Sustainable and Green Hospital: An Innovative Approach

SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

A 375 BEDS MULTI-SPECIALITY (DISTRICT)

HOSPITAL Thesis 2021 | School of Planning and Architecture, New Delhi

Abhishek Anand (A/2896/2016)

SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

A 375 BEDS MULTI-SPECIALITY (DISTRICT)

HOSPITAL, DWARKA SECTOR O9, NEW DELHI Thesis Report

Guides - Dr. Mandeep Singh, Mr. Amit Bahl Co-Ordinator - Dr. Aruna Ramani Grover

Abhishek Anand A/2896/2016

Candidate Declaration

31st May 2021

The thesis titled A Sustainable and Green Hospital : An Innovative Approach a requisite of the Bachelors Program in the Department of Architecture, School of Planning and Architecture, New Delhi – 110002, was completed by the undersigned in January – June 2021 The supervisors were Dr. Mandeep Singh and Mr. Amit Bahl (names of all guides) The undersigned hereby declares that this is his/her original work and has not been plagiarized in part or full from any source. Furthermore this work has not been submitted for any degree in this or any other University.

(candidate signature) Name:-

Abhishek Anand

Roll No:- A/2896/2016 Section :- A

Certificate

31st May 2021

We certify that the Thesis titled A Sustainable and Green Hospital : An Innovative Approach by Abhishek Anand roll no A/2896/2016 was guided by us in January – June 2021 and placed in front of the Jury by the candidate on 31st May and 1st June 2021.

On completion of the report in all respects including the last chapter by the candidate and based on the declaration by the candidate hereinabove, we forward the report to the Department to be placed in the library of the School of Planning and Architecture, New Delhi.

Dr. Mandeep Singh

Mr. Amit Bahl

(Design and Technology Guide)

(Design and Research Guide)

Acknowledgement

This thesis was completed during very hard times and it would have been the next to impossible task without encouragement, critical insights, and unquestioned support offered by peoples all around. I am grateful and appreciate every person who helped me along in this and keeps me motivated every time.

First and foremost, I would like to thank my family. Throughout the semester, they not only bared my ‘work attitude” but also ensure and maintain a cheerful environment around me. My sister is a medical student and she helped me to understand the complexity of hospital departments like how in-patient, the out-patient, emergency department works. Apart from these, their emotional support got me through tough times and made this journey possible.

I would like to thanks my thesis guides:- Dr. Mandeep Singh and Mr. Amit Bahl for their guidance during this project. They took out numerous hours to discuss the project at every stage and also always available to discuss new and different ideas of our design proposals. I would also like to thank my thesis Coordinators:- Dr. Aruna Ramani Grover and Dr. Jaya Kumar, who were a constant source of inspiration and always present for guidance.

This thesis was also shaped by critical insights, support, and guidance from many seniors and friends. Thesis Projects by Ar. Sandal Kapoor, Ankit Kumar, Anam Nasim, and Veeresh Angiras were constant sources of guidance and inspiration. Few discussions and suggestions by Wahaj, Himalaya, Himanshu helped shape the project.

I am very thankful to Wahaj, Dishant, Nabh, Sandrupthy, and Smiriti Guglani who helped me to provide vital information that helped me out to understand the complexity of Hospital Design and the Project.

This thesis has been never completed without the support of ‘ Thesis help’. I would like to express my deepest gratitude to Sovit Deo, Abhinav Kumar, Esthasam Ahmed, and Vivek who have been continuously supported me during the oddest hours.I would also like to apologize if, I would have missed any names. I am very lucky over the years, many peoples have helped me to learn and grow in their ways.

Last, but not least I want to thank me and every person who had encouraged me during my tough tim es.

Thank you so much.

Synopsis India has a universal healthcare model that is mostly administrated at the state level rather than the federal lavel. The India Constitution makes the provision of healthcare in India the responsinility of the state governments rather than central federal government. Hospitals have existed from ancient times. Even in 6th Centuary BC.during time of Buddha there were several Medical Hubs where they look after the handicapped and the poor.

The state of healthcare infrastructure in India, is extremly miserable in terms of Quality and Quantity, whencompared with many other developing nations. The number of beds required per 1000 population comes out to be adequate in other developing nations compared to india. However, In India cities like Chandigarh, New Delhi, Allahabad, Mumbai, Bangalore, Chennai and Hyderabad have some adequate medical Infrastructure but the fact is often disregarded that these cities have patients beyond city limits.

As per recent data, almost about 55% of inpatients in an urban medical hubs are found to be non-residents, at the given time, his results in tremendous pressure on these medical hubs.

The Project proposes a Sustainable and green hospital - A District Hospital where Multi- Speciality and Super-Speciality treatments are available and they are sustainable, works on efficient tecnology and can be seen as a place that can heal, smart, brings out sensative character of architecture. An extended space that integrates multiple functions and serves as a best medical hub, the rehabilation centre which is vibrant, relaxed and open to all and also proposes Residential facilities for doctors, nurses, Staffs.

The Project operates as a 2 Phase development. First, a 375 bedded Multi- Speciality Hospital with Rehab Centre, 20% Residential facility and having different kinds of public/ Private spaces, courtyards for better air circulation and interactive spaces, Green terraces, Double heighted waiting areas, canteen facilities etc.

Also focuses on providing right facilities for the patients and the right kind of environment which could really enhance the healing process of the patients.

Second, a 125 bedded Super Speciality Hospital having cancer treatment speciality. It will also have courtyards, Green terraces, effcient tecnology which will really help in healing process of the patients.

Finally, the project presents a design for Sustainable and green Hospital. It aims at creating an interesting building typology which helps all kinds of patients, staffs and visitors offering spaces alongside specialized program facilities, and it promotes sustainabile character of architecture.

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Contents CHAPTER 1 INTRODUCTION...................................................... ........................................................................16 - 19 Preposition Phenomenon Project CHAPTER 2 AREA OF RESEARCH & CASE STUDIES ..........................................................................................21 - 65 2. Area of Research History : Hospital Design Ancient History Medievial History Modern History

The Problem?

Challenges!

Objective Understanding the Hospital Planning Ineter-depatment Relationship

Sustainability: Hospital Design Healing Environment

Conclusion and Design Directives Case Studies Fortis Multi-Speciality Hospital, Mohali Assuta Medical Center, Israel Appolo Indraprastha Hospital, New Delhi Paras Multi-Speciality Hospital Conclusion and Design Directives CHAPTER 3 PROGRAM DEVELOPMENT.............................................................................................................67 - 83 Introduction Detailed Program Development CHAPTER 4 PROJECT SITE AND ANALYSIS.......................................................................................................85 - 102

Site Location Transportation Climate Analysis Figure Ground Site and Surroundings Land Use Site Views & 3D Modelling Site Details and Bye Laws CHAPTER 5 TECHNOLOGIES....................................................................................................................105 - 120 Introduction Architecture Structure Energy Water Waste Manangement Lighting System Air-Pressure System Oxygen, Hygene, Infection Control CHAPTER 6 DESIGN DIRECTIVES..............................................................................................................123 - 131 Inferences Zoning Concept- Project Vision Concept:- Building Massing Zoning :- Bubble Diagrams Movement Systems Inter-Connected Spaces DESIGN TRANSLATION CHAPTER 7 FORM DEVELOPMENT.........................................................................................................132 & 133 CHAPTER 8 DESIGN DEVELOPMENT.......................................................................................................134 - 147 CHAPTER 9 FINAL DESIGN.......................................................................................................................148 - 169 BIBLIOGRAPHY..........................................................................................................................................170 - 171

Table of Figures

Page No.

1 Introduction Fig. 1.2.1. All India Institute of Medical Science, Delhi....................................................................20 Fig. 1.2.2 Fortis Memorial Research Institute, Delhi.........................................................................20 Fig .1.2.3 Appolo, Delhi......................................................................................................................20 Fig .1.3.1 Site Views and Surroundings road Connectivity, Dwarka 09, Delhi..............................21 Fig .1.3.2 3D Site View, SKP...............................................................................................................21

2 Area of Research & Case Studies Fig. 2.1.1 During Vedic Period...........................................................................................................25 Fig. 2.1.2 During Buddhist Period.......................................................................................................25 Fig. 2.1.3 During Mughal Period........................................................................................................25 Fig. 2.1.4 Shows Portuguesl arrival in India.......................................................................................25 Fig. 2.1.5 Major transport system in hospital....................................................................................26 Fig. 2.1.6 Patient Safety: healing environment................................................................................27 Fig. 2.1.7 Sustainable and Green environment...............................................................................27 Fig. 2.1.8 Hospital Planning & functions............................................................................................28 Fig. 2.1.9 Site Main Entrance itration................................................................................................30 Fig. 2.1.10 A typical site Plan with site entrances marked.............................................................30 Fig. 2.1.11 A typical Ground Parking...................................................................................................31 Fig. 2.1.12 A typical Basement Parking.............................................................................................31 Fig. 2.1.13 A typical Ambulance Parking.........................................................................................31 Fig. 2.1.14 A typical Emergency Drop off in Hospital......................................................................33 Fig. 2.1.15 Lobby & Waiting Area....................................................................................................33 Fig. 2.1.16 Reception & Waiting Area: ...........................................................................................33 Fig. 2.1.17 Corridor Plan – width clear of handrails.........................................................................34 Fig. 2.1.18 Corridor Plan – disabled access....................................................................................34 Fig. 2.1.19 Functional Relationship Diagram: Administration.........................................................34 Fig. 2.1.20 Rehab Centre Iteration...................................................................................................34 Fig. 2.1.21 Rehabilitation Relationship dagram..............................................................................34 Fig. 2.1.22 Emergency Department Iteration.....................................................................................35 Fig. 2.1.23 EmergencyUnitFunctionalRelationsDiagram.................................................................35 Fig. 2.1.24 SingleCorridorAccessmodel.............................................................................................36 Fig. 2.1.25 Single Corridor Access model............................................................................................36 Fig. 2.1.26 I ntensive Care Unit Functional Relationship Diagram......................................................37 Fig. 2.1.27 unctional Relationship Diagram: Operating Unit – Single Corridor Model...................37 Fig. 2.1.28 Functional Relationship Diagram: Birthing Unit.........................................................38 Fig. 2.1.29 3D Visualization of Inpatient ward..................................................................................39 Fig. 2.1.30 3D Typical layout of Inpatient ward..............................................................................39

