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

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 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 PAM CPD 9th August 2008

3. Introduction Healthcare and Hospital Architecture 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.” Anthony Cox, Philip Groves.1990. Hospitals and Healthcare Facilities. Gt.Britain.Butterworth & Co. 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 ……………………Thus, provides the overview that health isnot just the absence of disease in physical sense but encompass the whole well-being of the person. 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 PAM CPD 9th August 2008

7. Health Pyramid • Healthcare buildings encompass the predefined healthcare strata of PRIMARY, SECONDARY and TERTIARY level of care. Tertiary Secondary Primary 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. Anthony Cox, Philip Groves.1990. Hospitals and Healthcare Facilities. Gt.Britain.Butterworth & Co. 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. PAM CPD 9th August 2008

10. PRIMARY CARE • At this level, health care services are based in the community and relatively accessible to patients and their families; they are also located at the periphery of the system. • The services include preventive health measures such as immunisation programme, ante-natal and child care and simple diagnosis and treatment. Anthony Cox, Philip Groves.1990. Hospitals and Healthcare Facilities. Gt.Britain.Butterworth & Co. PAM CPD 9th August 2008

11. PRIMARY CARE • They are operated by doctors,nurses,medical auxiliaries and social workers based in aid posts, dispensaries, clinics and health centres that serves relatively small numbers of people and situated as close as possible to their homes. This will enable medical and other health personnel to be in contact with their patients habitual environment. • In a more urban environment, primary care is provided by a group of general medical practitioners. Anthony Cox, Philip Groves.1990. Hospitals and Healthcare Facilities. Gt.Britain.Butterworth & Co. PAM CPD 9th August 2008

12. SECONDARY CARE • At this level, there is general hospital to which patients from wide surrounding area are referred to whenever necessary by primary care units for more sophisticated diagnosis or treatment. • Although expensive, hospitals are indispensable part of the health care provision as there will always be a proportion of patients who need the particular skills and equipment that can be concentrated in them as well as being centres for medical and health education ..and research. Anthony Cox, Philip Groves.1990. Hospitals and Healthcare Facilities. Gt.Britain.Butterworth & Co. PAM CPD 9th August 2008

13. SECONDARY CARE • Thus referral to hospital is essential for special diagnosis and treatment as outpatients where possible and only to be admitted when the degree of care is necessary for recovery. • Location of this facility is normally further away from their homes Proposed Ampang Hospital PAM CPD 9th August 2008

14. TERTIARY CARE • Tertiary care are healthcare services that deals in teaching of medicine i.e. the teaching hospitals as well as specialised institution such as the Cardio Thoracic Centre, The Spinal Centre. • Tertiary care include research activities that benefit the other level of care. HKL PAM CPD 9th August 2008

15. TERMINAL CARE • Terminal care or hospice care or palliative care means care or the terminally ill person that addresses the physical, psychological. Emotional and social needs of the person or his family. PAM CPD 9th August 2008

16. Spectrum of healthcare • These are again refined to PROMOTIVE, PREVENTIVE, CURATIVE,REHABILITATIVE and PALLIATIVE care. preventive Palliative Promotive Curative Rehabilitative PAM CPD 9th August 2008

17. The referral system • ….. a concept defined by WHO as a channel of filtering and referring patients to appropriate care,patients are referred promptly from the less intensive facilities to a highly intensive providing facilities from first point of access. • The interpretation may differ from country to country based on their own healthcare system and availability of appropriate care. • The requirements of the facilities influence the design of these facilities from simple structures to complex matrix. PAM CPD 9th August 2008

18. Health-care facilities • Healthcare impels the provision of a wide variety of buildings, to serve many different functions and accommodate the whole life span of man. “From cradle to grave” “From Womb to Tomb” • Shelter is needed for the promotion of health and the prevention of sickness, for assisting natural functions like childbirth, for curing disabilities and repairing malfunctions and for supporting the afflicted and incapacitated. Healthcare buildings as defined by Cox.A et al (1981) PAM CPD 9th August 2008

19. Health-care facilities • This shelter may fall into a number of generic types. Although medical knowledge is largely international, the ways in which it is applied and in which it is delivered in one country and another are likely to differ, as are the forms of building appropriate to the particular circumstances. • The forms reflect the nature of the organisation, culture, economy and geography of their respective situation and the peculiarities of their social microclimate. Healthcare buildings as defined by Cox.A et al (1981) PAM CPD 9th August 2008

