2010 Hospital Design Competition photos

2010 Hospital Design Competition photos: The wildcards

Here are some of the most beautiful and unique features from the 2011 Hospital Design Competition winners.

Feb 15, 2011 VETERINARY HOSPITAL DESIGN

Greek and Associates Veterinary Hospital
Yorba Linda, Calif.

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Hospital Design - Equipment

	6 tips for integrating equipment into your facility
	New technologies affecting design

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http://veterinaryhospitaldesign.dvm360.com/vethospitaldesign/article/articleDetail.jsp?id=707957&pageID=12

Way Finding & Signage in Hospitals & Clinics

Way Finding & Signage in Hospitals & Clinics

May.09, 2010 in Design Process, Disability Issues

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Visits to a hospital by patients or their visitors are almost always a stressful experience, especially the first visit. This stress can rapidly escalate, if they cannot get to where they need to go, quickly – be it to get treatment or to visit a loved one. The difficulty to find way can be compounded for the patient or a visitor if they are less able-bodied person e.g. if they are visually impaired, colour blind, or wheelchair bound etc.

Hence, hospital and clinic designers need to have a comprehensive Way Finding and Signage strategy to assist in efficient functioning of a hospital or a clinic. This is not limited to just providing department names on wall mounted boards with arrows pointing in the right direction. Way finding requires thorough analysis of various aspects of a modern medical facility including

• the locations of various departments with regards to entrances, -
• foot traffic,
• routes,
• different colours association with departments,
• strategic locations for signage including ceiling hung to complement the wall mounted signs,
• use of signs in Braille along the route frequented by people with little or no sight including buttons in the lifts and in toilets, for example
• correct use of lighting
• use of graphics to assist with speakers of foreign languages

There is a huge variety of signage available in the market ranging from printed wood and plastic panels, small hand-held audio devices to LED and even high definition LCD and plasma displays being used to help people find their way and access information. Hospitals also use interactive computer displays to provide public information including route maps and locations of various functions and general knowledge of interest to the public.

One of the latest developments is the use of environmentally friendly materials such as water based paints, re-programmable LED scrolling signs and as mentioned above use of latest HD TV technology to name a few. The last two can also be programmed to provide assistance in several different languages and signs.

Hospital medical signage, as you can see, has an important role to play in the smooth and efficient running of a modern patient friendly hospital. Get it wrong and you may have a lot of irate patients and visitors, which in turn would affect staff morale and even safety.

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About the Author:

Harry McQue is a hospital design manager with three masters degrees including business management and information technology. Harry has 15 years of international experience ranging from working on hospital projects in Dubai (Middle East) to over £1 Billion hospital projects in the UK. You can benefit from his experience at: www.hospitaldesigntips.com. If there are topics that you would like his advice on, you can get in touch on Harry_Mcque@HospitalDesignTips.com

Copyright 2008, http://www.hospitaldesigntips.com. Reproduction by permission only. Please contact harry_mcque@hospitaldesigntips.com for permissions and advice.

Any broken link? Please let us know at harry_mcque@hospitaldesigntips.com

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http://www.hospitaldesigntips.com/2010/05/way-finding-signage-hospitals-clinics/

Easy Guide to Pathology Lab Design

Easy Guide to Pathology Lab Design

Jul.11, 2008 in Design Process

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	Web www.hospitaldesigntips.com

Planning Pathology labs including microbiology, biochemistry and haematology should be fairly simple and straight forward. But we know from experience that if careful thought is not given at the design and planning stage, the simplest of things can and most probably will go wrong.

So what do we really need to watch out for? Although designing a hospital is a painstaking procedure best left to the professionals, still the following three basic aspects pertaining to hospital lab design need to be remembered:

Lab Benching
The material and surface are your first consideration. For labs that deal with strong chemicals, Trespa (a brand name and material by Trespa) is the best choice in the market. Within Trespa, there are two types – Trespa Athlon and Trespa TopLab (both registered trademarks of Trespa) .

Athlon is more impact and scratch resistant while TopLab is more chemical resistant.

The other important aspect is the height & depth of the lab benching. Generally recommended height is 920mm for standing and depths are 600mm or 750mm but you will come across situations where an 800mm deep benching is required. This maybe needed to accommodate a deep equipment above or below the lab benching.