Fig. 2.1.31 3D Typical layout of open plan bed bays....................................................................39 Fig. 2.1.32 Inpatient Accommodation Unit Functional Relationship Diagram................................39 Fig. 2.1.33 Medical Imaging-General Functional Relationship Diagram..........................................40 Fig. 2.1.34 The ideal functional Relationship diagram........................................................................41 Fig. 2.1.35 Pharmacy Unit Functional Relationship Diagram..............................................................41 Fig. 2.1.36 Blood Bank Functional Relationship Diagram....................................................................43 Fig. 2.1.37 Cleaning & Housekeeping Unit Fnl. Diagram..................................................................43 Fig. 2.1.37 Cleaning & Housekeeping Unit Fnl. Diagram..................................................................43 Fig. 2.1.38 Supply Unit Functional Relationship Diagram.................................................................43 Fig. 2.1.39 WM Functional Relationship Diagram.............................................................................43 Fig. 2.1.40 Hospital services relationship diagram............................................................................44 Fig. 2.1.41 Civil Services flow chart.....................................................................................................44 Fig. 2.1.42 Electrical Services flow chart.............................................................................................44 Fig. 2.1.43 Medical Services flow chart...............................................................................................45 Fig. 2.1.44 Mechanicall Services flow chart.......................................................................................45 Fig. 2.1.45 Fire Services flow chart........................................................................................................45 Fig. 2.1.46 Iteration of Sustainable Environment................................................................................46 Fig. 2.1.47 Iteration of clean waiting space......................................................................................46 Fig. 2.2.1 3D view of Fortis Super-Speciality Hospital Mohali...........................................................48 Fig. 2.2.2 Location Plan of Fortis Hospital, Mohali.............................................................................48 Fig. 2.2.3 Zoning of Blocks in Fortis Super-Speciality Hospital Mohali.............................................49 Fig. 2.2.4 Mortuary ..............................................................................................................................49 Fig. 2.2.5 Parking..................................................................................................................................49 Fig. 2.2.6 Physical Model of Fortis Hospital, Mohali..........................................................................49 Fig. 2.2.7 OPD Entry of Fortis Hospital, Mohali....................................................................................49 Fig. 2.2.8 3D Basement Plan Fortis Super-Speciality Hospital, Mohali...........................................50 Fig. 2.2.9 Services Plan Fortis Super-Speciality Hospital, Mohali.....................................................50 Fig. 2.2.10 Waiting Area Outside the consultation room................................................................51 Fig. 2.2.11 Consultation Room...........................................................................................................51 Fig. 2.2.12 OPD Clinic with Examination Room.................................................................................51 Fig. 2.2.13 OPD Clinic...........................................................................................................................51 Fig. 2.2.14 OPD Reception..................................................................................................................51 Fig. 2.2.15 Inpatient Entry.....................................................................................................................51 Fig. 2.2.16 Ground Plan of Fortis Super-Speciality Hospital, Mohali................................................51 Fig. 2.2.17 First Floor Plan of Fortis Super-Speciality Hospital, Mohali.............................................52 Fig. 2.2.18 Second Floor Plan of Fortis Super-Speciality Hospital, Mohali......................................53 Fig. 2.2.19 Third Floor Plan of Fortis Super-Speciality Hospital, Mohali............................................54 Fig. 2.2.20 Showing Double Glazing of Fortis Hospital, Mohali........................................................54 Fig. 2.2.21 Water treatment Pump room in Basement....................................................................55 Fig. 2.2.22 AC Plant Room, Cooling Towers & Generator Room..................................................55 Fig. 2.2.23 3D View of Assuta Medical Comlex, Israel.....................................................................56

Fig. 2.2.24 Ground Plan and views of Assuta Medical Comlex, Israel.........................................57 Fig. 2.2.25 Ground Plan with department markings.......................................................................58 Fig. 2.2.26 Section B B’ cutting through staircase...........................................................................58 Fig. 2.2.27 Shows Section A A’ of Assuta Medical Comlex, Israel...............................................59 Fig. 2.2.28 Shows Main Staircase of Assuta Medical Comlex, ....................................................59 Fig. 2.2.31 3D Physical Model of Appolo, Indraprasta, Delhi........................................................60 Fig. 2.2.32 view of Appolo, Indraprasta, Delhi................................................................................61 Fig. 2.2.33 Key Plan Appolo, Indraprasta, Delhi.............................................................................61 Fig. 2.2.34 Main Block Ground Floor, Indraprasta, Delhi...............................................................61 Fig. 2.2.35 OPD Block Plan, Indraprasta, Delhi..............................................................................61 Fig. 2.2.36 Atrium of Appolo, Indraprasta.......................................................................................62 Fig. 2.2.37 Corridoor of Appolo, Indraprasta, Delhi.......................................................................62 Fig. 2.2.38 Ground Zoning Plan of Appolo, Indraprasta,...............................................................62 Fig. 2.2.39 Typical Ward Floor of Appolo, Indraprasta..................................................................63 Fig. 2.2.40 Fortis Multi-Speciality Hospital, Mohali..........................................................................64 Fig. 2.2.41 Assuta Multi-Speciality Hospital, Israel..........................................................................64 Fig. 2.2.42 Appolo Multi-Speciality Hospital, Delhi.........................................................................65 Fig. 2.2.43 Paras Hospital, Patna.....................................................................................................65

3 Program Development Fig. 3.1.1 Area distribution between Hospital and Residential block.........................................70 Fig. 3.1.2 Area distribution between Multi,Super Speciality & Residence..................................70

4 Project Site & Analysis Fig. 4.1.1 Master plan of Delhi 2021................................................................................................88 Fig. 4.1.2 Site Location Plan.............................................................................................................90 Fig. 4.1.3 Sector 9 and Surrounding Sectors. ................................................................................91 Fig. 4.1.4 Delhi Public Transport Network.......................................................................................92 Fig. 4.1.5 IGI International Airport , Delhi........................................................................................93 Fig. 4.1.6 New Delhi Railway Station...............................................................................................93 Fig. 4.1.7 Old Delhi Railway Station.................................................................................................93 Fig. 4.1.8 Nearest Public Transport..................................................................................................96 Fig. 4.1.9 Precipitation days in a month.........................................................................................97 Fig. 4.1.10 Average temperatures and Precipitation...................................................................97 Fig. 4.1.11 Pie Chart of Precipitation amounts..............................................................................98 Fig. 4.1.12 Pie Chart of wind speed................................................................................................98 Fig. 4.1.13 Wind rose diagram.........................................................................................................98 Fig. 4.1.14 Figure Ground.................................................................................................................99

Fig. 4.1.15 Fig. 4.1.16 Fig. 4.1.17 Fig. 4.1.18

Immediate Surroundings................................................................................................100 Site Views.........................................................................................................................101 Land use Plan.................................................................................................................102 Site 3D view.....................................................................................................................103

5 Technology Fig. 5.1.1 Orientation of Hospital Block...........................................................................................108 Fig. 5.1.2 Shadow as on 21st June 10AM........................................................................................109 Fig. 5.1.3 Shadow as on 21st Dec 10AM.........................................................................................109 Fig. 5.1.4 Shadow as on 21st June 2PM..........................................................................................109 Fig. 5.1.5 Shadow as on 21st Dec 2PM...........................................................................................109 Fig. 5.1.6 Horizontal Shading in South direction.............................................................................110 Fig. 5.1.7 Vertical Shading in west direction..................................................................................110 Fig. 5.1.8 Thermal Analysis ( 2st March)..........................................................................................110 Fig. 5.1.9 Iteration showing Cool Island Effect...............................................................................111 Fig. 5.1.10 3D Visualition of courtyard spaces................................................................................111 Fig. 5.1.11 IInsulation wall.................................................................................................................111 Fig. 5.1.12 Average Energy Consumption in Hospital...................................................................112 Fig. 5.1.13 Average water Consumption.......................................................................................113 Fig. 5.1.14 Water System for Healthcare Facilities.........................................................................113

6 Design Directives Fig.6.1.1 Site Plan with edges connectivity....................................................................................126 Fig.6.1.2 Stage 1:- Initial zoning.......................................................................................................127 Fig.6.1.3 Stage 2:- Initial zoning of Entry/Exit. ................................................................................127 Fig.6.1.4 Inter-Connected Spaces in Ground Floor......................................................................128 Fig.6.1.5 large Central Courtyard for Passive Cooling.................................................................128 Fig.6.1.6 Stepping Masses:- With Green Terraces.........................................................................128 Fig.6.1.7 Courtyard Spaces for better lighting and Ventilation...................................................128

Chapter 1 Introduction

A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

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1.1 Proposition India is a country in South Asia which is officially known as the Republic of India. It is the world’s second most populous country, the seventh largest by landmass, and the world’s most populous democracy..

Every citizens of our country does have a fundamental need and right to health care. Hospitals, nursing homes, pharmacies, medical camps, and other medical facilities serve as the foundation for this healthcare delivery, which is supported by physicians, nurses, and other medical personnel. Unfortunately, India has a massive and rapidly growing population but have few hospitals.

The minimum 5 beds are required as per geography based on WHO requirements for a population of 1000 people.

As per latest metadata (2017) the no. of beds per 1000 is 0.53, which is far less than the minimum average and the country’s capital has 2.71 beds per 1000 of the population.

Over time, the health care system has evolved into a three-tiered system, with primary, secondary, and tertiary healthcare services.

The District Health System is the foundation for applying different health policy, healthcare delivery, and healthcare services management for a given geographic region. The district hospital is indeed an important part of the public health system because it serves as a secondary level of treatment for the district’s residents, providing curative, emergency, and promotional healthcare.

The Indian government is committed to enhancing the health sector in order to improve the population’s health.

Throughout the post-independence period, a number of solutions have been proposed towards this end for strengthening referral services, becomes the specific measure. and the provision of specialized services at the district and local levels and various clinicians have been appointed to the district headquarter hospital, including surgeons, physician, obstetricians and gynecologists, cardiologists, neurosurgeons, ophthalmologists, anesthetists, ENT specialists, and dentists.

The healthcare facilities represent the district’s urban (district headquarters town and surrounding areas) as well as rural residents. The district health authority must act not just as a curative center, but also as an intermediary with institutions outside of it, such as those operated by semi-government and private voluntary healthcare organizations. In today’s fast-changing world, a district hospital’s priorities must combine scientific thinking with realistic operations, attempting to integrate management strategies, behavioral actions, and decision-making models in order to serve the system and increase its performance and effectiveness.

The size of a district hospital is determined by the number of hospital beds required, which is determined by the population served.The number of beds needed for a district with a population of 10 lakhs would be about 300 beds if the annualized average of registration is 1 per 50 people and the average length of stay in a hospital is 5 days.

A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

This thesis intend to make a 375 beded Multi-Speciality District Hospital which will establish other side of the coin, can be viewd in the terms of urge of an architect to design spaces that can heal, sustainable, and smart which will seen as a sensative Character of the architecture at its best.

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1.2 Phenomenon :-

Need of Hospital in

Delhi Delhi is among India’s most rapidly expanding cities, with a perfect mix of modern and traditional architecture. It also serves as the legislative and judicial heart of the nation. The district, which spans 1,483 square kilometers and is 216 meters above the sea level, is bordered by two states: Haryana and Uttar Pradesh.

to the problem was to provide primary healthcare through Mohalla clinics to a population of 10,000 people, allowing them to seek medical care without having to travel more than two kilometers. Previously, a dispensary was scheduled for a population of 30,000-50,000 people.

It’s was also suggested to add 10,000 additional beds by evaluating the ongoing construction of three new hospitals and increasing their bed strength during the construction phase,

Healthcare profile & delivery system (DELHI) Mohalla Clinics Polyclinics Secondary Care Hospital Tertiary Care Hospital

Fig.1.2.1 All India Institute of Medical Science, Delhi

The Government of NCT of Delhi is taking all possible measures to develop an accessible, affordable, and quality model of health care delivery system in the National Capital, with a four-tier system that includes Mohalla clinics and many other health schemes.

People in the national capital have made health a top priority because it is a state subject.

Despite a growing body of services provided by various government bodies such as the Central Government, Municipal Corporations, and the New Delhi Municipal Council, as well as AIIMS and over 1000 private hospitals/nursing homes, the Government of the National Capital Territory of Delhi realized that the services were still insufficient With the growing population, the state faced a significant challenge in expanding the existing repositories of facilities each year to meet the demands of residents living in Delhi or visiting

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Best Medical Facilities in Delhi

Fig.1.2.2 Fortis Memorial Research Institute, Delhi

Fig .1.2.3 Appolo, Delhi

A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

1.3 Project The project is propose to be developed in two phases consisting 375 beded Multi-Speciality District Hospital with 125 beded Super-Speciality Cancer Hospital.

1st Phase:- 375 beded Multi-Speciality Hospital with Rehab Facility.

2nd Phase:- 125 beded Super-Speciality Cancer Hospital.