20. Health-care facilities • There are no universal solution for the provision of healthcare facilities. • It is dangerous to generalise but it is reasonable to make a broad distinction between the facilities available or provided for between the developed and the developing world. Healthcare buildings as defined by Cox.A et al (1981) PAM CPD 9th August 2008

21. Building typology • The healthcare building types falls into many generic types is wide ranging and of several hierarchy encompassing Clinics, General Practitioners, Health Centres, Ambulatory Care, Community Hospitals, General and District Hospitals, Teaching Hospitals, Hospices, Nursing Homes, Maternity Homes, Care of the Elderly, Convalescent, Rehabilitation Centre, and other health related facilities. PAM CPD 9th August 2008

22. Hospital Architecture As a building typology PAM CPD 9th August 2008

23. Hospital Architecture • Hospital Architecture are one of the architecture that addresses healthcare function with users as the very core of its creation • The planning and design of hospitals therefore need to focus on creating spaces and environment for users and thus sustaining the complete balance that could constitute a healthy organization vis-à-vis human management and its human-based facilities. PAM CPD 9th August 2008

24. Hospital Architecture • The emergence of hospitals with all its technicalities, do notexclude the fundamental of good architecture in addressing the environment, culture, needs and definitely the clinical requirements for the very purpose of treating and saving lives for all. PAM CPD 9th August 2008

25. Hospital Architecture • Throughout the hospital developmental history, hospital buildings plays a significant role in considering the people they house and shelter to get well are not infected by the very convergence of all the sickness they harbour at the inception. PAM CPD 9th August 2008

26. Functional requirement that include critical planning to work flow, operational policies, clinical procedures and infection control plays a fundamental role in determining the success of the facility PAM CPD 9th August 2008

27. Brief history • Hospitals began with a humble beginning of charitable organization for the poor, the sanatorium for the mentally ill, the hospices for the terminally ill, religious buildings and make shift buildings during the early wars PAM CPD 9th August 2008

28. Brief history • On passive design considerations, the Greeks, through Aesculepius, invented spas and gardens with fresh air, sunlight, music and places for relaxation as a mean of healing. PAM CPD 9th August 2008

29. The necessity to divide and separate spaces for the sick due to contamination and infection came after bouts of serious epidemic leaving many people dead, and the scientific findings of the microbes that spreads through air, water and touch. • Florence Nightingale, revolutionisedthe modern hospital designs by bringing standards in the requirements of fresh air, day-lighting and the need to wash after every contact as a norm to good infection control practices. HD,04 PAM CPD 9th August 2008

30. Good environment plays an important role in recuperating back the health well-being of patients, …in the Muslim history of healthcare during the Ayubbid, the Andalusian and Ottoman period, based on the ayah, “You shall not attain to virtue unless you spend (for the welfare of the poor) from the choicest part of your wealth.” 3:92, hospitals or Bimaristan were converted from palaces apart from purpose built structures of the kulliyye or mosque cum madrasa complexes. PAM CPD 9th August 2008

31. The hospital commands a good location in terms of • accessibility by the public, • design with large windows and high ceilings allowing natural fresh air and sunlight into the interiors, • built in a appropriate orientation for optimisation of the natural assets and with flowing rivers for sanitation as well as transport, • commanding good view of the city or the countryside with • pockets of sunlit gardens in the interior for psychological and physical support. PAM CPD 9th August 2008

32. “If all forms of the Islamic worship are carefully examined, principles of public health and hygiene, which is the most important objective of medical science, have been kept in view with attention to the minutest details.” • There were even reports that when Adudi hospital was set up in Baghdad in 982 AD by Buyid ’Adud al-Daula near the bank of Tigris river, several meat was hanged for a few days at the proposed site. The site where the meat was least infected were eventually chosen for the construction of the proposed hospital. Internet: hospital in Islam Excerpted from English translation of Dr. Sibai's book "Min Rawa-i-Hazaratuna" by S.A. Khan. PAM CPD 9th August 2008

33. Hospital basic components Non Medical Support Outpatient Diagnostic and Treatment Administration Inpatient Area Training Medical Support Research PAM CPD 9th August 2008

34. Basic Hospital Forms and Configurations • Pavilion / Village Concept • Finger Like • Town / Tower and podium Concept • Compact • Doughnut • The Mall • Other PAM CPD 9th August 2008

35. Pavilion / Village Concept Individually designed pavilion or standard templates Open ended corridor for flexibilty PAM CPD 9th August 2008

36. Tower & Podium tower podium Compact Where all the departments are stack up and put together in one whole structure PAM CPD 9th August 2008

37. Finger like Doughnut/ Courtyard PAM CPD 9th August 2008