You need to remember that with a 750mm deep benching the space below is less than that due to the back panel which hides the services running behind such as electrical cables and water and drain pipes. Make sure you know the height and depth of your under bench fridges and cupboards as well as how big and heavy your worktop mounted analysers and centrifuges are.

Services
The second important consideration is the quantity and type of services required for each piece of equipment dotted around the labs and the need for power, data, potable or special water (distilled, de-ionised, RO), lab gasses, sinks and drainage. Some of these are normally placed at regular measurements around the labs depending on the activities being carried out.

Environment
Depending on chemicals and equipment used, fumes and heat dissipation (such as -70 degree freezers and blood fridges) issues can be significant. This has to be dealt with ventilation and convection cooling/air-conditioning.

While on ventilation, attention needs to be given to the fume cabinets and safety cabinets that require very careful and purpose built exhausts. These can be re-circulating (requiring specific filtration) or exhaust type that take the extract out to a certain level outside the building.

As experts in the field for a long while we strongly encourage hospital design students and newbies to get in touch with us. We are happy to assist upcoming and budding designers of the future!

About the Author:
Harry McQue is a hospital design manager with three masters degrees including business management and information technology. Harry has 15 years of international experience ranging from working on hospital projects in Dubai (Middle East) to over £1 Billion hospital projects in the UK. You can benefit from his experience at: www.hospitaldesigntips.com. If there are topics that you would like his advice on, you can get in touch on Harry_Mcque@HospitalDesignTips.com

Copyright 2008, http://www.hospitaldesigntips.com. Reproduction by permission only. Please contact harry_mcque@hospitaldesigntips.com for permissions and advice.

Any broken link? Please let us know at harry_mcque@hospitaldesigntips.com

source
http://www.hospitaldesigntips.com/2008/07/easy-guide-to-lab-design/

Planning Imaging Rooms for a Hospital

Planning Imaging Rooms for a Hospital

Oct.17, 2008 in Design Process

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	Web www.hospitaldesigntips.com

Of all the clinical areas in any hospital, X-Ray, CT, and Fluoroscopy need much more planning and co-ordination than any other thing imaginable. This is mostly due to the fact that the equipment used and its implications on the building structure and services is much more complex with the exception of the MRI. We will deal with MRI in another article and will only discuss factors to be considered while designing an X-Ray room, which, in principle will hold for the CT & Fluoroscopy rooms as well.

Room Dimensions, Entrance and Access Route
As X-Rays are large and heavy pieces of kit, first and foremost consideration should be: Can the largest part be brought to its intended location from the entrance via any corridors and lifts? You should consult the equipment manufacturer’s specific model pre-installation guide before you make the purchase and involve an architect to ensure the kit will pass through all doors and corners and will not get stuck in the lift doors (if the location is not on ground floor)!

The manufacturers will advise of the critical room dimensions for the equipment to work and intended clinical procedures to be carried out successfully with regards to the prevailing local regulations.

Structure
As clinicians will know, X-Ray equipment consists of the floor mounted table, wall mounted chest bucky and (mostly) ceiling mounted X-Ray tube. In addition, there is the operator’s control console and the generator cabinet with a couple of Emergency Stop buttons.

The ceilings and walls must be strong enough to not only take the weight of these items but have proper pattresing to attach the equipment as recommended.

All these pieces of equipment require power and interaction hence cables run between these items. With the table being in the middle of the room, there is a need for having a floor trunking with removable lid between the wall and the table to house any cables. The exact location, dimensions and details of this trunking must be established with the equipment manufacturer. If your hospital is a new build, you need to pass that information together with the floor loading and ceiling slab deflection and minimum vibration requirements to your structural engineer and the architect. If it is an existing building, you are best advised to establish the above requirements and involve your builder, architect and a structural engineer before purchasing the equipment.

Most probably, the services between the floor mounted equipment and the ceiling mounted tube will be run on surface mounted floor to ceiling wall trunking with removable lid.