The proposed Hospital shall have a capacity of 375 Beds which will include:

Fig .1.3.1 Site Views and Surroundings road Connectivity, Dwarka 09, Delhi

User Type: Public Administrative Department Diagnostics Centre Emergency Pharmacy IPD Central Kitchen OPD NICU(Neonatal) ICU Hospital and Waste Management Operation Theatre Unit CSSD Rehabilitation Centre(24beds) Laundry Laboratories Blood Bank Delivery Suite Unit The Proposed Residential Facility shall have: 3BHK For Doctors and Administration 2BHK For Nurses and Paramedics 1BHK For Interns

Fig .1.3.2 3D Site View, SKP

A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

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Chapter 2 Area of Research & Case Studies

A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

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2.1 Area of Research 2.1.1 History? : Hospital Design

Healthcare facilities have developed in India since ancient times. During the time of Buddha, throughout the 6th century BC, there seem to be a numbers of healthcare facilities for the severely disabled and the needy.

Some of India’s most impressive hospitals were built by King Ashoka (273–232 BC). In the nineteenth century, systematic medical education system began.

The medical history has been categorised in three phases:-

physical and mental aspects of good health, as evidenced by Yajur Veda (16/4), which states that the world should really be free of illnesses and also that (almost everyone) should really have a positive mindset.

The Ayur Veda is the philosophy of life and tells us about How to Live a Longer Life. In the Ayur Veda, there are many figures. Ayur Veda is the foundation of traditional medicine. A court physician named Charak which was further elaborated by King Kanishka.

Many people were introduced by Dhanvantari, the principal god of Indian medicine.

Sushruta, the renowned physician of his time, received the knowledge and handed it on to him.

Ancient Period

During his tenure, Akbar (1555–1605) urged the unification of the Unani and Herbal medicine systems. The conversion of medical textbooks into Arabic, Persian, and finally Urdu was perhaps the most impressive achievement.

The influence of Muslim dominance was tangible. After the Portugal occupied Goa in 1510, it began to decline.

Fig. 2.1.2 During Buddhist Period

Fig. 2.1.1 During Vedic Period

Vedic Period Even though Aryans introduced their own gods and medical knowledge, the Indus valley culture was so advanced that it assimilated the Aryan culture. The four Vedas are the primary sources of Aryan culture and medical knowledge.

The Atharva Veda is full of hymns and prayers that describe how to safeguard people from various illnesses and environmental disasters. People in the Vedic period were concerned about both

Fig. 2.1.3 During Mughal Period

The Great Ashoka built numerous hospitals across the country. Middle eastern doctors educated in the Unani system made a huge impact as Islamic rule spread from the tenth century onward.

The curative approach had the greatest effect.

The Buddhist Period Lord Buddha was an active supporter of medical research. Furthermore, due to the extreme Ahinsa doctrine, Indian surgery suffered a setback during this time. Lord Buddha then used to personally attend to the sick. Taking care of the sick was considered a noble cause. During his travels to spread Buddhism, Buddha established Buddhist Viharas in various locations, with special attention given to the sick and medical education in each Vihara.

Medieval Period

A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

Modern Period

Fig. 2.1.4 Shows Portuguesl arrival in India

Throughout 1510 and 1515, the Portuguese built the Royal Hospital in Goa, and the Jesuits later added a simple standard medical training sys-

25

tem. This was transformed into a medical and surgical school in 1842.

Despite the fact that the Portugal were the first to introduce modern medicine to India, it was the French as well as the British who advanced it.

In 1664 and 1668, simultaneously, the first hospitals were built. In the year1846, the first medical school was established in Calcutta and it was followed by Madras. Locals were displaced as British rule spread across the region.

Dispensaries were required to be established at the sub-division and district levels by the authorities. At the regional governments the hospitals were upgraded into teaching hospitals.tals affiliated with medical schools on various levels.

In the year 1885, there were 1250 hospitals and dispensaries in British India.

Slow steps were taken, then on the day of independence, the nation had 7400 hospitals and dispensaries with 1,13,000 beds, a bed population ratio of 0.24 per 1000 people. At the moment, the country had 47,000 physicians and 7000 nurses, 19 medical schools, and 28 medical colleges.

The Good Medical facilities play an important role in healing of patients. At that time Ayurveda and other natural medicine was used with living in nature as the time passes medicine changes due to the development of tecnology but sometimes patients required much more than only medicine which can lead to less stay time in hospital and increase the health of several users.

India has a universal healthcare model that is

26

the federal level.The Indian Constitution makes the provision of healthcare in India the responsibility of the state governments, rather than the central federal government. Health has become the number one priority as our faith in the steady progress and improvement of society at large.

The increasing concern and obsession with health and wellness, being amongst both urban and rural populations, triggers an inevitable increase and demand for healthcare facilities.

The state of healthcare infrastructure in India, is extremly miserable in terms of Quality and Quantity, when compared with many other developing nations. The number of beds required per 1000 population comes out to be adequate in other developing nations compared to India.

However, In India cities like Chandigarh, New Delhi, Allahabad, Mumbai, Bangalore, Chennai and Hyderabad have some adequate medical infrastructure but the fact is often disregarded that these cities have patients beyond city limits.

As per recent data, almost about 55% of inpatients in an urban medical Hubs are found to be non-residents, at the given time. his results in tremendous pressure on these medical Hubs..

area is 5 beds. As per latest metadata (2017) the no. of beds per 1000 is 0.53, which is far less than the minimum and the country’s capital has 2.71 beds per 1000 of the population.

2.1.3 Challanges?

Hospital architecture is not just providing the right facilities for the patients but also focusing on the right kind of environment which could really enhance the healing process of the patients.

Throughout the rush to design health-care facilities, basic concerns such as ecological, social, mental, and spiritual health and happiness are often ignored.

The focus should be on efficiency of functionility of the building and taking care relationship between spaces and heal Currently, If we see Hospital Architecture in India the design of facilities focused on the support of Patient health only, not focusing on patients requirement.

Accessibility

2.1.2 The Problem?

Demand of Public

Fig. 2.1.5 Major transport system in hospital.

Deficiency in Supply

As per WHO norms for a population of 1000, the minimum bed requirement in the geographical

Hospital Architecture should focus on attempt to create healthy spaces, rather than space just provide Health. Whenever a healthcare facility

A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

becomes inaccessible to the public due to the location or inadequate infrastructure, may as well not even exist.

Patient Safety

2.1.4 The Objective

I

Understanding the Complexity of Hospital Design.

II

Understanding and Integrating the application of Sustainability.

Fig.2.1.6 Patient Safety: healing environmentl.

Patient safety is amongst the most important needs in healthcare design and operation, and a growing body of research shows that planning and development considerations have a direct effect on it. Providing handrails, designing flushed flooring transitions, and allowing direct, undisturbed paths to commonly areas such as toilets are all evidence-based design strategies to minimize safety issues such as patient falls.

III

Understanding and Implimenting the Healing Environment Concept.

Sustainability

Fig.2.1.7 Sustainable and Green environment

A hospital is among the most energy-intensive buildings, and sustainable design is critical for reducing natural energy consumption and lowering life cycle costs. To reduce waste of any kind, it is critical to apply the principles of efficient design, efficient operations, and simplified design.

A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

IV

Understanding and Implimenting Efficient Tecnology for Sustainability

27

2.1.5 Understanding the Hospital Planning.

ical personnel early on.include major insight from the investor and key.

All hospitals, regardless of their location, size, or budget, should share certain characteristics:-

The basic form of a hospital is, ideally, based on its functions:

• They must Promote staff efficiency by minimizing distance of necessary travel between frequently used space.

Emergency bed-related inpatient functions outpatient-related functions diagnostic and treatment functions administrative functions Rehab functions OT functions service functions (food, supply) research and teaching functions Circulation and Parking

Fig. 2.1.8 Hospital Planning & functions.

Hospitals are considered as very complicated structures. Each hospital offers a wide range of facilities and operational departments. Clinical laboratories, ultrasound, emergency departments, and surgery are examples of diagnosis and treatment services; hospitality functions such as food service and housekeeping; and basic inpatient care or bed-related services such as food service and housekeeping are examples of hospitality functions. This culture is reflected in the breadth and complexity of the rules, codes, and supervision that govern hospital design and operations.

In addition to accommodating a wide variety of facilities, hospitals must accommodate and support a diverse range of users and participants. The design process should, in theory, med

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The Hospital building configuration has an impact on the road networks, and the configuration is heavily reliant on the transportation systems. Site constraints and opportunities, environment, surrounding facilities, budget, and available technology all influence hospital layout.

Because the layout of a typical nursing unit can be repeated several times in a medium and large hospitals, it is a key component of the overall design. Nursing units are more compact than they were in the past, with elongated rectangles being the most common shape. In an effort to reduce the space between the nurse station as well as the patient’s bed, compact rectangles, modified triangles, and even circles have been used.

The solution selected is heavily influenced by program concerns including the nursing program’s organization, the number of beds in a nursing unit, and the number of beds in a patient room are designed as per guidelines provided by the Healthcare Authorithy of the nation.

• Make effective use of space by placing support spaces near adjacent functional departments so that they can be shared, and by using multi-purpose spaces wisely.Places like the surgical intensive care unit next to the operating room for optimum functional adjacencies. These connections should be based on a comprehensive functional plan that outlines the hospital’s planned activities in terms of patients, staff, and supplies.

• Each project should include a “way-finding” process. Patients, visitors, and staff must all know where they are, what they’re doing and, or where to go and back. Creating spaces easy to discover, recognize, and use without asking for help increases a patient’s sense of efficacy. External walls, colors, textures, and pattern, as well as paintings and advertising, should all provide cues.

• Trash, recyclables, and soiled materials should be kept separate from food and clean supplies, and both should be kept away from patient and visitor pathways.

• Ensure whether reception zones are designed to handle patients who adapt to dark and light at a slower rate; clearly mark glass walls and doors so that their presence is obvious.

• Safe control of violent or unstable patients

A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

Interdepartment Relationship The hospital’s layout is determined by the physical interactions between these functions. Certain connections between the various functions are needed, as shown in the system analysis below.

RESIDENTIAL FACILITY

RESIDENCE ENTRY NURSING STATION

CSSID ACCIDENT & EMERGENCY DEPARTMENT

EMERGENCY ENTRY

ICU OT

EMERGENCY LOBBY DELIVERY SUITES

INPATIENT DEPARTMENT & DAY CARE

SERVICES LABROTARIES

DIAGNOSTIC

NICU BLOOD BANK VISITOR’S ENTRY

PHARAMACY REHAB CENTRE

MAIN ENTRANCE A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

OUT PATIENT DEPARTMENT OPD

SERVICE ENTRY

CLINICS

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The point of entry to the site should always be viewed as a portal to the hospital. The planning, detail, and maintenance of this area must exercise subtle but clear control over the site entrance and main entrance, providing a suitable approach route and allowing effective site circulation.

Fig. 2.1.9 Site Main Entrance itration.

Site Entrance

A clear visual objective and a landmark for orientation while approaching the building are provided by a direct view of the main entrance canopy from the point of arrival onto the site.

Alignlng the approach road with the entrance canopy before directlng cars away to the vlsitors’ car parking.

The main entrance design should conider these factors: • • • •

ensure a moderate local climate; avoid strong winds; give shelter from the prevailing weather; provide sunlight areas to the associated external and internal spaces

For the incoming visitor or patient, the entrance gate canopy and external entrance area serve as the initial focus and objective. The layout should provide weather protection while also allowing for the numerous activities associated with people arriving and departing.

