms
Procedure Room
C/E rooms
Clean Utility  
reception
  Natural Day light
12
Development of Hospital Architecture Abroad

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

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 throughPrivate Finance
  Initiative (PFI)

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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.
http//mysite.wanadoo-members.co.uk/offkilter/page
6.html retrieved 070808
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
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
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.

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Worldwide experience summary

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

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

19

• 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
20
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.

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.

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Malaysian Healthcare Services System
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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
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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

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• 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

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Spectrum of Healthcare Facilities
27
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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 countrys health
  trend.

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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
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Bed Numbers
31
The Private Sector
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Private Healthcare Facilities and Services Act
1998
PRIVATE HEALTHCARE ( URBAN BASED)
Mid 1970s- 1990s
post independent period 1957-1970s
Pre Colonial Period
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
5yrs x 1,2,3,4,5,6,7,8,9.. Malaysia Plans 50yrs
1957
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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
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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
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Private Sectors in the Industry
Miriam Hospital,Penang
Island Hospital, Penang
Upgrading and expansion
36
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
37
The Public Sector
38
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
5yrs x 1,2,3,4,5,6,7,8,9.. Malaysia Plans 50yrs
1957
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Facility Planning Norms
Rural Health Clinic
Community Clinic
For 2,000 to 4,000 population.
Health Centre
For 15-20,000 population

• State Hospital at every State
• Regional Hospital
• Hospital for every district
• Network of facilities for sub-specialties

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
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.

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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
Site Planning
TABLE A
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
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
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
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