Make sure that the ceiling is strong enough to take the load of the tube and that the area above does not have any equipment or plant that makes vibrations. In addition, the veiling mounted tube glides along the length of the table on two rails. These rails are mounted on secondary steel attached to the ceiling. This secondary steel is usually UniStrut or MarsStrut which are registered trademarks and you will normally employ specialist sub-contractors to install these as the radiographic equipment suppliers work once the room is complete with all services available, secondary steel installed and floor and wall trunkings and high level cable trays in place and room finished to builder’s clean.

Services & Environment
Will suffice to say that you will require power and data (check if broadband) as per the manufacturer’s specification. The equipment will generate significant heat and hence cooling will also be required. Make sure you ask whether humidity control is also required as generally people do not understand differences between comfort cooling, air-conditioning and humidity control.

There will usually be an emergency stop button at the control console and another possibly near the table.

The actual location of all services and equipment will have to be precise according to the supplied drawings provided specifically for your project by the equipment manufacturer.

Radiation Protection
Depending on the equipment, room size and location of the equipment and adjacent areas, a qualified Radiation Protection Advisor must be employed to advise on what materials must be used for walls and doors (and floor and ceiling if required) to ensure the X-Ray equipment radiation is contained an does not harm anyone. (The operator in the room operates from behind a lead screen).

I hope that the above main points will help you think and plan ahead when you want to add/update your next imaging room and will allow you to quiz manufacturers, builders, architects and engineers involved to give you the best and most effective and economical solution for your money!

As always I would love to hear your feedback, comments and your experiences – good or (God forbid) bad.

About the Author:
Harry McQue is a hospital design manager with three masters degrees including business management and information technology. Harry has 15 years of international experience ranging from working on hospital projects in Dubai (Middle East) to over £1 Billion hospital projects in the UK. You can benefit from his experience at: www.hospitaldesigntips.com. If there are topics that you would like his advice on, you can get in touch on Harry_Mcque@HospitalDesignTips.com

Copyright 2008, http://www.hospitaldesigntips.com. Reproduction by permission only. Please contact harry_mcque@hospitaldesigntips.com for permissions and advice.

Any broken link? Please let us know at harry_mcque@hospitaldesigntips.com

source

http://www.hospitaldesigntips.com/2008/10/planning-imaging-rooms-hospital/

General Operating Theatre Design

General Operating Theatre Design

Mar.23, 2009 in Design Process

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	Web www.hospitaldesigntips.com

Designing an operating theatre outlines the intricacies of the hospital design process. An operating theatre suite consists of the Theatre, the Anaesthetic room, Scrub room and the Dirty Utility (or just Utility) room. We will look at planning just the Operating Theatre itself in this hospital design guide article.

The size and room dimensions vary but as an indication it should be about 7 meters wide by 8 meters long (56 square meters).

Any surgeon will tell you that over-riding principles while designing an operating theatre are:

• Flexibility of use of the space;
• Ease of cleaning the theatre – including the floor, walls, surgeons panel and any equipment such as pendants and theatre lights;
• Ease of use of surgeons panels, theatre lights and pendants.

There are different arguments for either having all equipment and instruments on mobile trolleys to allow 100% flexibility on use of the theatre and ease of cleaning the theatre versus mounting a great majority of equipment on ceiling mounted theatre pendants. The ceiling slab must be able to hold the weight of the theatre lights, pendants and the equipment if mounted on the pendants. It is highly recommended that you check with your structural engineer.

Ceiling Mounted Equipment:

1. Pendants

Expect a Surgical and an Anaesthetic Pendant in any theatre which have power, data and various gas outlets. There are several major suppliers on the market with numerous different types. Pendants can be rigid, rigid, retractable or fully articulated. Theatres require fully articulated pendants for maximum flexibility. A lot of co-ordination is required between medical gas, electrical, and pendant trade contractors together with electrical, mechanical and structural engineers/consultants while installing pendants to ensure all structural steel support is in place, gas pipes are properly connected and power and data cables run at the correct programmed dates.

Various life saving equipment must be powered off Un-interruptible Power Socket(s) – UPS, in case of power failure during surgery.

2. Theatre Lights

There used to be the Gas Discharge lights or Halogen lights. Aspects to consider were bulb life, costs associated and Theatre down time while bulbs were changed.