The Site entrance location will have an impact on circulation and connections within the hospital. Generally, the entrance of the Hospital Site is designed after considering number of criteria: • • • • • • • • • • •

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Hospital layout Plan; Relationship to site functions; Relationship to public transport facilities; relationshlp to available parking areas to minimise walking distances, existing site landscape features; localised climate; site circulation; future development proposals, characteristics of adjacent sites.

The main entrance would be located in relation to several other services as part of an overall plan for the hospital’s internal layout.

Connections to the hospital street and specific services like outpatient clinics, emergency care, and rehabilitation should be scheduled with the primary goal of minimizing internal circulation distances.

Fig. 2.1.10 A typical site Plan with site entrances marked.: Foothills Medical Centre A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

Fig. 2.1.11 A typical Ground Parking

Fig. 2.1.12 A typical Basement Parking

Parking The availability, location, and design of car parking should be considered early in the site planning process to avoid obstructing the foreground and approach to the hospital with unnatural looking parking areas. Visitors should not have to walk long distances from the parking lot to the main entrance. Parking for patients and visitors, staff, disabled users, and temporary parking for medical transport and service vehicles is all part of a comprehensive site strategy.

Key factors:• location of adequate parking as close as possible the main entrance, including designated areas or disabled users; • easy wayfinding, clear signing; • retention of existing landscape features and extensive landscaping of parking areas; • designated areas for bicycles and motorcycles; • separate parking for staff; • control of unauthorised parking; • security against vandalism and theft; • suitable night lighting.

A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

Fig. 2.1.13 A typical Ambulance Parking

T Y P I C A L P A R K I N G A T 9 0 31

Ambulance Bays:-

Parallel Parking Bays: with Obstructions

Provide the following minimum drive through area for ambulances:

Parallel spaces shall be located at least 300 mm clear of obstructions higher than 150 mm such as walls, fences and columns. If the opposite side of the aisle is bounded by obstructions higher than 150 mm then the aisle width (W) should be increased by at least 300 mm.

If a single space is obstructed at both ends the dimensions of the space shall be increased by 300 mm.

Parking Aisles

Minimum width is 5200 mm; minimum depth is 5500 mm.

The ambulance bay requires a covered space with a minimum length of 8000 mm and height of 3600 mm:

• Aisles for 90º bays need to allow for two way traffic. Aisles for 30º, 45º or 60º angled bays shall be • one way traffic. Parallel parking bay aisles may be either one way or two way traffic.

The width of • aisles for angled parking bays will vary according to the width of the parking bays, wider bays require less aisle width.

• Where there are blind aisles, the aisle shall extend 1 metre beyond the last parking bay. If the last • parking bay is bounded by a wall or a fence, it should be widened by 300 mm.

Wheel Stops • Wheel stops may be provided if necessary to limit the travel of a vehicle. Wheel stops should not be used in situations where they are in the path of pedestrians moving to and from parked vehicles or where pedestrians cross a car park. If required, wheelstops are installed at right angles to the direction of parking or where the ends of angled parking form a sawtooth pattern.

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A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

Fig. 2.1.14 A typical Emergency Drop off in Hospital

Fig. 2.1.15 Lobby & Waiting Area

Drop off

Lobby, Waiting and Reception

Getting to your intended destination in a hospital, whether you’re a patient, guest, or staff member, can be difficult if destinations aren’t clearly marked for you. Larger public hospitals with inpatient and outpatient facilities attract far more traffic, not only internally but also externally.

The reception area is also where a patient communicates with healthcare personnel for the first time.

That’s why making a good first impression is so critical for healthcare receptionists. Inviting reception areas may make the difference between one-time and repeat patients, particularly if it’s a first-time visit. Whether in a hospital, private practice, or walk-in clinic, a well-designed reception and waiting area would greatly enhance the patient experience.

Wherever there is a crossover between pedestrian and automobile circulation, which should be avoided as much as possible, traffic control and calming measures must be used.

On a daily basis, at least five types of drivers usually travel to and from a hospital: • Ambulance • Emergency walk-in patient • Service and hospital support deliveries/logistics • Inpatient visitor or extended stay • Outpatient or temporary clinical treatment • Staff

Fig. 2.1.16 Reception & Waiting Area:

Source- Jtv.tv

The patient experience should begin in the hospital lobby, and lobby design can help to create a positive first impression and set expectations. The evolution of hospital lobby design is part of a broader trend among hospitals to enhance patient satisfaction, increase room design versatility, and integrate new technologies.

The following are some of the most current hospital lobby architecture trends: • Digital check-in is available prior to arrival.

• Reduce wait times by monitoring and alerting patients using radio-frequency identification (RFID) technology.

• To allow social distancing, use waiting nooks and versatile furniture layouts.

• Leverage outdoor areas to encourage people to spread out • Touch-free building technologies, such as automatic doors, hands-free security systems, voice recognition elevators, and self-disinfecting surfaces and antimicrobial finishes, should all be considered.

• To sterilize public spaces, no-touch automatic disinfection systems such as UVD lighting are used.

A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

33

Corridoors

Administration

Hospital floors have traditionally been built as “corridors.” As the length of the corridors grows longer, a hospital may become more “detached” and monotonous. Because of the old way of building hospitals, some of the older hospitals have very long halls.

Administration Unit can be given as a single unit for small facilities or as separate functional units clustered according to services (medical, nursing, finance, education, etc.) in different locations for larger facilities, depending on the size of the facility. The scale, organizational policies, and service plan of the facility will decide the operational model.

Hospitals may be planned with clearly designated staff-only and patient corridors; the requirements for patient corridors will not apply to staff only accessed corridors.

Rehab Centre

Fig. 2.1.20 Rehab Centre Iteration.

The Rehabilitation – Allied Health Unit offers multidisciplinary rehabilitation services with the therapeutic purpose or treatment objective of improving a patient’s functional condition after suffering from an impairment, disability, or handicap.

Fig. 2.1.17 Corridor Plan – width clear of handrails.

Fig. 2.1.18 Corridor Plan – disabled access

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Fig. 2.1.19 Functional Relationship Diagram: Administration

Fig. 2.1.21 Rehabilitation – Relationship dagram

A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

Emergency

Fig. 2.1.22 Emergency Department Iteration

The Emergency Department’s responsibility is to accept, triage, stabilize, and treat patients who need immediate medical attention. Patients that need resuscitation as well as those with emergent, critical, semi-urgent, and less urgent conditions are included. An emergency department must also be capable of dealing with mass casualties and disasters. In the Emergency Department, there are some patient groups that may have unique psychosocial and treatment needs. There are some of them: • • • • • • • • •

Major trauma patients; Elderly patients; Children and adolescents; Patients with physical and mental disabilities; Victims of child abuse, domestic violence, or sexual assault; Patients with mental health issues; Patients with infectious diseases or who are immunocompromised; Custodial patients; and Patients affected by chemical, biological or radiological contaminants.

Fig. 2.1.23 Emergency Unit Functional Relationship Diagram

Entrance Area The Emergency Unit’s entrance must be at grade level, well-marked, well-lit, and well-protected. It must provide direct access for ambulance and truck traffic from public roads, with the entrance and driveway clearly marked. For pedestrian and wheelchair access, a ramp must be provided.

The entrance to the Emergency Unit must be paved to enable patients to be discharged from automobiles and ambulances. Near the entrance, temporary parking should be available.

Waiting Area The waiting area should be large enough to accommodate all waiting patients and their rela-

A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

tives/escorts. The area should be visible from the Triage and Reception areas since it should be accessible.

Comfortable and sufficient seating should be provided.

Wheelchairs, prams, walking aids, and patients who need assistance should all be accommodated. There should be a play area for children.

Support facilities, such as a television should also be available. Fittings must not provide the opportunity for self harm or harm towards staff.

Waiting Areas shall be negatively pressured.

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Out-Patient Department Outpatient care, also known as ambulatory care, is delivered in hospital-based outpatient or stand-alone facilities, physician offices, ambulatory surgical centers, and a variety of other specialized settings where patients undergo treatment but do not stay overnight.

The Outpatient Unit may perform the following functions: • • • • • • •

Consultation with medical specialists, examination and investigations Treatment on a same day basis Minor procedures Follow up review consultation and ongoing case management Patient screening prior to surgery – perioperative services Health education or counselling sessions for patients and families Referral of patients to other units or disciplines for ongoing care and treatment • Referral for admission to a hospital for inpatient services.

Fig. 2.1.24 Single Corridor Access model

Patients will be served during regular business hours, which are Monday through Friday from 8:00 a.m. to 5:00 p.m. To meet demand and operational policies, however, patient care standards and flexible work schedules can necessitate extending operating hours to evenings and weekends. During the planning process, consider the availability of assistance, cleaning, and repair facilities.

36

Fig. 2.1.25 Single Corridor Access model A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

Operation Theatre & ICU The Operating Room offers a safe and controlled atmosphere for patients undergoing diagnostic/surgical procedures under anaesthesia, as well as peri-operative treatment and post-operative recovery.

Critically ill patients who need invasive life support, high levels of medical and nursing care, and complex treatment are admitted to Intensive Care.

The intensive care unit brings together clinical experience, technical advancements, and therapeutic tools to provide care for critically ill patients.

Fig. 2.1.26 Intensive Care Unit Functional Relationship Diagram A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

Fig. 2.1.27 Functional Relationship Diagram: Operating Unit – Single Corridor Model

37

Delivery Suite & NICU The Birthing Unit is a private facility that offers secure prenatal, childbirth, and immediate postnatal treatment for mothers and their newborn babies. The number of birthing rooms and the scale of the corresponding service areas will be determined by the Service Plan’s planned obstetrical workload.

The Birthing Unit will form a component of the Maternity Unit or Obstetric Unit which consists of the following areas: • Inpatient unit for mothers suffering from antenatal complications • Inpatient unit for postnatal care, normal or complicated • General Care (Well Baby) Nursery for newborn babies requiring minimal care • Special Care Nursery for newborn babies requiring care for complications arising from • medium risk factors.

• Neonatal Intensive Care Unit may be incorporated into Maternity Unit or with Critical Care • Units according to the Operational Policy of the facility.

Infection Control The placenta is known as contaminated/clinical waste and should be disposed of according to hospital waste disposal policies. The use of placental macerators for disposal is not recommended and should be avoided. For cultural reasons, freezer storage should be provided inside the unit to allow for family collection. It should also be possible to dispose of the placenta using cultural methods.

Hand Basins A clinical scrub basin will be included in each Assessment and Birthing Space.

Handwashing stations will be required at the Unit’s entrance and exit, as well as in the Staff Stations and corridors.

Isolation Rooms An infection management risk assessment will be used to decide the need for Negative Pressure Birthing Isolation rooms, which will be in accordance with the Service Plan’s specifications.

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Fig. 2.1.28 Functional Relationship Diagram: Birthing Unit A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

Inpatient Ward

Acoustic treatment will be required to the following: • patient bedrooms, • interview and meeting rooms • consult rooms

Fig. 2.1.29 3D Visualization of Inpatient ward

The Inpatient Unit’s primary role is to provide adequate accommodations for the delivery of health care services to inpatients, including diagnosis, care, and treatment.

In addition, the Unit must have services and conditions to meet the needs of patients and visitors, as well as staff workplace standards.

Fig. 2.1.30 3D Typical layout of Inpatient ward

Fig. 2.1.31 3D Typical layout of open plan bed bays.

the models of care that could be implemented include: • • • • •

patient allocation task assignment team nursing case management primary care

The Inpatient Unit should be built to reduce ambient noise levels inside the unit as well as sound propagation between patient, staff, and public areas.

Location of noisy areas or operation away from quiet areas, such as patient bedrooms, should be considered, as should the selection of sound absorbing materials and finishes.

Fig. 2.1.32 Inpatient Accommodation Unit Functional Relationship Diagram

A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

39

Diagnosic Department (Imagining Unit)

Infection Control

The Medical Imaging Department is a separate hospital unit that specializes in general X-ray diagnostic imaging. Diagnostic screening (fluoroscopy), ultrasound, mammography, computed tomography (CT), and interventional radiographic procedures may be available depending on the level of service.

Each Imaging Room must have hand-washing facilities, either inside or outside the room’s entrance.

Part D - Infection Control: Handwashing Facilities addresses the types of basins that are acceptable for this area.

Planning

Functional Requitement The location of the Medical Imaging Unit, if provided, is variable. Consideration must be given to its proximity to Accident and Emergency, and to the Operating Unit where dedicated intheatre X-ray is not provided. The requirement for an Outpatient X-ray Service may also dictate where in the facility it is located.

Since area specifications can differ from machine to machine, the architecture of a Medical Imaging Unit should be designed in accordance with manufacturer’s recommendations. Since technology evolves rapidly and from manufacturer to manufacturer, rooms should be larger to allow for potential equipment upgrades.

Functional Areas The Medical Imaging Unit may consist of the following Functional Areas depending on the Operational Policy and service demand: • Reception and Waiting Areas • Imaging and screening rooms with access to patient change areas and toilets • Support areas including preparation areas, storage, disposal and utility rooms • Film processing areas - both daylight and darkroom areas as required; alternatively, • medical imaging may be based on a filmless digital imaging system with its own • equipment and storage requirements • Film storage areas • Viewing and Reporting areas • Administrative and Office areas Fig. 2.1.33 Medical Imaging-General Functional Relationship Diagram

40

A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

Laboratory

Pharamacy

A ‘Hospital Laboratory’ is a place where clinical pathology experiments are pharmacy services, including dispensing, non-sterile and sterile commodity performed on clinical specimens to collect information about a patient’s preparation as required, clinical trial conduct as needed, adverse drug rehealth to assist in disease detection, care, and prevention. action reporting, and drug information and education.

Planning A pharmacy’s operation can be extended beyond a single health care facility to include outlying facilities.

For various operating models, specific design specifications for packaging, storage, and dispatch of products must be considered.

The Pharmacy Unit shall be located for convenient access, staff control, and security. Direct access to loading dock and bulk storage is required if not located within the main PharmacyUnit.

Fig. 2.1.34 The ideal functional Relationship diagram.

• One centralized laboratory which should have different sections.

• Collection counters at different places, both in wards & outpatient area.

• Have separate section for emergency investigation to prevent delay in reporting.

Location & arrangement of areas It is desirable to have the laboratory on ground floor. It should be easily accessible to outdoor, indoor & casualty patients. Proximity to radiology department will increase patient convenience.

Laboratory requires space for: • • • • •

actually carrying out tests space for collection of specimen space for dispatch of reports store room for equipments, glass ware, chemical reagents etc. office space for reporting & administrative work Fig. 2.1.35 Pharmacy Unit Functional Relationship Diagram

A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

41

Blood Bank Under the administration of the Central Drugs Standard Control Organization (CDSCO) India, the Blood Bank provides approved facilities for the collection, storage, refining, and distribution of human blood and blood components in accordance with the National Blood Policy, 2002.

Planning For processing and routine laboratory services, the Blood Bank is open during business hours, but for deliveries, it is open 24 hours a day.

At the Reception desk, patients will be greeted and enrolled. Waiting areas should be large enough to accommodate a variety of people, including wheelchairs and prams. Waiting areas would necessitate convenient access to public bathrooms.

Blood Bank will consist of the following Functional Areas: • Patient/ Donor areas • Preparation/ Processing area • Staff Areas A patient consult room with an observation couch for patient assessment and interview will be included in the patient/donor areas. Comfortable blood collection chairs or couches, staff handwashing facilities, and a staff work area are all needed in collection areas.

Patient/ donor areas will require access to emergency and resuscitation equipment including suction and oxygen.

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Fig. 2.1.36 Blood Bank Functional Relationship Diagram

Functional Relationships The Blood Bank, which is housed inside a hospital, would need to maintain good working relationships with units that require regular blood supplies, such as the Operating Room and the Intensive Care Unit.

Donors would need convenient access to the stand-alone Blood Bank, as well as fast access to transportation providers for blood transfers to hospitals.

The Blood Bank must not be situated near open drains, sewage, public restrooms, animal shelters, or any other unsanitary setting. Files, insects, and rodents must not be allowed into the facility; mesh screens can be used if appropriate.

Infection Control is important in this Unit. Strict infection control measures are required within the unit to protect laboratory staff from potentially contaminated body fluids (blood, plasma)and to ensure aseptic environment for manufacture and packaging of blood products, preventing cross infection.

A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

Services

Supply Unit

Waste Management

Cleaning and Housekeeping Unit

The Supply Unit shall provide for the following functions:

A Waste Management Unit is required in every hospital to store waste and used linen. The following features must be included in the Waste Management Unit:

The Cleaning and Housekeeping Unit is in charge of keeping the hospital clean in all areas, including the inpatient units and public areas.

Cleaning services may be outsourced or offered in-house. Others may be needed in the facility to maintain a safe and sanitary atmosphere, in addition to the Cleaner’s Rooms already requested in the specialist Units.

Planning A typical hospital Cleaning/ Housekeeping Unit comprises the following: • Manager’s Office • Cleaner’s Meeting/ Briefing room • Cleaner’s Equipment / Supply Store

Fig. 2.1.37 Cleaning & Housekeeping Unit Fnl. Diagram.

• purchase and receipt of equipment and bulk medical supplies • storage of bulk dry goods, consumables, intravenous fluids, drugs and flammable liquids • storage of surplus hospital equipment and equipment awaiting repairs • deliveries to hospital units for regular restocking of unit based supplies Planning

• • • •

Located close to all functional areas Accessible from within the unit and externally Fitted with a deadlock Located away from food and clean storage areas • Not accessible to the public.

The Supply Unit will be made up of many rooms and areas for storing large quantities of goods, equipment, and furniture as required.

The Supply Unit may consist of the following Functional Areas: • Loading Dock • Receivals area • Dispatch areas for stock awaiting collection

The Waste Management Unit should be designed to keep materials safe, minimize organic decomposition, contain odors, and allow for sanitary cleaning of storage areas and carts. The construction of a mechanized bin washing facility could be advantageous to larger institutions. Waste that is liquid disinfection procedures can need to be stabilized before being disposed of. systems of sewage disposal

Fig. 2.1.38 Supply Unit Functional Relationship Diagram

Fig. 2.1.39 WM Functional Relationship Diagram

A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

43

Engineering Services

Civil Engineering Services

Electrical Engineering Services

Fig. 2.1.40 Hospital services relationship diagram.

Engineering services of a hospital include: – The civil assets - Includes: • Building, Roads, Storm Water Drainage, Waste water drainage, Sewage Treatment Plant • Electricity supply • Water supply including plumbing and fixture • Steam supply • Acoustics and Lighting • Piped medical gas and vacuum system (PMGV) • Air conditioning and refrigeration • Lifts, pneumatic tube system and dumbwaiters • Public health services Solid Waste Disposal System • Communication system, paging, CCTV • Building management system • Workshop facilities for repair and maintenance

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Fig. 2.1.41 Civil Services flow chart.

Fig. 2.1.42 Electrical Services flow chart.

A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

Bio Engineering Services

Fig. 2.1.43 Medical Services flow chart.

A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

Mechinacial Engineering Services

Fig. 2.1.44 Mechanicall Services flow chart.

Fire- Fighting Engineering Services

Fig. 2.1.45 Fire Services flow chart.

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Sustainability: Hospital Design Well, according to a report compiled by the World Health Organization and Health Care Without Harm, there are seven facets of an environmentally-friendly hospital. These include “energy efficiency, green building design, alternative energy generation, transportation, food, waste and water,” Strategies will provide significant environmental and economic benefits to organizations, which will help hospitals and health systems grow now and in the future.

Genuinely sustainable initiatives, on the other hand, must be financially viable while still supporting society and the community. Sustainability must also be a part of a hospital’s overall corporate plan and the driving force behind services and infrastructure improvements. Every hospital and healthcare system, on the other hand, must determine the best course of action based on its own goals. A technique that works in one hospital could not be appropriate in another.

Fig. 2.1.46 Iteration of Sustainable Environment.

Healing Environment: Hospital Design

7 Elements of a Green Hospital – WHO/HCWH Energy Efficiency – Reducing energy consumption through efficiency and conservation measures ‍ Green Building Design – LEED standard, consulting green design company, responsive to local climate conditions. ‍ Alternative Energy Generation – Usage of clean, renewable energy. ‍ Transportation – Have employees walk, or bicycle to work; use of public transport, use alternative fuel for hospital vehicles. ‍ Food – Consumption of local, organic and sustainable foods. ‍ Waste – Reduce, reuse, recycle, compost ‍ Water – Conserve water; use safe non-bottled water if possible

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Fig. 2.1.47 Iteration of clean waiting space.

Healthcare facilities are designed to improve a hospital’s ability to deliver high-quality care while still being cost-effective. However, the ability of architecture to influence a patient’s recovery time and the overall efficacy of a facility is often ignored.

Both healing environments have the purpose of including patients in their own healing and rehabilitation. As a result, these spaces are built to be supportive and therapeutic in order to relieve tension among patients and their families. Healing architecture seeks to achieve the following goals in order to aid recovery:

• Eliminate environmental stressors, such as noise, lack of privacy, poor air quality and glare.

• Connect patients to nature by providing outdoor views and other natural features, including interior gardens and water elements .

• Enhance the patient’s feeling of being in control by offering options and choices – these may include privacy versus socialization, lighting level, type of music and quiet versus active waiting areas.

• Encourage opportunities for social support, such as providing appropriate seating in patient rooms, privacy for small groups and overnight accommodations in patient rooms.

• Provide positive distractions, such as interactive art, fireplaces, aquariums, internet connection, music, or soothing video or light installations suited to the healthcare setting.

• Inspire feelings of peace, hope, reflection and spiritual connection.

A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

2.2 Case Studies

2.2.1 Fortis Super-Speciality Hospital Mohali

2.2.2 Assuta Medical Centre, Israel

2.2.3 Appolo Hospital, Delhi

2.2.4 Paras Hospital, Patna

A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

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2.2.1 Fortis Super-Speciality Hospital Mohali CLIENT:-

FORTIS HEALTH CARE LIMITED

DESIGN TEAM:CALIFORNIA

KAPLAN MC LAUGHLIN DIAZ,

ARCHITECTURE FIRM:CIATES, NEW DELHI

ACHAL KATARIA & ASSO-

TOTAL PLOT AREA:-

8.22 ACRES.

TOTAL BUILT-UP:-

40,000 Sq. M.

H. OF BUILDING:TOWER).

30M. (INCLUDING GLASS

COMPLETION YEAR:-

2001

COST OF PROJECT:-

155CRORES.

Fig.2.2.1 3D view of Fortis Super-Speciality Hospital Mohali

Fortis Hospital - Mohali includes three sub-facilities on one campus:

CONSTRUCTION TIME:- 18MONTHS ONLY Location:-

(i) A Super-specialty cardiac center equipped to provide advanced cardiac treatments for all forms of heart disease,

Located in Sector 62, Phase VIII, S.A.S. Nagar, Mohali (Distt. Ropar). Punjab, India 7km from Chandigarh.

(ii)

It is 14kms from the Airport, 9km from bus stand (Sec 17) and 12km from Railway Station.