There is a new kid on the block in the last couple of years – LED technology. About 30% more expensive compared to the existing technology but very long life bulbs (over 20,000 hours), ease of maintenance (couple of minutes to replace an LED), cheap cost of replacement (fraction of older technology) and ability to vary light temperature hence helping to diagnose cancerous cells etc.

Theatre Lights must be backed up by a battery back up in case of power failure during surgery. Suggested time can be 3 hours back up. Note that general lighting and emergency escape lighting should also be on similar battery/UPS back up time.

3. Camera

In a teaching facility, a camera (now a days High Definition Camera) and microphone is also required for one way video (from Operating Theatre to Lecture Theatre and/or Seminar Rooms) and two-way audio for surgeons and students to communicate. The camera can either be installed in the handle of the main Theatre Light of installed on a separate ceiling mounted arm. Consider all implications for power and data transfer (HD requires much higher bit rate transfer). Consider a wireless Reality TV / Big Brother style microphone on the surgeon to allow freedom of movement.

In Orthopaedic Theatres you would need to consider the largest ceiling mounted item – The Laminar Flow or the Ultra Clean Ventilation (UCV) Canopy. This item will need a separate article as we are planning a general Theatre in this article.

Wall Mounted Equipment:

1. Surgeons Panel

The panels can the older style steel type or the more current Membrane Type panels which allow ease of cleaning/disinfection. The membrane can be made anti-microbial by inclusion of silver nitrate. A newer version of panels can be touch screen however its not proving very popular as it can take several screen touches to reach a certain function, whereas other two panel types have all the buttons available in the panel.

For ease of cleaning and aesthetics, the panels should be flush mounted.

Note that all the pendants, theatre lights, general lights, gas alarm panel, IPS/UPS, and warning signs for X-Ray in-use / Laser in-use signs outside Theatre, air sampling ducts, clocks etc need considered and carefully co-ordinated among the trade contractors and design consultants for services and wiring.

Floor Mounted Equipment:

1. Theatre Table

Generally these are rechargeable and don’t necessarily require power socket close by.

2. Trolleys

Trolleys are used for instruments and equipment such as video endoscopes and anaesthetic equipment.

We mentioned ease of cleaning at the start. To enable this the walls should have special plastic enamel paint to allow chemical cleaning if required in case of disinfection. The ceiling is generally constructed of plaster board or special metal to ensure it is air-tight and easily cleaned.

Airflow regime is an important part of moving the air from clean areas towards dirty and out of the Operating Theatre suite to ensure the Theatre is the most clean environment for operating on the patients.

I trust the above has given you some basics to consider when planning your next operating theatre.

---

About the Author:

Harry McQue is a hospital design manager with three masters degrees including business management and information technology. Harry has 15 years of international experience ranging from working on hospital projects in Dubai (Middle East) to over £1 Billion hospital projects in the UK. You can benefit from his experience at: www.hospitaldesigntips.com. If there are topics that you would like his advice on, you can get in touch on Harry_Mcque@HospitalDesignTips.com

Copyright 2008, http://www.hospitaldesigntips.com. Reproduction by permission only. Please contact harry_mcque@hospitaldesigntips.com for permissions and advice.

Any broken link? Please let us know at harry_mcque@hospitaldesigntips.com

source

http://www.hospitaldesigntips.com/2009/03/general-operating-theatre-design/

Health and Design

By Andrew Blum

How Hospital Design Saves Lives

Design changes can cut infection rates, lower physician errors, improve staff performance, and make all the difference in delivering care

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In 1999, the Institute of Medicine shocked the health-care industry with its landmark report, "To Err Is Human," which highlighted the staggering human and financial costs of medical error: an estimated 44,000 to 98,000 in the U.S. dead each year as a result of medical errors, more than from motor vehicle accidents or breast cancer, costing the country between $17 billion and $29 billion in health-care costs, disability, and lost income.

Yet it wasn't all fire and brimstone. The report emphasized the benefit to be had from focusing not on individual people making individual mistakes, but rather on the systems themselves. Health care, the Institute of Medicine said, had to learn from industries such as aviation, nuclear power, and construction that dramatically increased safety using "systems thinking," looking holistically at failures, rather than identifying a single weak link.

For health care, that meant replacing individual blame with collective responsibility. Improvements are already visible. In June, Dr. Donald Berwick of the Harvard School of Public Health announced that an estimated 122,300 lives had been saved in just the last 18 months, as a result of changes—ranging from improved hand-washing to establishing an organization-wide mandate for safety—recommended by the "100,000 Lives Campaign" sponsored by the Institute for Healthcare Improvement, a Cambridge (Mass.)-based nonprofit.

DESIGN FOR LIFE. But there is plenty more to be done and one of the most promising areas to focus on is design. "Hospitals are dangerous places because of systems, and systems are a design problem," explains Derek Parker, co-founder of the Center for Health Design, a nonprofit think-tank, and a director in San Francisco at Anshen + Allen Architects, a leading health-care design firm.

For Parker, the solution starts with the building. "We're expanding the definition of architecture. It isn't about choosing fabrics for the lobby," Parker adds.

Forget fancy entrances, healing gardens, and feng shui—more aesthetic elements of building design whose impact on patient health is easy to suppose but difficult to prove. Over the past seven years, hospital architects have increasingly awakened to the possibilities for design to save lives. To do that, they are taking a page from medicine's playbook.

ONE-TIME DEAL. Just as doctors are increasingly turning to "evidence-based medicine," which uses research data, rather than expert opinion, as a tool to make clinical decisions, so architects are linking statistical evidence—on patient outcomes, staff turnover, etc.—to the physical environment. Such "evidence-based design" is driving a range of innovations.

Yet in health care, large-scale innovation is easier said than done. "Most people building a hospital have never done it before, and will never do it again," says architect Parker. "They're spending several hundred million dollars of their community's money and they're scared." So the evidence not only informs design decisions, it helps convince building clients and communities to accept them.

And not a moment too soon: The aging baby-boomer population is expected to drive annual spending on hospital construction past $30 billion by 2009, up from $19.8 billion last year, according to FMI, a construction research firm. For the evidence-based design movement, that boom means a unique opportunity to have a major effect on the next generation of hospitals.

PROVEN RESULTS. But given the financial strain hospitals are under—a recent McKinsey & Company report showed that, between 1990 and 2004, health-care facilities' compound annual growth rate was 5.1%, while pharmaceuticals and insurance grew 8.9% and 11.3%, respectively—there's little appetite to invest in untested ideas. Ample data is crucial to implement innovation.

In a research report funded by the Robert Wood Johnson Foundation, the Center for Health Design identified more than 600 articles in peer-reviewed scientific journals demonstrating the effects of the hospital environment on patient health and safety, care efficiency, and staff effectiveness and morale.

The report opened the door for design improvements, many of which are now being deployed in "Pebble Projects," a research program run by the Center for Health Design to help hospitals compare design innovations with pre-existing conditions. The goal is for the nearly three dozen hospitals currently participating to be "pebbles" that create ripples through the entire health-care industry.

WRONG SIDE SURGERY. The opportunities for using design to improve hospitals range from the subtle to the mundane, the environmental to the ergonomic. Increasing natural light and reducing noise, for instance, lower stress levels for both patients and staff (see BusinessWeek.com, 08/15/06, "Seeing the Light").

Standardizing operating rooms within a hospital minimizes the likelihood of wrong-site, wrong-side, or wrong-patient surgery (a not uncommon occurrence). Arranging nursing stations to improve access to both patients and charts reduces errors and fatigue. And perhaps most important, providing private rooms improves infection control, allows families to help with care, and minimizes environmental stressors such as noise and light.

Many of these changes have an impact on more traditional management and financial metrics as well. For example, at the newly constructed 210-bed Parrish Medical Center in Titusville, Fla., surveys revealed that a majority of hospital workers thought the new design improved their ability to deliver care. In the first year after the building's completion, staff turnover dropped from 14.1% to 12.5%.

CLEAN AIR. A Pebble Project at the $181 million Bronson Methodist Hospital in Kalamazoo, Mich., is comparing the old and new facilities in terms of employee turnover, patient outcomes, patient length of stay, health-care costs, cost per unit of health-care service, patient waiting time and satisfaction levels, hospital-acquired ("nosocomial") infection rates, and a culture that promotes safer care.