Fortis Hospital - Mohali commenced operations in 2001. It includes a comprehensive cardiac program in northwest India and also provides emergency trauma care services, and serves as a “hub” for a number of smaller, secondary care hospitals in the surrounding areas.

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A general multi-specialty hospital and

(iii) The Fortis Inn rehabilitation center designed to provide “step-down” care to patients based outside the Mohali area to help them fully recover from surgery, as well as accommodation for visitors, including attendants and patients’ relatives.

Fig. 2.2.2 Location Plan of Fortis Hospital, Mohali

The approach to the site is from a 24m wide road running all around the site.

A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

ermissible ground coverage of 30%, the complex has been divided into 4 blocks A, B, C & D. Orientation:The building faces north-east, the most favourable orientation. It is designed in curved shape so that building block can get maximum exposure to glare-free light.

The linear Proportion of the Site 3:1 have brought out the linear plan the hospital building, the two entrances being on the longest side.

Rectangular Plot : 344 x 110m.

Fig.2.2.3 Zoning of Blocks in Fortis Super-Speciality Hospital Mohali

Basement

Block A & Block B It provides parking for Doctors, staffs & Administration 85cars & 75 Bikes.

Block A also houses the waste disposal storage.

In Patient

It has Public toilets and lift Lobby.

Block B also has mortuary and Prayer room.

Fig.2.2.6 Physical Model of Fortis Hospital, Mohali

Fig.2.2.4 Mortuary

Fig.2.2.7 OPD Entry of Fortis Hospital, Mohali

Diagnostic and Treatment OPD and Emergency Administrative Services

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Fig. 2.2.5 Parking

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Circulation

Fig. 2.2.8 3D Basement Plan Fortis Super-Speciality Hospital, Mohali

Fig. 2.2.9 Services Plan Fortis Super-Speciality Hospital, Mohali

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A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

Fig. 2.2.14 OPD Reception

Fig. 2.2.10 Waiting Area Outside the consultation room

Fig. 2.2.15 Inpatient Entry

Fig. 2.2.11 Consultation Room

Fig. 2.2.12 OPD Clinic with Examination Room

Fig. 2.2.13 OPD Clinic Fig. 2.2.16 Ground Plan of Fortis Super-Speciality Hospital, Mohali A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

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Fig.2.2.17 First Floor Plan of Fortis Super-Speciality Hospital, Mohali

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A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

Fig.2.2.18 Second Floor Plan of Fortis Super-Speciality Hospital, Mohali A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

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Fig.2.2.19 Third Floor Plan of Fortis Super-Speciality Hospital, Mohali

Block A & B Similar as First Floor level. This Block have single and Double rooms.

Block C It is compose of Dining Hall, Cfe, terrace Garden & dialysis unit on one side & nursing school with 2 lecture halls & conference room etc.

Elevation Features

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Red Agra Stone has been used for external Cladding along with Dhaulpur stone strips.

Double insulated glass windowsa has been used.

For balancing the composition they used vertically and horizontally bands.

Block D It has basically the board room & Administration areas.

Fig.2.2.20 Showing Double Glazing of Fortis Hospital, Mohali

A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

Services Water Supply:There are 6 water storage tanks in Hospital which have been constructed under ground: Fire- water tanks-3 Treated water tanks-1 Raw water tank-1 Estimated quantity of water 450liters per head per day.

Fig.2.2.21 Water treatment Pump room in Basement.

Sewage treatment Plant:To treat all the waste water and sewage waste, sewage treatment plant has been provided which is located on the right side of the IPD entrance while facing emergency.

Fire Fighting:Fire- resistant construction has been done using ACC blocks.

Two types of detectors has been used: Smoke sensors Heat sensor HVAC (Heat Ventilation & Air Conditioning) :The whole building is centrally air conditioned with toilets have ventilators in shafts.

Water cooler chiller has been used for chilled air.

Structural Details :Raft footing has been provided and Grid is combination of Radical and square grid.

Fig.2.2.22 AC Plant Room, Cooling Towers & Generator Room

Circular columns with 850dia in basement.

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2.2.2 Assuta Medical Centre, Israel CLIENT:-

ASSUTA MEDICAL CENTRE

DESIGN TEAM:ZEDLER PARTNERSHIP ARCHITECTS, MOORE ARCHITECTS, M. BRESTOVISKY ARCHITECTS TOTAL PLOT AREA:-

12,000. SQ.M.

TOTAL BUILT-UP:-

46,450, SQ. M.

COMPLETION YEAR:-

2009

COST OF PROJECT:-

$ 100 M+.

HT. BUILDING:-

G+8

The project adds significantly to the capacity of the existing six Assuta facilities in Israel.

Location:It is located in the northern sector of Tel Aviv on Habarzel Street and backs onto Hayarkon Park situat ed on the Hayarkon River. The project includes 4 levels of parking below grade and approximately 50,000 sq. m. of accommodation above grade, located on a 12.000 sq. m. site. The hospital program was developed by the Metis Ad visory Group.

Fig.2.2.23 3D View of Assuta Medical Comlex, Israel

The design features the diagnostic and treatment functions, including 16 surgical suites, 27 ICU rooms. 17 dialysis stations, 38 day surgery stations, 2 cath and non - invasive diagnostic labs on the first four levels with the major public circulation systems overlooking the park and highway view.

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A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

Fig.2.2.24 Ground Plan and views of Assuta Medical Comlex, Israel A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

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Fig.2.2.25 Ground Plan with department markings

Fig.2.2.26 Section B B’ cutting through staircase

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A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

Fig.2.2.27 Shows Section A A’ of Assuta Medical Comlex, Israel

Fig.2.2.28 Shows Main Staircase of Assuta Medical Comlex, A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

Fig.2.2.29 Shows Reception Lobby of

Fig.2.2.30 Shows waiting Area.

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2.2.3 Appolo Hospital, Delhi CLIENT:-

APPOLO HOSPITAL

ARCHITECT:-

HAFEEZ CONTRACTOR

TOTAL PLOT AREA:-

15 ACRES.

TOTAL BUILT-UP:-

62,750 Sq. M.

H. OF BUILDING:

G+8

COMPLETION YEAR:-

1996

CLIMATE:-

COMPOSITE

AREA PER BED:-

90.2

TOTAL BEDS:-

650

CONSTRUCTION COST:- 75CRORES Fig. 2.2.31 3D Physical Model of Appolo, Indraprasta, Delhi

Location:Apollo Indrapastha Hospital is in SaritaVihar New Delhi, on Delhi-Mathura road, while going towards Badarpur.

The hospital has only one approach road, and that also shortened because of the position of a plot between the road and the hospital.

The hospital lies in a strong green belt. Opposite the hospital across the road is a railway track.

It spreads over 15 acres of prime land in South Delhi

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In the Indian scenario, the families are close knit and most patients are often accompanied by their relatives.

This social context was totally ignored by most of the core idea of creating a central spine atrium plaza from which the entire design set off.

The plan is also an early example of the central circulation spine used as an organizational device in Indian hospital designs.

The two major blocks of the hospital are connected by this atrium of huge volume, which acts as the large waiting area.

The design was also primarily conceived as a tower on podium structure with all its services in basement; clinical and treatment zones in ground and immediate upper floors while keeping all the nursing zones in upper floors.

The in-patient wards have cross-ventilation and every bed has a visual connection to the outdoors.

The clinical zone consisting of the diagnostic and acute-care areas are located with the operation theatres and set within deep-spanned, podium floor, on top of a double basement housing the complex support zone consisting of the various services.

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Fig. 2.2.32 view of Appolo, Indraprasta, Delhi

Fig. 2.2.34 Main Block Ground Floor, Indraprasta, Delhi

Central atrium is a vast sky lit area, dotted with wrought iron tables and chairs evocative of garden furniture.

This pedestrian atrium enlivens the hospital with an almost street-like atmosphere.

The flexible setting allows ample space for patients and visitors to relax, eat their lunch, take a breather or catch a quick nap.

Fig. 2.2.35 OPD Block Plan, Indraprasta, Delhi

The 650 bed, multi-speciality hospital has been designed to house the most advanced medical technology and equipment. This modern edifice aims to break down the complexity normally inherent in such large institutional spaces.

Fig. 2.2.33 Key Plan Appolo, Indraprasta, Delhi

A different concept has been dwelt upon for the different functional areas such as the out patient department, the medical facilities and the inpatient wards.

A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

Indraprastha Apollo is the largest corporate hospital outside the United States.

It is the third super specialty tertiary care hospital set by the Apollo Hospitals Group, jointly with the Government of New Delhi, India’s capital. It is a 650 bedded hospital, with the provision for expansion to 1000 beds in future.

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Fig.2.2.36 Atrium of Appolo, Indraprasta,

Fig.2.2.37 Corridoor of Appolo, Indraprasta, Delhi

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Fig.2.2.38 Ground Zoning Plan of Appolo, Indraprasta, A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

Fig.2.2.39 Typical Ward Floor of Appolo, Indraprasta,

Clinical Zone The clinical zone consisting of the diagnostic and the acute care areas were placed with the operation theatres and housed within a deep spanned podium floor, sitting on top of double basement housing the complex support zone consisting of the various services.

Sandwiched between the inpatient wards and the clinical zone is an interstitial floor housing the engineering plants and services which support the complex medical facilities and clinical zone below.

Basement: services with store room of kitchen, lockers of staff,

oncology department, mortuary, engineering department and parking.

radiology department, emergency, kitchen, labs and main entrance to inpatient area.

Oncology department: The oncology department which is equipped with two state of the art linear accelerator with one giving a high- energy radiation and the other designed for sterostatic radiotherapy and radio surgery, physio therapy department. This department has its own waiting area and conference room. Seven consultation rooms are around the waiting area.

Emergency department has its own separate entry with all the basic facility but emergency department not has his separate OT. Kitchen is at the east end of the building and connected to upper floor through service elevators.

First floor: Total 14 OT are situated on the first floor.

East wing has 8 OT and west wing has 5 OTs. OT area has the U.P.S. (uninterrupted power supply) in all clinical areas.

This floor also constitute of ICUs of 4 different departments, CCU, Cath lab and Office.

Ground floor: On the ground floor in the main block constitute labs,

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Case Study Matrix Inferences

Fig.2.2.40 Fortis Multi-Speciality Hospital, Mohali

Fig.2.2.41 Assuta Multi-Speciality Hospital, Israel

Client:-

FORTIS HEALTH CARE LIMITED

Client:-

ASSUTA MEDICAL HOSPITAL

Architect:-

ACHAL KATARIA & ASSOCIATES

Architect:-

ZEDLER ARCHITECTS

Total Plot Area:-

33,265 Sq.M. (8.2Acre)

Total Plot Area:-

12,000 Sq.M. (2.96 Acre)

Total Build up:-

40,000 Sq. M

Total Build up:-

46,450 Sq. M.

Completion Year:-

2001

Completion Year:-

2009

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A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

Fig.2.2.42 Appolo Multi-Speciality Hospital, Delhi

Fig.2.2.43 Paras Hospital, Patna

Client:-

APPOLO HOSPITAL, DELHI

Client:-

PARAS HOSPITAL, PATNA

Architect:-

HAFEEZ CONTRACTOR

Architect:-

RSMA ARCHITECTS

Total Plot Area:-

60,702 Sq.M. (15 Acre)

Total Plot Area:-

10,925 Sq.M. (2.7 Acre)

Total Build up:-

62,750 Sq. M.

Total Build up:-

30,120 Sq. M.

Completion Year:-

1996

Completion Year:-

2010

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66

F,A.R:-

1.3

F,A.R:-

3.85

HT. OF BUILDING:

G+4

HT. OF BUILDING:

G+8

CLIMATE:-

WARM & TEMPERATE

CLIMATE:-

HOT & DRY , COOL AND RAINY

TOTAL BEDS:-

405

TOTAL BEDS:-

280

AREA PER BED:-

98.76

AREA PER BED:-

65.8

CONSTRUCTION COST:-155CRORES

CONSTRUCTION COST:-$100M+

SURFACE PARKING:-

120 CARS + 50 BIKES

SURFACE PARKING:-

30-45 CARS

BUILD TYPOLOGY:-

SINGLE BLOCK TYPOLOGY

BUILD TYPOLOGY:-

SINGLE BLOCK TYPOLOGY

STRUCTURE TYPE:SLAB

RCC FRAMED STRUCTURE, FLAT

STRUCTURE TYPE:SLAB

RCC FRAMED STRUCTURE, FLAT

GRID TYPE:8M

8.5M X 6M X 8.5M &

GRID TYPE:6.5M

8M X 8M X 8M &

CORRIDOOR WIDTH:-

INTER DEPARTMENT - 2400MM INTRA DEPARTMENT - 1800MM

CORRIDOOR WIDTH:-

INTER DEPARTMENT - 4200MM INTRA DEPARTMENT - 2700MM

EMERGENCY:-

SEPERATE ENTRY/EXIT LOCATED ON GROUND FLOOR

EMERGENCY:-

SEPERATE ENTRY/EXIT LOCATED ON GROUND FLOOR

IPD:-

LOCATED ON 2ND FLOOR

OPD:-

LOCATED ON GROUND FLOOR

8M X 8MX

IPD:FLOOR

LOCATED ON GROUND & 1ST

OPD:FLOOR

LOCATED ON GROUND & 1ST

6.5M X 6.5MX-

A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

F,A.R:-

1.1

F,A.R:-

3

HT. OF BUILDING:

G+8

HT. OF BUILDING:

G+5

CLIMATE:-

COMPOSITE

CLIMATE:-

COMPOSITE

TOTAL BEDS:-

650

TOTAL BEDS:-

350

AREA PER BED:-

90.2

AREA PER BED:-

86.2

CONSTRUCTION COST:-75 CRORES

CONSTRUCTION COST:-150 CRORES

SURFACE PARKING:-

350-400 CARS

SURFACE PARKING:-

50-55 CARS

BUILD TYPOLOGY:-

SINGLE BLOCK TYPOLOGY

BUILD TYPOLOGY:-

SINGLE BLOCK TYPOLOGY

STRUCTURE TYPE:SLAB

RCC FRAMED STRUCTURE, FLAT

STRUCTURE TYPE:SLAB

RCC FRAMED STRUCTURE, FLAT

GRID TYPE:-

-------------------------------------------

GRID TYPE:-

6M X 12M X 6M &

6M X 6MX6M

CORRIDOOR WIDTH:-

INTER DEPARTMENT - 3000MM INTRA DEPARTMENT - 2700MM

CORRIDOOR WIDTH:-

INTER DEPARTMENT - 2400MM INTRA DEPARTMENT - 1800MM

EMERGENCY:-

SEPERATE ENTRY/EXIT LOCATED ON GROUND FLOOR

EMERGENCY:-

SEPERATE ENTRY/EXIT LOCATED ON GROUND FLOOR

IPD:-

LOCATED ON 2ND FLOOR

IPD:-

------------------------------------------

OPD:-

LOCATED ON GROUND FLOOR

OPD:-

LOCATED ON GROUND FLOOR

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Chapter 3 Program Development

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Area Program The science and technology of developing a hospital in any location is a difficult task. Aside from the technical demands of modern healthcare and the rigid functional relationships between different medical teams, the designer/Architect must contend with several more intangible issues, such as the patient’s pain, the staff’s difficult work atmosphere, and the need to build a long-lasting and healing framework.

The aim is to spread the departments’ areas around the different floors in order to determine how much space each floor template holds, as well as which departments.

Fig. 3.1.1 Area distribution between Hospital and Residential block

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Fig. 3.1.2 Area distribution between Multi,Super Speciality & Residence.

A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

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Chapter 4 Project Site & Analysis

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4.1 Site Analysis 4.1.1 Introduction

Delhi, city and national capital region, north central India. The city of Delhi actually consists of two components: Old Delhi, in the north, the historic city; and New Delhi, in the south, since 1947 the capital of India, built in the first part of the 20th century as the capital of British India.

DWARKA Population - 12.000,00 Area- 56.1 sq.km Language- Hindi, English Dwarka is a sub - city of Delhi, developed by the Delhi Development Authority (ODA). Dwarka, along with Rohini, are the planned residential developments of Delhi.

The residential development here mostly consists of low - rise apart ment developments by the DDA and various multi - storey Cooperative Group Housing Society (CGHS) project Dwarka’s development has benefitted from its proximity to Indira Gandhi International Airport and Gurgaon, city.

DDA has implemented a unique concept of Mixed Land Use (MLU) in Dwarka.

Most of the DDA housing clusters in Dwarka have commercial buildings in close proximity.

Fig. 4.1.1 Master plan of Delhi 2021

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A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

Project As Per masterplan of Delhi 2021 the selected site for propose hospital in sector-9, Dwarka, New Delhi.

BYE LAWS Total Plot Area:- 37450.5Sqm. Permissible Ground Cov.30% of the Plot area Permissible FAR: 2 Permissible Height: 28m Setbacks:Front: 15m All Sides: 09m A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

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Site is located at Dwarka Sector 09 pressway in the so Fig. 4.1.2 Site Location Plan

90

The Prominent Land mark n A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

4.1.2 Location:-

9 road which connects to dwarka exouth-west and mall road in north-east.

near the site is IGI International Airport, Delhi.

Fig. 4.1.3 Sector 9 and Surrounding Sectors.

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Fig. 4.1.4 Delhi Public Transport Network

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4.1.3 Transportation A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

Fig. 4.1.5 IGI International Airport , Delhi

Fig. 4.1.6 New Delhi Railway Station.

Fig. 4.1.7 Old Delhi Railway Station.

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94

A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

I M M E D I A T E T R A N S P O R T

Fig. 4.1.8 Nearest Public Transport

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4.1.4 Climate The Climate of Delhi is an Overlap between the Monsoon- Influenced Humid Subtropical and Semi- Arid with Variation between Summer and Winter Temperatures and Precepitation.

The distance from the Sea makes Delhi an Extreme type of Continental Climate with the Prevalence of Continental Air during major Parts of the year. Only during the three monsoon months of July, August and September creates oceanic and Origen Penetrate to this region and causes increased humidity, Cloiudiness and rain.

The year can be broadly divided into four seasons. The cold season start from december and extends up to February. This is folloed by the hot weather season which lasts till about end of june when monsoon arrives over the region. The monsoon continues till the third week of September.

The two Post monsoon months of October and November Constitute a transitition from monsoon to winter consitions.

Fig. 4.1.9 Precipitation days in a month

The Summer in delhi are very hot and winters very cold.

The temperature may rise up to about 45 degrees Celcius in summers, in average temperature is around 43 degree celcius.

The winters are also marked by mist and fog in morning through the sun in the open out in the afternoon.

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Fig. 4.1.10 Average temperatures and Precipitation

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Fig. 4.1.11 Pie Chart of Precipitation amounts

Fig. 4.1.12 Pie Chart of wind speed

Fig. 4.1.13 Wind rose diagram

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A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

Fig. 4.1.14 Figure Ground

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Fig. 4.1.15 Immediate Surroundings

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A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

Fig. 4.1.16 Site Views

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Fig. 4.1.17 Land use Plan

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A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

Fig. 4.1.18 Site 3D view

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• Site is located at Dwarka Sector 9 Highway near to Dwarka Bus Deport.

• The distance between Dwarka sector 9 metro and site is 300m.

• Well connected with public transport.

• There is lots of Greenery around the site which regulates the microclimate.

• Site is surrounded by Institutional and Public spaces like Police station, School, Metro, Bus Depot etc .

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• There are lots of shrubs and small trees in the site. So, it may cause problem at the time of environmental clearance.

• The District Hospital will caters more than 1million population of Dwarka and neighbouring districts like palam and Raj Nagar.

• Currently, site is used as abandoned car parking by Dwarka Police.

• The Hospital can be seen as a best Green and Sustainable Government Hospitals in Delhi.

• The site is very close to IGI Airport.

• The Runway of IGI Airport is towards the site.

• The project can create lots of employment during its construction period.

• The Hospital can also reflect diverse things by means of architectural elements and built form.

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Chapter 5 Technology

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5 Technology

5.2 Energy

Orientation:-

5.1 Introduction

Reducing energy use is a key focus for green buildings especially when considering ventilation and lighting. Maximizing the use of natural lighting during the day can reduce energy costs and improve the atmosphere for buildings’ users.

Healthcare facilities can have wide exterior facades or envelopes, which have a direct impact on energy consumption.

Modern building activities use a large amount of energy and natural resources while also producing a large number of by-products. As a result of the processing of tons of by-products, unwanted materials are introduced into the atmosphere, further polluting it. The modern world is afflicted by plenty of concerns, including a variety of diseases.

Considering following features during designing the hospital:-

In hot climates, large unprotected facades or envelopes facing the sun can increase cooling needs and increase long-term energy expenditure. By carefully designing a facade or envelope to fit climatic preference and solar orientation, you can save money on electricity, reduce cooling equipment sizing, and reduce cooling

The urgent need to conserve the earth and preserve it for future generations shows the main importance of adopting a sustainable lifestyle.

What is Sustainable and Green Architecture?

Architecture that seeks to minimize the negative environmental impact of buildings by efficiency and moderation in the use of materials, energy, and development space.

Environmental Benefits •Enhance and protect biodiversity and ecosystems •Improve air and water quality •Reduce waste streams •Conserve and restore natural resources Economic Benefits • Reduce operating costs • Improve occupant productivity • Enhance asset value and profits • Optimize life-cycle economic performance Social Benefits • Enhance occupant health and comfort • Improve indoor air quality • Minimize strain on local utility infrastructure

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Fig. 5.1.1 Orientation of Hospital Block A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

Shading: Permanent horizontal overhangs, vertical fins, or recessed windows minimize cooling demand by blocking excessive solar radiation. Seasonal strategic shading will also help the hospital save money on energy bills.

This can be accomplished by planting trees around the hospital that block sunlight during peak hours of the day, keeping the interior cool. You may also place the structure to take advantage of natural light. For example, you can want plenty of natural light at the entrance in the morning to brighten the area and reduce the need for artificial lighting. Similarly, patient rooms can be located on the building’s shadier side to make patients more relaxed.

Fig. 5.1.2 Shadow as on 21st June 10AM

Fig. 5.1.3 Shadow as on 21st Dec 10AM

Fig. 5.1.4 Shadow as on 21st June 2PM

Fig. 5.1.5 Shadow as on 21st Dec 2PM

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Fig. 5.1.6 Horizontal Shading in South direction

Fig. 5.1.8 Thermal Analysis ( 2st March)

Fig. 5.1.7 Vertical Shading in west direction

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Green Courtyard Improved air quality, improved acoustic efficiency, reduced energy usage, and created a positive biophilic healing atmosphere are all benefits of interior green spaces.

Open spaces and gardens not only absorb less heat than concrete and asphalt, but they also consume less water.

Native plants that are drought-tolerant and used in xeriscape design can withstand the heat while conserving water. In hot and humid climates, you can also use sustainable eco atriums.

Green spaces make a hospital feel welcoming to patients.

Urban Cool Islands By reflecting sunlight rather than absorbing it, cool roofs reduce a facility’s carbon footprint.