Most significantly, nosocomial infection rates decreased by 11% since the opening of the building—thanks to the use of private rooms, the installation of more sinks to encourage frequent hand-washing, and a new ventilation system design. Evidence of the benefits of private rooms has proved so overwhelming, in fact, that last month the American Institute of Architects changed its guidelines for hospital design to mandate them in all new hospital construction.

Of all of the Pebble Project sites, Bronson Methodist is perhaps the closest there is to the Center for Health Design's "Fable Hospital," an imagined facility encompassing all known improvements based on the pebble research. Conceived as a 300-bed urban hospital built for $240 million, Fable has all private, "acuity-adaptable" patient rooms—meaning they can accommodate a variety of conditions, reducing the need for room changes which provoke errors and extend recovery times.

PAYS FOR ITSELF. The Center for Health Design estimates that, all told, these and Fable's other features would add $12 million to the hospital's construction costs. But thanks to reduced patient falls, transfers, nosocomial infections, nurse turnover, and drug costs, as well as increased market share and philanthropy, the Center believes those costs would be recouped within a year.

"There's a limited pot of money out there to build and operate these facilities," explains architect Robin Guenther, whose New York-based Guenther 5 Architects has a national reputation for innovative medical facilities. "And if it's going to cost more to build it better cost less to operate."

Adds the Center for Health Design's Parker, "It costs a lot of money to build a poor hospital, and only a little more to build a better hospital."

PUSH TO GREEN. It's a message Kaiser Permanente—the nation's largest HMO, with eight million patients and 63 million square feet of space—is taking seriously. Kaiser's massive scale puts it in a unique position to embrace evidence-based design. By mining its built-in treasure trove of patient information, Kaiser's national facilities team can correlate patient outcomes with hospital design—exploring the impact on patient outcomes of everything from the cardinal direction a patient room faces to the type of flooring.

"We're trying to take accountability for evidence-based design and see what we can do to push it," says John Kouletsis, Kaiser Permanente's director of Strategy, Planning, and Design in its National Facilities Services office.

One of the directions the evidence is pushing Kaiser is towards green design. Just as businesses are finding green design increases productivity, there is data showing that sustainable design allows hospitals to improve care while keeping down costs. At best, sustainable design increases natural light and views, improves indoor air quality, and reduces toxic chemicals in hospitals—a crucial issue in an industry dependent on powerful disinfectants and with staggeringly high rates of adult-onset asthma among staff.

PATIENTS FIRST. For Kaiser, green design includes both resource-saving measures such as green roofs and permeable paving, as well as solutions that improve patient outcomes. For example, Kaiser has changed its network-wide flooring standard to eliminate PVC-based vinyl flooring, reducing the pollution created on disposal, while reducing slips, trips, and falls, lowering noise levels, and creating a more comfortable work environment for staff.

"We would never pursue green just for the sake of green," explains Kouletsis. "It will always be high on our agenda to do no harm to the communities in which we operate, but we also consider if it provides for patient safety, for better patient outcomes, and for staff and physician safety."

Green materials are just one element of Kaiser's Sidney R. Garfield Center for Healthcare Innovation, a 35,000-square-foot space near the Oakland airport used to mock up a variety of care environments, in order to test new technologies and design strategies.

ENVIRONMENTAL CARE. Opened in June, the research center will provide the evidence to guide Kaiser as it embarks on a $24 billion, 10-year capital building campaign, for both new construction and seismic retrofit in accordance with California's Hospital Seismic Safety Act. Known as SB 1953, the legislation requires that all acute care hospitals be seismically upgraded by 2013—a move expected to cost at least $41.7 billion, according to a 2002 RAND report, which is currently being revised.

Yet for all of these projects, the challenge remains bringing design deeper into the process of delivering care. As Dr. Paul Schyve of the Joint Commission on Accreditation of Healthcare Organization explains, "When people use the phrase 'evidence-based medicine' they're thinking about specific things you do in clinical care.

But I would be inclined toward a broader concept of evidence-based health-care: How does the team as a whole come together and how does it interact with its environment? Evidence-based design is a component of evidence-based health-care because the design is part of the systems and processes and those are what cause errors."

Blum is a contributing editor to BusinessWeek Online in New York

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How Hospital Design Saves Lives

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