Fig. 5.1.10 3D Visualition of courtyard spaces

It’s important to take advantage of the natural environment and regenerative techniques wherever possible. Rather than depleting capital, regenerative architecture strives to generate and replenish them. Building siting for natural shade orientation, solar shading, biophilic interiors, and grid independence are all regenerative design concepts that help reduce the building’s carbon footprint.

Insulating Walls

Fig. 5.1.9 Iteration showing Cool Island Effect.

A reflective roof and insulation in the roof and exterior walls to minimize heat gain in the building, which also minimizes energy usage.

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Fig. 5.1.11 IInsulation wall

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Energy Efficiency: Hospital

Several possible HVAC systems to consider as part of the analysis may include various configurations of the following options:

Confederation of Indian Industry (CII) reported that nearly 60% of health care services and hospitals do not meet the minimum of Energy Performance Index (EPI) criteria.

Energy Conservation Building Code (ECBC) of India shows that hospitals in India have a potential to achieve 42% energy saving by implementing energy efficient measures.

• Central air handling units (variable or constant air volume) • Terminal heating and cooling systems • Heating and ventilation systems • Exhaust systems There are three basic components of HVAC: (1) outdoor air intake and air exhaust ducts and controls, (2) air handling units (AHU), and (3) air distribution systems.

Fig. 5.1.12 Average Energy Consumption in Hospital

HVAC stands for heating, ventilation, and air conditioning:- 52% All types of Lighting:- 30% Water Heating:- 10% All Medical Equipments + Other services:- 8% HVAC systems are playing a very important role in hospitals, not only by maintaining comfortable climate conditions of temperature and humidity control, but also by maintaining a clean, germ-free environment to contribute to the well-being of patients and to prevent the spread of disease.

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Fig. 5.1.9 ECBC Standards for Energy Efficiency

Outdoor air intake and air exhaust ducts and controls Dampers are used to cut off central air-conditioning to unused rooms and for regulating the air supply room-by-room. These can play a role as economizers that can be placed at supply, relief and return components of HVAC system. Louvres are used for protection from water infiltration.

Chillers are located in the basement (cooled by water) or on the roof (cooled by air). Chillers remove heat from the water, and then this water is used as a refrigerant to remove heat from the building and dehumidify air.

Compressor This is located at the outdoor condenser unit which supplies air or other gases at increased pressure to the AHU.

Air handling units (AHU) Its function is to take in outside air, re-condition it and supply as fresh air Heat exchangers and chillers (humidity modification system) Heat exchangers transfer heat (energy) from one fluid to another, which is being physically separated.

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5.3 Water

Prevension: Water Watage

For healthcare facilities, the design, installation, and commissioning of potable water systems are important. The provision of safe, treated water for patients and workers, as well as the use of medical supplies, is critical to many processes and operations of healthcare facilities.

Waterless urinals and efficient sensor fixtures help in reducing water wastage. The hospitals should be focused on reduction of water use through xeriscaping (landscaping that does not require supplemental irrigation), low-flow fixtures.

The scope of the Water Systems design will include the following: ▪ Potable Cold-Water System ▪ Potable Cooled-Cold Water Systems ▪ Water Treatment System ▪ Hot Water Systems ▪ Healthcare Sanitary Fittings ▪ Irrigation Systems ▪ Grey-Water Systems ▪ Steam Systems

For

1Bed water requirement= 590 liters/day

375 Beds = 590 x 375 = 2,21,250 liters/ day 500 Beds = 599 x 500 = 2,99,500 liters/ day Fig. 5.1.13 Average water Consumption

Water Treatment Water management technologies must be considered for current hospital design and potential expansion depending on the type of healthcare facility.

Generally, to control microbiological growth within water systems, temperature, chemical and mechanical control methods will be enforced to reduce the risk of water contamination.

The methods that can be used are the following: • • Pasteurization • Chemical Treatment (Biocides, Chlorine etc.)

• Silver-Copper Ionization • Filtration Fig. 5.1.14 Water System for Healthcare Facilities A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

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Chapter 6 Design Directives

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Zoning

Key influences from site • Presence of metro station 300m from the site helps in better public transport connectivity.

• Presence of dwarka police station on Northwest • Presence of DTC Depot 50m from the east.

• 45m Main road connecting two ages of the site.

• Traffic Junction on the North-east.

Fig.6.1.1 Site Plan with edges connectivity.

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Fig.6.1.2 Stage 1:- Initial zoning.

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Fig.6.1.3 Stage 2:- Initial zoning of Entry/Exit.

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Concept: Project Vision

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Fig.6.1.4 Inter-Connected Spaces in Ground Floor

Fig.6.1.6 Stepping Masses:- With Green Terraces

Fig.6.1.5 large Central Courtyard for Passive Cooling

Fig.6.1.7 Courtyard Spaces for better lighting and Ventilation

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Large Central Courtyard for Passive Cooling and it also helps in creating healing environment.

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Concept: Building

Active Public Realm ( Public and Semi-Public Spaces)

Stepping Masses II Forming terrace garden and creating spillout Spaces

Inter-connected Masses II Forming tnice visual connected spaces

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Zoning : Bubble Diagrams, Hospital Block

Ground Floor

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First Floor

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2nd Floor

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3rd Floor

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4th Floor

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5th Floor

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7 : Form Development

Identification of Axis II Based on wind Direction, Orientation, Creating Connections between spaces.

Primary & Secondary Axes II By defining Public and Private relationship.

Massing II Beigining of Massing around the axis.

Massing II Defining the Massing

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8 : Design Development Stage 1

Initial Conceptual Design

Creating a basic framework of initial idea, form, entry/exit identification.

Identification of Spaces II Based on road networks, Public/ Semi-Public/ Private zoning.

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Identification of Entry/Exit II Based on nearest approachable roads, service roads and drop off off major departments.

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• Initial Stage of Blocking with Inter-Connected spaces.

• Formation of Courtyard between the blocks.

Initial Blocking of Hospital and Residence.

• Entry/Exit is not working Properly • Placement of Housing Block in the middle.

• No legible response for site edges • Minimal addressal of context.

• Very Poor and insufficient circulation.

Entry/Exit Identification.

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Stage 2

Conceptual Design-2

Zoning the departments according to their relationships, indentifying the entry/exit etc.

Identification of Entry/Exit II Based on nearest approachable roads, service roads and drop off off major departments.

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Zoning II Based on inter-department relations, Public/ Semi-Public/ Private space, Drop off, circulation etc.

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• Identification of entry/exit Point • Placement of Housing Blocks in Private area

• All Entry/Exit is not working Properly • Entry/Exit of housing block is not working Properly

• Identification of future expansion Area.

• No legible response for site edges • Seperate Service entry from 9m • Minimal addressal of context.

• Very Poor climatic response.in the design.

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Stage 3

Conceptual Design 3

Defining the Proper entry/exit and one main central axis approaching both roads.

Central axis II Defining services dropoff and emergency Dropoff

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Circulation Based on inter-department relations, Public/ Semi-Public/ Private space, Drop off etc.

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• Better circulation • Placement of Housing Blocks in Private area

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• Some issues in emergency entry/ exit • No legible response for site edges

• Inter Connected Spaces with double heighted courtyard.

• Courtyards spaces are not properly defined

• Creating Green Spaces for visitors.

• Very Poor climatic response.in the design.

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Stage 4

Detailing the Plans

Detailing each departments of the Hospital Blocks and defining Air Conditioned zone/ Non Air Conditioned Zone.

Site Plan: Main entry from the front side and Emergency entry from the 20m secondary road.

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Detailing out the department considering AC , Non-AC areas, clean and dirty corridoors etc.

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Central atrium Spaces with double heighted waiting spaces.

• Identification of Ac/ Non-Ac areas • Detailing of CoreS and Vertical Circulation Spaces

• Issues in Overall form.

• • Issues in Inter-department relationship.

• Identification of Seperate entry/ • Sustainaibility strategies are igexit for visitors, Patients, staffs. nored in this form.

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Stage 5

New form and Iteration

Creating new form and desiging Super Speciality, Multi-Speciality and Residential as in Master Plan.

3D Visualization of new Iteration.

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Detailing Out the Super-Speciality block with Proper Connectivity of roads.

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Detailing Out the Emergency and Services Depatment considering Proper Circulation, Waiting Areas and Cores.

Detailing Out the Operation theatre Depatment considering Proper Circulation, Waiting Areas, Clean Corridoor, Dirty Corridoor etc.

• Proper Circulation with Seperate Entry/Exit.

• 60% area are oriented EastWest.

• Creating Multiple Courtyard • Issues in OPD area and ReSpaces. hab.

• Services, Emergency, OT are • Sustainaibility strategies are working Properly. ignored in this form.

Detailing Out the Out-Patient Depatment A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

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Stage 6 Pre- Final

Context Plan

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Orientation A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

3D View of Site.

Ground Plan

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Section A A’

Ground Plan

• • Clear heirarcy between Public and Semi Public Spaces.

• Decrease in Ground Coverage more open area for green spaces.

• Individual Drop off Point for each department.

• Multiple Courtyard Spaces for cool air Circulation and 65% mass oriented in North-South direction.

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Chapter 9 Design Portfolio

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Site and Surroundings

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Context Plan

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Site Plan

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Ground Plan

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Emergency Plan

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1st Floor Plan

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Operation Theatre

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2nd Floor Plan

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3rd Floor Plan A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

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5th Floor Plan

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Basement 1 Plan A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

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Section A A’

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Elevation A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

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Front Elevational View

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Emergency Block

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Elevational view from South-East side

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View towards North- East side A SUSTAINABLE AND GREEN HOSPITAL : AN INNOVATIVE APPROACH

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View towards South West

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Dhillon, V.S. (2015). Green Hospital and Climate Change: Their Interrelationship and the Way Forward. JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH. Salehi, F. and Eslami, S. (n.d.). Green Strategies of Healthcare Design: Case Studies of Medical Centers. [online] . Available at: https://www.irbnet.de/ daten/iconda/CIB_DC22689.pdf [Accessed 5 Apr. 2021]. www.asianhhm.com. (n.d.). Green Hospitals - Towards sustainability - Information Technology. [online] Available at: https://www.asianhhm.com/facilities-operations/green-hospitals-towards-sustainability [Accessed 5 Apr. 2021] www.corporatewellnessmagazine.com. (n.d.). Redefining Healthcare with Design of the Green Hospital. [online] Available at: https://www.corporatewellnessmagazine.com/article/redefining-healthcare-design-green-hospital [Accessed 5 Apr. 2021].

Medicaltourism.com. (2019). Sustainable Hospitals ~ Consider Going Green? [online] Available at: https://www.magazine.medicaltourism.com/article/ sustainable-hospitals-consider-going-green

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Knowlittle Matharu (2012). Green hospitals. [online] Available at: https://www.slideshare.net/KnowlittleMatharu/green-hospitals-15591918 [Accessed 5 Apr. 2021] EMERGENCY DEPARTMENT DESIGN GUIDELINES Contents. (n.d.). [online] . Available at: https://acem.org.au/getmedia/faf63c3b-c896-4a7e-aa1f226b49d62f94/G15_v03_ED_Design_Guidelines_Dec-14.aspx.

ArchDaily. 2021. Assuta Medical Center / Zeidler Partnership Architects + Moore Architects + M. Brestovisky Architects. [online] Available at: <https:// www.archdaily.com/231318/assuta-medical-center-zeidler-partnership-architects-moore-architects-m-brestovisky-architects> [Accessed 25 April 2021] Slideshare.net. 2021. fortis hospital mohali case study. [online] Available at: <https://www.slideshare.net/PrincePathania/fortis-mohali-case-study> [Accessed 25 April 2021]..

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